Sociocultural Influences on Employment Functioning Over Time: Clinical Implications for Sustaining Work Productivity

Purpose: There is growing evidence that psychosocial rehabilitation (PSR) services result in positive outcomes for clients with severe and persistent mental illness (SPMI). Despite evidence of the effectiveness of PSR on reducing psychotic relapse and re-hospitalization, there remain conflicting findings regarding the impact of these services on employment outcomes. Employment outcomes for ethnic minority individuals are even less understood. A key component of PSR intervention is the client support system. There is considerable theoretical and empirical evidence indicating that support is vitally important to individuals with SPMI. Yet the limited understanding of the effectiveness and range of support systems in PSR treatment calls for new efforts to isolate client support systems in order to identify the “effective ingredients” that fit well with the multi-elemental nature of PSR. In PSR, different systems of support can be identified as service support (case managers), social support provided by friends and family, and the internal intrapsychic support of the individual. Minority-majority status is treated as a proxy variable for sociocultural influences to determine its moderating influence on the support factors and employment outcome. This study examined the sociocultural support factors, relationships, and trajectories of change for work productivity in a multiethnic sample of individuals with SPMI.

Methods: N=136 consumers diagnosed with schizophrenia participating in four psychosocial rehabilitative programs in Southern California were followed for 1 year. The psychosocial assessments at baseline, 6 months, and 12 months were completed by trained master-level research interviewers. Mplus Version 5 multivariate repeated model approach was used to run a series of latent growth curve models. The minority group included African Americans and Latinos.

Results: The ethnic composition consisted of 64 Euro-Americans (47%), 56 African Americans (41%), and 16 Latinos (12%). There were 42 females (31%). BPRS score for the whole sample was x=39.16 (sd=10.43). Sample retention was 81.6% at 6 months and 72.8% at 12 months. The nonlinear trajectory best described work productivity. There was a significant improvement from baseline to 6 months (z=3.6, p<.001). However after six months, work productivity steadily declined. Intrapsychic support explained 65% of the variance of work productivity at baseline, however social support explained the most variance for sustaining the growth in work scores (z=2.6, p<.01). Minority-majority status moderated the relationship between social support and the rate of change for work productivity. Social support was the strongest significant predictor of work functioning at 6 months and 12 months (z=2.4, p<.01) for minority consumers but did not have a significant impact for majority consumers.

Discussion/Implications: The 6th month appears to be a critical time for work outcome. Individuals with SPMI may benefit from ongoing employment case management support. Results reveal how different support systems may have different impact on work productivity at different time (baseline or slope) and these relationships may differ by minority-majority status. The ethnic variation in the association of support variables and employment calls for more tailored cultural appropriate interventions. Understanding the specific cultural influences of support variables can facilitate the development of effective, culturally responsive interventions for individuals with SPMI.