目标:主要和综述研究表明,支持的就业干预措施在帮助患有严重精神疾病(SMI)的人实现成功的就业和与健康相关的结果方面显示出希望。这篇综述综合了来自各种综述研究的证据,这些研究涉及对SMI患者的就业干预措施,确定与五个关键成果相关的关键发现和实施挑战:(1)就业,(2)生活质量,(3)社会功能,(4)临床/服务利用,(5)经济成果。
方法:对11个数据库和寄存器的系统搜索(CINAHL,科克伦,EmCare,JBIEBP,ProQuest,PsycINFO,PubMed,Scopus,和WebofScience,以及Prospero和Campbell)进行了研究,以确定对SMI患者的支持就业干预措施的荟萃分析和系统评价,同行评审并以英文发表。使用标准化的JoannaBriggs研究所(JBI)工具进行质量评估和数据提取。采用混合方法综合方法来整合定量和定性证据。
结果:26项综述研究的综合主要集中在各种支持的就业干预措施中的个人安置和支持(IPS)模型上。总的来说,将支持的就业与有针对性的干预措施相结合,例如神经认知疗法和与工作相关的社会技能培训,对就业(包括工作保留)和非就业结果(例如,健康,生活质量,社会功能)相对于SMI患者的标准支持就业形式。情境因素(干预保真度,设置,系统性障碍)是干预实施和有效性的重要考虑因素。
结论:26项综述研究中主要研究的显著重叠揭示了作者在解释和结论方面的显著差异,对其可靠性提出质疑。在综述研究中,美国关于IPS干预措施的大量重叠报告可能会对有效性产生偏见。没有一个放之四海而皆准的解决方案来支持SMI的个人获得和维持就业。根据个人需求和情况制定策略对于解决心理健康恢复的复杂性至关重要。我们建议创建集中的注册中心或数据库来监控评论中包含的主要研究,从而避免冗余。
■这项伞式研究已在PROSPERO注册(编号:CRD42023431191)。
OBJECTIVE: Primary and review studies show that supported employment interventions showed promise in assisting people with severe mental illness (SMI) in achieving successful employment and health-related outcomes. This umbrella review synthesises evidence from across review studies on supported employment interventions for individuals with SMI, to identify key findings and implementation challenges in relation to five key outcomes: (1) employment, (2) quality of life, (3) social functioning, (4) clinical/service utilisation, and (5) economic outcomes.
METHODS: A systematic search of eleven databases and registers (CINAHL, Cochrane, EmCare, JBI EBP, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science, and Prospero and Campbell) was conducted to identify meta-analyses and systematic reviews on supported employment interventions for individuals with SMI, peer reviewed and published in English. Quality assessment and data extraction were performed using standardised Joanna Briggs Institute (JBI) tools. A mixed-methods synthesis approach was employed to integrate both quantitative and qualitative evidence.
RESULTS: The synthesis of 26 review studies primarily focused on the Individual Placement and Support (IPS) model among various supported employment interventions. Overall, combining supported employment with targeted interventions such as neurocognitive therapy and job-related social skill training showed a positive effect on employment (including job retention) and non-employment outcomes (e.g., health, quality of life, social functioning) relative to standard forms of supported employment for people with SMI. Contextual factors (intervention fidelity, settings, systemic barriers) were important considerations for intervention implementation and effectiveness.
CONCLUSIONS: Significant overlap of primary studies across 26 review studies exposed considerable variations in interpretation and conclusions drawn by authors, raising questions about their reliability. High volume of overlap reporting from the USA on IPS interventions in review studies is likely to have biased perceptions of effectiveness. There is no one-size-fits-all solution for supporting individuals with SMI in obtaining and maintaining employment. Tailoring strategies based on individual needs and circumstances appears crucial to address the complexity of mental health recovery. We propose creating centralised registries or databases to monitor primary studies included in reviews, thus avoiding redundancy.
UNASSIGNED: This umbrella study was registered with PROSPERO (No. CRD42023431191).