Abstract
Background: Negative symptoms are a core characteristic of schizophrenia affecting vocational, social and daily life functioning (Haro et al, 2015; Hunter and Barry, 2012). Of the negative symptoms, apathy has an independent negative impact on both social and vocational functioning (Fervaha et al, 2015; Strauss et al, 2013). However, less is known about the relationship between apathy and functional impairment in the context of vocational rehabilitation studies.
We are interested in whether the provision of vocational rehabilitation augmented with cognitive remediation (CR) or cognitive behavior therapy (CBT) techniques might influence the association between apathy and functioning. This paper examines the impact of apathy on social and vocational outcome at 2-year follow-up in a vocational rehabilitation study.
Methods: A total of 148 participants were included in the Job Management Program (JUMP) study.
Clinical and functional measures were assessed on inclusion, at approximately 10 months, and at 2-year follow-up. Apathy was assessed with the Apathy Evaluation Scale (Marin, Biedrzycki, and Firinciogullari, 1991) and social functioning with the Social Functioning Scale (Birchwood et al, 1990). Employment outcome included competitive and sheltered work, and hours worked per week.
Results: From baseline to follow-up there was a small but significant improvement in apathy (F = 9.0, df = 2,239, P < .001), and a marked increase in employment rate (16%–60%) and hours worked per week (3–21 h), with no significant difference in improvement between the CR and CBT groups. Baseline apathy did not predict vocational outcome. The model for hours worked (F7, 116 = 1.35, P = .23) was not significant. The final model for employment status included baseline variables, employment status and the intervention groups (χ2 (9,124) = 9.70, P = .38), and was repeated with the number of intervention sessions but not the intervention groups (χ2 (9,118) = 14.6, P = .10). Higher levels of baseline apathy predicted all the SFS social functioning subscales scores except Independence competence, where the model was not significant (F(7,86) = 1.84, P = .09). Controlling for baseline social functioning, higher levels of baseline apathy predicted social functioning at follow-up. Apathy change from baseline to post-treatment did not predict vocational or social functioning at follow-up.
Conclusion: Apathy remained fairly stable over 2 years. Neither baseline nor change in apathy predicted vocational outcome. The intervention did however attenuate the negative impact of apathy on vocational functioning, enabling people with schizophrenia and higher levels of apathy to work, and to work more or less the same number of hours as those with lower levels of apathy. It did not attenuate the effect of apathy on social functioning, indicating the need for targeted interventions.