The impact of employment on recovery among individuals who are homeless with severe mental illness in the Vancouver At H
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ORIGINAL PAPER
The impact of employment on recovery among individuals who are homeless with severe mental illness in the Vancouver At Home/Chez Soi trial Kiana Yazdani1,3,5 · Mohammadali Nikoo2 · Eric C. Sayre3 · Fiona Choi2 · Kerry Jang4 · Reinhard Michael Krausz2 Received: 5 July 2019 / Accepted: 15 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To assess impact of employment on recovery in a sample of adults from Vancouver At Home (VAH) study, who were homeless and were diagnosed with severe mental disorders. Methods The VAH included two randomized controlled trials investigating the effect of housing first with support intervention in vulnerable population. Employment was assessed at baseline and during the follow-up using Demographics, Housing, Vocational, and Service Use History (DSHH), and Vocational Timeline Follow-Back (VTLFB) self-report questionnaires, respectively. Recovery was examined using Recovery Assessment Scale (RAS) at baseline and at 24-month follow-up visit. Multivariable regression models were built to examine: (1) the effect of current employment at baseline on RAS score at baseline, and RAS score at 24-month follow-up visit; and (2) and to examine the cumulative effect of recent employment over 8 follow-up visits on RAS score at 24-month visit. Cumulative effect of employment over the follow-up visits was weighted by recency using a pre-specified weighting function. Results Employment at baseline was associated with an increase in recovery score at baseline [8.06 (95% CI 1.21, 14.91); p = 0.02], but not with recovery score at 24-month follow-up visit [3.78 (−4.67, 12.24); p = 0.37]. Weighted cumulative effect of employment over 8 follow-up visits was associated with increase in RAS score at 24-month follow-up visit [8.33 (1.68, 14.99) p = 0.01]. Conclusion Employment is associated with an increase in recovery. Our result suggests a dual effect of employment on recovery, an immediate effect through current employment, and a long-term effect of cumulative employment. Keywords Employment · Recovery · Homelessness · Severe mental illness
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00127-020-01887-9) contains supplementary material, which is available to authorized users. * Kiana Yazdani [email protected] 1
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Addiction and Concurrent Disorders Group, Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada Addiction and Concurrent Disorders Group, Centre for Health Evaluation Outcome Sciences, Department of Psychiatry, Faculty of Medicine, Institute of Mental Health, University of British Columbia, Vancouver, Canada
Recovery from mental illness, particularly among individuals who are homeless, is multidimensional and a complex process [1]. An operational view of recovery was purposed by Whitley and Drake [2], who outlined five components: clinical recovery (improvement in symptoms and substance use re
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