Predictors of employment in schizophrenia: The importance of intrinsic and extrinsic motivation

https://doi.org/10.1016/j.schres.2016.08.006Get rights and content

Abstract

Unemployment is a primary functional deficit for the majority of adults with schizophrenia. Research indicates that over two-thirds of adults living in the community with schizophrenia are unemployed. Despite effective programs to assist with job identification and placement, the ability to attain and maintain employment remains a pressing concern. A contributing factor that may be relevant but has received little attention in the work rehabilitation literature is motivation. People with schizophrenia show marked deficits in both intrinsic and extrinsic motivation but these deficits have not been directly examined in relation to work outcomes. The present study sought to examine the relationship between intrinsic and extrinsic motivation and work outcome among a sample of 65 adults with schizophrenia enrolled in a supported employment program. One-third of the participants in the study obtained work. Intrinsic motivation related to valuing and feeling useful in a work role significantly predicted who would obtain employment. Extrinsic motivation related to gaining rewards and avoiding obstacles showed a non-significant trend-level relationship such that workers had higher extrinsic motivation than nonworkers. These findings highlight the importance of considering both intrinsic and extrinsic motivation in work-related interventions and supported employment for individuals with schizophrenia. The results are discussed in terms of clinical implications for improving rehabilitation and occupational outcomes in schizophrenia.

Section snippets

Participants

The sample included 65 participants who met SCID-based DSM-IV criteria for schizophrenia or schizoaffective disorder, and were enrolled in supported employment programs at the VA Greater Los Angeles Healthcare System or the San Fernando Mental Health Center. The participants were clinically stable outpatients (i.e., no psychiatric hospitalizations in the past three months and no medication changes in the past two months). All participants were a minimum of 21 years of age and expressed an

Descriptive data

We examined the clinical and demographic characteristics of the sample for the participants who got a job and participants who did not get a job during the study (Table 1). Workers were significantly younger than nonworkers so age was included as a covariate in subsequent analyses. The groups were comparable in sex, race, education, and parental education. Our overall sample was predominantly male, around 45 years of age with 13 years of education, approximately half were Latino/Hispanic and

Discussion

This study examined the role of intrinsic and extrinsic motivation on work outcomes among adults with schizophrenia enrolled in supported employment. The primary finding was that, among a large sample of adults who voluntarily participated in a program to seek employment, baseline levels of intrinsic and extrinsic motivation were somewhat related to work outcomes in a two-year follow-up period. Previous research has primarily focused on cognition and psychiatric symptoms, but the current

Role of funding source

This project was funded by a VAMERIT Award (D4505I) to Dr. Kern. The funding source had no direct role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Contributors

RKS initiated and designed the study. LFR, KL, and RKS analyzed the data. LFR wrote the first draft of the manuscript. LFR, KL, and RKS proof-read the manuscript and contributed to the discussion of the manuscript. LFR wrote the final draft of the manuscript and submitted it with the approval of all co-authors.

Conflict of interest

Dr. Kern is an officer for MATRICS Assessment, Inc. and receives financial compensation for his role in that nonprofit organization. Dr. Reddy and Dr. Llerena have no financial interests or potential conflicts of interest.

Acknowledgements

We gratefully acknowledge all of the individuals who participated in the present study.

References (35)

  • BeckerD.R. et al.

    What predicts supported employment program outcomes?

    Community Ment. Health J.

    (2006)
  • BiegelD.E. et al.

    Predictors of competitive employment among consumes with co-occurring mental and substance use disorders

    Res. Soc. Work. Pract.

    (2010)
  • BlanchardJ.J. et al.

    Anhedonia, positive and negative affect, and social functioning in schizophrenia

    Schizophr. Bull.

    (1998)
  • ChoiJ. et al.

    Intrinsic motivation inventory: an adapted measure for schizophrenia research

    Schizophr. Bull.

    (2010)
  • K.H. Choi et al.

    Beyond cognition: a longitudinal investigation of the role of motivation during a vocational rehabilitation program

    J. Nerv. Ment. Dis.

    (2013)
  • DeciE.L. et al.

    Facilitating internalization: the self-determination theory perspective

    J. Pers.

    (1994)
  • GardD.E. et al.

    Do people with schizophrenia have difficulty anticipating pleasure, engaging in effortful behavior, or both?

    J. Abnorm. Psychol.

    (2014)

    • Cited by (0)

    View full text
    Published by Elsevier B.V.