Associations of insight and treatment adherence with employment status of people with schizophrenia

Purpose
Analyze insight and adherence to medication in patients with chronic schizophrenia and undergoing psychiatric occupational rehabilitation as well as to assess the relations between these two factors and employment ability.

Methods
A group of 51 participants diagnosed with chronic schizophrenia according to DSM-V criteria were divided into those employed in social firm (SF, n = 22) and participants of occupational therapy workshops (OTW, n = 29). Insight was measured with item G12 of PANSS scale and with “My thoughts and feelings” subjective insight scale, adherence to medication with MARS scale, symptom severity with PANSS and BNSS scales, general functioning with GAF and SOFAS scales; cognitive functions with MoCA, RAVLT, RHLB scales and Tower of Hanoi task.

Results
The group of employed subjects had significantly higher level of insight, lower symptom severity and better general and social functioning. In the group of unemployed participants lower insight was related to lower functioning and much higher number of clinical symptoms and cognitive impairments. Level of adherence to medication was related to symptom severity and presence of cognitive impairments. No correlation between adherence and insight was observed. Patients’ subjective assessment of insight correlated with psychiatrists assessment.

Conclusions
Subjective assessment of insight measured by “My thoughts and feelings” self-assessment questionnaire correlates with its objective assessment by item G12 PANSS scale. Higher level of insight, lesser symptom severity and general and better social functioning are associated with employment, whereas adherence to medication is not.