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Published Online: 1 December 2013

Assisting Social Security Disability Insurance Beneficiaries With Schizophrenia, Bipolar Disorder, or Major Depression in Returning to Work

Abstract

A comprehensive new intervention assisting individuals disabled by schizophrenia, bipolar disorder, or depression increased workforce participation and earnings and produced better self-reported mental health and quality of life than usual care.

Abstract

Objective

People with psychiatric impairments (primarily schizophrenia or a mood disorder) are the largest and fastest-growing group of Social Security Disability Insurance (SSDI) beneficiaries. The authors investigated whether evidence-based supported employment and mental health treatments can improve vocational and mental health recovery for this population.

Method

Using a randomized controlled trial design, the authors tested a multifaceted intervention: team-based supported employment, systematic medication management, and other behavioral health services, along with elimination of barriers by providing complete health insurance coverage (with no out-of-pocket expenses) and suspending disability reviews. The control group received usual services. Paid employment was the primary outcome measure, and overall mental health and quality of life were secondary outcome measures.

Results

Overall, 2,059 SSDI beneficiaries with schizophrenia, bipolar disorder, or depression in 23 cities participated in the 2-year intervention. The teams implemented the intervention package with acceptable fidelity. The intervention group experienced more paid employment (60.3% compared with 40.2%) and reported better mental health and quality of life than the control group.

Conclusions

Implementation of the complex intervention in routine mental health treatment settings was feasible, and the intervention was effective in assisting individuals disabled by schizophrenia or depression to return to work and improve their mental health and quality of life.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 1433 - 1441
PubMed: 23929355

History

Received: 16 February 2012
Revision received: 22 April 2013
Revision received: 29 April 2013
Accepted: 6 May 2013
Published online: 1 December 2013
Published in print: December 2013

Authors

Details

Robert E. Drake, M.D., Ph.D.
From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.
William Frey, Ph.D.
From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.
Gary R. Bond, Ph.D.
From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.
Howard H. Goldman, M.D., Ph.D.
From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.
David Salkever, Ph.D.
From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.
Alexander Miller, M.D.
From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.
Troy A. Moore, Pharm.D.
From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.
Jarnee Riley, M.S.
From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.
Mustafa Karakus, Ph.D.
From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.
Roline Milfort, Ph.D.
From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.

Notes

Address correspondence to Dr. Drake ([email protected]).

Funding Information

Dr. Miller has served on data monitoring committees for Otsuka and has received an investigator-initiated research grant from Pfizer. The other authors report no financial relationships with commercial interests.

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