A Cochrane review [Abstract] 1 included 14 studies with a total of 2265 patients with severe mental illness. All 14 studies recruited outpatients. Thirteen RCTs were conducted in the setting of community psychiatric/mental health service. Patients were adults with a long history of severe mental illness, with schizophrenia or schizoaffective disorder well represented. Supported employment was compared with other vocational approaches or treatment as usual. The primary outcome was days in competitive employment in over one year follow-up. Only 7 out of 14 of the studies contributed to this outcome. Supported employment seemed to significantly increase levels of any employment obtained during the course of studies (RR 3.24 CI 2.17 to 4.82; 7 RCTs, n = 951), increase length of competitive employment when compared with other vocational approaches (MD 70.63 CI 43.22 to 94.04; 1 RCT, n = 204) and also showed some advantages in other secondary outcomes. It appears to increase length (in days) of any form of paid employment (MD 84.94 CI 51.99 to 117.89; 2 RCTs, n = 510) and job tenure (weeks) for competitive employment (MD 9.86 CI 5.36 to 14.36; 1 RCT, n = 204) and any paid employment (MD 3.86 CI -2.94 to 22.17; 3 RCTs, n = 735). Furthermore, one study (n=204) indicated a decreased time to first competitive employment in the long term for people in supported employment (MD -161.60 CI -225.73 to -97.47).
Comment: The quality of evidence is downgraded by imprecise results (primary outcome available only for 50% of the studies).
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