Vol.:(0123456789) 1 3 Journal of Occupational Rehabilitation https://doi.org/10.1007/s10926-018-9794-6 Determinants of Employment Outcome for the People with Schizophrenia Using the WHODAS 2.0 Shu‑Jen Lu 1,2,3  · Tsan‑Hon Liou 4,5  · Chia‑Feng Yen 6  · Feng‑Hang Chang 7  · Yen‑Ling Chen 8  · Reuben Escorpizo 9,10  · David R. Strauser 11  · Ay‑Woan Pan 1,12 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Purpose Since the vocational outcomes of people with schizophrenia should be viewed in a holistic way, the second edition of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) might provide an evaluation regard- ing employment potential. To determine whether the WHODAS 2.0 scores can be used to predict employment status, we examined the probabilistic cut-of values of the scores and analyzed the relationship between work status and demographic characteristics. Methods We selected 31,793 people aged between 18 and 65 with schizophrenia or schizoafective disorder from the disability evaluation database in Taiwan and separated them into two groups based on employment status (employed and unemployed). We used logistic regression to explore the association between employment and demographic character- istics. Moreover, we conducted a receiver operating characteristic (ROC) analysis to determine the cut-of point to assist in determining employment potential based on the WHODAS 2.0 score. Results Among the 31,793 participants, 3367 were employed and 18,801 were unemployed. The unemployed participants accounted for a higher percentage of disability in each domain of the WHODAS. The ROC analysis revealed that the optimal cut-of point of the WHODAS score to distinguish the people who were employed and unemployed was 25.78 (area under curve = 0.80). Conclusions The present study indi- cated that work status can be determined by the total score across the six domains of the WHODAS score. Furthermore, the probability of employment may be determined initially by the cut-of point of the WHODAS score in order to economize evaluation time and prepare prevocational training for those with scores above 25.78. Keywords International classifcation of functioning · Disability and (ICF) · World Health Organization Disability Assessment Schedule (WHODAS 2.0) · Schizophrenia · Vocational rehabilitation · Employment Introduction Schizophrenia is characterized by defciencies in functional outcomes including employment. The decreased ability to perform basic activities involved in daily living among patients with schizophrenia makes meeting the demands of competitive employment exceedingly difcult [1, 2]. Recently, perspectives on recovery have shifted from the conventional medical model that is based on symptom reduc- tion and relapse prevention, to a more functional approach that emphasizes participation [3, 4]. Given that work repre- sents a social norm for most people, and is viewed as a key component of overall functioning, obtaining employment or returning to work is considered benefcial to the recovery of people with schizophrenia [5]. Previous studies in indi- viduals with schizophrenia have indicated that employment strengthens self-empowerment, the feeling of accomplish- ment, well-being, societal participation, and overall self- determination [6–8]. As a result, work not only provides fnancial remuneration but also enhances quality of life and overall participation in the community, socially activities, and overall quality of life [9]. Research regarding the employment of people with schiz- ophrenia has indicated that vocational outcomes can be pre- dicted by work history [10–13], cognitive function [13–16], social competence [9, 13, 17–19], and negative symptoms [16]. Although heterogeneous abnormalities exist, cogni- tive impairment has long been regarded as a symptom of schizophrenia [20, 21] that impacts one’s ability to meet the contextual demands of the work environment and overall * Ay-Woan Pan aywoan@ntu.edu.tw Extended author information available on the last page of the article