Employment rates among people with schizophrenia are higher in Germany than in the UK or France, a new study has found.

Work is a frequently stated goal of people with schizophrenia, but their employment rate is low. Recent European estimates of employment rates among them range from 8% to 35%.

The aim of this study was to examine employment patterns and variables associated with working in the largest representative sample to date of people with schizophrenia resident in Germany, France and the UK.

Published in the July 2007 issue of the British Journal of Psychiatry, the study analysed data from the European Schizophrenia Cohort Study, a 2-year investigation of 1208 people aged between 18 and 64 with schizophrenia in contact with secondary psychiatric services.

Centres taking part in the study were Lille, Lyon and Marseille in France, Leipzig, Hemer and Heilbronn in Germany, and London (Islington) and Leicestershire in the UK.

Similar numbers of participants were living alone in each country, but more German respondents were living with partners and/or children, and more French respondents with their parents.

It was found that the overall employment rate of participants was 21.5%, but varied between countries and sites, with rates of 12.9% in the UK, 11.5% in France and 30.3% in Germany. This compares with general population employment rate of 71% in the UK, 62.2% in France and 65.4% in Germany in the year 2000.

The German centres had the highest proportion of people supporting themselves entirely through work. The number of people in each centre who had never worked was low, apart from in Marseille.

The most common type of jobs were 'elementary', such as cleaning and labouring, and 'skilled trade occupations', such as plumbing and metalwork. The proportion of people in official or managerial positions was very small.

More people in Germany were doing sheltered or voluntary work. The German centres had more vocational services, and more placements provided within them, than the other 2 countries.

Employment was significantly associated with area of residence, having a diploma or degree, living with family, drug misuse, more severe general psychopathology symptoms of schizophrenia such as poor impulse control and social anxiety, illness course and age of illness onset.

The authors of the study comment that as in other recent studies, the employment rate in the UK sample was low, especially in London. The rate in France is equally concerning, at approximately a third of the German rate.

The large numbers of unemployed people with schizophrenia represent a significant financial cost to the welfare states of the 3 countries, and indicate considerable social exclusion among the mentally ill.

Local and national factors that may contribute towards variations in employment between centres include the decline in availability of relatively unskilled and undemanding jobs, professionals' and patients' attitudes and values regarding the feasibility and importance of work, the attitudes of employers and the public, the stigma patients experience in the labour market, benefits systems, and employment law.

The researchers found that people with schizophrenia who were also misusing drugs were less likely to be working, in line with a previous study showing high levels of social exclusion among people with 'dual diagnosis'.

Earlier onset of the illness also reduced the odds of working, reflecting a poorer prognosis in people who become unwell earlier.

"Rates and correlates of employment in people with schizophrenia in the UK, France and Germany"
Marwaha S, Johnson S, Bebbington P, Stafford M, Angermeyer MC, Brugha T, Azorin J-M, Kilian R, Hansen K and Toumi M (2007).
British Journal of Psychiatry, 191, 30-37
Click here to see abstract

The Royal College of Psychiatrists
www.rcpsych.ac