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Study finds unintended consequences of disability benefits for schizophrenia

A coordinated specialty care intervention did not reduce likelihood of receiving Social Security Administration disability benefits among individuals with first-episode schizophrenia; however, findings indicated some adverse consequences of receiving benefits.

“While receipt of Social Security Administration (SSA) disability benefits is not itself a reliable indicator of disablement, these benefits are a major feature of the lives of many people living with schizophrenia, providing essential income support and conferring eligibility for health insurance,” Robert A. Rosenheck, MD, of Yale Medical School, and colleagues wrote. “Although programs for first-episode psychosis have been studied in many countries in recent years, their impact on entry into disability income replacement programs has not been studied.”

To determine the impact of coordinated specialty care on SSA disability benefits in first-episode psychosis, researchers evaluated data from the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a 34-site cluster-randomized trial that compared a coordinated specialty care program (NAVIGATE) to usual community care. SSA benefits and clinical outcomes were measured among 399 participants at study entry and every 6 months for 2 years.

At baseline, 9% of participants were receiving SSA disability benefits. During the study period, 34.1% of participants obtained SSA benefits.

The NAVIGATE intervention improved quality of life, symptoms and employment; however, it did not significantly reduce the probability of receiving SSA disability benefits.

More severe psychotic symptoms and greater dysfunction were predictors of obtaining benefits.

Obtaining benefits led to higher total income but fewer days of employment, reduced motivation (eg, sense of purpose, greater anhedonia) and fewer intoxication days.

“We found that an effective coordinated specialty care intervention did not significantly reduce the 40% proportion of first-episode psychosis patients who had obtained SSA disability benefits by the end of the first 2 years of treatment, and that receipt of benefits increased income but unintentionally may be an obstacle to gainful employment and other aspects of recovery,” the researchers wrote. “There is a substantial need for new approaches to income supports that ensure access to needed health care insurance while minimizing possible adverse effects on the motivation for employment and recovery.” – by Amanda Oldt

Disclosure: Rosenheck reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.