Employment functioning in people with severe mental illnesses living in urban vs. rural areas in India
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ORIGINAL PAPER
Employment functioning in people with severe mental illnesses living in urban vs. rural areas in India Chitra Khare1,2 · Kim T. Mueser2,3,4 · Daniel Fulford1,4 · Vidyadhar G. Watve5 · Neeraj J. Karandikar6 · Sailee Khare7 · Dipti N. Karandikar6 · Susan R. McGurk2,3,4 Received: 19 November 2019 / Accepted: 9 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Research on employment in people with severe mental illnesses (SMI) in developing countries is sparse and largely limited to employment rates. We conducted a comprehensive study of work, interest in work, and perceived benefits and barriers to work in people with SMI in India. Methods Semi-structured interviews were conducted with 550 individuals with SMI receiving private psychiatric outpatient services in two districts in western India, one urban (Pune) and the other rural (Ahmednagar). Results More than half of the participants were employed, with significantly more men working (79.4%) than women (35.9%). Higher rates of work were found in rural areas (77.8%), where most work was in family agricultural businesses, than in urban areas (48.9%), where most work was for independent employers. Participants in rural areas worked fewer hours and earned less money, and reported fewer benefits and fewer problems related to work than urban participants. Over 45% of participants working for independent employers found jobs with help from families and extended social networks. Most unemployed participants wanted to work, and desired a variety of supports, including assistance with job finding and illness management. Conclusions Gender-specific social role expectations and families play an important role in work in people with SMI in India. Despite higher rates of work in this sample than most studies from developed countries, a significant subgroup was unemployed but wanted to work. Persons with SMI in developing countries may benefit from the adaptation of validated vocational rehabilitation approaches in developed countries to their cultural context. Keywords Severe mental illness · Schizophrenia · Employment · Developing countries · India
Introduction Schizophrenia is one of the fifteen most burdensome diseases in both developing and developed countries [1]. Schizophrenia and other severe mental illnesses (SMI) are characterized by persistent adverse effects on personal, social, and occupational functioning [2], including obtaining and sustaining work [3]. Research from developed countries has typically reported rates of employment below 25% in people with SMI [3, 4], with unemployment associated with lower Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00127-020-01901-0) contains supplementary material, which is available to authorized users. * Kim T. Mueser [email protected] Extended author information available on the last page of the article
education [5], diagnosis of schizophrenia (vs. mood disorder) [6], and cognitive impairment [7]. Despite these low
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