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Assisting Social Security Disability Insurance Beneficiaries With Schizophrenia, Bipolar Disorder, or Major Depression in Returning to Work
Robert E. Drake, M.D., Ph.D.; William Frey, Ph.D.; Gary R. Bond, Ph.D.; Howard H. Goldman, M.D., Ph.D.; David Salkever, Ph.D.; Alexander Miller, M.D.; Troy A. Moore, Pharm.D.; Jarnee Riley, M.S.; Mustafa Karakus, Ph.D.; Roline Milfort, Ph.D.
Am J Psychiatry 2013;170:1433-1441. doi:10.1176/appi.ajp.2013.13020214
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Dr. Miller has served on data monitoring committees for Otsuka and has received an investigator-initiated research grant from Pfizer. The other authors report no financial relationships with commercial interests.

The authors thank Susan Kalasunas and Tom Hale from the U.S. Social Security Administration (SSA) for their assistance. This study extends work that was conducted under contract SS00-05-60072 between the SSA and Westat. This analysis was conducted for the benefit of the SSA. The opinions expressed in this article are those of the authors and not necessarily those of the SSA.

From the Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Hanover, N.H.; the Department of Psychiatry, University of Maryland School of Medicine, Baltimore; the Department of Public Policy, University of Maryland–Baltimore County, Baltimore; the Department of Psychiatry, University of Texas at San Antonio School of Medicine; the South Texas Veterans Health Care System, San Antonio; and Westat, Rockville, Md.

Address correspondence to Dr. Drake (robert.e.drake@dartmouth.edu).

Copyright © 2013 by the American Psychiatric Association

Received February 16, 2012; Revised April 22, 2013; Revised April 29, 2013; Accepted May 06, 2013.

Abstract

Objective  People with psychiatric impairments (primarily schizophrenia or a mood disorder) are the largest and fastest-growing group of Social Security Disability Insurance (SSDI) beneficiaries. The authors investigated whether evidence-based supported employment and mental health treatments can improve vocational and mental health recovery for this population.

Method  Using a randomized controlled trial design, the authors tested a multifaceted intervention: team-based supported employment, systematic medication management, and other behavioral health services, along with elimination of barriers by providing complete health insurance coverage (with no out-of-pocket expenses) and suspending disability reviews. The control group received usual services. Paid employment was the primary outcome measure, and overall mental health and quality of life were secondary outcome measures.

Results  Overall, 2,059 SSDI beneficiaries with schizophrenia, bipolar disorder, or depression in 23 cities participated in the 2-year intervention. The teams implemented the intervention package with acceptable fidelity. The intervention group experienced more paid employment (60.3% compared with 40.2%) and reported better mental health and quality of life than the control group.

Conclusions  Implementation of the complex intervention in routine mental health treatment settings was feasible, and the intervention was effective in assisting individuals disabled by schizophrenia or depression to return to work and improve their mental health and quality of life.

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FIGURE 1. CONSORT Diagram for a Study of a Multifaceted Intervention to Assist Social Security Disability Insurance Beneficiaries With Schizophrenia, Bipolar Disorder, or Major Depression in Returning to Work

FIGURE 2. Monthly Paid Employment Rates Among Social Security Disability Insurance Beneficiaries With Mental Disorders Receiving a Multifaceted Intervention or Care as Usuala

a Significant difference between groups, starting at month 5 (p<0.05) and continuing through month 25 (p<0.0001).

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TABLE 1.Demographic and Baseline Characteristics of Social Security Disability Insurance Beneficiaries in a Study of a Multifaceted Intervention
Table Footer Note

a The mean age for each group and for the overall sample ranged from 47.2 to 47.5 years.

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b Significant difference between groups, p=0.03.

Table Footer Note

c Significant difference between groups, p=0.02.

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TABLE 2.Employment Outcomes for Social Security Disability Insurance Beneficiaries in a Study of a Multifaceted Intervention
Table Footer Note

a Intervention group, N=1,004; control group, N=1,051.

Table Footer Note

b The worker sample comprises beneficiaries who worked at least one paid job during the follow-up period: intervention group, N=605; control group, N=423.

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c Data were available for 335 participants in the intervention group and 178 in the control group.

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TABLE 3.Service Use Among Social Security Disability Insurance Beneficiaries in a Study of a Multifaceted Intervention
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TABLE 4.Changes in Self-Reported Mental Health, Physical Health, and Life Satisfaction at Baseline and Follow-Up in a Study of a Multifaceted Intervention
Table Footer Note

a Significant difference between groups (t=5.32, p<0.001; d=0.23).

Table Footer Note

b Significant difference between groups (t=3.94, p<0.001, d=0.18).

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What approximate percentage of SSDI beneficiaries with mental health disabilities sign up for free evidence-based employment services?
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What approximate percentage of SSDI beneficiaries with mental health disabilities who receive evidence-based employment services will achieve paid employment?
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What approximate percentage of SSDI beneficiaries with mental health disabilities who receive evidence-based employment services and achieve paid employment will leave the SSDI program?
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