Twenty-four trials with 2,715 participants were included.
The results of the review are orientated towards answering 4 questions.
1. Do vocational rehabilitation interventions enhance the vocational outcomes of persons with schizophrenia?
Vocational rehabilitation enhances employment rates among persons with psychiatric disabilities. Supportive employment closely coordinated with clinical care can enhance the rate of competitive employment amongst these patients.
2. Do vocational rehabilitation interventions enhance outcomes other than vocational functioning?
Vocational interventions are associated with reduced hospital admissions. Vocational rehabilitation patients are more likely to be sociable, to socialise with friends and hold a driving licence, and are less likely to be heavy drinkers.
3. Are there differences in the effectiveness of the various types of vocational rehabilitation interventions for persons with schizophrenia?
Patients were more likely to work if paid. Accelerated supported employment is more effective than gradual entry into supported employment for competitive employment, competitive full-time employment, full-time jobs, total weeks worked and total earnings. There is no difference between accelerated supported employment and gradual entry into supported employment for employed at follow-up, ending hourly wage, employer ratings of job performance and job satisfaction.
4. What patient characteristics predicted response to vocational rehabilitation?
The nature of the literature prevents an adequate assessment of the impacts of patient characteristics on response to vocational interventions. There is a suggestion that patients with schizophrenia are less responsive to vocational interventions than patients in other diagnostic groups, and that past functioning, age at onset, and duration of employment are significant prognostic factors for vocational outcomes.