Work functioning of schizophrenia patients in a rural south Indian community: status at 4-year follow-up

This report describes the work functioning of schizophrenia patients receiving antipsychotic treatment in a rural south Indian community and examines the factors associated with it.

We assessed work functioning of 201 patients who have completed a minimum of 3 years of follow-up as part of a cohort study of schizophrenia patients receiving community-based treatment. 'Work' section of the Indian disability evaluation and assessment scale (IDEAS) was used to evaluate work-related disability at the time of recruitment and after a mean (SD) 47.0 (9.6) months of follow-up. Patients with moderate to profound work-related disability were compared with those with no or mild disability across socio-demographic and clinical variables.

75 (37.3 %) were agriculturists; 58 (28.9 %) were pursuing household jobs; 28 (13.9 %) were daily wage labourers; 7 (3.5 %) were skilled labourers; 7 (3.5 %) were involved in other jobs. 26 (12.9 %) were not doing any sort of work. The proportion of patients with moderate or profound disability reduced from 137/201 (68.2 %) at baseline to 82/201 (40.8 %) at follow-up (p < 0.001). Work-related disability reduced significantly [mean (SD) work score on IDEAS was 2.2 (1.6) at baseline and 1.1 (1.2) at follow-up; t = -9.1; p < 0.001]. Logistic regression analysis showed that work-related disability was significantly associated with male gender, longer duration of illness, higher psychopathology and poor treatment adherence.

Nearly two-thirds of schizophrenia patients living in this rural south Indian community had satisfactory work functioning, a rate, which is substantially higher than rates reported from high-income countries. Agrarian work atmosphere and rural sociocultural milieu may have contributed to this in our sample. However, substantial proportion of patients remains considerably disabled. This highlights the need for concerted, community-level efforts to improve their functioning.