Adolescent Psychotic Disorders Tied to Long-Term Education, Employment Exclusion

Slightly more than one-third of those diagnosed with psychosis in adolescence experienced long-term NEET.

Serious long-term functional disability is independently associated with a psychosis diagnosis in adolescence, and educational problems in individuals with psychotic disorders are markers of adverse labor market outcomes. These are among the study findings published in Schizophrenia Bulletin.

Researchers conducted a review and analysis of cohort data from the 1987 Finnish Birth Cohort study which included all 59,476 live births in Finland in 1987. The study cohort encompassed the subgroup of 288 individuals diagnosed with psychotic disorders from 2004 through 2007 (range, age 16-20 years) and the control cohort (n=55,883) without a psychotic disorder diagnosis. Individuals diagnosed with a psychotic disorder from 1998 to 2003, diagnosed with an intellectual disability, those who had lived outside Finland, or died before 2016 were excluded.

The primary endpoint was individuals who were not being in education, employment, and training (NEET) for more than 5 years. The secondary endpoints were to assess risk markers for this population and determine whether socioeconomic and educational factors were associated with using rehabilitation services.

Researchers used the national register data for these 288 individuals from 2008 through 2015 (ages 20-28 years) to relate associations between NEET status and sociodemographic factors. They defined NEET as not studying on parental leave, not working, or not taking part in jobseekers’ programs. Education was defined as receiving any student benefits. Parental leave was defined as receiving childcare benefits. Employment was defined as receiving a salary that contributed to a pension. Jobseeker program participation reflected training.

Despite the high prevalence of NEET in individuals diagnosed with a psychotic disorder, only a small proportion received vocational rehabilitation.

Long-term NEET (≥5 years) was found to affect those without psychosis (2.2%), those with any nonaffective psychotic disorder (35.8%), and those with schizophrenia or schizoaffective disorders (57.0%).

Not applying for secondary education, not finishing upper secondary education, being diagnosed with schizophrenia or schizoaffective disorders, being hospitalized for psychosis, and having parents receiving welfare benefits were associated with long-term NEET in addition to having a psychotic disorder. The 86 individuals diagnosed with schizophrenia or schizoaffective disorders were more likely to be not working (46.5%), not studying (70.9%), and not on parental leave (87.2%) compared with the 288 individuals with any psychosis, including those 2 diagnoses, or those in the control cohort.

Fewer than 25% of individuals diagnosed with psychotic disorders participated in vocational rehabilitation. This population was more likely to have taken part in mainstream unemployment agency training (47.9%) vs those without a psychotic disorder (36.2%). A total of 36.0% of the subgroup of 86 individuals with schizophrenia or schizoaffective disorders participated in this training.

Long-term NEET among individuals with psychotic disorders vs those without psychotic disorders was poorly predicted by family-related risk factors. Among the individuals diagnosed with a psychotic disorder, there were no significant associations observed between being long-term NEET and comorbidities of learning disabilities, autism spectrum disorder, conduct disorder, depressive disorder, or substance use disorder.

Limitations of the study include the fact that the analysis was limited to psychotic disorders diagnosed by specialist health care services, a lack of information about protective factors and resilience, and a lack of generalizability to populations in other countries.

Study authors conclude, “Furthermore, 57.0% of individuals diagnosed with schizophrenia or schizoaffective disorders were long-term NEET, highlighting the serious long-term functional morbidity associated with such a diagnosis in adolescence.” They add, “Despite the high prevalence of NEET in individuals diagnosed with a psychotic disorder, only a small proportion received vocational rehabilitation.”

References:

Ringbom I, Suvisaari J, Kääriälä A, et al. Psychotic disorders in adolescence and later long-term exclusion from education and employment. Schizophr Bull. Published online October 28, 2022. doi:10.1093/schbul/sbac151