What improvements can be expected in employment and non-employment outcomes in individuals with mental illness (Major Depressive Disorder, MDD), such as those with anxiety disorders or psychotic disorders?

From the Guidelines

Comprehensive approaches combining medication, therapy, vocational support, and social interventions are essential for improving employment and non-employment outcomes in individuals with mental illness, such as those with Major Depressive Disorder (MDD), anxiety disorders, or psychotic disorders. Improvements in employment and non-employment outcomes for individuals with mental illness require a multifaceted strategy that addresses the biological, psychological, and social factors contributing to disability in mental illness. Evidence-based practices like Individual Placement and Support (IPS) have shown significant success in helping people with mental illness obtain and maintain competitive employment, with placement rates of 60-70% compared to 25-40% for traditional vocational rehabilitation 1.

Key elements of successful interventions include:

• Medication optimization to minimize side effects that interfere with work functioning
• Cognitive behavioral therapy (typically 12-16 weekly sessions) and cognitive remediation therapy to address cognitive deficits and negative thought patterns
• Supported education programs to help individuals complete educational goals
• Peer support services to provide role models for recovery
• Supported housing models like Housing First to provide stable living situations without requiring treatment compliance as a prerequisite
• Family psychoeducation (typically 9-12 months of biweekly sessions) to improve family functioning and reduce relapse rates

Recent studies have also highlighted the potential of occupational eMental health (OeMH) interventions in improving mental health in work settings 1. OeMH interventions use information and communication technology to deliver knowledge and services such as psychoeducation, workplace health promotion, psychological and medical treatment, and return to work assistance to employees. However, implementing OeMH interventions is a complex process that requires careful planning and consideration of unique challenges, including adherence to regulatory frameworks, interoperability with existing systems, and threats to employee privacy and security.

The most effective approach is likely to be a tailored and multifaceted one, taking into account the individual's specific needs and circumstances, and incorporating a combination of these evidence-based practices. By addressing the complex interplay of biological, psychological, and social factors that contribute to disability in mental illness, it is possible to improve employment and non-employment outcomes for individuals with mental illness, and ultimately enhance their overall quality of life.

From the FDA Drug Label

The pooled analyses of placebo–controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short–term trials (median duration of 2 months) of 11 antidepressant drugs in over 77,000 patients. There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression

The FDA drug label does not answer the question.

From the Research

Improvements in Employment Outcomes

• Supported employment interventions have shown promise in assisting individuals with severe mental illness (SMI) in achieving successful employment and health-related outcomes 2.
• Combining supported employment with targeted interventions such as neurocognitive therapy and job-related social skill training can have a positive effect on employment and non-employment outcomes 2.
• Augmented supported employment was found to be the most effective intervention in obtaining competitive employment, followed by supported employment 3.

Improvements in Non-Employment Outcomes

• Supported employment interventions can also improve non-employment outcomes such as health, quality of life, and social functioning 2, 3.
• Interventions that focus on rapid search for a competitive job, with ongoing support to keep the job, can be effective in improving employment outcomes for individuals with SMI 3.
• Cognitive training and symptom-related skills training can also be beneficial in improving employment outcomes 3.

Effectiveness of Supported Employment Interventions

• Supported employment interventions have been found to be effective in improving competitive employment in populations with conditions other than severe mental illness, such as affective disorders, mental disorders and justice involvement, and veterans with posttraumatic stress disorder (PTSD) 4.
• The effectiveness of supported employment interventions can be influenced by contextual factors such as intervention fidelity, settings, and systemic barriers 2.
• Defining competitive employment and increasing measurement of non-vocational outcomes can help to improve research in this area 4.

Collaboration and Implementation

• Collaboration between Vocational Rehabilitation (VR) and Individual Placement and Support (IPS) programs can enhance employment outcomes for individuals with SMI 5.
• Features of strong collaborations between VR and IPS programs include expertise, consistency, accessibility, and integration 5.
• Modest changes in the federal/state VR program can enhance the system's capability to foster employment outcomes for persons with severe mental illness 5.