Symptomatic remission in schizophrenia affects employment outcomes; Instrumental activity of daily living is a determinant for non-remitted patients

Background: Remission criteria were proposed by Andreasen for classifying patients with schizophrenia according to the severity of psychopathology. Up to the present time, there have been no cohort studies exploring the association between remission status and employment outcomes in patients with schizophrenia. The study aimed to explore whether symptomatic remission is significantly associated with employment outcomes in a two-year longitudinal study, and to investigate factors associated with favorable employment outcomes for patients without symptomatic remission at baseline.Methods: All of 525 stable patients with schizophrenia in the therapeutic community of a public mental hospital between 2013 and 2015 in Taiwan were recruited. Employment outcomes, defined as the cumulative on-the-job duration (months/per year) and income (new Taiwan dollars, NT$/per year), were investigated at the end of 1- and 2-year follow-up after enrollment. For repeated measurements, linear mixed models were constructed to examine the association between symptomatic remission and employment outcomes after controlling for potential confounding variables including age, sex, education, type and daily dose of antipsychotics, cognitive function, activities of daily living (ADL), instrumental activities of daily living (IADL), and initial employment type.Results: The average age was 51.8 years, and 65.3% were males. Among them, 124 patients (23.6%, 124/525) met the remission criteria at baseline. The linear mixed-model analysis showed that patients who had symptomatic remission were employed 0.69 of a month longer ( p = 0.04) and earned NT$2,490 more ( p = 0.03) within 1 year than did those who did not show symptomatic remission. For finding factors related to employment outcomes in patients without remission, initial IADL scores were significantly associated with both outcomes (B = 0.089, p = 0.001 and B =153, p = 0.003 for cumulative duration and income).Conclusion: Our study suggests that assessing symptomatic remission is an useful part of monitoring treatment effectiveness for schizophrenia, and all strategies targeting the bio-psycho-social domains to attain symptomatic remission are paramount to maintain favorable employment outcomes. To enhance the level of instrumental daily activities is an important issue for schizophrenia patients to return to the community with promising employment outcomes.