Cognitive Functioning and Work Outcome Among People with Schizophrenia Spectrum Disorder: The Contribution of the International Classification of Functioning
Objectives Cognitive impairment can be a barrier to employment of people with a schizophrenia spectrum disorder (SSD). However, other factors have also been identified as potentially hindering work integration and job tenure. But the links between all these factors remain unknown. The objective of this article is to propound an integrative model, using the International Classification of Functioning (ICF), of how cognitive impairment associated with SSD is related to other factors involved in difficulties in work integration and job tenure. Methods The description of the theoretical framework of the ICF enables to organize these factors in a comprehensive model. Then, a review of recent literature allows us to identify factors associated with employment of people with SSD, and to see the link between cognitive functioning and other factors. Results Most of reviewed studies find moderate correlations or no correlation between cognitive impairments and work integration or job tenure. Stronger correlations were nevertheless found between cognitive factors and work behavior or performance. Considering other factors, like personal or environmental factors, and the framework of the ICF, a comprehensive view of the vocational rehabilitation for people with SSD is developed. Interactions between some personal (e.g. self-efficacy or self esteem) and environmental (e.g. job coach or layout of workstation) factors may influence the translation of cognitive difficulties into work participation restrictions. Conclusion Vocational rehabilitation programs should further consider the complexity of interactions between cognitive, personal and environmental factors, and how they impact work functioning. As defined in ICF, activity limitations may represent an interesting mediator between cognitive variables and work functioning. Future research should be conducted to bring a better understanding of these patterns of interactions.