Experiences of returning to work in schizophrenic patients after treatment: a longitudinal qualitative study

Background: Returning to work (RTW) has always been regarded as one of the important indicators to evaluate the therapeutic effect of patients with schizophrenia, which plays a positive role in improving the quality of life and mental symptoms of patients with schizophrenia.The existing studies on RTW in schizophrenic patients are mostly focused on intervention measures, and the qualitative research on RTW is very limited. The purpose of this study was to evaluate the experience of the RTW after treatment in schizophrenic patients. Method: A longitudinal qualitative study was conducted involving 24 patients with schizophrenia in China. The interviews were held at three time-points during their RTW process, (1) when patients had improved and were close to discharge, (2) within one month post-discharge, and (3) six months post-discharge. The interview recordings were transcribed by the research team, and transcripts were independently analyzed by two independent coders using reflexive thematic analysis. Results: ： A total of 24 patients with schizophrenia participated in 72 personal interviews. The thematic framework based on the experience of schizophrenic patients reveals a three-phases of the process of RTW: improved, being at a loss, and job crisis. The study identified one theme of the first phase：the expectation and optimism. Two themes in the second phase: (1) psychological distress of upcoming work; (2 expectation of assistance pre-work. And four themes in the third phase: (1）tremendous pressure of RTW; (2）lack of medical and social support; (3) social status and interpersonal relationships change; (4) high level of financial pressure. Conclusion: The experience of RTW is a dynamic process with great challenges in each phase，schizophrenic patients have been deeply affected by what they have experienced. There is an urgent need to ensure that existing community and social support is integrated into daily care，and follow-up mental health services and disease information should be accessible to support schizophrenic patients to RTW successful. The findings of this study also suggest relevant departments and employers should be aware of the barriers to RTW for people with schizophrenia, and take certain measures to change the current situation.