Does competitive employment improve nonvocational outcomes for people withsevere mental illness?

The authors examined the cumulative effects of work on symptoms, quality of life, and self-esteem for 149 unemployed clients with severe mental illnes s receiving vocational rehabilitation. Nonvocational measures were assessed at 6-month intervals throughout the 18-month study period, and vocational activity was tracked continuously. On the basis of their predominant work a ctivity over the study period, participants were classified into 4 groups: competitive work, sheltered work, minimal work, and no work. The groups did not differ at baseline on any of the nonvocational measures. Using mixed e ffects regression analysis to examine rates of change over time, the author s found that the competitive work group showed higher rates of improvement in symptoms; in satisfaction with vocational services, leisure, and finance s; and in self-esteem than did participants in a combined minimal work-no w ork group. The sheltered work group showed no such advantage.