Schizophrenia and other severe mental illnesses (SMI) often have adverse effects on work functioning. However, most research on employment in people with SMI has been conducted in developed countries and much less is known about work patterns and interest in work in people with SMI living in developing countries, including India. Moreover, treatment for SMI in developing countries is largely limited to pharmacotherapy; psychosocial interventions including vocational rehabilitation are rarely available. A comprehensive understanding of employment in people with SMI living in developing countries would inform the development of vocational services for this population. Therefore, a series of three studies were conducted as part of this dissertation with the goal of evaluating rates of employment, interest in employment, perceived benefits of work and problems related to work among employed participants, perceived barriers and desired job supports among unemployed participants, and to examine stability and change in work status and interest in work over a one-year period.
In Study 1, interviews were conducted with 550 people with SMI receiving psychiatric outpatient services at two private hospitals in two different districts in the state of Maharashtra in western India. The results were that 60.9% of participants were working, with employment rates being significantly higher in men than in women (79.4% vs. 35.9%). In addition, the rates of work were higher in people who were living in rural areas compared to those living in urban areas (77.8% vs. 48.9%). The majority of employed participants living in rural areas were working in family operated businesses such as farming, while work for independent employers was more common in urban areas. Among the participants who were working for independent employers, more than 45% obtained jobs through their family or friends. Interest in work was high (77.4%) among unemployed participants and the majority indicated wanting help with their job search and with managing their mental illness. Social norms related to gender specific roles in Indian society, in which men are expected to be primary wage earners, and the involvement of families in employment may have contributed to high work rates in this study. The strong interest in work among unemployed participants suggests that the deployment of vocational services for people with SMI in India could improve employment rates.
Study 2 was a one-year follow-up of participants in Study 1 to evaluate stability and change in employment status and interest in work. A total of 459 (83.5%) participants completed follow-up interviews, of whom 62.9% were employed at follow-up, compared to 60.9% at the baseline assessment. Employment status was highly stable over the one-year period, with 56.4% working at both assessments and 32.4% not working at either assessment. Among the participants who were working at both assessments, more than 80% of were employed in the same job, for an average period of 10 years. Among the participants who were unemployed at baseline, 16.9% began working at follow-up. Although interest in work among those who were unemployed was lower at follow-up than baseline (62.8% vs. 73%, respectively), 58.1% expressed a consistent interest in work across both assessments. The most commonly desired job supports for unemployed participants were assistance with finding a job and help with mental illness management. The findings suggest that the work status of people with SMI in India is stable over a period of one year. The majority of participants who wanted to work at baseline remained unemployed at follow-up but still wanted to work, suggesting that vocational rehabilitation programs for people with SMI in India could improve their employment functioning.
Study 3 employed the same methods used in Study 1 to collect data from 150 participants with SMI who were receiving psychiatric outpatient services from a public hospital located in the same predominantly urban district in the state of Maharashtra as the private hospital in Study 1. This study was aimed at evaluating employment functioning in people with SMI receiving public outpatient psychiatric services as compared to those receiving private outpatient treatment in Study 1 based on the assumption that people with lower economic means would be more likely to receive treatment at a public hospital. The results of this study were that 40% of participants were working, which was slightly lower than the 48.9% employment rate in urban areas in Study 1, and much lower than rates of employment in the general population. The majority of participants were working for independent employers, similar to the employed participants urban areas in Study 1, who found their jobs with the help of family and/or friends. Over 90% of the unemployed participants expressed interest in work (compared to 79% in urban areas in Study 1), and most of them wanted help finding a job and coping with their mental illness. The slightly lower rates of work in this study compared to Study 1 may be related to the smaller proportion of participants who were working in family businesses than in Study 1 (5% vs. 13%, respectively), and greater severity of illness, as suggested by the higher proportion of participants with schizophrenia-spectrum disorders than Study 1 (90% vs. 66.2%, respectively), and a greater proportion of participants with a history of psychiatric hospitalization than Study 1 (89.3% vs. 49.5%). The findings indicate that there are significant levels of unemployment among people with SMI living in urban areas in India who are receiving publicly funded treatment, and a very high interest in work. The findings provide further support for the need for interventions designed to improve employment functioning in people with SMI living in India.
Taken together these three studies indicated that while rates of work in people with SMI in India are higher than rates reported in developed countries, significant unemployment is still present, especially in urban areas. Furthermore, most unemployed persons want to work. Work status was relatively stable over time, as was the strong interest in work among unemployed participants. A high proportion of participants endorsed the need for work supports related to the job search and illness management across the three studies, suggesting the need for vocational rehabilitation services that are culturally tailored for Indian society. / 2021-09-25T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/41439 |
| Date | 26 September 2020 |
| Creators | Khare, Chitra |
| Contributors | McGurk, Susan R. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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