Cognitive predictors and genetic moderators of employment outcomes in people with schizophrenia

Although some individuals with schizophrenia are able to maintain gainful employment, many are not. To better understand this differential real-life outcome, we tested general and specific cognitive measures as predictors of future employment and genetic moderators of these relationships. One hundred and twenty-four patients with schizophrenia spectrum illness (31.5 % female, mean age 32.5 ± 10.5 years) participated in a research study at the National Institute of Mental Health Intramural Research Program's Clinical Center and were later recontacted regarding outcomes (average time to recontact = 8.6 ± 4.0 years). At the initial visit, patients completed a comprehensive battery of neuropsychological tests and provided blood samples for genotyping. Cognitive scores at the initial visit were tested as predictors of future employment status (employed vs. unemployed) at follow-up using logistic regressions, and polygenic risk scores for schizophrenia were tested as moderators. At follow-up, 45.2 % of individuals were employed. General cognitive ability indexes ("g" and IQ) and verbal memory were predictive of subsequent employment status. Additionally, polygenic risk for schizophrenia moderated the effect of working memory cognitive scores on the prediction of future employment. The results suggest that certain broad indexes of cognitive dysfunction may be particularly salient in targeting interventions to address real-world functioning in schizophrenia. These data also suggest that further investigation into the genetic underpinnings of real-life outcomes in this illness is warranted.