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Schizophrenia Bulletin Advance Access published online on March 5, 2009
Schizophrenia Bulletin, doi:10.1093/schbul/sbn182
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© The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Work, Recovery, and Comorbidity in Schizophrenia

Susan R. McGurk13, Kim T. Mueser2,4, Thomas J. DeRosa5 and Rosemarie Wolfe2,3
2 Department of Psychiatry, Dartmouth Medical School, NH
3 Dartmouth Psychiatric Research Center, Main Building, 105 Pleasant Street, Concord, NH 03301
4 Department of Community and Family Medicine, Dartmouth Medical School, NH
5 Department of Vocational Services, The Mount Sinai School of Medicine

1 To whom correspondence should be addressed; tel: 603-271-5369, fax: 603-271-5265, e-mail: susan.r.mcgurk{at}dartmouth.edu.

Employment is central to the concept of recovery in severe mental illness. However, common comorbid conditions present significant obstacles to consumers seeking employment and benefiting from vocational rehabilitation. We review research on the effects of three common comorbid conditions on work and response to vocational rehabilitation, including cognitive impairment, substance abuse, and medical conditions, followed by research on vocational rehabilitation. We then present the results of a randomized controlled trial evaluating the effects of adding cognitive remediation to a vocational rehabilitation program compared with vocational rehabilitation alone in 34 consumers with severe mental illness. Consumers who received both cognitive remediation and vocational rehabilitation demonstrated significantly greater improvements on a cognitive battery over 3 months than those who received vocational rehabilitation alone and had better work outcomes over the 2-year follow-up period. Substance abuse was associated with worse employment outcomes, but did not interact with treatment group, whereas medical comorbidity was not related to work outcomes. More research is warranted to evaluate the interactions between substance abuse and medical comorbidity with vocational rehabilitation and cognitive remediation.

Keywords: recovery / vocational rehabilitation / medical comorbidities / substance abuse / severe mental illness / cognitive remediation


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