Pathomechanisms and Signatures in the Longitudinal Course of Psychosis

13.01.2015

2022-10-01

060_ Stability of employment and relationship status over time in patients from the affective-to-psychotic spectrum

Research Question and Aims

Employment and relationship status are major indicators for social integration and rank among the most desired goals by patients (Emsley et al., 2011; Heering et al., 2015; Lambert et al., 2010). Employment is shown to decline after the diagnosis of schizophrenia (SZ), bipolar disorder (BPD) or depression (Christensen et al., 2021). Meta-analysis of follow-up studies shows, that the relationship status often changes after diagnosis of first episode psychosis (Ajnakina et al., 2021). Low satisfaction with occupation and relationship status affect quality of life and might therefore need special attention (Nyer et al., 2010; Sylvia et al., 2017). This project will investigate the stability of employment and relationship over time within the PsyCourse study. We want to investigate if, social integration is mediated by the diagnostic subgroups over time or based on the symptomatic burden of the disease.
The hypothesis is that patients once diagnosed with a disorder from the affective to psychotic spectrum remain in their state of employment and relationship status. We hypothesize that differences are based on the diagnostic subgroup, and these are better explained by the symptomatic burden than the diagnostic subgroup itself.

Analytic Plan

Hypothesis
1. We hypothesize that overall, neither employment nor relationship status will change over time.
2. We hypothesize that the changes in employment and/or relationship status are dependent on the diagnostic group ("affective" vs. "psychotic") (significant diagnosis x time interaction effect).
3. We hypothesize that these changes are better explained by the symptomatic burden (measured by GAF), than the diagnostic group ("affective" vs. "psychotic") alone.

Participants
Longitudinal Data from all PsyCourse participants (younger than 65 years old) will be used.

Analytic methods
The analyses will be performed cross-diagnostically and at four timepoints in the following diagnostic subgroups: psychotic disorder and affective disorder as well as in the healthy control group (as control group).

Dependent variables
employment and relationship status

Independent variables
Diagnostic group (psychotic or affective) and symptomatic burden measured by GAF

Covariates
age
sex
educational level

H1
descriptive analysis

H2
Multistate model with two transient states each: 1. employment status and dx group ; 2. relationship status and dx group ; 3. employment status and symptomatic burden ; 4. relationship status and symptomatic burden.

H3
comparison of model 1 vs. 3 and model 2 vs. 4 compared via Akaike's information criterion (AIC)

Resources needed

v1_ID
v1_stat
v1_interv_date
v2_interv_date
v3_interv_date
v4_interv_date
v1_sex
v1_ageBL
v1_yob
v1_center
v1_dur_illness
v1_marital_stat
v2_marital_stat
v3_marital_stat
v4_marital_stat
v1_partner
v2_partner
v3_partner
v4_partner
v1_curr_paid_empl
v2_curr_paid_empl
v3_curr_paid_empl
v4_curr_paid_empl
v1_disabl_pens
v2_disabl_pens
v3_disabl_pens
v4_disabl_pens
v1_spec_emp
v2_spec_emp
v3_spec_emp
v4_spec_emp
v1_scid_dsm_dx_cat
v1_gaf
v2_gaf
v3_gaf
v4_gaf
v1_Antidepressants
v2_Antidepressants
v3_Antidepressants
v4_Antidepressants
v1_Antipsychotics
v2_Antipsychotics
v3_Antipsychotics
v4_Antipsychotics
v1_Mood_stabilizers
v2_Mood_stabilizers
v3_Mood_stabilizers
v4_Mood_stabilizers
v1_Tranquilizers
v2_Tranquilizers
v3_Tranquilizers
v4_Tranquilizers
v1_Other_psychiatric
v2_Other_psychiatric
v3_Other_psychiatric
v4_Other_psychiatric
v1_cur_psy_trm
v2_cur_psy_trm
v3_cur_psy_trm
v4_cur_psy_trm