Evidence-based interventions for vocational recovery in first-episode psychosis: A meta-analysis of employment and education rates.

Abstract

Background: Young people with first-episode psychosis experience high rates of disruption in work and education and consistently describe vocational participation as a core priority of recovery. This meta-analysis aimed to evaluate the effectiveness of evidence-based interventions in improving employment and education rates after a first-episode psychosis.

Method: A PROSPERO-registered meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three endpoints were analysed: (a) employment, (b) education, and (c) combined vocational rates. Both meta-analyses of proportions and comparative meta-analyses (intervention vs control) were performed under random-effects models. Risk of bias (RoB2), Risk of Bias in Non-randomised Studies - of Exposure and certainty of evidence Grading of Recommendations, Assessment, Development and Evaluation were assessed.

Results: Thirty-one studies (n = 8651) were included. Vocational interventions - particularly Individual Placement and Support (odds ratio = 2.86, 95% CI 1.81-4.54) - were consistently associated with improved competitive employment compared with control conditions (odds ratio = 2.35, 95% CI 1.88-2.94). No intervention showed a consistent advantage for education rates (odds ratio = 1.19, 95% CI 0.80-1.76). The combined endpoint showed substantial heterogeneity (I² = 69.6%, τ² = 0.296, p < 0.001) and possible publication bias, limiting interpretability (odds ratio = 2.02, 95% CI 1.29-3.17).

Conclusions: Our findings support integrating structured, evidence-based vocational support - particularly Individual Placement and Support - as a routine component of services for early psychosis, specifically for patients with employment goals.