Ragna Kristín Guðbrandsdóttir¹

Oddur Ingimarsson^1,2

 

¹University of Iceland, Faculty of Medicine ²Mental Health Services, Landspítali University Hospital of Iceland.

Correspondence: Oddur Ingimarsson, odduri@landspitali.is

Key words: First episode psychosis, schizophrenia spectrum disorders, early intervention psychosis, employment, vocational predictors, cannabis.

 

BACKGROUND: Because of the early onset and disabling symptoms of schizophrenia spectrum disorders many individuals with these disorders are unemployed from an early age and disability pension rates are high. The aim of this study was to assess functional recovery and identify vocational predictors among young first episode psychosis patients registered in an early intervention psychosis center in Iceland in 2010-2020.

METHODS: The study is a retrospective cohort study based on the medical records of those who were discharged from Laugaras, the only early intervention psychosis program in Iceland after six months or longer rehabilitation in 2010-2020 (n=144). Univariate and multivariate logistic regression was used to identify vocational predictors.

RESULTS: 75% of patients were unemployed at admission to the early intervention center but over half of the patients were employed or in school at discharge. Vocational rehabilitation was the strongest vocational predictor (OR 13.93, 95% CI 3.85-63.89). Other vocational predictors were those that reflect a disabling psychiatric disorder and social functioning before the onset of early intervention. 66% of patients had a history of cannabis use which had a negative impact on employment and education at discharge.

CONCLUSIONS: In spite of intensive rehabilitation at an early intervention center, almost half of the patients were neither employed nor in school at discharge. The strongest vocational predictor was vocational rehabilitation which was also one of few vocational predictors that can be influenced by admission to an early intervention psychosis center. It therefore seems important to ensure that effective vocational rehabilitation is readily available at early intervention psychosis centers.

Table I. Demographic characteristics of patients admittet to Laugaras.

	Men (n=101)	Women (n=43)	Total (n=144)
Age at admission (Mean (SD))	23,4 (3,3)	23,1 (3,4)	23,4 (3,3)
Years in treatment at Laugaras (Mean (SD))	3,3 (2,1)	2,8 (1,9)	3,2 (2,0)
Nationality (n (%))
Icelandic	95 (94,1)	42 (97,7)	137 (95,1)
Other	6 (5,9)	1 (2,3)	7 (4,9)
Education (n (%))
Not finished compulsory education	6 (5,9)	2 (4,7)	8 (5,6)
Finished compulsory education	72 (71,3)	20 (46,5)	92 (63,9)
Upper secondary education	14 (13,9)	8 (18,6)	22 (15,3)
Higher education experience	8 (7,9)	8 (18,6)	16 (11,1)
Higher education	1 (1,0)	5 (11,6)	6 (4,2)
Experience of the labor market (n (%))
Stable job	61 (60,4)	25 (58,1)	86 (59,7)
Summer job	21 (20,8)	10 (23,3)	31 (21,5)
Unknown	11 (10,9)	7 (16,3)	18(12,5)
No experience	8 (7,9)	1 (2,3)	9 (6,2)
Relationship status at admission (n (%))
Single	87 (86,1)	32 (74,4)	119 (82,6)
In a relationship	14 (13,9)	11 (25,6)	25 (17,4)
Relationship status at discharge (n (%))
Single	83 (82,2)	31 (72,1)	114 (79,2)
In a relationship	18 (17,8)	12 (27,9)	30 (20,8)
Housing status at admission (n (%))
Own	6 (5,9)	1 (2,3)	7 (4,9)
Rental	19 (18,8)	11 (25,6)	30 (20,8)
Social housing	1 (1,0)	1 (2,3)	2 (1,4)
Living with family	68 (67,3)	25 (58,1)	93 (64,6)
Specialized housing	2 (2,0)	2 (4,7)	4 (2,8)
Homeless	3 (3,0)	1 (2,3)	4 (2,8)
Other*	2 (2,0)	2 (4,7)	4 (2,8)
Housing status at discharge (n (%))
Own	11 (10,9)	6 (14,0)	17 (11,8)
Rental	22 (21,8)	11 (25,6)	33 (22,9)
Social housing	8 (7,9)	5 (11,6)	13 (9,0)
Living with family	39 (38,6)	15 (34,9)	54 (37,5)
Specialized housing	12 (11.9)	2 (4,7)	14 (9,7)
Homeless	5 (5,0)	2 (4,7)	7 (4,9)
Other*	4 (4,0)	2 (4,7)	6 (4,2)
Bodyweight at admission**
Mean weight in kilograms (SD)	89,4 (22,6)	74,0 (22,9)	85,0 (23,7)
Median [Lowest value ; highest value]	81,6 [59,0 ; 190]	68,1 [42,6 ; 132]	79,7 [42,6 ; 190]
Bodyweight at discharge**
Mean weight in kilograms (SD)	98,4 (20,7)	83,9 (29,0)	94,2 (24,2)
Median [Lowest value ; highest value]	98,5 [62,7 ; 163]	71,0 [50,3 ; 148]	92,8 [50,3 ; 163]
Body mass index (BMI) at admission**
Mean BMI (SD)	27,0 (6,1)	26,2 (7,6)	26,8 (6,6)
Median [Lowest value ; highest value]	25,8 [18,8 ; 48,9]	23,7[16,0 ; 45,5]	25,0 [16,0 ; 48,9]
Body mass index (BMI) at admission**
Mean BMI (SD)	29,8 (5,8)	29,7 (9,7)	29,8 (7,1)
Median [Lowest value ; highest value]	29,0 [19,7 ; 42,1]	24,9 [19,2 ; 51,1]	28,7 [19,2 ; 51,1]
* Living in a halfway house or admitted to a hospital before admission. ** Mean and median BMI and weight was calculated for patients with weight measurements available both at admission and discharge. (n=100, men = 71, women = 29).