Employment trajectories until midlife in schizophrenia and other psychoses: the Northern Finland Birth Cohort 1966

Soc Psychiatry Psychiatr Epidemiol. 2023 Jan;58(1):65-76. doi: 10.1007/s00127-022-02327-6. Epub 2022 Jul 7.


Purpose: Psychoses are associated with poor labour market attachment, but few studies have compared schizophrenia (SZ) and other psychoses (OP). Moreover, studies on long-term employment trajectories over individuals' working life courses are lacking. We compared 30 year employment trajectory patterns in a general population sample among individuals with SZ, OP, and those with no psychosis (NP).

Methods: Utilising the Northern Finland Birth Cohort 1966, we collected survey data on employment from ages 16 to 45 and detected individuals with register-based history of SZ (n = 62), OP (n = 87), or NP (n = 6464) until age 46. Through gender-specific latent class analyses on annual employment roles, we identified traditional, highly educated, self-employed, delayed and floundering employment trajectories with distinct socioeconomic characteristics. We addressed attrition by conducting weighted analyses.

Results: Floundering trajectories were common among individuals with SZ (79% of men, 73% of women) and OP (52% of men, 51% of women). In NP, a traditional employee trajectory was most common in men (31%), and a highly educated trajectory in women (28%). A history of psychosis was associated with heightened odds ratios (ORs; 95% confidence intervals (CIs)) for floundering trajectories in both men (SZ: 32.9 (13.3-81.4); OP: 7.4 (4.0-13.9)) and women (SZ: 9.9 (4.6-21.5); OP: 3.9 (2.1-7.1)) compared to NP. Weighted analyses produced similar results.

Conclusion: Most individuals with SZ or OP have floundering employee trajectories reflecting an elevated risk of unemployment and part-time work until midlife. These results indicate the importance of improving labour market attachment during the early phases of psychoses.

Keywords: Employment; Follow-up; Outcome; Psychosis; Schizophrenia; Trajectory.

MeSH terms

  • Adolescent
  • Adult
  • Birth Cohort
  • Cohort Studies
  • Employment
  • Female
  • Finland / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Psychotic Disorders* / epidemiology
  • Schizophrenia* / epidemiology
  • Young Adult