Frailty affects employment outcomes in patients with schizophrenia in noncompetitive employment: A 4-year longitudinal study

Objectives: Employment status is considered a crucial predictor of improved functioning for patients with psychotic disorders. Frailty affects not only physical well-being but also employment outcomes, but few studies have explored the association between frailty and employment outcomes in patients with schizophrenia. This study is a longitudinal follow-up study that aimed to determine whether frailty is associated with employment outcomes in schizophrenia. Methods: All 561 stable patients with schizophrenia in a therapeutic community in Taiwan were recruited. Employment outcomes, defined as the cumulative annual work duration (months per year) and income (USD per year), were investigated repeatedly at the end of 1-, 2-, 3-, and 4-year follow-ups after enrollment. Generalized estimating equation models were constructed to determine the association between frailty and employment outcomes after controlling for variables, including age, sex, education, antipsychotic medication and daily dose, cognitive function, instrumental activities of daily living, medical comorbidity, and initial employment state at the beginning year. Results: The average age was 53.78 years, and 64.7% were men. Among them, 57 patients (10.2%) met the frailty criteria at the baseline. After controlling for other factors, we found that patients with frailty were employed 1.01 month less (p = 0.004) and earned 17.2 USD less (p = 0.029) per year than those without frailty. Conclusions: Frailty may reduce duration of employment and income for patients with schizophrenia. The biopsychosocial care model for these patients should include development of strategies to prevent or reverse preexisting frailty to improve and preserve employment outcomes.