The effectiveness of supported employment programs : Meta-regression analysis of the global secular trend, 1990-2015

Richter, Dirk; Hoffmann, Holger (2019). The effectiveness of supported employment programs : Meta-regression analysis of the global secular trend, 1990-2015 PsyArXiv Preprints, pp. 1-33.

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Importance: Supported employment programs aim to re-integrate unemployed people with mental illness into the competitive labour market. While it is known that short-term economic developments like the 2008 recession may have negative consequences on the supported employment effectiveness rates, research into long-term secular trends has not yet been conducted. Objective: The primary objective of the regression analysis was to assess the effectiveness of supported employment programs for clients with any mental disorder over a longer time period. Further objectives were a comparison to prevocational training and the identification of moderating variables. Data sources: We retrieved publications on randomized controlled trials and on routine implementation programs that were included in four recent systematic reviews on supported employment for people with mental illness, plus very recent publications that were identified by a new search. This search was conducted in the following databases: Pubmed, PsycInfo, CINAHL (Cumulative Index on Nursing and Allied Health Literature), and Google Scholar. Study selection: We included any publication that was used in the four meta-analyses plus very recently published studies. The included studies were conducted between 1990 and 2015. Data extraction and synthesis: 80 studies with 14,437 participants were included in the analysis. Data was extracted by one author and cross-checked by the second author. We have conducted univariate and multivariate meta-regressions on the basis of a random-effects meta-analysis of proportions. The best-fitting model was computed by utilizing a statistical model selection procedure. Main Outcome and Measures: The outcome was the competitive employment rate over time. The year of study conduction (1990 to 2015) was regressed on the competitive employment rate. Regression coefficient estimates were computed and graphically displayed. Results: The competitive employment rate of supported employment programs was negatively associated with the study year (estimate -0.0068, CI -0.0114 - -0.0021) and the study period 2008 to 2015 had a larger decline in the competitive employment rate than the period 2000 to 2007. For prevocational training we found no change (estimate 0.0002, CI -0.0059 – 0.0063). Significant moderators were covariates study year/study period, augmented programs and study design (RCT vs. routine implementation). Conclusions and relevance: Results of this meta-regression suggest that supported employment programs have become less effective over time. Supported employment programs need to adapt to a changing labour market that is becoming more challenging to people with mental illness.

Item Type:

Journal Article (Original Article)


School of Health Professions


Richter, Dirk0000-0002-6215-6110 and
Hoffmann, Holger




Christoph Golz

Date Deposited:

24 Jan 2020 06:40

Last Modified:

10 Mar 2021 14:26

Additional Information:

Date: 2019




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