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首页> 外文期刊>Administration and policy in mental health >Working with a Severe Mental Illness: Estimating the Causal Effects of Employment on Mental Health Status and Total Mental Health Costs
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Working with a Severe Mental Illness: Estimating the Causal Effects of Employment on Mental Health Status and Total Mental Health Costs

机译：患有严重的精神疾病：估算就业对心理健康状况和全面心理健康成本的因果影响

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Employment is an important goal for persons who have a severe mental illness (SMI). The current literature finds some evidence for a positive relationship between employment and measures of mental health (MH) status, however study design issues have prevented a causal interpretation. This study aims to measure the causal effect of employment on MH status and total MH costs for persons with SMI. In a quasi-experimental prospective design, self-reported data measured at baseline, 6-months, and 12-months, on MH status and employment are paired with Public Mental Health System (PMHS) claims data. The study population (N=5162) is composed of persons with a SMI who received PMHS services for a year or more. Outcome variables are MH status symptom scores from the BASIS-24 instrument and total MH costs. The estimation method is full information maximum likelihood, which allows for tests of employment endogeneity. Outcomes with an insignificant test of endogeneity are estimated using tobit or ordinary least square (OLS). Employment has modest but meaningful effects on MH status (including overall MH status, functioning, and relationships) and reduces total mental health costs on average by $538 in a 6-month period. Tests of endogeneity were largely insignificant, except for the depression score that tested marginally statistically significant. Interaction terms between baseline MH scores and employment indicated larger employment effects for individuals with worse baseline scores. This study demonstrates the non-vocational benefits of employment for individuals with SMI. Results have high generalizability and should be of interest to federal and state governments in setting appropriate disability policy and funding vocational programs. From a methodological perspective, future research should still be concerned with potential endogeneity problems, especially if employment status and MH outcomes are simultaneously measured and/or baseline measures of MH are not adequately controlled for future research should continue to examine the multi-dimensional nature of MH status and costs. Our analyses also demonstrate the practical use of a state-wide outcomes measurement program in assessing the factors that influence the recovery trajectories of individuals with SMI.
机译：就业是具有严重精神疾病（SMI）的人的重要目标。目前的文献发现了一些证据表明就业和心理健康措施（MH）地位之间的积极关系，但研究设计问题已阻止因果解释。本研究旨在衡量SMI人员就业对MH地位的因果效应和总MH成本。在准实验前瞻性设计中，在基线，6个月和12个月地区测量的自我报告的数据与MH地位和就业相结合，与公共心理健康系统（PMHS）声明数据配对。研究人口（n = 5162）由具有一年或更长时间收到PMHS服务的SMI的人组成。结果变量是MH的基础-24仪器的状态症状分数和总MH成本。估计方法是全额信息最大可能性，其允许对非营利性的测试。使用TOBIT或普通最小二乘（OLS）估计具有非关头性的微不足道的结果。就业对MH地位（包括整体MH地位，运作，和关系）具有适度但有意义的影响，并在6个月内平均降低了538美元的总精神健康成本。外科性测试在很大程度上是微不足道的，除了在统计学上进行边际测试的抑郁症分数。基线MH分数与就业之间的互动条款表明对基线分数更严重的个人的就业效果。本研究表明，与SMI的个人就业的非职业效益。结果具有很大的普遍性，并且在制定适当的残疾政策和资助职业方案方面应该对联邦和州各国政府感兴趣。从方法的角度来看，未来的研究仍应涉及潜在的内情问题，特别是如果就业状况和MH结果同时测量和/或MH的基线措施而不适当控制未来的研究，应继续检查多维性质MH状态和成本。我们的分析还展示了全息成果测量计划的实际应用，以评估影响患有SMI个人恢复轨迹的因素。

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