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Program improves cognitive, employment outcomes in patients with severe mental illness

A cognitive enhancement program improved employment outcomes for participants with severe mental illness, according to data recently published in The American Journal of Psychiatry.

The Thinking Skills for Work program specifically targeted populations unable to find or maintain work, even with support from employment specialists. The program used three tools — computer-based cognitive exercises, strategy coaching and teaching coping tactics — to boost participant cognition and competitive work outcomes.

“The findings suggest that cognitive enhancement interventions can reduce cognitive impairments that are obstacles to work, thereby increasing the number of people who can benefit from supported employment and competitive work,” Susan R. McGurk, PhD, from the center for psychiatric rehabilitation at Boston University, and colleagues wrote.

McGurk and colleagues randomly assigned 107 participants with severe mental illness (46% with schizophrenia/schizoaffective disorder) to either enhanced supported employment alone, where specialists assisted participants seeking employment and managing impairments, or enhanced supported employment plus the Thinking Skills for Work program, where participants’ abilities and work history were further assessed and weekly cognitive exercises were performed. All participants continued to receive their typical mental health care.

Researchers blinded to treatment measured neurocognition at baseline and at 6 months, 12 months and 24 months follow-up. The primary outcome was difference in cognitive functioning between the groups postintervention.

Eighty-five percent of the participants received a similar amount of supported employment for at least 6 months with a mean enrollment duration of 520.2 days. In the intervention group, 70% of participants were “treatment exposed” after completing at least six computer sessions. They had approximately 25.3 contacts with cognitive specialists over a mean duration of 154.9 days during the intervention and 2.3 hours postintervention.

An intention-to-treat analysis demonstrated that intervention participants performed better in overall composite cognition compared with participants not receiving the supplemental program at post-intervention and follow-up (P = .005). Further analysis showed that only participants with schizophrenia or schizoaffective disorder had improved outcomes on the Continuous Performance Test, Identical Pairs version (P = .05) and category fluency test (P = .02).

Over 2 years, all participants who received the Thinking Skills for Work program had better outcomes for competitive (P = .003) and paid work (P = .01) vs. participants only receiving enhanced supported employment Specifically, participants in the cognitive enhancement program obtained more jobs (60% vs 36%), worked more weeks (23.9 vs 9.2) and earned more wages ($3,421 vs $1,728).

“The increases in competitive work for the Thinking Skills for Work group were substantial in light of the poor history of vocational functioning among these participants, especially considering that the study took place during the financial crisis of 2008,” McGurk and researchers wrote.

They added that an upward trajectory was observed among participants in the Thinking Skills for Work group, with participants averaging 8.1 weeks of work during the last 6 months of the 2-year study period. - by Stephanie Viguers

Disclosure: The researchers report no relevant financial disclosures.