Psychiatrists’ Knowledge of Their Patients’ Job Functioning

To the Editor: Conservative estimates suggest that 23 million working-age Americans have chronic health and mental health problems that diminish their ability to work (1). Mental health symptoms impair functioning and functional status, which in turn inhibits improvement in mental health status. Mental health clinicians know how to assess and manage symptom reduction and interpersonal functioning. But even though clinicians have long recognized the importance of work in their patients’ lives, they may know less about how to assess work functioning and employment status. Clinicians may also assume that work functioning will simply improve with symptom improvement and may therefore not prioritize a detailed occupational assessment (2). An evolving literature has demonstrated that symptom reduction alone does not improve job performance and satisfaction (3,4). Clinicians need to understand the details of their patients’ jobs to intervene directly regarding work performance.

The Psychopathology Committee of the Group for Advancement of Psychiatry (GAP) undertook an Internet survey of 1,700 psychiatrists to assess the degree to which they were knowledgeable about their employed patients’ work functioning. For the survey, they were asked to select two of their employed patients (anonymously) and, using a Likert scale, to answer ten work-related questions about each patient and four statements about the importance of their knowledge about patients’ work functioning. [A list of the GAP committee members and more information about the survey are available online as a data supplement to this letter.]

A total of 136 psychiatrists answered work-related questions for 269 patients. The low response rate (8%), which is unfortunately common with Internet surveys (nonresponse bias) (5), limited our ability to draw solid conclusions. However, the respondents claimed to know more about their patients’ work functioning than prior qualitative interviewing undertaken by the committee suggested. It may be that those who responded knew more about their patients’ work functioning than those who did not respond; that respondents made socially desirable responses; or that respondents overestimated their knowledge of patients’ work functioning, much as parents believe that they know what their children perceive and believe. The poor response rate may have several implications. It could reflect the generally low response to Internet surveys or a lack of interest in the topic.

Although we cannot answer these questions, it is time for our field to identify what we need to know to maximize our patients’ participation in the labor market and function effectively on the job in spite of current or ongoing psychiatric difficulties. The importance of clinicians’ attention to the domain of work has been highlighted by the impact of the current economy on all working adults and particularly on those with psychiatric symptoms. Symptom reduction must be addressed, but addressing symptoms is insufficient to help patients do well occupationally. Work is intimately connected to life satisfaction, and clinicians should strengthen their ability to help patients attain positive work-related outcomes. To this end, clinicians should become more knowledgeable about their patients’ work functioning. Training programs should emphasize the importance of exploring patients’ functioning. Finally, further research is needed to test collaborative care strategies to better enable patients with psychiatric disorders to be productive and engaged in work.