Effectiveness of augmented Individual Placement and Support interventions for competitive employment in people with schizophrenia: Systematic review and meta-analysis

Martin Felipe Vázquez-Estupiñán, Sol Durand-Arias, Claudia Iveth Astudillo-García, Eduardo Ángel Madrigal

DOI: https://doi.org/10.17711/SM.0185-3325.2018.027


Background. It has been estimated that over 70% of people living with a diagnosis of schizophrenia wish to work. The Individual Placement and Support (IPS) model has proven to be highly effective in enhancing competitive employment in people with schizophrenia. However, the efficacy of augmented IPS interventions, in other words, those that incorporate a psychosocial intervention into the model, has not been evaluated in this population.

Objective. To assess the efficacy of augmented IPS interventions designed to obtain competitive employment in people with schizophrenia.

Method. A systematic review of the literature on randomized clinical trials of augmented IPS interventions, published in English between 2007 and 2017, was conducted in the electronic databases of PubMed, Science Direct, and EBSCO. Risk of bias and competitive employment rates were calculated. A meta-analysis was performed using the random effects method to estimate the effect of augmented IPS interventions.

Results. Twelve articles were identified in which 10 augmented IPS interventions were compared with other interventions. In eight studies conducted on people with schizophrenia, the intervention was based on IPS + social skills/work skills/cognitive remediation vs. IPS or modified IPS. No general effect favoring augmented interventions (RR = 1.37, 95% CI [.97, 1.95], I2 = 52%) was found. Augmented IPS interventions tend to be more effective when they are implemented during the first psychotic episode.

Discussion and conclusion. It is not possible to conclude that augmented IPS interventions have a significant effect over standard IPS interventions in obtaining competitive employment in people with schizophrenia.


Supported employment; schizophrenia; meta-analysis; literature review

Full Text:

HTML Pdf ePub Xml


Au, D. W., Tsang, H. W., So, W. W., Bell, M. D., Cheung, V., Yiu, M. G., . . . Lee, G. T. (2015). Effects of integrated supported employment plus cognitive remediation training for people with schizophrenia and schizoaffective disorders. Schizophr Res, 166(1-3), 297-303. doi: 10.1016/j.schres.2015.05.013

Baksheev, G. N., Allott, K., Jackson, H. J., McGorry, P. D., & Killackey, E. (2012). Predictors of vocational recovery among young people with first-episode psychosis: findings from a randomized controlled trial. Psychiatr Rehabil J, 35(6), 421-427. doi: 10.1037/h0094574

Becker DR, Drake RE. (1993). A working life: the individual placement and support (IPS) program: Concord NH: New Hampshire-Dartmouth Psychiatric Research Center.

Bell, M. D., Choi, K. H., Dyer, C., & Wexler, B. E. (2014). Benefits of cognitive remediation and supported employment for schizophrenia patients with poor community functioning. Psychiatr Serv, 65(4), 469-475. doi: 10.1176/appi.ps.201200505

Bell, M. D., Zito, W., Greig, T., & Wexler, B. E. (2008). Neurocognitive enhancement therapy with vocational services: work outcomes at two-year follow-up. Schizophr Res, 105(1-3), 18-29. doi: 10.1016/j.schres.2008.06.026

Bond, G. R., Drake, R. E., Mueser, K. T., & Becker, D. R. (1997). An update on supported employment for people with severe mental illness. Psychiatr Serv, 48(3), 335-346. doi: 10.1176/ps.48.3.335

Bond, G. R., Peterson, A. E., Becker, D. R., & Drake, R. E. (2012). Validation of the Revised Individual Placement and Support Fidelity Scale (IPS-25). Psychiatr Serv, 63(8), 758-763. doi: 10.1176/appi.ps.201100476

Bouwmans, C., de Sonneville, C., Mulder, C. L., & Hakkaart-van Roijen, L. (2015). Employment and the associated impact on quality of life in people diagnosed with schizophrenia. Neuropsychiatr Dis Treat, 11, 2125-2142. doi: 10.2147/ndt.s83546

Carmona, V. R., Gomez-Benito, J., Huedo-Medina, T. B., & Rojo, J. E. (2017). Employment outcomes for people with schizophrenia spectrum disorder: A meta-analysis of randomized controlled trials. Int J Occup Med Environ Health, 30(3), 345-366. doi: 10.13075/ijomeh.1896.01074

Cloutier, M., Aigbogun, M. S., Guerin, A., Nitulescu, R., Ramanakumar, A. V., Kamat, S. A., . . . Wu, E. (2016). The Economic Burden of Schizophrenia in the United States in 2013. J Clin Psychiatry, 77(6), 764-771. doi: 10.4088/JCP.15m10278

Craig, T., Shepherd, G., Rinaldi, M., Smith, J., Carr, S., Preston, F., & Singh, S. (2014). Vocational rehabilitation in early psychosis: cluster randomised trial. Br J Psychiatry, 205(2), 145-150. doi: 10.1192/bjp.bp.113.136283

Charzynska, K., Kucharska, K., & Mortimer, A. (2015). Does employment promote the process of recovery from schizophrenia? A review of the existing evidence. Int J Occup Med Environ Health, 28(3), 407-418. doi: 10.13075/ijomeh.1896.00341

Chong, H. Y., Teoh, S. L., Wu, D. B., Kotirum, S., Chiou, C. F., & Chaiyakunapruk, N. (2016). Global economic burden of schizophrenia: a systematic review. Neuropsychiatr Dis Treat, 12, 357-373. doi: 10.2147/ndt.s96649

Dickersin, K. (1990). The existence of publication bias and risk factors for its occurrence. JAMA, 263(10), 1385-1389.

Drake, R. E., Frey, W., Bond, G. R., Goldman, H. H., Salkever, D., Miller, A., . . . Milfort, R. (2013). Assisting Social Security Disability Insurance beneficiaries with schizophrenia, bipolar disorder, or major depression in returning to work. Am J Psychiatry, 170(12), 1433-1441. doi: 10.1176/appi.ajp.2013.13020214

Drake, R. E., McHugo, G. J., Bebout, R. R., Becker, D. R., Harris, M., Bond, G. R., & Quimby, E. (1999). A randomized clinical trial of supported employment for inner-city patients with severe mental disorders. Arch Gen Psychiatry, 56(7), 627-633.

Drake, R. E., & Whitley, R. (2014). Recovery and severe mental illness: description and analysis. Can J Psychiatry, 59(5), 236-242. doi: 10.1177/070674371405900502

Drake RE, Becker DR. (1996). The individual placement and support model of supported employment. Psychiatric Services. Psychiatric Services, 47(5), 473–475.

Drake RE, Bond GR, Becker DR (2012). Individual Placement and Support. An Evidence-Based Approach to Supported Employment. USA: Oxford University Press.

Glynn, S. M., Marder, S. R., Noordsy, D. L., O'Keefe, C., Becker, D. R., Drake, R. E., & Sugar, C. A. (2017). An RCT Evaluating the Effects of Skills Training and Medication Type on Work Outcomes Among Patients With Schizophrenia. Psychiatr Serv, 68(3), 271-277. doi: 10.1176/appi.ps.201500171

Gold, P. B., Meisler, N., Santos, A. B., Carnemolla, M. A., Williams, O. H., & Keleher, J. (2006). Randomized trial of supported employment integrated with assertive community treatment for rural adults with severe mental illness. Schizophr Bull, 32(2), 378-395. doi: 10.1093/schbul/sbi056

Harvey, P. D., Heaton, R. K., Carpenter, W. T., Jr., Green, M. F., Gold, J. M., & Schoenbaum, M. (2012). Functional impairment in people with schizophrenia: focus on employability and eligibility for disability compensation. Schizophr Res, 140(1-3), 1-8. doi: 10.1016/j.schres.2012.03.025

Higgins JPT, Green S. (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 In T. C. Collaboration (Ed.).

Killackey, E., Jackson, H. J., & McGorry, P. D. (2008). Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual. Br J Psychiatry, 193(2), 114-120. doi: 10.1192/bjp.bp.107.043109

Kinoshita, Y., Furukawa, T. A., Kinoshita, K., Honyashiki, M., Omori, I. M., Marshall, M., . . . Kingdon, D. (2013). Supported employment for adults with severe mental illness. Cochrane Database Syst Rev(9), CD008297. doi: 10.1002/14651858.CD008297.pub2

Luciano, A., Bond, G. R., & Drake, R. E. (2014). Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research. Schizophr Res, 159(2-3), 312-321. doi: 10.1016/j.schres.2014.09.010

McGurk, S. R., Mueser, K. T., DeRosa, T. J., & Wolfe, R. (2009). Work, recovery, and comorbidity in schizophrenia: a randomized controlled trial of cognitive remediation. Schizophr Bull, 35(2), 319-335. doi: 10.1093/schbul/sbn182

McGurk, S. R., Mueser, K. T., Feldman, K., Wolfe, R., & Pascaris, A. (2007). Cognitive training for supported employment: 2-3 year outcomes of a randomized controlled trial. Am J Psychiatry, 164(3), 437-441. doi: 10.1176/ajp.2007.164.3.437

McGurk, S. R., Mueser, K. T., & Pascaris, A. (2005). Cognitive training and supported employment for persons with severe mental illness: one-year results from a randomized controlled trial. Schizophr Bull, 31(4), 898-909. doi: 10.1093/schbul/sbi037

Metcalfe, J. D., Drake, R. E., & Bond, G. R. (2018). Economic, Labor, and Regulatory Moderators of the Effect of Individual Placement and Support Among People With Severe Mental Illness: A Systematic Review and Meta-analysis. Schizophr Bull, 44(1), 22-31. doi: 10.1093/schbul/sbx132

Modini, M., Tan, L., Brinchmann, B., Wang, M. J., Killackey, E., Glozier, N., . . . Harvey, S. B. (2016). Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence. Br J Psychiatry, 209(1), 14-22. doi: 10.1192/bjp.bp.115.165092

Mueser, K. T., Aalto, S., Becker, D. R., Ogden, J. S., Wolfe, R. S., Schiavo, D., . . . Xie, H. (2005). The effectiveness of skills training for improving outcomes in supported employment. Psychiatr Serv, 56(10), 1254-1260. doi: 10.1176/appi.ps.56.10.1254

Mueser, K. T., Drake, R. E., & Bond, G. R. (2016). Recent advances in supported employment for people with serious mental illness. Curr Opin Psychiatry, 29(3), 196-201. doi: 10.1097/yco.0000000000000247

Rinaldi, M., Perkins, R., McNeil, K., Hickman, N., & Singh, S. P. (2010). The Individual Placement and Support approach to vocational rehabilitation for young people with first episode psychosis in the UK. J Ment Health, 19(6), 483-491. doi: 10.3109/09638230903531100

Rosenheck, R., Mueser, K. T., Sint, K., Lin, H., Lynde, D. W., Glynn, S. M., . . . Kane, J. M. (2017). Supported employment and education in comprehensive, integrated care for first episode psychosis: Effects on work, school, and disability income. Schizophr Res, 182, 120-128. doi: 10.1016/j.schres.2016.09.024

Rusch, N., Nordt, C., Kawohl, W., Brantschen, E., Bartsch, B., Muller, M., . . . Rossler, W. (2014). Work-related discrimination and change in self-stigma among people with mental illness during supported employment. Psychiatr Serv, 65(12), 1496-1498. doi: 10.1176/appi.ps.201400073

Suijkerbuijk, Y. B., Schaafsma, F. G., van Mechelen, J. C., Ojajarvi, A., Corbiere, M., & Anema, J. R. (2017). Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev, 9, CD011867. doi: 10.1002/14651858.CD011867.pub2

Tsang, H. W., Bell, M. D., Cheung, V., Tam, K. L., & Yeung, W. S. (2016). Integrated supported employment plus cognitive remediation training for people with schizophrenia. Hong Kong Med J, 22 Suppl 2, S15-18.

Tsang, H. W., Chan, A., Wong, A., & Liberman, R. P. (2009). Vocational outcomes of an integrated supported employment program for individuals with persistent and severe mental illness. J Behav Ther Exp Psychiatry, 40(2), 292-305. doi: 10.1016/j.jbtep.2008.12.007

Tsang, H. W., Fung, K. M., Leung, A. Y., Li, S. M., & Cheung, W. M. (2010). Three year follow-up study of an integrated supported employment for individuals with severe mental illness. Aust N Z J Psychiatry, 44(1), 49-58. doi: 10.3109/00048670903393613

Van Rijn, R. M., Carlier, B. E., Schuring, M., & Burdorf, A. (2016). Work as treatment? The effectiveness of re-employment programmes for unemployed persons with severe mental health problems on health and quality of life: a systematic review and meta-analysis. Occup Environ Med, 73(4), 275-279. doi: 10.1136/oemed-2015-103121

Wallace, C. J., & Tauber, R. (2004). Supplementing supported employment with workplace skills training. Psychiatr Serv, 55(5), 513-515. doi: 10.1176/appi.ps.55.5.513