Clinical benefits of paid work activity in schizophrenia: 1-year followup

In a previous article in the Schizophrenia Bulletin (Vol. 22, No. 1, 1996), we presented findings of a study on the clinical and rehabilitative effects of work activity on 150 subjects diagnosed with schizophrenia or schizoaffective disorder. Subjects were randomly assigned to either a Pay ($3.40/hr) or No-Pay group and given 6-month work placements in a Department of Veterans Affairs medical center. At the 5-month followup, Pay subjects had worked more hours and earned more money (from any employment) than No-Pay subjects. Pay subjects also had significantly greater improvement in symptoms and lower rehospitalization rates. Clinical improvement was closely linked to amount of participation. We concluded that pay increased participation. The current study examined clinical and rehabilitative outcomes at 1-year followup, 6 months after the conclusion of the work program. Results indicated that the Pay subjects had a significant decrease in work activity once they had completed the work program. However, 75 percent of those who had fully participated in the program continued working during the subsequent 6 months, either as volunteers or for pay. Clinical outcomes for subjects in the Pay condition were attenuated at 1-year followup but still significantly better than for subjects in the No-Pay condition. More than 40 percent of participants continued to be "much improved" on total symptoms, and more than 50 percent were "much improved" on positive symptoms. Discussion focuses on the importance and limitations of work for pay as a clinical intervention and concludes that continuous work services are necessary and beneficial for many people with schizophrenia.