The overall aim of the project is to evaluate the effects of psychiatric treatments on the restoration of the capacity to work, and, more broadly, to examine restoration of work function as an aspect of psychiatric recovery. To date, we have published a comprehensive literature review on work outcomes in psychiatry, compiled original databases with unanalyzed and unpublished work outcome data from 18 treatment studies, and published our analyses of the work outcome data from ten of the studies (involving over 800 patients) on treatments of depression. The proposed research continues our studies of recovery in depression, and expands on our earlier work with new analyses in the areas of anxiety disorders and schizophrenia. First, we propose to return to the depression databases to examine functional impairment and recovery in the homemaker role. Because of the Social Security Administration';s focus on disability in the work-for-pay sector, our analyses to date completely excluded depressed homemakers. These women, the only large group that was excluded from our prior study, represent approximately one-third of the females in the samples. Including an additional 25% or so of the women in the samples who were working homemakers, we have information about homemaker role functioning on approximately half of the depressed women in these studies. Impairment in the homemaker domain has been reported to be even more severe than at work, but controlled studies of its treatment and course are lacking. The current proposal also includes new studies. Following up on the suggestion in our literature review that maintenance neuroleptic treatment of schizophrenia might be associated with poorer vocational outcomes, we have compiled several data sets from major clinical trials involving randomized assignment of schizophrenic patients to more versus less neuroleptic, and now propose to analyze them to test this specific hypothesis. The unifying thematic link among these studies of different populations is that they bear on work outcome as an effect of symptomatically-oriented treatments, and more generally as an important component of psychiatric recovery.
