394P
What Employment Means to Individuals with Schizophrenia: A Phenomenological Qualitative Interpretive Meta Synthesis
Therapies that incorporate occupational goals are common in mental health treatment. However, individuals with schizophrenia are significantly less likely to be employed than individuals without mental illness and individuals with other mental illnesses. Between the U.K. and the U.S., rates of employment vary between 10 and 20%.
The objective of this study was to generate a rich description of the meaning of employment for individuals with schizophrenia.
Methods
Design
Qualitative interpretive meta-synthesis (QIMS) serves to integrate qualitative findings from multiple studies in order to discover “the shared human experience of this phenomenon” (Aguirre & Bolton, 2013, p. 5). This study employs the qualitative tradition of transcendental phenomenological research, seeking to describe the lived experiences of many individuals and amalgamate their descriptions into an ‘essence’ of the phenomenon studied.
Sample
Sampling was purposeful and involved an exhaustive review of over 500 related qualitative articles. From these, 7 articles were included in the QIMS. The sample consisted of 59 participats, and included a range of ethnicities, ages, and socioeconomic statuses. Participants in the included studies were recruited from a variety of settings, generally through referrals from rehabilitation settings.
Analysis
Analysis of the data occurred in stages. The first step involved identifying each article’s original themes. Content from the original themes was analyzed, and statements of significance identified. The original themes were then reworked into larger, overarching themes, translated across studies. The development of new themes was triangulated with a co-analyst.
Results
After synthsizing original themes and coding participant quotations, four themes emerged. First, employment for many participants constituted a sign of recovery from their mental illness, or normality. This was also described in terms of an increase in self-worth and purpose. Second, participants described how employment provided structure and responsibility. These responsibilities were crucial in disputing feelings of meaninglessness. Third, employment provided opportunities for social contact and social interaction. Social withdrawal is a cornerstone feature of schizophrenia, so methods to combat this are the goals of many interventions. Finally, employment provided either financial stability, or counter intuitively, financial instability due to the complex system that dictates Social Security and Medicaid imbursements that sometimes penalizes part time employment.
Conclusions
The results of this study encompass barriers to, effects of, and motivations for or against employment for individuals with schizophrenia. It is meant to be a comprehensive analysis of the meaning of employment to both employed and unemployed individuals. The results of this study provide understandings of the value and role of occupational therapy for individuals with schizophrenia. However, several distinctions should be made. That employment provides social contact is understood in occupational therapy. However, this uniquely affects individuals with schizophrenia given the symptoms of their illness. Additionally, responsibility and structure are perceived differently for individuals with schizophrenia from individuals with different mental illnesses. This study provides insight for future research that further attempts to postulate biopsychosocial correlates of employment, including a better understanding of financial and symptomatic covariates.