Cognitive Functioning and Work in People With Severe Mental Illness Living in Urban and Rural Areas in India.

Abstract

Background and hypotheses: Evidence on the role of cognition in employment of people with severe mental illness (SMI) living in India and other developing countries is limited. This study examined the relationship between cognitive functioning and work in people with SMI living in urban and rural areas in India.

Study design: Cognition (evaluated with the Montreal Cognitive Assessment: MoCA) and vocational functioning were assessed in 340 persons with SMI (59% schizophrenia-schizoaffective) receiving private psychiatric outpatient treatment at two hospitals in western India.

Study results: Participants with higher levels of cognitive functioning were more likely to be employed than those with lower levels, including both those living in urban and rural areas. Among employed participants, better cognitive functioning was associated with working at more complex and skilled jobs that paid higher wages. There were no differences in cognitive functioning between participants working for a family-run business (eg, a farm) vs. an independent employer, suggesting that families operating such businesses did not provide more work accommodations for cognitive impairment to their relatives with SMI than independent employers.

Conclusions: Impaired cognitive functioning is an important predictor of unemployment in people with SMI in both rural and urban regions in India. Providing interventions for enhancing cognitive functioning may increase the ability of unemployed people with SMI in developing countries to work for both family-operated businesses and independent employers, thereby improving their economic standing and the welfare of their families.