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Intervenciones para conseguir y mantener un empleo en pacientes adultos con enfermedades mentales graves: un metanálisis en red

Appendices

Appendix 1. MEDLINE search strategy for systematic reviews

#1 (Severe) mental disorders

"Mental Disorders"[Mesh] OR "mentally ill persons"[mesh] OR "mentally ill"[tw] OR "mental disorder"[tw] OR "mental disorders"[tw] OR "mental disease"[tw] OR "mental diseases"[tw] OR "mental illness"[tw] OR "mental illnesses"[tw] OR schizophreni*[tw] OR "Psychotic Disorders"[Mesh] OR psychosis[tw] OR psychotic[tw] OR "bipolar disorder"[tw] OR "bipolar disorders"[tw] OR "major depressive disorder"[tw] OR "major depressive disorders"[tw] OR "personality disorder"[tw] OR "personality disorders"[tw] OR "anxiety disorder"[tw] OR "anxiety disorders"[tw] OR "post‐traumatic stress disorder"[tw] OR "post‐traumatic stress disorders"[tw] OR PTSD[tw] OR autis*[tw]

#2 Return to work, work (dis)ability, sick leave and presenteeism, vocational rehabilitation

“Return to Work”[Mesh] OR “return to work”[tw] OR return‐to‐work[tw] OR “work participation”[tw] OR “work performance”[tw] OR “performance at work”[tw] OR work function*[tw] OR “employment status”[tw] OR “work status”[tw] OR “work ability”[tw] OR workability[tw] OR ”work capacity“[tw] OR ”work activity“[tw] OR ”work disability“[tw] OR ”work rehabilitation“[ tw] OR ”work status“[tw] OR ”work retention“[tw] OR employability[tw] OR employable[tw] OR employee*[tw] OR employment[MeSH Terms] OR employment OR unemployment[MeSH Terms] OR unemployment[tw] OR unemployed[tw] OR retirement[tw] OR (early[tw]) AND (retirement[Mesh]) OR “early retirement”[tw] OR “presenteeism”[tw] OR “Absenteeism”[Mesh] OR “absenteeism”[tw] OR “disability absence”[tw] OR “sickness absence”[tw] OR sick leave[MeSH Terms] OR sick leave[tw] OR “work absenteeism”[tw] OR “work absence”[tw] OR “work day loss”[tw] OR “work time loss”[tw] OR “work productivity”[tw] OR “occupational health”[tw] OR “occupational health”[Mesh] OR occupational health services[MeSH Terms] OR “Disability evaluation”[Mesh] OR “disability evaluation”[tw] OR ”disability management“[tw] OR “disability prevention”[tw] OR “work capacity evaluation”[Mesh]OR “work capacity evaluation”[tw] OR “work disability”[tiab] OR “work incapacity”[tiab] OR “work incapability”[tiab] OR “work inhibition”[tw] OR “working incapacity”[tw] OR (“disabled persons”[Mesh] AND work[MeSH Terms] OR occupations[MeSH Terms] OR occupation* OR vocational*) OR “sick leave“[Mesh] OR “medical leave”[tw] OR “sick leave”[tw] OR (“disability”[tw]) AND (“pension”[Mesh]) OR “disability pension”[tw] OR ”Rehabilitation, Vocational“[Mesh] OR “vocational rehabilitation”[tw] OR “cognitive training”[tw] OR “clubhouse model”[tw] OR ”Sheltered Workshops“[Mesh] OR “social skills training”[tw] OR ”Employment, Supported“[Mesh] OR “supported employment”[tw] OR “individual placement or support”[tw] OR “individual placement”[tw] OR “individual support”[tw]

#3 (Systematic) Reviews

"Review" [Publication Type] OR "systematic review"[tw] OR ”intervention review”[tw] OR “review” [tw] OR "Meta‐Analysis" [Publication Type] OR "Meta‐Analysis" [tw] OR "Meta Analysis" [tw] OR "Meta‐Analyses" [tw] OR "Meta Analyses"[tw]

#4

#1 AND #2 AND #3

#5

#4 animals [mh] NOT humans [mh]

#6

#4 NOT #5

Appendix 2. MEDLINE search strategy for RCTs

#1 (Severe) mental disorders

"Mental Disorders"[Mesh] OR "mentally ill persons"[mesh] OR "mentally ill"[tw] OR "mental disorder"[tw] OR "mental disorders"[tw] OR "mental disease"[tw] OR "mental diseases"[tw] OR "mental illness"[tw] OR "mental illnesses"[tw] OR schizophreni*[tw] OR "Psychotic Disorders"[Mesh] OR psychosis[tw] OR psychotic[tw] OR "bipolar disorder"[tw] OR "bipolar disorders"[tw] OR "major depressive disorder"[tw] OR "major depressive disorders"[tw] OR "personality disorder"[tw] OR "personality disorders"[tw] OR "anxiety disorder"[tw] OR "anxiety disorders"[tw] OR "post‐traumatic stress disorder"[tw] OR "post‐traumatic stress disorders"[tw] OR PTSD[tw] OR autis*[tw]

#2 Return to work, work (dis)ability, sick leave and presenteeism, vocational rehabilitation

“Return to Work”[Mesh] OR “return to work”[tw] OR return‐to‐work[tw] OR “work participation”[tw] OR “work performance”[tw] OR “performance at work”[tw] OR work function*[tw] OR “employment status”[tw] OR “work status”[tw] OR “work ability”[tw] OR workability[tw] OR ”work capacity“[tw] OR ”work activity“[tw] OR ”work disability“[tw] OR ”work rehabilitation“[ tw] OR ”work status“[tw] OR ”work retention“[tw] OR employability[tw] OR employable[tw] OR employee*[tw] OR employment[MeSH Terms] OR employment OR unemployment[MeSH Terms] OR unemployment[tw] OR unemployed[tw] OR retirement[tw] OR (early[tw]) AND (retirement[Mesh]) OR “early retirement”[tw] OR “presenteeism”[tw] OR “Absenteeism”[Mesh] OR “absenteeism”[tw] OR “disability absence”[tw] OR “sickness absence”[tw] OR sick leave[MeSH Terms] OR sick leave[tw] OR “work absenteeism”[tw] OR “work absence”[tw] OR “work day loss”[tw] OR “work time loss”[tw] OR “work productivity”[tw] OR “occupational health”[tw] OR “occupational health”[Mesh] OR occupational health services[MeSH Terms] OR “Disability evaluation”[Mesh] OR “disability evaluation”[tw] OR ”disability management“[tw] OR “disability prevention”[tw] OR “work capacity evaluation”[Mesh]OR “work capacity evaluation”[tw] OR “work disability”[tiab] OR “work incapacity”[tiab] OR “work incapability”[tiab] OR “work inhibition”[tw] OR “working incapacity”[tw] OR (“disabled persons”[Mesh] AND work[MeSH Terms] OR occupations[MeSH Terms] OR occupation* OR vocational*) OR “sick leave“[Mesh] OR “medical leave”[tw] OR “sick leave”[tw] OR (“disability”[tw]) AND (“pension”[Mesh]) OR “disability pension”[tw] OR ”Rehabilitation, Vocational“[Mesh] OR “vocational rehabilitation”[tw] OR “cognitive training”[tw] OR “clubhouse model”[tw] OR ”Sheltered Workshops“[Mesh] OR “social skills training”[tw] OR ”Employment, Supported“[Mesh] OR “supported employment”[tw] OR “individual placement or support”[tw] OR “individual placement”[tw] OR “individual support”[tw]

#3 RCTs

("randomized controlled trial"[pt] OR "controlled clinical trial"[pt] OR "Randomized Controlled Trials as Topic"[mh] OR "Controlled Clinical Trials as Topic"[mh] OR "Random Allocation"[mh] OR "Double‐Blind Method"[mh] OR "Single‐Blind Method"[mh] OR "clinical trial"[pt] OR "Clinical Trials as Topic"[mh] OR "clinical trial"[tw] OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR "latin square"[tw] OR Placebos[mh] OR placebo*[tw] OR random*[tw] OR Epidemiological Studies[mh] OR "Research Design"[mh:noexp] OR "Comparative Study"[mh] OR "evaluation studies"[pt] OR "Evaluation Studies As Topic"[mh] OR "Follow‐Up Studies"[mh] OR "Prospective Studies"[mh] OR "Cross‐Over Studies"[mh] OR control*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (Animals[mh] NOT Humans[mh])

#4

#1 AND #2 AND #3

#5

#4 animals [mh] NOT humans [mh]

#6

#4 NOT #5

Appendix 3. CENTRAL search strategy for systematic reviews and RCTs

#1 MeSH descriptor: [Mental Disorders] explode all trees

#2 "mental illness":ti,ab,kw (Word variations have been searched)

#3 "schizophrenia":ti,ab,kw (Word variations have been searched)

#4 MeSH descriptor: [Psychotic Disorders] explode all trees

#5 "psychosis":ti,ab,kw (Word variations have been searched)

#6 "psychotic disorder":ti,ab,kw (Word variations have been searched)

#7 "bipolar disorder":ti,ab,kw (Word variations have been searched)

#8 "major depressive disorder":ti,ab,kw (Word variations have searched)

#9 "personality disorder":ti,ab,kw (Word variations have been searched)

#10 "anxiety disorder":ti,ab,kw (Word variations have been searched)

#11 "post‐traumatic stress disorder":ti,ab,kw (Word variations have s)

#12 "PTSD":ti,ab,kw (Word variations have been searched)

#13 "autistic disorder":ti,ab,kw (Word variations have been searched)

#14 "autism":ti,ab,kw (Word variations have been searched)

#15 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11
or #12 or #13 or #14

#16 MeSH descriptor: [Return to Work] explode all trees

#17 "return to work":ti,ab,kw (Word variations have been searched)

#18 "work participation":ti,ab,kw (Word variations have been searched)

#19 "work performance":ti,ab,kw (Word variations have been searched)

#20 "performance at work":ti,ab,kw (Word variations have been searched)

#21 "work function":ti,ab,kw (Word variations have been searched)

#22 "employment status":ti,ab,kw (Word variations have been searched)

#23 "work status":ti,ab,kw (Word variations have been searched)

#24 #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23

#25 "work ability":ti,ab,kw (Word variations have been searched)

#26 "work capacity":ti,ab,kw (Word variations have been searched)

#27 "work activity":ti,ab,kw (Word variations have been searched)

#28 "work disability":ti,ab,kw (Word variations have been searched)

#29 "work rehabilitation":ti,ab,kw (Word variations have been searched)

#30 "work status":ti,ab,kw (Word variations have been searched)

#31 "work retention":ti,ab,kw (Word variations have been searched)

#32 "employability":ti,ab,kw (Word variations have been searched)

#33 "employable":ti,ab,kw (Word variations have been searched)

#34 employe*:ti,ab,kw (Word variations have been searched)

#35 MeSH descriptor: [Employment] explode all trees

#36 "employment":ti,ab,kw (Word variations have been searched)

#37 MeSH descriptor: [Unemployment] explode all trees

#38 "unemployment":ti,ab,kw (Word variations have been searched)

#39 "unemployed":ti,ab,kw (Word variations have been searched)

#40 "retirement":ti,ab,kw (Word variations have been searched)

#41 MeSH descriptor: [Retirement] explode all trees

#42 early and #41

#43 "early retirement":ti,ab,kw (Word variations have been searched)

#44 #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33 or #34
or #35 or #36 or #37 or #38 or #39 or #40 or #41 or #42 or #43

#45 "presenteeism":ti,ab,kw (Word variations have been searched)

#46 MeSH descriptor: [Absenteeism] explode all trees

#47 "absenteeism":ti,ab,kw (Word variations have been searched)

#48 "disability absence":ti,ab,kw (Word variations have been searched)

#49 "sickness absence":ti,ab,kw (Word variations have been searched)

#50 MeSH descriptor: [Sick Leave] explode all trees

#51 "sick leave":ti,ab,kw (Word variations have been searched)

#52 "work absenteeism":ti,ab,kw (Word variations have been searched)

#53 "work absence":ti,ab,kw (Word variations have been searched)

#54 "work day loss":ti,ab,kw (Word variations have been searched)

#55 "work time loss":ti,ab,kw (Word variations have been searched)

#56 "work productivity":ti,ab,kw (Word variations have been searched)

#57 MeSH descriptor: [Occupational Health] explode all trees

#58 "occupational health":ti,ab,kw (Word variations have been searched)

#59 MeSH descriptor: [Occupational Health Services] explode all trees

#60 #45 or #46 or #47 or #48 or #49 or #50 or #51 or #52 or #53 or #54
or #55 or #56 or #57 or #58 or #59

#61 MeSH descriptor: [Disability Evaluation] explode all trees

#62 "disability evaluation":ti,ab,kw (Word variations have been searched)

#63 "disability management":ti,ab,kw (Word variations have been searched)

#64 "disability prevention":ti,ab,kw (Word variations have been searched)

#65 MeSH descriptor: [Work Capacity Evaluation] explode all trees

#66 "work capacity evaluation":ti,ab,kw (Word variations have been s)

#67 "work disability":ti,ab,kw (Word variations have been searched)

#68 "work incapacity":ti,ab,kw (Word variations have been searched)

#69 "work incapability":ti,ab,kw (Word variations have been searched)

#70 "work inhibition":ti,ab,kw (Word variations have been searched)

#71 "working incapacity":ti,ab,kw (Word variations have been searched)

#72 MeSH descriptor: [Disabled Persons] explode all trees

#73 MeSH descriptor: [Work] explode all trees

#74 MeSH descriptor: [Occupations] explode all trees

#75 occupation*:ti,ab,kw (Word variations have been searched)

#76 vocational*:ti,ab,kw (Word variations have been searched)

#77 #72 and (#73 or #74 or #75 or #76)

#78 MeSH descriptor: [Sick Leave] explode all trees

#79 "sick leave":ti,ab,kw (Word variations have been searched)

#80 "medical leave":ti,ab,kw (Word variations have been searched)

#81 "disability":ti,ab,kw (Word variations have been searched)

#82 MeSH descriptor: [Pensions] explode all trees

#83 #81 and #82

#84 "disability pension":ti,ab,kw (Word variations have been searched)

#85 #61 or #62 or #63 or #64 or #65 or #66 or #67 or #68 or #69 or #70 or
#71 or #77 or #78 or #79 or #80 or #83 or #84

#86 MeSH descriptor: [Rehabilitation, Vocational] explode all trees

#87 "vocational rehabilitation":ti,ab,kw (Word variations have been s)

#88 "cognitive training":ti,ab,kw (Word variations have been searched)

#89 "clubhouse model":ti,ab,kw (Word variations have been searched)

#90 MeSH descriptor: [Sheltered Workshops] explode all trees

#91 "social skills training":ti,ab,kw (Word variations have been searched)

#92 MeSH descriptor: [Employment, Supported] explode all trees

#93 "supported employment":ti,ab,kw (Word variations have been s)

#94 "individual placement or support":ti,ab,kw (Word variations have)

#95 "individual placement":ti,ab,kw (Word variations have been searched)

#96 "individual support":ti,ab,kw (Word variations have been searched)

#97 #86 or #87 or #88 or #89 or #90 or #91 or #92 or #93 or #94 or #95 or #96

#98 #24 or #44 or #60 or #77 or #97

#99 #15 and #98

#100 #99 in Cochrane reviews

#101 #99 in other reviews

#102 #99 in trials

Appendix 4. Embase search strategy for systematic reviews

#1

'mental disease'/exp OR 'mental disease' OR 'mental illness'/de OR 'mental illness' OR 'schizoaffective disorder'/de OR 'schizoaffective disorder' OR 'schizophrenia'/exp OR 'schizophrenia' OR 'psychotic disorders'/exp OR 'psychotic disorders' OR 'psychosis'/exp OR psychosis OR 'psychotic disorder' OR 'bipolar disorder'/exp OR 'bipolar disorder' OR 'major depressive disorder'/exp OR 'major depressive disorder' OR 'major depression'/exp OR 'major depression' OR 'personality disorder'/exp OR 'personality disorder' OR 'anxiety disorder'/exp OR 'anxiety disorder' OR 'post‐traumatic stress disorder'/exp OR 'post‐traumatic stress disorder' OR 'ptsd'/exp OR 'ptsd' OR 'autistic disorder'/exp OR 'autistic disorder' OR 'autism'/exp OR 'autism'

#2

'return to work'/exp OR 'return to work' OR 'work participation' OR 'work performance' OR 'job performance' OR performance NEAR/5 work OR 'work function' OR 'employment status' OR 'work status'

#3

'work ability' OR 'work capacity' OR workability OR 'work activity' OR 'work disability'/exp OR 'work disability' OR work NEAR/5 rehabilitation OR 'work status' OR 'work retention' OR employability'/exp OR employability OR employable OR employee OR 'employment'/exp OR 'employment' OR 'unemployment'/exp OR 'unemployment' OR 'unemployed'/exp OR unemployed OR 'retirement'/exp OR 'retirement' OR (early AND ('retirement'/exp OR retirement)

#4

'presenteeism' OR 'absenteeism' OR 'disability absence'/exp OR 'disability absence' OR 'sickness absence' OR 'sick leave'/exp OR 'sick leave' OR 'medical leave'/exp OR 'medical leave' OR 'work absenteeism' OR 'work absence' OR 'work day loss' OR 'work time loss' OR 'work productivity' OR 'occupational health' OR 'occupational health'/exp OR 'occupational health service'/exp

#5

disability NEAR/5 evaluation OR 'disability management' OR 'disability prevention' OR 'work capacity'/exp OR 'work capacity evaluation' OR 'work capacity' NEAR/5 evaluation OR 'work disability':ab,ti OR 'work incapacity':ab,ti OR 'work incapability':ab,ti OR 'work inhibition' OR 'working incapacity' OR ('disabled person'/exp AND ('work'/exp OR 'occupation'/exp OR occupation* OR vocational* OR 'medical leave'/exp OR 'medical leave' OR 'sick leave' OR ('disability' AND 'pension'/exp) OR 'disability pension'

#6

'vocational rehabilitation'/exp OR 'vocational rehabilitation' OR 'cognitive training' OR 'clubhouse model' OR 'sheltered workshop'/exp OR 'social skills training' OR 'supported employment' OR 'individual placement support' OR 'individual placement' OR 'individual support'

#7

#2 OR #3 OR #4 OR #5 OR #6

#8 #1 AND #7

#9

'review'/exp OR 'systematic review': ti,ab OR 'meta analysis'/exp OR 'metaanalysis':ti,ab OR 'metaanalyses':ti,ab OR 'meta analysis':ti,ab OR 'meta analyses':ti,ab

#10

#9 OR #10

#11

#8 AND #11

#12

#11 AND [embase]/lim NOT [medline]/lim

Appendix 5. Embase search strategy for RCTs

#1

'mental disease'/exp OR 'mental disease' OR 'mental illness'/de OR 'mental illness' OR 'schizoaffective disorder'/de OR 'schizoaffective disorder' OR 'schizophrenia'/exp OR 'schizophrenia' OR 'psychotic disorders'/exp OR 'psychotic disorders' OR 'psychosis'/exp OR psychosis OR 'psychotic disorder' OR 'bipolar disorder'/exp OR 'bipolar disorder' OR 'major depressive disorder'/exp OR 'major depressive disorder' OR 'major depression'/exp OR 'major depression' OR 'personality disorder'/exp OR 'personality disorder' OR 'anxiety disorder'/exp OR 'anxiety disorder' OR 'post‐traumatic stress disorder'/exp OR 'post‐traumatic stress disorder' OR 'ptsd'/exp OR 'ptsd' OR 'autistic disorder'/exp OR 'autistic disorder' OR 'autism'/exp OR 'autism'

#2

'return to work'/exp OR 'return to work' OR 'work participation' OR 'work performance' OR 'job performance' OR performance NEAR/5 work OR 'work function' OR 'employment status' OR 'work status'

#3

'work ability' OR 'work capacity' OR workability OR 'work activity' OR 'work disability'/exp OR 'work disability' OR work NEAR/5 rehabilitation OR 'work status' OR 'work retention' OR employability'/exp OR employability OR employable OR employee OR 'employment'/exp OR 'employment' OR 'unemployment'/exp OR 'unemployment' OR 'unemployed'/exp OR unemployed OR 'retirement'/exp OR 'retirement' OR (early AND ('retirement'/exp OR retirement)

#4

'presenteeism' OR 'absenteeism' OR 'disability absence'/exp OR 'disability absence' OR 'sickness absence' OR 'sick leave'/exp OR 'sick leave' OR 'medical leave'/exp OR 'medical leave' OR 'work absenteeism' OR 'work absence' OR 'work day loss' OR 'work time loss' OR 'work productivity' OR 'occupational health' OR 'occupational health'/exp OR 'occupational health service'/exp

#5

disability NEAR/5 evaluation OR 'disability management' OR 'disability prevention' OR 'work capacity'/exp OR 'work capacity evaluation' OR 'work capacity' NEAR/5 evaluation OR 'work disability':ab,ti OR 'work incapacity':ab,ti OR 'work incapability':ab,ti OR 'work inhibition' OR 'working incapacity' OR ('disabled person'/exp AND ('work'/exp OR 'occupation'/exp OR occupation* OR vocational* OR 'medical leave'/exp OR 'medical leave' OR 'sick leave' OR ('disability' AND 'pension'/exp) OR 'disability pension'

#6

'vocational rehabilitation'/exp OR 'vocational rehabilitation' OR 'cognitive training' OR 'clubhouse model' OR 'sheltered workshop'/exp OR 'social skills training' OR 'supported employment' OR 'individual placement support' OR 'individual placement' OR 'individual support'

#7

#2 OR #3 OR #4 OR #5 OR #6

#8 #1 AND #7

#9

random* OR factorial* OR crossover* OR cross NEXT/1 over* OR placebo* OR doubl* NEAR/1 blind* OR singl* NEAR/2 blind* OR assign* OR allocat* OR volunteer*

#10

'crossover procedure'/exp OR 'double blind procedure'/exp OR 'single blind procedure'/exp OR 'randomized controlled trial'/exp OR 'randomized controlled trial (topic)'/exp

#11

#9 OR #10

#12

#8 AND #11

#13

#12 AND [embase]/lim NOT [medline]/lim

Appendix 6. CINAHL search strategy for systematic reviews

#1 Severe mental illness

(MH "Mental Disorders+") OR (TX mental* ill*) OR (MH "Mental Disorders, Chronic+") OR (MH "Schizophrenia+") OR (TX schizophrenia) OR (MH "Psychotic Disorders+") OR (TX psychosis) OR (TX psychotic disorder) OR (MH "Schizoaffective Disorder+") OR (MH "Affective Disorders, Psychotic+") OR (MH "Bipolar Disorder+") OR (TX bipolar disorder) OR( TX personality disorder) OR (MH “Depression+”) OR (TX major depressive disorder) OR (MH Anxiety Disorders+)”OR (TX anxiety disorder) OR (MH "Stress Disorders, Post‐Traumatic+") OR (TX post‐traumatic stress disorder) OR (MH “autistic disorder+”) OR (TX autistic disorder) OR (TX autism)

#2 RTW

(MH "Job Re‐Entry+") OR (TX return to work) OR (MH "Social Participation+") OR (MH “Job Performance+”) OR (MH “Employment+”) OR (TX employ*) OR (TX work ability) OR (TX workability) OR (TX work capacity) OR (TX work* disab*) OR (MH "Unemployment") OR (TX unemploy*) OR (MH "Presenteeism") OR (MH "Absenteeism") OR (MH "Sick Leave") OR (TX absenteeism) OR (TX sickness absence) OR (TX sick leave) OR (TX work productivity) OR (TX work* incapacity) OR (TX disability pension) OR (MH "Employee, Disabled+") OR (MH "Insurance Benefits") OR (MH "Insurance, Disability+") OR (MH "Insurance, Unemployment") OR (TX disability benefit) OR (MH "Occupational Health+") OR (MH "Occupational Health Services+") OR (MH "Occupational Medicine") OR (TX occupation*) OR (MH "Disability Management") OR (MH "Disability Evaluation+") OR (TX disability evaluation) OR (TX disability management) OR (MH "Rehabilitation, Psychosocial+") OR (MH "Rehabilitation, Vocational+") OR (MH "Rehabilitation, Community‐Based") OR (TX psychosocial rehabilitation) OR (TX vocation*) OR (TX vocational rehabilitation) OR (TX supported employment) OR (MH "Employment, Supported") OR (MH "Employment of Disabled+") OR (MH "Sheltered Workshops") OR (TX sheltered employment) OR (MH "Rehabilitation, Cognitive") OR (MH "Cognitive Therapy") OR (MH "Social Skills Training") OR (MH "Vocational Education") OR (TX cognitive training) OR (TX cognitive therapy) OR (TX cognitive rehabilitation) OR (TX social skills) OR (MH "Social Skills") OR (TX individual placement and support)

#3 Systematic review

(MH “Systematic Review”) OR (MH “Meta Analysis”) or (TI (meta‐analy* OR metaanaly*)) OR (AB (meta‐analy* OR metaanaly*)) OR (PT systematic review) OR (TI systematic review OR AB systematic review)

#1 AND 2 AND 3#

Appendix 7. CINAHL search strategy for RCTs

#1 Severe mental illness

(MH "Mental Disorders+") OR (TX mental* ill*) OR (MH "Mental Disorders, Chronic+") OR (MH "Schizophrenia+") OR (TX schizophrenia) OR (MH "Psychotic Disorders+") OR (TX psychosis) OR (TX psychotic disorder) OR (MH "Schizoaffective Disorder+") OR (MH "Affective Disorders, Psychotic+") OR (MH "Bipolar Disorder+") OR (TX bipolar disorder) OR( TX personality disorder) OR (MH “Depression+”) OR (TX major depressive disorder) OR (MH Anxiety Disorders+)”OR (TX anxiety disorder) OR (MH "Stress Disorders, Post‐Traumatic+") OR (TX post‐traumatic stress disorder) OR (MH “autistic disorder+”) OR (TX autistic disorder) OR (TX autism)

#2 RTW

(MH "Job Re‐Entry+") OR (TX return to work) OR (MH "Social Participation+") OR (MH “Job Performance+”) OR (MH “Employment+”) OR (TX employ*) OR (TX work ability) OR (TX workability) OR (TX work capacity) OR (TX work* disab*) OR (MH "Unemployment") OR (TX unemploy*) OR (MH "Presenteeism") OR (MH "Absenteeism") OR (MH "Sick Leave") OR (TX absenteeism) OR (TX sickness absence) OR (TX sick leave) OR (TX work productivity) OR (TX work* incapacity) OR (TX disability pension) OR (MH "Employee, Disabled+") OR (MH "Insurance Benefits") OR (MH "Insurance, Disability+") OR (MH "Insurance, Unemployment") OR (TX disability benefit) OR (MH "Occupational Health+") OR (MH "Occupational Health Services+") OR (MH "Occupational Medicine") OR (TX occupation*) OR (MH "Disability Management") OR (MH "Disability Evaluation+") OR (TX disability evaluation) OR (TX disability management) OR (MH "Rehabilitation, Psychosocial+") OR (MH "Rehabilitation, Vocational+") OR (MH "Rehabilitation, Community‐Based") OR (TX psychosocial rehabilitation) OR (TX vocation*) OR (TX vocational rehabilitation) OR (TX supported employment) OR (MH "Employment, Supported") OR (MH "Employment of Disabled+") OR (MH "Sheltered Workshops") OR (TX sheltered employment) OR (MH "Rehabilitation, Cognitive") OR (MH "Cognitive Therapy") OR (MH "Social Skills Training") OR (MH "Vocational Education") OR (TX cognitive training) OR (TX cognitive therapy) OR (TX cognitive rehabilitation) OR (TX social skills) OR (MH "Social Skills") OR (TX individual placement and support)

#3 RCT

(MH "Randomized Controlled Trials") OR (MH "Clinical Trials+") OR (PT clinical trial) OR (PT randomized controlled trial) OR (TX clinical trial) OR (TX randomi* control* trial*) OR (MH "Random Assignment") OR (TX random* allocat*) OR (TX allocate* random*) OR (TX placebo*) OR (MH “Placebos”) OR (MH “Quantitative Studies”)

#1 AND 2 AND 3#

Appendix 8. PsycINFO search strategy for systematic reviews

# 1 severe mental illness

(SU.EXACT("Mental Disorders") OR "mental disorder" OR "mental illness" OR schizophrenia OR psychosis OR "psychotic disorder" OR "bipolar disorder" OR "major depressive disorder" OR "personality disorder" OR "anxiety disorder" OR "post‐traumatic stress disorder" OR "PTSD" OR "autistic disorder" OR autism)

# 2 RTW

(SU.EXACT("Return to Work") OR "return to work" OR return‐to‐work OR "work participation" OR "work performance" OR "performance at work" OR work function* OR "employment status" OR "work status") OR ("work ability" OR workability OR "work capacity" OR "work activity" OR "work disability" OR "work rehabilitation" OR "work status" OR "work retention" OR employability OR employable OR employe* OR employment OR SU.EXACT("Employment status") OR SU.EXACT("Unemployment") OR unemployment OR unemployed OR retirement OR "early retirement" OR early NEAR/1 retirement) OR (presenteeism OR SU.EXACT("Absenteeism") OR absenteeism OR "disability absence" OR "sickness absence" OR "sick leave" OR SU.EXACT("Employee Leave Benefits") OR "work absenteeism" OR "work absence" OR "work day loss" OR "work time loss" OR "work productivity" OR "occupational health" OR SU.EXACT("Occupational Health")) OR (SU.EXACT("Vocational Rehabilitation") OR "vocational rehabilitation" OR "cognitive training" OR "clubhouse model" OR SU.EXACT("Sheltered Workshops") OR "social skills training" OR SU.EXACT("Supported Employment") OR "supported employment" OR "individual placement" OR "individual support") OR ((SU.EXACT("Disability evaluation") OR "disability evaluation" OR "disability management" OR "disability prevention" OR ("work capacity" NEAR/5 evaluation) OR "work capacity evaluation" OR "work disability" OR "work incapacity" OR "work incapability" OR "work inhibition" OR "working incapacity") OR ("disability pension" OR (disability AND pension) OR (disability AND SU.EXACT("Employee Pension Plans"))))))

#3 systematic reviews

(TI "Systematic Review" OR "Meta Analysis" OR "Meta‐Analyses" OR "Meta Analyses") OR (AB "Systematic Review" OR "Meta Analysis" OR "Meta‐Analyses" OR "Meta Analyses")

#1 AND #2 AND #3

Appendix 9. PsycINFO search strategy for RCTs

# 1 severe mental illness

(SU.EXACT("Mental Disorders") OR "mental disorder" OR "mental illness" OR schizophrenia OR psychosis OR "psychotic disorder" OR "bipolar disorder" OR "major depressive disorder" OR "personality disorder" OR "anxiety disorder" OR "post‐traumatic stress disorder" OR "PTSD" OR "autistic disorder" OR autism)

# 2 RTW

(SU.EXACT("Return to Work") OR "return to work" OR return‐to‐work OR "work participation" OR "work performance" OR "performance at work" OR work function* OR "employment status" OR "work status") OR ("work ability" OR workability OR "work capacity" OR "work activity" OR "work disability" OR "work rehabilitation" OR "work status" OR "work retention" OR employability OR employable OR employe* OR employment OR SU.EXACT("Employment status") OR SU.EXACT("Unemployment") OR unemployment OR unemployed OR retirement OR "early retirement" OR early NEAR/1 retirement) OR (presenteeism OR SU.EXACT("Absenteeism") OR absenteeism OR "disability absence" OR "sickness absence" OR "sick leave" OR SU.EXACT("Employee Leave Benefits") OR "work absenteeism" OR "work absence" OR "work day loss" OR "work time loss" OR "work productivity" OR "occupational health" OR SU.EXACT("Occupational Health")) OR (SU.EXACT("Vocational Rehabilitation") OR "vocational rehabilitation" OR "cognitive training" OR "clubhouse model" OR SU.EXACT("Sheltered Workshops") OR "social skills training" OR SU.EXACT("Supported Employment") OR "supported employment" OR "individual placement" OR "individual support") OR ((SU.EXACT("Disability evaluation") OR "disability evaluation" OR "disability management" OR "disability prevention" OR ("work capacity" NEAR/5 evaluation) OR "work capacity evaluation" OR "work disability" OR "work incapacity" OR "work incapability" OR "work inhibition" OR "working incapacity") OR ("disability pension" OR (disability AND pension) OR (disability AND SU.EXACT("Employee Pension Plans"))))))

#3 RCTs

(SU.EXACT("Clinical Trials") OR random* OR factorial* OR crossover* OR placebo* OR assign* OR allocat* OR volunteer* OR (cross over*) OR (double blind*) OR (singl* blind*)

#1 AND #2 AND #3

Appendix 10. Cochrane 'Risk of bias' assessment tool

Random sequence generation

Selection bias (biased allocation to interventions) due to inadequate generation of a randomised sequence

Criteria for a judgement of ‘low' risk of bias

The investigators describe a random component in the sequence generation process such as:

  • referring to a random number table;

  • using a computer random‐number generator;

  • coin tossing;

  • shuffling cards or envelopes;

  • throwing dice;

  • drawing of lots;

  • minimisation*.

*Minimisation may be implemented without a random element, and this is considered to be equivalent to being random.

Criteria for the judgement of ‘high' risk of bias

The investigators describe a non‐random component in the sequence generation process. Usually, the description would involve some systematic, non‐random approach, for example:

  • sequence generated by odd or even date of birth;

  • sequence generated by some rule based on date (or day) of admission;

  • sequence generated by some rule based on hospital or clinic record number.

Other non‐random approaches happen much less frequently than the systematic approaches mentioned above and tend to be obvious. They usually involve judgement or some method of non‐random categorisation of participants, for example:

  • allocation by judgement of the clinician;

  • allocation by preference of the participant;

  • allocation based on the results of a laboratory test or a series of tests;

  • allocation by availability of the intervention.

Criteria for the judgement of ‘unclear' risk of bias.

Insufficient information about the sequence generation process to permit judgement of ‘low' risk or ‘high' risk.

Allocation concealment

Selection bias (biased allocation to interventions) due to inadequate concealment of allocations prior to assignment

Criteria for a judgement of ‘low' risk of bias

Participants and investigators enrolling participants could not foresee assignment because one of the following, or an equivalent method, was used to conceal allocation:

  • central allocation (including telephone, web‐based and pharmacy‐controlled randomisation);

  • sequentially numbered drug containers of identical appearance;

  • sequentially numbered, opaque, sealed envelopes.

Criteria for the judgement of ‘high' risk of bias

Participants or investigators enrolling participants could possibly foresee assignments and thus introduce selection bias, such as allocation based on:

  • using an open random allocation schedule (e.g. a list of random numbers);

  • assignment envelopes were used without appropriate safeguards (e.g. if envelopes were unsealed or non­opaque or not sequentially numbered);

  • alternation or rotation;

  • date of birth;

  • case record number;

  • any other explicitly unconcealed procedure.

Criteria for the judgement of ‘unclear' risk of bias

Insufficient information to permit judgement of ‘low' risk or ‘high' risk. This is usually the case if the method of concealment is not described or not described in sufficient detail to allow a definite judgement – for example if the use of assignment envelopes is described, but it remains unclear whether envelopes were sequentially numbered, opaque and sealed.

Blinding of participants and personnel

Performance bias due to knowledge of the allocated interventions by participants and personnel during the study

Criteria for a judgement of ‘low' risk of bias

Any one of the following:

  • no blinding or incomplete blinding, but the review authors judge that the outcome is not likely to be influenced by lack of blinding;

  • blinding of participants and key study personnel ensured, and unlikely that the blinding could have been broken.

Criteria for the judgement of ‘high' risk of bias

Any one of the following:

  • no blinding or incomplete blinding, and the outcome is likely to be influenced by lack of blinding;

  • blinding of key study participants and personnel attempted, but likely that the blinding could have been broken, and the outcome is likely to be influenced by lack of blinding.

Criteria for the judgement of ‘unclear' risk of bias

Any one of the following:

  • insufficient information to permit judgement of ‘low' risk or ‘high' risk;

  • the study did not address this outcome.

Blinding of outcome assessment

Detection bias due to knowledge of the allocated interventions by outcome assessors

Criteria for a judgement of ‘low' risk of bias

Any one of the following:

  • no blinding of outcome assessment, but the review authors judge that the outcome measurement is not likely to be influenced by lack of blinding;

  • blinding of outcome assessment ensured, and unlikely that the blinding could have been broken.

Criteria for the judgement of ‘high' risk of bias

Any one of the following:

  • no blinding of outcome assessment, and the outcome measurement is likely to be influenced by lack of blinding;

  • blinding of outcome assessment, but likely that the blinding could have been broken, and the outcome measurement is likely to be influenced by lack of blinding.

Criteria for the judgement of ‘unclear' risk of bias

Any one of the following:

  • insufficient information to permit judgement of ‘low' risk or ‘high' risk;

  • the study did not address this outcome.

Incomplete outcome data

Attrition bias due to amount, nature or handling of incomplete outcome data

Criteria for a judgement of ‘low' risk of bias

Any one of the following:

  • no missing outcome data;

  • reasons for missing outcome data unlikely to be related to true outcome (for survival data, censoring unlikely to be introducing bias);

  • missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups;

  • for dichotomous outcome data, the proportion of missing outcomes compared with observed event risk not enough to have a clinically relevant impact on the intervention effect estimate;

  • for continuous outcome data, plausible effect size (difference in means or standardised difference in means) among missing outcomes not enough to have a clinically relevant impact on observed effect size;

  • missing data have been imputed using appropriate methods.

Criteria for the judgement of ‘high' risk of bias

Any one of the following:

  • reason for missing outcome data likely to be related to true outcome, with either imbalance in numbers or reasons for missing data across intervention groups;

  • for dichotomous outcome data, the proportion of missing outcomes compared with observed event risk enough to induce clinically relevant bias in intervention effect estimate;

  • for continuous outcome data, plausible effect size (difference in means or standardised difference in means) among missing outcomes enough to induce clinically relevant bias in observed effect size;

  • ‘as‐treated’ analysis done with substantial departure of the intervention received from that assigned at randomisation;

  • potentially inappropriate application of simple imputation.

Criteria for the judgement of ‘unclear' risk of bias

Any one of the following:

  • insufficient reporting of attrition/exclusions to permit judgement of ‘low' risk or ‘high' risk (e.g. number randomised not stated, no reasons for missing data provided);

  • the study did not address this outcome.

Selective reporting

Reporting bias due to selective outcome reporting

Criteria for a judgement of ‘low' risk of bias

Any of the following:

  • the study protocol is available and all of the study’s pre‐specified (primary and secondary) outcomes that are of interest in the review have been reported in the pre‐specified way;

  • the study protocol is not available but it is clear that the published reports include all expected outcomes, including those that were pre‐specified (convincing text of this nature may be uncommon).

Criteria for the judgement of ‘high' risk of bias

Any one of the following:

  • not all of the study’s pre‐specified primary outcomes have been reported;

  • one or more primary outcomes was reported using measurements, analysis methods or subsets of the data (e.g. sub scales) that were not pre‐specified;

  • one or more reported primary outcomes were not pre‐specified (unless clear justification for their reporting was provided, such as an unexpected adverse effect);

  • one or more outcomes of interest in the review were reported incompletely so that they could not be entered in a meta‐analysis;

  • the study report fails to include results for a key outcome that would be expected to have been reported for such a study.

Criteria for the judgement of ‘unclear' risk of bias

Insufficient information to permit judgement of ‘low' risk or ‘high' risk. It is likely that the majority of studies will fall into this category.

Other bias

Bias due to problems not covered elsewhere in the table

Criteria for a judgement of ‘low' risk of bias

The study appears to be free of other sources of bias.

Criteria for the judgement of ‘high' risk of bias

There is at least one important risk of bias. For example, the study:

  • had a potential source of bias related to the specific study design used; or

  • has been claimed to have been fraudulent; or

  • had some other problem.

Criteria for the judgement of ‘unclear' risk of bias

There may be a risk of bias, but there is either:

  • insufficient information to assess whether an important risk of bias exists; or

  • insufficient rationale or evidence that an identified problem will introduce bias.

PRISMA Study flow diagram
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Figure 1

PRISMA Study flow diagram

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Network plot of direct comparisons of intervention main groups (long‐term follow‐up). Psych care: psychiatric care only; PVT: prevocational training; SE: supported employment; SE+: augmented supported employment; TE: transitional employment
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Figure 2

Network plot of direct comparisons of intervention main groups (long‐term follow‐up). Psych care: psychiatric care only; PVT: prevocational training; SE: supported employment; SE+: augmented supported employment; TE: transitional employment

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Network plot of direct comparisons of intervention subgroups (long‐term follow‐up). CH: Clubhouse; CT: cognitive training; hf IPS: high‐fidelity Individual Placement and Support; job : job‐related skills training; lf IPS: low‐fidelity Individual Placement and Support; Psych care: psychiatric care only; SE + ACT: supported employment + assertive community treatment; SE + job: supported employment + job‐related skills training; SE + symp: supported employment + symptom‐related skills training; SE + TE: supported employment + transitional employment; SST: social skills training; SWS: sheltered workshops
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Figure 3

Network plot of direct comparisons of intervention subgroups (long‐term follow‐up). CH: Clubhouse; CT: cognitive training; hf IPS: high‐fidelity Individual Placement and Support; job : job‐related skills training; lf IPS: low‐fidelity Individual Placement and Support; Psych care: psychiatric care only; SE + ACT: supported employment + assertive community treatment; SE + job: supported employment + job‐related skills training; SE + symp: supported employment + symptom‐related skills training; SE + TE: supported employment + transitional employment; SST: social skills training; SWS: sheltered workshops

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 4

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 5

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Network meta‐analysis estimates of intervention benefit.CI: confidence interval; Psych care: psychiatric care only; PVT: prevocational employment; RR: risk ratio; SE: supported employment; SE+: augmented supported employment; TE: transitional employment;
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Figure 6

Network meta‐analysis estimates of intervention benefit.

CI: confidence interval; Psych care: psychiatric care only; PVT: prevocational employment; RR: risk ratio; SE: supported employment; SE+: augmented supported employment; TE: transitional employment;

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Plots of the surface under the cumulative ranking curves (SUCRAs) for the interventions included in the network (long‐term follow‐up).PVT: prevocational training; Psych care: psychiatric care only; SE: supported employment; SE+: augmented supported employment; TE: transitional employment
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Figure 7

Plots of the surface under the cumulative ranking curves (SUCRAs) for the interventions included in the network (long‐term follow‐up).

PVT: prevocational training; Psych care: psychiatric care only; SE: supported employment; SE+: augmented supported employment; TE: transitional employment

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Effectiveness of intervention subgroups in obtaining competitive employment (long‐term follow‐up).CH: Clubhouse; CI: confidence interval; CT: cognitive training; hf IPS: high‐fidelity Individual Placement and Support; job training: job‐related skills training; lf IPS: low‐fidelity Individual Placement and Support;Psych care only: psychiatric care only; RR: risk ratio; SE + ACT: supported employment + assertive community treatment; SE + job: supported employment + job‐related skills training; SE + symp: supported employment + symptom‐related skills training; SE + TE: supported employment + transitional employment; SST: social skills training; SWS: sheltered workshops
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Figure 8

Effectiveness of intervention subgroups in obtaining competitive employment (long‐term follow‐up).

CH: Clubhouse; CI: confidence interval; CT: cognitive training; hf IPS: high‐fidelity Individual Placement and Support; job training: job‐related skills training; lf IPS: low‐fidelity Individual Placement and Support;Psych care only: psychiatric care only; RR: risk ratio; SE + ACT: supported employment + assertive community treatment; SE + job: supported employment + job‐related skills training; SE + symp: supported employment + symptom‐related skills training; SE + TE: supported employment + transitional employment; SST: social skills training; SWS: sheltered workshops

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Plots of the surface under the cumulative ranking curves (SUCRAs) for the interventions subgroups included in the network (long‐term follow‐up)CH: Clubhouse; CT: cognitive training; hf IPS: high‐fidelity Individual Placement and Support; job: job‐related skills training; lf IPS: low‐fidelity Individual Placement and Support;Psych care: psychiatric care only; SE + ACT: supported employment + assertive community treatment; SE + job: supported employment + job‐related skills training; SE + symp: supported employment + symptom‐related skills training; SE + TE: supported employment + transitional employment; SST: social skills training; SWS: sheltered workshops
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Figure 9

Plots of the surface under the cumulative ranking curves (SUCRAs) for the interventions subgroups included in the network (long‐term follow‐up)

CH: Clubhouse; CT: cognitive training; hf IPS: high‐fidelity Individual Placement and Support; job: job‐related skills training; lf IPS: low‐fidelity Individual Placement and Support;Psych care: psychiatric care only; SE + ACT: supported employment + assertive community treatment; SE + job: supported employment + job‐related skills training; SE + symp: supported employment + symptom‐related skills training; SE + TE: supported employment + transitional employment; SST: social skills training; SWS: sheltered workshops

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Inconsistency plots for long‐term follow‐up and loop‐specific heterogeneity estimates.PVT: prevocational training; Psych care: psychiatric care only; ROR: risk odds ratio; SE: supported employment; SE+: augmented supported employment; TE: transitional employment
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Figure 10

Inconsistency plots for long‐term follow‐up and loop‐specific heterogeneity estimates.

PVT: prevocational training; Psych care: psychiatric care only; ROR: risk odds ratio; SE: supported employment; SE+: augmented supported employment; TE: transitional employment

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Loop‐specific inconsistency in intervention subgroup network (long‐term follow‐up). hf IPS: high‐fidelity Individual Placement and Support; job: job‐related skills training; lf IPS: low‐fidelity Individual Placement and Support;Psych care: psychiatric care only; SE: supported employment;TE: transitional employment; SWS: sheltered workshops
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Figure 11

Loop‐specific inconsistency in intervention subgroup network (long‐term follow‐up). hf IPS: high‐fidelity Individual Placement and Support; job: job‐related skills training; lf IPS: low‐fidelity Individual Placement and Support;Psych care: psychiatric care only; SE: supported employment;TE: transitional employment; SWS: sheltered workshops

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Study limitations distribution for each network estimate for pairwise comparisons. Calculations are based on the contributions of direct evidence to the network estimates. The colours represent the risk of bias. PVT: prevocational training; Psych care: psychiatric care only; SE: supported employment; SE+: augmented supported employment; TE: transitional employment
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Figure 12

Study limitations distribution for each network estimate for pairwise comparisons. Calculations are based on the contributions of direct evidence to the network estimates. The colours represent the risk of bias. PVT: prevocational training; Psych care: psychiatric care only; SE: supported employment; SE+: augmented supported employment; TE: transitional employment

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Contribution matrix: Percentage contribution of each direct estimate to the NMA estimates. PVT: prevocational training; Psych care: psychiatric care only; SE: supported employment; SE+: augmented supported employment; TE: transitional employment
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Figure 13

Contribution matrix: Percentage contribution of each direct estimate to the NMA estimates. PVT: prevocational training; Psych care: psychiatric care only; SE: supported employment; SE+: augmented supported employment; TE: transitional employment

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Comparison‐adjusted funnel plot for the network of intervention for obtaining competitive employment for people with severe mental illness (long‐term follow‐up). The black line represents the null hypothesis that the study‐specific effect sizes do not differ from the respective comparison‐specific pooled effect estimates. The blue line is the regression line. The interventions are ordered based on their focus on competitive job search. Missing small studies on the right side of the zero line (means ratio of RR > 1) suggests that small studies tend to exaggerate the effectiveness of interventions with more focus on competitive job search. PVT: prevocational training; Psych care: psychiatric care only; RR: risk ratio; SE: supported employment; SE+: augmented supported employment; TE: transitional employment
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Figure 14

Comparison‐adjusted funnel plot for the network of intervention for obtaining competitive employment for people with severe mental illness (long‐term follow‐up). The black line represents the null hypothesis that the study‐specific effect sizes do not differ from the respective comparison‐specific pooled effect estimates. The blue line is the regression line. The interventions are ordered based on their focus on competitive job search. Missing small studies on the right side of the zero line (means ratio of RR > 1) suggests that small studies tend to exaggerate the effectiveness of interventions with more focus on competitive job search. PVT: prevocational training; Psych care: psychiatric care only; RR: risk ratio; SE: supported employment; SE+: augmented supported employment; TE: transitional employment

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Comparison 1 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Obtaining competitive employment, short‐term follow‐up (≤ 1 year).
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Analysis 1.1

Comparison 1 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Obtaining competitive employment, short‐term follow‐up (≤ 1 year).

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Comparison 1 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Obtaining competitive employment, long‐term follow‐up (> 1 year).
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Analysis 1.2

Comparison 1 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Obtaining competitive employment, long‐term follow‐up (> 1 year).

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Comparison 2 Any intervention to improve maintaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Weeks in competitive employment, short‐term follow‐up (≤ 1 year).
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Analysis 2.1

Comparison 2 Any intervention to improve maintaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Weeks in competitive employment, short‐term follow‐up (≤ 1 year).

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Comparison 2 Any intervention to improve maintaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Weeks in competitive employment, long‐term follow‐up (> 1 year).
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Analysis 2.2

Comparison 2 Any intervention to improve maintaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Weeks in competitive employment, long‐term follow‐up (> 1 year).

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Comparison 3 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Days to first competitive employment, short‐term follow‐up (≤ 1 year).
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Analysis 3.1

Comparison 3 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Days to first competitive employment, short‐term follow‐up (≤ 1 year).

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Comparison 3 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Days to first competitive employment, long‐term follow‐up (> 1 year).
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Analysis 3.2

Comparison 3 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Days to first competitive employment, long‐term follow‐up (> 1 year).

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Comparison 4 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Obtaining non‐competitive employment, short‐term follow‐up (≤ 1 year).
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Analysis 4.1

Comparison 4 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Obtaining non‐competitive employment, short‐term follow‐up (≤ 1 year).

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Comparison 4 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Obtaining non‐competitive employment, long‐term follow‐up (> 1 year).
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Analysis 4.2

Comparison 4 Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Obtaining non‐competitive employment, long‐term follow‐up (> 1 year).

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Comparison 5 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Quality of life, long‐term follow up (> 1 year).
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Analysis 5.1

Comparison 5 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Quality of life, long‐term follow up (> 1 year).

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Comparison 6 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Mental health long‐term follow‐up (> 1 year).
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Analysis 6.1

Comparison 6 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Mental health long‐term follow‐up (> 1 year).

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Comparison 7 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Dropouts, short‐term follow‐up (≤ 1 year).
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Analysis 7.1

Comparison 7 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Dropouts, short‐term follow‐up (≤ 1 year).

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Comparison 7 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Dropouts, long‐term follow‐up (> 1 year).
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Analysis 7.2

Comparison 7 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Dropouts, long‐term follow‐up (> 1 year).

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Comparison 8 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Hospital admissions, short‐term follow‐up (≤ 1 year).
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Analysis 8.1

Comparison 8 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 1 Hospital admissions, short‐term follow‐up (≤ 1 year).

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Comparison 8 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Hospital admissions, long‐term follow‐up (> 1 year).
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Analysis 8.2

Comparison 8 Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness, Outcome 2 Hospital admissions, long‐term follow‐up (> 1 year).

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Summary of findings for the main comparison. Summary of findings of network meta‐analysis

Patient or population: adults with severe mental illness

Settings: (community) psychiatric care/mental health services

Interventions/comparisons: interventions for obtaining competitive employment: augmented supported employment, supported employment. pre‐vocational training, transitional employment, psychiatric care only

Comparison

Illustrative comparative risksa (95% CI)

Relative effect
(95% CI)

SUCRA

No of participants
(studies with direct evidence) b

Quality of the evidence
(GRADE)c

Assumed likelihood with control intervention

Corresponding likelihood with intervention

Outcome: Number of participants who obtained competitive employment (follow up > 1 year)

Augmented supported employment vs. psychiatric care only

187 per 1000

(18.7%)

712 per 1000

(372 to 1366)

RR 3.81 (1.99 to 7.31)

98.5%

256

(1 study)

⊕⊕⊕⊝
moderate1

Supported employment vs. psychiatric care only

187 per 1000

(18.7%)

509 per 1000

(290 to 890)

RR 2.72

(1.55 to 4.76)

76.5%

2238

(1 study)

⊕⊕⊝⊝
low2

Pre‐vocational training vs. psychiatric care only

187 per 1000

(18.7%)

236 per 1000

(136 to 410)

RR 1.26

(0.73 to 2.19)

40.3%

161

(2 studies)

⊕⊝⊝⊝
very low3

Transitional employment vs. psychiatric care only

187 per 1000

(18.7%)

187 per 1000

(95 to 367)

RR 1.00

(0.51 to 1.96)

17.2%

0

⊕⊕⊝⊝
low 4

Augmented supported employment vs. transitional employment

223 per 1000

(22.3%)

845 per 1000

(522 to 1369)

RR 3.79

(2.34 to 6.14)

212

(2 studies)

⊕⊕⊝⊝
low5

Supported employment vs. transitional employment

223 per 1000

(22.3%)

604 per 1000

(401 to905)

RR 2.71

(1.80 to 4.06)

87

(4 studies)

⊕⊕⊕⊝
moderate6

Pre‐vocational training vs. transitional employment

223 per 1000

(22.3%)

281 per 1000

172 to 457)

RR 1.26

(0.77 to 2.05)

0

⊕⊕⊝⊝
low7

Augmented supported employment vs. pre‐vocational training

263 per 1000

(26.3%)

794 per 1000

(494 to 1280)

RR 3.02

(1.88 to 4.87)

193

(2 studies)

⊕⊕⊝⊝
low8

Supported employment vs prevocational training

263 per 1000

(26.3%)

568 per 1000

(419 to 771)

RR 2.16

(1.59 to 2.93)

1569

(9 studies)

⊕⊝⊝⊝
very low9

Augmented supported employment vs supported employment only

457 per 1000

(45.7%)

640 per 1000

420 to 978)

RR 1.40

(0.92 to 2.14)

205

(3 studies)

⊕⊕⊝⊝
low10

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

a The corresponding likelihood of obtaining employment with intervention (and its 95% CI) is based on the assumed likelihood with the control intervention (= median likelihood across studies) and the relative effect of the intervention (and its 95% CI).
b Number of participants in direct comparison only.

c We did not downgrade because of reporting bias as insufficient studies contributed to network treatment estimates to allow us to draw meaningful conclusions.

1 We downgraded one level due to study limitations (majority moderate risk of bias studies).

2 We downgraded one level due to study limitations (majority moderate risk of bias studies) and one level due to inconsistency (predictive interval for intervention effect includes effect that would have different interpretation and loop inconsistency).

3 We downgraded one level due to study limitations (majority moderate risk of bias studies), one level because of inconsistency (predictive interval for intervention effect includes effect that would have different interpretations) and one level for imprecision (CIs include values favouring either intervention).

4 We downgraded one level due to study limitations (majority moderate risk of bias studies) and one level because of imprecision (CIs include values favouring either intervention).

5 We downgraded two levels due to study limitations (majority high risk of bias studies).

6 We downgraded one level due to study limitations (majority moderate risk of bias studies).

7 We downgraded one level due to study limitations (majority moderate risk of bias studies) and one level because of imprecision (confidence intervals include values favouring either intervention).

8 We downgraded one level due to study limitations (majority moderate risk of bias studies) and one level because ofinconsistency (moderate level of heterogeneity).

9 We downgraded one level due to study limitations (majority moderate risk of bias studies), one level due to inconsistency (predictive interval for intervention effect includes effect that would have different interpretation and loop inconsistency) and one level because of detected publication bias (small study effects).

10 We downgraded one level due to study limitations (majority moderate risk of bias studies) and one level because of imprecision (confidence intervals include values favouring either intervention).

CI: confidence interval
RR: risk ratio

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Summary of findings for the main comparison. Summary of findings of network meta‐analysis
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Table 1. Descriptive details of included studies

Study

Country

Follow‐upa

N

Mean age

Male

participants

Diagnosis (majority)

Working history (majority)

Au 2015

China

short

90

36

63%

Psychotic disorder

yes

Beard 1963

USA

short

212

N/A

60%

Psychotic disorder

N/A

Becker 1967

USA

short

50

46

N/A

Psychotic disorder

yes

Bejerholm 2015

Sweden

long

120

38

56%

Psychotic disorder

yes

Blankertz 1996

USA

short

122

36

64%

Psychotic disorder

yes

Bond 1986

USA

long

131

25

69%

Psychotic disorder

yes

Bond 1995

USA

short

86

35

51%

Psychotic disorder

yes

Bond 2007

USA

long

200

39

64%

Psychotic disorder

no

Bond 2015b

USA

short

90

44

79%

Psychotic disorder

yes

Burns 2007

Europe (UK, Italy,

Germany, Netherlands, Bulgaria, Switzerland)

long

312

38

60%

Psychotic disorder

yes

Burns 2015

UK

long

123

38

59%

Psychotic disorder

yes

Chandler 1996

USA

long

256

N/A

43%

Psychotic disorder

N/A

Craig 2014

UK

short

159

24

73%

Psychotic disorder

yes

Dincin 1982

USA

short

132

25

53%

Psychotic disorder

N/A

Drake 1996

USA

long

143

37

48%

Psychotic disorder

N/A

Drake 1999b

USA

long

152

39

39%

Psychotic disorder

N/A

Drake 2013

USA

long

2238

44

47%

Affective disorder

N/A

Drebing 2005

USA

short

21

46

95%

Affective disorder + substance dependence

yes

Drebing 2007

USA

short

100

46

99%

Affective disorder + substance dependence

yes

Eack 2009

USA

long

58

26

69%

Psychotic disorder

N/A

Gervey 1994

USA

short

34

19

67%

N/A

no

Gold 2006

USA

long

143

N/A

38%

Psychotic disorder

yes

Hoffmann 2012

Switzerland

long

100

34

65%

Affective disorder

yes

Howard 2010

UK

long

219

38

67%

Psychotic disorder

yes

Killackey 2008

Australia

short

41

21

81%

Psychotic disorder

yes

Killackey 2014

Australia

short

146

20

67%

Psychotic disorder

yes

Latimer 2006

Canada

short

150

40

62%

Psychotic disorder

yes

Lecomte 2014

Canada

short

24

32

71%

Psychotic disorder

N/A

Lehman 2002

USA

long

219

42

57%

Psychotic disorder

yes

McFarlane 1996

USA

long

68

30

65%

Psychotic disorder

N/A

McFarlane 2000

USA

long

69

33

70%

Psychotic disorder

N/A

McGurk 2007

USA

long

48

38

55%

Psychotic disorder

yes

McGurk 2009

USA

long

34

44

59%

Psychotic disorder

yes

Michon 2014

Netherlands

long

151

35

74%

Psychotic disorder

yes

Mueser 2004

USA

long

135

41

61%

Psychotic disorder

yes

Nuechterlein 2012

USA

long

69

25

67%

Psychotic disorder

N/A

O'Brien 2003

UK

short

1037

N/A

55%

Psychotic disorder

yes

Oshima 2014

Japan

short

37

41

49%

N/A

yes

Penk 2010

USA

short

89

45

100%

Affective disorder +substance abuse/dependence

yes

Schonebaum 2006

USA

long

177

38

55%

Psychotic disorder

yes

Tsang 2001

China

short

97

36

62%

Psychotic disorder

yes

Tsang 2010

China

long

189

35

49%

Psychotic disorder

yes

Twamley 2012a

USA

short

58

51

64%

Psychotic disorder

yes

Viering 2015

Switzerland

long

183

43

47%

Affective disorder

yes

Waghorn 2014

Australia

short

208

32

69%

Psychotic disorder

N/A

Walker 1969

USA

short

28

N/A

96%

Psychotic disorder

N/A

Wong 2008

China

long

92

34

60%

Psychotic disorder

N/A

Xiang 2007

China

long

103

38.6

47%

Psychotic disorder

N/A

aFollow‐up: short ≤ 1 year; long > 1 year.

bSecondary outcomes:

1 = maintaining employment
2 = obtaining non‐competitive employment
3 = days to first competitive employment
4 = mental health
5 = quality of life
6 = dropouts
7 = hospital admissions.

Figures and Tables -
Table 1. Descriptive details of included studies
Navigate to table in Review
Table 2. Comparisons and outcomes in included studies

Study

Comparison intervention

main group

Comparison intervention subgroups

Secondary outcomesb

Included in meta‐analysis

Included in network met‐analysis

Au 2015

SE+ vs SE+

SE+ symp vs

SE+ symp

1, 4, 5, 6

no

no

Beard 1963

TE vs psych care

CT vs psych care

7

yes

no

Becker 1967

TE vs psych care

SWS vs psych care

2, 7, 6

yes

no

Bejerholm 2015

SE vs PVT

hf IPS vs job skills training

1, 2, 3,5 6,

yes

yes

Blankertz 1996

PVT vs psych care

Job skills training vs psych care

2, 6

yes

no

Bond 1986

TE vs TE

Not classified

CH accelerated vs gradual

2, 6, 7

no

no

Bond 1995

SE+ vs SE

SE+job skills training vs lfIPS

1, 2, 7

yes

no

Bond 2007

SE vs TE

hf IPS vs CH

1,2,3,4,5,6

yes

yes

Bond 2015b

SE vs PVT

hf IPS vs job skills training

1, 2,, 6, 7

yes

no

Burns 2007

SE vs PVT

hf IPS vs job skills training

1, 3, 4, 5, 6, 7

yes

yes

Burns 2015

SE vs SE

hf IPS vs lf IPS

1, 3, 4,5, 6, 7,

no

yes (sub)

Chandler 1996

SE+ vs psych care

SE+ACT vs ACT

2, 5, 6, 7

yes

no

Craig 2014

SE+ vs SE

SE+motivational interviewing vs hf IPS

1, 2, 6

yes

no

Dincin 1982

TE vs psych care

CH vs psych care care

, 6, 7

yes

no

Drake 1996

SE vs PVT

lf IPS vs job skills training

4, 5, 6

yes

yes

Drake 1999b

SE vs TE

hf IPS vs SWS

2, 3, 4, 5, 6

yes

yes

Drake 2013

SE vs psych

hf IPS vs psych

1, 2, 4, 5, 6

yes

yes

Drebing 2005

SE+ vs SE+

unclassified

SE+TE+contingency management vs SE+TE

1, 6

no

no

Drebing 2007

SE+ vs SE+

unclassified

SE+TE+contingency management vs SE+TE

1

no

no

Eack 2009

PVT vs psych care

CT vs psych care

4, 6

yes

yes

Gervey 1994

SE vs TE

lf IPS vs SWS

1

yes

no

Gold 2006

SE vs TE

hf IPS vs SWS

1,2,3,4,5,6

yes

yes

Hoffmann 2012

SE vs TE

hf IPS vs SWS

1, 2, 3, 4, 5, 6

yes

yes

Howard 2010

SE vs PVT

hf IPS vs job skills training

4, , 5, 6, 7

yes

yes

Killackey 2008

SE vs psych

hf IPS vs psych

1, 6

yes

no

Killackey 2014

SE vs psych

hf IPS vs psych

6

yes

no

Latimer 2006

SE vs TE

hf IPS vs SWS

1, 2, 3, 6

yes

no

Lecomte 2014

SE+ vs SE

SE+symp vs hfIPS

1, 2

yes

no

Lehman 2002

SE vs PVT

hf IPS vs job skills training

2, 6

yes

yes

McFarlane 1996

Psych care vs psych care

Not classified

ACT+multifamily groups vs ACT+crisis family intervention

2, 4

no

no

McFarlane 2000

SE+ vs TE

ACT+SE vs SWS

1, 2

yes

yes

McGurk 2007

SE+ vs SE

SE+symp vs lf IPS

1, 4, 7, 6

yes

yes

McGurk 2009

SE+ vs SE

SE+symp vs lf IPS

1, 4

yes

yes

Michon 2014

SE vs PVT

hf IPS vs job skills training

1, 2, 3, 4, 5, 6, 7

yes

yes

Mueser 2004

SE vs TE

hf IPS vs CH

1, 2, 3, 4, 6

yes

yes

Nuechterlein 2012

SE+ vs PVT

SE+job vs SST

6

yes

yes

O'Brien 2003

SE vs psych care

lf IPS vs psych care

2, 6, 7

yes

no

Oshima 2014

SE vs PVT

hf IPS vs job skills training

1, 2, 6

yes

no

Penk 2010

TE vs PVT

SWS vs job skills training

1, 2, 3, 6

yes

no

Schonebaum 2006

SE+ vs SE+

ACT+SE vs SE+TE

1, 6

yes

yes(sub)

Tsang 2001

PVT vs psych care

SST vs psych care

none

yes

no

Tsang 2010

SE+ vs SE vs PVT

SE+symp vs hf IPS vs job skills training

1, 5, 6

yes

yes

Twamley 2012a

SE vs PVT

hf IPS vs job skills training

1, 2, 3, 6

yes

no

Viering 2015

SE vs PVT

lf IPS vs job skills training

6

yes

yes

Waghorn 2014

SE vs SE

lf IPS vs hfIPS

1, 6

no

no

Walker 1969

TE vs psych care

SWS vs psych care

1, 2, 7

yes

no

Wong 2008

SE vs PVT

hf IPS vs job skills training

1, 2, 3, 6

yes

yes

Xiang 2007

PVT vs psych care

SST vs psych care

4, 6, 7

yes

yes

(sub) = included in subgroup network meta‐analysis only.

ACT: assertive community treatment
CH: Clubhouse
CT: cognitive training
job: job related skills training
hf IPS: high‐fidelity Individual Placement and Support
lf IPS: low‐fidelity Individual Placement and Support
Psych care: psychiatric care only
PVT: prevocational training
SE: supported employment
SE+: augmented supported employment
SST: social skills training
SWS: sheltered workshops
Symp: symptom‐related skills training
TE: transitional employment

Figures and Tables -
Table 2. Comparisons and outcomes in included studies
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Table 3. Effectiveness of interventions on obtaining competitive employment (long‐ term follow‐up)

SE+

1.40 (0.92 to 2.14)

SE

3.02 (1.88 to 4.87)

2.16 (1.59 to 2.93)

PVT

3.79 (2.34 to 6.14)

2.71 (1.80 to 4.06)

1.26 (0.77 to 2.05)

TE

3.81 (1.99 to 7.31)

2.72 (1.55 to 4.76)

1.26 (0.73 to 2.19)

1.00 (0.51 to 1.96)

Psych care

Network meta‐analysis estimates of intervention effect (RR with 95% CI).

The column intervention is compared with the row intervention. RR > 1 favours the column intervention.

Psych care: psychiatric care only
PVT: prevocational employment;
SE: supported employment
SE+: augmented supported employment
TE: transitional employment

Figures and Tables -
Table 3. Effectiveness of interventions on obtaining competitive employment (long‐ term follow‐up)
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Table 4. Relative ranking of estimated probabilities (long‐term follow‐up)

Intervention

SUCRA

mean rank

SE+

98.5

1.1

SE

76.5

1.9

PVT

40.3

3.4

TE

17.2

4.3

Psychiatric care only

17.5

4.3

SUCRA = surface under the cumulative ranking curve
PVT: prevocational training
SE: supported employment
SE+: augmented supported employment
TE: transitional employment

Figures and Tables -
Table 4. Relative ranking of estimated probabilities (long‐term follow‐up)
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Table 5. Effectiveness of intervention subgroups on obtaining competitive employment (long‐term follow‐up)

SE + job

0.82

(0.09 to 7.17)

SE + symp

1.03 (0.10 to 11.00)

1.26

(0.22 to 7.04)

SE + TE

0.89

(0.11 to 7.18)

1.08

(0.29 to 4.04)

0.86

(0.28 to 2.63)

SE + ACT

1.73 (0.23 to 12.82)

2.10

(0.93 to 4.76)

1.67

(0.37 to 7.63)

1.94

(0.69 to 5.44)

hf IPS

2.08 (0.25 to 17.21)

2.53

(1.14 to 5.63)

2.02 (0.38 to 10.58)

2.34

(0.68 to 7.99)

1.20 (0.62 to 2.35)

lf IPS

5.46 (0.63 to 47.60)

6.64 (2.09 to 21.16)

5.29 (0.94 to 29.68)

6.14 (1.64 to 22.89)

3.16 (1.39 to 7.18)

2.63 (0.91 to 7.58)

CH

2.38 (0.30 to 18.92)

2.89

(0.91 to 9.16)

2.30

(0.58 to 9.09)

2.67

(1.19 to 5.96)

1.37 (0.61 to 3.09)

1.14 (0.40 to 3.27)

0.44 (0.14 to 1.38)

SWS

4.62 (0.59 to 35.99)

5.62 (2.44 to 12.95)

4.47 (0.92 to 21.76)

5.19 (1.69 to 15.95)

2.67 (1.70 to 4.20)

2.22 (1.17 to 4.23)

0.85 (0.33 to 2.16)

1.94 (0.77 to 4.89)

Job

1.63

(0.44 to 6.08)

1.98 (0.36 to 11.06)

1.58 (0.22 to 11.27)

1.83 (0.36 to 9.25)

0.94 (0.21 to 4.27)

0.78 (0.15 to 4.09)

0.30 (0.05 to 1.66)

0.69 (0.14 to 3.41)

0.35 (0.07 to 1.70)

SST

0.68

(0.06 to 8.42)

0.83

(0.09 to 7.35)

0.66

(0.06 to 7.14)

0.77

(0.09 to 6.28)

0.39 (0.05 to 2.98)

0.33 (0.04 to 2.76)

0.12 (0.01 to 1.11)

0.29 (0.04 to 2.32)

0.15 (0.02 to 1.17)

0.42 (0.05 to 3.56)

CT

2.97 (0.51 to 17.40)

3.61 (1.03 to 12.63)

2.88 (0.60 to 13.87)

3.34 (1.10 to 10.13)

1.72 (0.67 to 4.42)

1.43 (0.45 to 4.55)

0.54 (0.16 to 1.90)

1.25 (0.42 to 3.71)

0.64 (0.23 to 1.83)

1.82 (0.56 to 5.93)

4.35 (0.73 to 25.98)

Psych care

Network meta‐analysis estimates of intervention effect (RR, 95% CI).

The column intervention is compared with the row intervention. RR > 1 favours the column intervention.

CH: Clubhouse
CT: cognitive training
hf IPS: high‐fidelity Individual Placement and Support
Job : job‐related skills training
lf IPS: low‐fidelity Individual Placement and Support
Psych care: psychiatric care only
SE + ACT: supported employment + assertive community treatment
SE + job: supported employment + job‐related skills training
SE + symp: supported employment + symptom‐related skills training
SE + TE: supported employment + transitional employment
SST: social skills training
SWS: sheltered workshops

Figures and Tables -
Table 5. Effectiveness of intervention subgroups on obtaining competitive employment (long‐term follow‐up)
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Table 6. Relative ranking of estimated probabilities of intervention subgroups (long‐term follow‐up)

Intervention

SUCRA

mean rank

SE + symp

80.3

3.2

CT

78.4

3.4

SE + ACT

77.8

3.4

SE + TE

69

4.4

SE + job

68.4

4.5

Hf IPS

51.9

6.3

SST

51.8

6.3

lf IPS

42.4

7.3

SWS

35.8

8.1

Psychcare

25.8

9.2

Job

10.6

10.8

CH

7.9

11.1

SUCRA = surface under the cumulative ranking curve
CH: Clubhouse
CT: cognitive training
hf IPS: high‐fidelity Individual Placement and Support
Job : job‐related skills training
lf IPS: low‐fidelity Individual Placement and Support
Psych care: psychiatric care only
SE + ACT: supported employment + assertive community treatment
SE + job: supported employment + job‐related skills training
SE + symp: supported employment + symptom‐related skills training
SE + TE: supported employment + transitional employment
SST: social skills training
SWS: sheltered workshops

Figures and Tables -
Table 6. Relative ranking of estimated probabilities of intervention subgroups (long‐term follow‐up)
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Table 7. Summary of our confidence in effect estimates and ranking of interventions

Comparison

evidence

confidence

reasons for downgrading

SE + vs psych care

mixed

moderate

study limitationsa

SE vs psych care

indirect

low

study limitationsa;inconsistencyb,c

PVT vs psych care

mixed

very low

study limitationsa; inconsistencyb;imprecisiond

TE vs psych care

indirect

low

study limitationsa; imprecisiond

SE + vs TE

mixed

low

study limitationse

SE vs TE

mixed

moderate

study limitationsa

PVT vs TE

indirect

low

study limitationsa; imprecisiond

SE + vs PVT

mixed

low

study limitationsa inconsistencyf

SE vs PVT

mixed

very low

study limitationsa; inconsistencyb,c; publication biasg

SE + vs SE

mixed

low

study limitationsa; imprecisiond

Ranking

very low

study limitationsa; inconsistencyh; publication biasg

a Dominated by evidence at high or moderate risk of bias.
b Predictive interval for intervention effect includes effect that would have different interpretations.

c Moderate level of heterogeneity.
d Confidence intervals include values favouring either intervention.

e Dominated by evidence at high risk of bias.

f Loop inconsistency ROR 3.156 (95% CI 1.46 to 6.84).

g Evidence for small study effects.

h Evidence for inconsistency in the network (P = 0.001).

psych care: psychiatric care only
SE: supported employment
SE +: augmented supported employment
PVT: prevocational training
TE: transitional employment

Figures and Tables -
Table 7. Summary of our confidence in effect estimates and ranking of interventions
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Comparison 1. Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Obtaining competitive employment, short‐term follow‐up (≤ 1 year) Show forest plot

18

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 SE vs psych care

3

1087

Risk Ratio (M‐H, Random, 95% CI)

1.79 [0.94, 3.40]

1.2 PVT vs psych care

2

171

Risk Ratio (M‐H, Random, 95% CI)

8.96 [1.77, 45.51]

1.3 TE vs psych care

4

422

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.88, 1.45]

1.4 SE vs TE

3

231

Risk Ratio (M‐H, Random, 95% CI)

3.49 [1.77, 6.89]

1.5 SE vs PVT

2

148

Risk Ratio (M‐H, Random, 95% CI)

2.52 [1.21, 5.24]

1.6 TE vs PVT

1

89

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.59, 1.04]

1.7 SE+ vs SE

3

143

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.37, 2.25]

2 Obtaining competitive employment, long‐term follow‐up (> 1 year) Show forest plot

22

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 SE+ vs psych care

1

256

Risk Ratio (M‐H, Random, 95% CI)

4.32 [1.49, 12.48]

2.2 SE vs psych care

1

2238

Risk Ratio (M‐H, Random, 95% CI)

1.51 [1.36, 1.68]

2.3 PVT vs psych care

2

161

Risk Ratio (M‐H, Random, 95% CI)

2.19 [1.07, 4.46]

2.4 SE+ vs TE

2

212

Risk Ratio (M‐H, Random, 95% CI)

2.45 [1.69, 3.55]

2.5 SE vs TE

4

587

Risk Ratio (M‐H, Random, 95% CI)

3.28 [2.13, 5.04]

2.6 SE+ vs PVT

2

193

Risk Ratio (M‐H, Random, 95% CI)

5.42 [1.08, 27.11]

2.7 SE vs PVT

9

1570

Risk Ratio (M‐H, Random, 95% CI)

2.31 [1.85, 2.89]

2.8 SE+ vs SE

3

205

Risk Ratio (M‐H, Random, 95% CI)

1.94 [1.03, 3.65]
Figures and Tables -
Comparison 1. Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness
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Comparison 2. Any intervention to improve maintaining employment compared to another intervention in adults with severe mental illness

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Weeks in competitive employment, short‐term follow‐up (≤ 1 year) Show forest plot

8

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 SE+ vs SE

1

32

Mean Difference (IV, Random, 95% CI)

‐1.46 [‐3.38, 0.46]

1.2 SE vs TE

2

187

Mean Difference (IV, Random, 95% CI)

4.18 [1.27, 7.09]

1.3 SE vs PVT

1

58

Mean Difference (IV, Random, 95% CI)

6.89 [1.26, 12.52]

1.4 SE vs psych care

2

131

Mean Difference (IV, Random, 95% CI)

4.87 [0.37, 9.37]

1.5 TE vs PVT

1

60

Mean Difference (IV, Random, 95% CI)

6.70 [‐1.76, 15.16]

1.6 TE vs psych care

1

10

Mean Difference (IV, Random, 95% CI)

‐4.39 [‐17.75, 8.97]

2 Weeks in competitive employment, long‐term follow‐up (> 1 year) Show forest plot

11

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 SE+ vs SE

3

154

Mean Difference (IV, Random, 95% CI)

10.09 [0.32, 19.85]

2.2 SE+ vs PVT

1

47

Mean Difference (IV, Random, 95% CI)

22.79 [15.96, 29.62]

2.3 SE vs TE

4

587

Mean Difference (IV, Random, 95% CI)

17.36 [11.53, 23.18]

2.4 SE vs PVT

5

390

Mean Difference (IV, Random, 95% CI)

11.56 [5.99, 17.13]
Figures and Tables -
Comparison 2. Any intervention to improve maintaining employment compared to another intervention in adults with severe mental illness
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Comparison 3. Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Days to first competitive employment, short‐term follow‐up (≤ 1 year) Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 SE vs TE

1

49

Mean Difference (IV, Fixed, 95% CI)

‐26.60 [‐98.53, 45.33]

1.2 SE vs PVT

1

25

Mean Difference (IV, Fixed, 95% CI)

‐35.94 [‐121.73, 49.85]

1.3 TE vs PVT

1

60

Mean Difference (IV, Fixed, 95% CI)

12.60 [‐23.53, 48.73]

2 Days to first competitive employment, long‐term follow‐up (> 1 year) Show forest plot

6

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 SE+ vs TE

1

62

Mean Difference (IV, Fixed, 95% CI)

‐142.80 [‐238.70, ‐46.90]

2.2 SE vs TE

3

205

Mean Difference (IV, Fixed, 95% CI)

‐64.86 [‐115.95, ‐13.77]

2.3 SE vs PVT

2

96

Mean Difference (IV, Fixed, 95% CI)

‐35.01 [‐105.21, 35.19]
Figures and Tables -
Comparison 3. Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness
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Comparison 4. Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Obtaining non‐competitive employment, short‐term follow‐up (≤ 1 year) Show forest plot

11

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 SE+ vs SE

2

57

Risk Ratio (M‐H, Random, 95% CI)

1.59 [0.15, 17.22]

1.2 SE vs TE

2

187

Risk Ratio (M‐H, Random, 95% CI)

1.10 [0.18, 6.84]

1.3 SE vs PVT

2

148

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.39, 2.06]

1.4 SE vs psych care

1

900

Risk Ratio (M‐H, Random, 95% CI)

1.10 [0.61, 2.00]

1.5 TE vs PVT

1

89

Risk Ratio (M‐H, Random, 95% CI)

3.82 [2.24, 6.53]

1.6 TE vs psych care

2

78

Risk Ratio (M‐H, Random, 95% CI)

4.27 [0.00, 4883.69]

1.7 PVT vs psych care

1

122

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.12, 72.23]

2 Obtaining non‐competitive employment, long‐term follow‐up (> 1 year) Show forest plot

12

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 SE+ vs TE

2

212

Risk Ratio (M‐H, Random, 95% CI)

0.44 [0.12, 1.66]

2.2 SE+ vs psych care

1

256

Risk Ratio (M‐H, Random, 95% CI)

44.69 [6.25, 319.49]

2.3 SE vs TE

4

587

Risk Ratio (M‐H, Random, 95% CI)

0.22 [0.08, 0.63]

2.4 SE vs PVT

4

582

Risk Ratio (M‐H, Random, 95% CI)

1.29 [0.47, 3.53]

2.5 SE vs psych care

1

2238

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.76, 1.40]
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Comparison 4. Any intervention to improve obtaining employment compared to another intervention in adults with severe mental illness
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Comparison 5. Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Quality of life, long‐term follow up (> 1 year) Show forest plot

9

Std. Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 SE+ vs psych care (QOLI)

1

256

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.79 [‐1.05, ‐0.54]

1.2 SE vs psych care (QOLI)

1

2238

Std. Mean Difference (IV, Fixed, 95% CI)

0.14 [0.06, 0.23]

1.3 SE vs TE (QOLI)

2

352

Std. Mean Difference (IV, Fixed, 95% CI)

0.05 [‐0.16, 0.26]

1.4 SE+ vs SE (PWI)

1

114

Std. Mean Difference (IV, Fixed, 95% CI)

0.33 [‐0.04, 0.70]

1.5 SE vs TE (W‐QLI objective)

1

100

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.14 [‐0.53, 0.26]

1.6 SE vs TE (W‐QLI subjective)

1

100

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.50, 0.29]

1.7 SE+ vs PVT (PWI)

1

124

Std. Mean Difference (IV, Fixed, 95% CI)

0.41 [0.06, 0.77]

1.8 SE vs PVT (PWI)

1

131

Std. Mean Difference (IV, Fixed, 95% CI)

0.14 [‐0.20, 0.48]

1.9 SE vs PVT (MANSA)

2

369

Std. Mean Difference (IV, Fixed, 95% CI)

0.14 [‐0.06, 0.35]

1.10 SE vs PVT (QOLP)

1

312

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.22, 0.22]
Figures and Tables -
Comparison 5. Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness
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Comparison 6. Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mental health long‐term follow‐up (> 1 year) Show forest plot

7

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 SE vs psych care (SFHS)

1

2238

Mean Difference (IV, Random, 95% CI)

2.88 [1.78, 3.98]

1.2 PVT vs psych care (PANSS positive symptoms)

1

103

Mean Difference (IV, Random, 95% CI)

‐2.48 [‐3.95, ‐1.01]

1.3 PVT vs psych care (PANSS negative symptoms)

1

103

Mean Difference (IV, Random, 95% CI)

‐1.61 [‐2.99, ‐0.23]

1.4 PVT vs psych care (PANSS general symptoms)

1

103

Mean Difference (IV, Random, 95% CI)

‐1.86 [‐3.09, ‐0.63]

1.5 PVT vs psych care (composite index, multiple scales)

1

58

Mean Difference (IV, Random, 95% CI)

‐7.09 [‐326.22, 312.04]

1.6 SE vs TE (PANSS positive symptoms)

1

200

Mean Difference (IV, Random, 95% CI)

‐0.02 [‐1.71, 1.67]

1.7 SE vs TE (PANSS negative symptoms)

1

200

Mean Difference (IV, Random, 95% CI)

‐0.80 [‐2.79, 1.19]

1.8 SE vs TE (PANSS general psychopathology)

1

200

Mean Difference (IV, Random, 95% CI)

‐2.69 [‐7.58, 2.20]

1.9 SE vs TE (BPRS)

1

152

Mean Difference (IV, Random, 95% CI)

‐1.90 [‐5.69, 1.89]

1.10 SE vs PVT (HADS anxiety)

1

312

Mean Difference (IV, Random, 95% CI)

0.10 [‐0.88, 1.08]

1.11 SE vs PVT (HADS depression)

1

312

Mean Difference (IV, Random, 95% CI)

‐0.10 [‐1.08, 0.88]

1.12 SE vs PVT (MHI)

1

150

Mean Difference (IV, Random, 95% CI)

‐1.00 [‐8.63, 2.63]

1.13 SE vs PVT (PANSS positive symptoms)

1

312

Mean Difference (IV, Random, 95% CI)

0.10 [‐0.93, 1.13]

1.14 SE vs PVT (PANSS negative symptoms)

1

312

Mean Difference (IV, Random, 95% CI)

‐0.20 [‐1.38, 0.98]

1.15 SE vs PVT (PANSS general psychopathology)

1

312

Mean Difference (IV, Random, 95% CI)

0.40 [‐1.34, 2.14]
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Comparison 6. Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness
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Comparison 7. Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Dropouts, short‐term follow‐up (≤ 1 year) Show forest plot

13

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 SE vs psych care

3

1087

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.41, 1.10]

1.2 PVT vs psych care

1

122

Risk Ratio (M‐H, Fixed, 95% CI)

5.0 [0.25, 102.04]

1.3 TE vs psych care

2

182

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.43, 1.06]

1.4 SE vs TE

2

187

Risk Ratio (M‐H, Fixed, 95% CI)

1.78 [0.84, 3.77]

1.5 SE vs PVT

2

148

Risk Ratio (M‐H, Fixed, 95% CI)

1.36 [0.56, 3.30]

1.6 TE vs PVT

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

3.92 [0.19, 79.40]

1.7 SE+ vs SE

2

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.43, 1.67]

2 Dropouts, long‐term follow‐up (> 1 year) Show forest plot

19

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 SE+ vs psych care

1

256

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.50, 1.08]

2.2 SE vs psych care

1

2238

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.78, 1.52]

2.3 PVT vs psych care

2

161

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.45, 2.19]

2.4 SE+ vs SE

1

123

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.37, 1.14]

2.5 SE+ vs TE

1

143

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.33, 1.13]

2.6 SE vs TE

4

587

Risk Ratio (M‐H, Fixed, 95% CI)

1.92 [0.89, 4.15]

2.7 SE+ vs PVT

2

193

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.59, 1.64]

2.8 SE vs PVT

9

1569

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.80, 1.13]
Figures and Tables -
Comparison 7. Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness
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Comparison 8. Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Hospital admissions, short‐term follow‐up (≤ 1 year) Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 SE vs psych care

1

900

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.74, 1.73]

1.2 TE vs psych care

4

422

Risk Ratio (M‐H, Random, 95% CI)

0.59 [0.30, 1.15]

1.3 SE vs PVT

1

90

Risk Ratio (M‐H, Random, 95% CI)

1.24 [0.76, 2.01]

2 Hospital admissions, long‐term follow‐up (> 1 year) Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 SE+ vs psych care

1

256

Risk Ratio (M‐H, Random, 95% CI)

1.11 [0.73, 1.70]

2.2 PVT vs psych care

1

103

Risk Ratio (M‐H, Random, 95% CI)

0.26 [0.11, 0.65]

2.3 SE+ vs TE

1

143

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.55, 1.63]

2.4 SE vs PVT

3

681

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.60, 1.45]
Figures and Tables -
Comparison 8. Any intervention to improve obtaining or maintaining employment compared to another intervention in adults with severe mental illness
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