Article Text

Original research
Effectiveness of vocational interventions for gaining paid work for people living with mild to moderate mental health conditions: systematic review and meta-analysis
  1. Joanna K Fadyl1,
  2. David Anstiss1,
  3. Kirk Reed1,2,
  4. Mariya Khoronzhevych3,
  5. William M M Levack4
  1. 1Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand
  2. 2School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
  3. 3Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, Norway
  4. 4Department of Medicine, University of Otago, Wellington, New Zealand
  1. Correspondence to Joanna K Fadyl; joanna.fadyl{at}


Objectives To evaluate the effectiveness of vocational interventions to help people living with mild to moderate mental health conditions gain paid work.

Methods Systematic review of international, peer-reviewed literature. Development of the prepublished protocol and search strategy was done in consultation with stakeholder reference groups consisting of people with lived experience of long-term conditions, advocates and clinicians. We searched academic databases MEDLINE, EMBASE, PsychINFO, AMED, CINAHL, Proquest Dissertations and Theses database, and Business Source Complete for controlled trials comparing a specific vocational intervention against a control intervention or usual care, published between 1 January 2004 and 1 August 2019. Two authors independently screened search results, extracted data and appraised studies using the Cochrane risk of bias tool.

Results Eleven studies met inclusion criteria. Seven studies investigated Individual Placement and Support (IPS) modified for people who were not in intensive mental health treatment services. These studies occurred settings such as community vocational rehabilitation services, a housing programme and community mental health services. The studies provided very low quality evidence that people who receive IPS-style vocational rehabilitation are more likely to gain competitive employment than people who receive usual care (risk ratio 1.70, 95% CI 1.23 to 2.34, seven studies, 1611 participants). The remaining four studies considered cognitive behavioural therapy or specific vocational rehabilitation interventions designed to fit a unique context. There was insufficient evidence from these studies to draw conclusions regarding the effectiveness of non-IPS forms of vocational rehabilitation for people with mild to moderate mental health conditions.

Discussion The meta-analysis showed a clear intervention effect but low precision, and more high-quality studies are needed in this field. There is currently very low quality evidence that IPS-style intervention results in more participants in competitive employment compared with ‘usual care’ control groups in populations with mild to moderate mental health conditions.

  • occupational & industrial medicine
  • depression & mood disorders
  • anxiety disorders
  • rehabilitation medicine
  • social medicine

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  • Contributors JF had oversight of the review and was involved in protocol development, search, screening, risk of bias assessment, data extraction and synthesis and write up. DA was involved in protocol development, search, screening, risk of bias assessment, data extraction and synthesis. KR was involved in search, screening and risk of bias assessment. MK was involved in data extraction and synthesis. WL was involved in protocol development, data analysis, synthesis and write up. All authors approved the final manuscript for submission.

  • Funding This work was supported by New Zealand Ministry of Social Development and Health Research Council partnership grant number 18/804.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no data sets generated and/or analysed for this study.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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