Barriers and facilitators of employment in severe mental illness: an umbrella review

TL;DR

This review explores factors that help or hinder employment for people with severe mental illness, identifying key facilitators and barriers.

Contribution

The study synthesizes existing literature to identify seven evidence-based factors influencing employment in severe mental illness.

Findings

Individual placement and support is the most researched facilitator, with employment rates up to 61%.

Negative symptoms are the most robustly identified barrier to employment.

The literature shows significant heterogeneity, limiting generalizability of results.

Abstract

Employment is one of the most important means of meeting an individual's psychological, social, and economic needs. Severe mental health illness (SMI) poses a significant challenge to managing psychological resources, which can further impede one's employability. The purpose of this research is to investigate the contextual factors associated with employment for individuals suffering from SMI, for the benefit of both their well-being, as well as the wider economic and social context they live in.

This umbrella review evaluates the available literature from PubMed and PsycINFO. It included systematic reviews, meta-analyses, and scoping reviews, for which a quality appraisal was conducted using the AMSTAR 2 Checklist and the Scoping Review Checklist.

Our search identified 40 reviews, from which we pulled seven evidence-based factors associated with employment, four facilitators, and three barriers. Receiving individual placement and support represents the facilitator that was most extensively researched, with reported employment rates up to 61%, while negative symptoms represent the most robustly identified barrier.

Overall, the synthesis of evidence highlights underlying factors that might shape employment for individuals with SMI and identifies interventions that hold potential for further development. It also underscores the necessity for conceptual consistency and reveals significant heterogeneity in the literature, which diminishes the generalizability of the results.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42023460410, PROSPERO CRD42023460410.

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