Psychiatric Symptoms and Work Performance: the moderating effect of job accommodations

정신장애인 직업재활은 정신의학적 증상이 직업수행에 부정적 영향을 미칠 것이지만 역으로 성공적인 직업수행은 증상을 완화시킬 것이라는 함축적 의미를 내포하고 있다. 상식적으로도 증상과 직업수행은 공변할 것으로 기대된다. 그럼에도 불구하고 양자 간의 관계성을 검토한 연구결과들은 서로 불일치하고 일관성있는 결론을 위해 관련 연구들을 검토한 질적개관연구들은 대체로 관계성이 미약하다는 결론을 내리고 있다. 증상과 직업수행 간 관계성이 전반적으로 높지 않고 연구마다 다르게 나타나는 양상은 관계를 증감시키거나 아예 관계의 방향을 바꾸어버리는 조절요인(moderator)이 존재할 가능성을 시사한다. 그동안 연구결과 간 불일치를 설명하기 위해 다양한 조절요인들이 제기되어왔지만 이를 경험적으로 검증한 연구는 찾아보기 어렵다. 이에 본 연구는 직업재활의 대표적 환경수정 전략인 직장편의가 증상과 직업수행 간 관계에 대한 조절요인인지 알아보았다. 이를 위해 정신보건센터나 사회복귀시설의 직업재활서비스를 통해 주당 일정시간 일하고 있는 정신장애인 218명과 전문가 60명을 대상으로 증상(양성, 음성), 직업수행, 직장편의를 질문지를 통해 조사하였다. 그 결과, 직장편의의 조절효과는 고용형태(보호고용 대 경쟁고용)에 관계없이 양성증상과 직업수행에 대해서는 나타나지 않았고 오직 경쟁고용 장면에서 음성증상과 직업수행에 대해서만 나타났다. 즉, 경쟁고용에서 직장편의가 양호할수록 음성증상이 직업수행에 미치는 부정적 영향력은 감소하였다. 또한 경쟁고용에서 음성증상이 직업수행에 미치는 부정적 영향력을 완화시키는 직장편의의 하위요인은 직무지원보다는 대인적 지원과 일정한 작업환경이었다. 연구결과는 경쟁고용의 정신장애인에 대한 사후지도에서 직장편의, 특히 대인적 지원과 일정한 작업환경 유지에 주력해야 함을 시사한다.

keywords: 조절요인, 직장편의, 정신의학적 증상, 직업수행, 정신장애인, moderator, job accommodation, psychiatric symptoms, job performance, vocational rehabilitation

Abstract

Psychiatric vocational rehabilitation has assumed close relation between psychiatric symptoms and work performance that psychiatric symptoms negatively affect work performance but successful work performance reversely relieve psychiatric symptoms. According to the assumption, psychiatric symptoms and work performance are supposed to covary. Previous study results, however, are mixed and the review studies dealing with this issue conclude that if they are related, their strengths are generally meager. These findings suggest the existence of potential moderators that may change either the direction or the strength of bivariate relationship. Although many variables were suggested as potential moderators by researchers, few studies empirically addressed them to explain conflicting findings, To test if job accommodations moderate the negative effect of psychiatric symptoms on work performance, present study surveyd 218 employees with psychiatric disabilities and 60 mental health professionals who completed questionnaires of (positive or negative) psychiatric symptoms, work performance, or job accommodation. The results showed that the moderating effect was limited only to the relation between negative symptom and competitive work performance, not to the relation between positive symptoms and (both competitive and sheltered) work performance. That is, better job accommodation relieves the more negative impact of negative symptoms on competitive work performance. Among three factors of job accommodations, did interpersonal support and structured work condition, but not job support, have clearly moderating effects. These findings suggest that job accommodations, especially interpersonal support and structured work condition, are important for job maintenance of competitively employed clients

keywords: 조절요인, 직장편의, 정신의학적 증상, 직업수행, 정신장애인, moderator, job accommodation, psychiatric symptoms, job performance, vocational rehabilitation

참고문헌

김상희, 박권생, 정현희 (2005). 정신장애인의 직무특성에 대한 정신보건전문가 집단간의 태도 차이. 한국심리학회지: 건강, 10, 489-508.

김상희, 손명자, 정현희 (2005). 정신장애인을 위한 직장편의. 한국심리학회지: 일반, 24, 1-22.

김철권, 변원탄 (2000). 정신분열병을 극복하는 법: 환자와 가족을 위한 교육지침서. 서울: 하나의학사.

삼성서울병원 정신과 낮병원 (2004). 통합 재활 프로그램 워크북: 정신과 환자를 위한. 서울:학지사.

심경순 (2001). 정신분열병 환자의 직업유지에 영향을 미치는 요인에 관한 연구. 미간행 박사학위논문: 대구대학교 대학원.

이금진 (2000). 정신장애인의 직업유지기간에 영향을 미치는 요인에 관한 연구. 미간행 석사학위논문: 숭실대학교 대학원.

이만홍, 유계준 (1999). 정신분열병의 통합재활치료. 서울: 하나의학사.

이성규, 김상희 (2003). 정신장애인 직업재활모델과 직업평가: 직업수행척도 개발을 위한 예비분석. 사회복지학, 54, 123-148.

이성규, 유숙렬, 김상희, 이성은, 이세영 (2000). 정신장애인의 적합직종 개발연구. 직업안정연구원 연구보고서.

10.

주소현 (1999). 정신분열병 환자의 직업유지와 작업환경에 관한 연구. 미간행 석사학위논문: 서울여자대학교 대학원.

11.

Akabas, S. H. (1994). Workplace responsiveness: Key employer characteristics in support of job maintennance for people with mental illness. Psychosocial Rehabilitation Journal, 17, 91-101.

12.

Anderson, C. M., Hogatty, G. E., & Reiss, D. J. (2003). 정신교육 치료자를 위한 지침서 (김철권, 서지민, 역). 서울: 하나의학사. (원전출판, 1986).

13.

Anthony, W. A. (1994a). Characteristics of people with psychiatric disabilities that are predictive of entry into the rehabilitation process and successful employment. Psychosocial Rehabilitation Journal, 17, 3-13.

14.

Anthony, W. A. (1994b). The vocational rehabilitation of people with severe mental illness: Issues and myths. Innovations and Research, 3(2), 17-24.

15.

Anthony, W. A., Cohen, M. R., & Vitalo, R. L. (1978). The measurement of rehabilitation outcome. Schizophrenia Bulletin, 4, 365-383.

16.

Anthony, W. A., & Jansen, M. A. (1984). Predicting the vocational capacity of the chronically mentally ill: Research and policy implications. American Psychologist, 39, 537-544.

17.

Anthony, W. A., Rogers, E. S., Cohen, M., & Davies, R. R. (1995). The relationships between psychiatric symptomatology, work skills, and future vocational performance. Psychiatric Services, 46, 353-358.

18.

Bailer, J., Brauer, W., & Rey, E. R. (1996). Premorbid adjustment as predictor of outcome in schizophrenia: Results of a prospective study. Acta Psychiatrica Scandinavica, 93, 368-377.

19.

Baker, F., & Weiss, R. S. (1984). The nature of case manager support. Hospital and Community Psychiatry, 35, 925-928.

20.

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.

21.

Bell, M. D., & Lysaker, P. H. (1995). Psychiatric symptoms and work performance among persons with severe mental illness. Psychiatric Services, 46, 508-510.

22.

Bond, G. R., & Friedmeyer, M. H. (1987). Predictive validity of situational assessment at a psychiatric rehabilitation center. Rehabilitation Psychology, 32, 99-112.

23.

Bond, G. R., & McDonel, E. C. (1991). Vocational rehabilitation outcomes for persons with psychiatric disabilities: An update. Journal of Vocational Rehabilitation, 1(3), 9-20.

24.

Breier, A., Schreiber, J. L., Dyer, J., & Pickar, D. (1992). Course of illness and predictors of outcome in chronic schizophrenia: Implications for pathophysiology. British Journal of Psychiatry, 161 (Suppl. 18), 38-43.

25.

Broadbent, D. E. (1995). The clinical impact of job design. British Journal of Clinical Psychology, 24, 33-44.

26.

Bryson, G., Bell, M. D., Lysaker, P., & Zito, W. (1997). The Work Behavior Inventory: A scale for the assessment of work behavior for people with severe mental illness. Psychiatric Rehabilitation Journal, 20, 47-55.

27.

Cheadle, A. J., & Morgan, R. (1972). The measurement of work performance of psychiatric patients: A reappraisal. British Journal of Psychiatry, 120, 437-441.

28.

Clark, J. R., Koch, B. A., Nichols, R. C. (1965). A factor analytically derived scale for rating psychiatric patients in occupational theapy: Part I. Development. The American Journal of Occupational Therapy, 16, 14-18.

29.

Cook, J. A. (1992). Job ending among youth and adults with severe mental illness. Journal of Mental Health Administration, 19(2), 158-169.

30.

Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297-334.

31.

Ettner, S. L., Frank, R. G., & Kessler, R. C. (1997). The impact of psychiatric disorders on labor market outcome. Industrial & Labor Relations Review, 51, 64-83.

32.

Fabian, E. S. (1992). Longitudinal outcomes in supported employment: A survival analysis. Rehabilitation Psychology, 37(1), 23-35.

33.

Fabian, E. S., Waterworth, A., & Ripke, B. (1993). Reasonable accommodations for workers with serious mental illness: Type, frequency, and associated outcome. Psychosocial Rehabilitation Journal, 17, 163-172.

34.

Fischler, G. L., & Booth, N. B. (2004). 정신장애와 직업수행, 그리고 직장편의 (김상희, 역). 서울: 시그마프레스. (원전출판 1999).

35.

Frey, W. D. (1984). Functional assessment in the 1980s: A conceptual enigma, a technical challenge. In A. S. Halpern & M. J. Furher (Eds.), Functional assessment in rehabilitation (pp. 11-43). Baltimore: Brookes.

36.

Gates, L. B., Akabas, S. H., & Oran-Sabia, V. (1998). Relationship accommodations involving the work group: Improving work prognosis for mental health conditions. Psychiatric Rehabilitation Journal, 21, 264-272.

37.

Glynn, S. M., Randolph, E. T., Eth, S., Paz, G. G., Leong, G. B., Shaner, A. L., & Vort, W. V.? (1992). Schizophrenic symptoms, work adjustment, and behavioral family therapy. Rehabilitation Psychology, 37(4), 323-338.

38.

Granger, B. (2000). The role of psychiatric rehabilitation practitioners in assisting people in understanding how to best assert their ADA rights and arrange job accommodations. Psychiatric Rehabilitation Journal, 23, 215-223.

39.

Granger, B., & Baron, R., & Robinson, S. (1997). Findings from a national survey of job coaches and job developers about job accommodations arranged between employers and people with psychiatric disabilities. Journal of Vocational Rehabilitation, 9, 235-251.

40.

Griffiths, R. D. P. (1973). A standardized assessment of the work behavior of psychiatric patients. British Journal of Psychiatry, 123, 403-408.

41.

Hauser, R., & Scharfetter, C. (1990). On the prognostic relevance of ego-psychopathology in schizophrenia: A 25 year follow-up. European Archives of Psychiatry Neurological Sciences, 239, 293-302.

42.

Ho, B. C., Nopoulos, P., Flaum, M., Arndt, S., & Andreason, N. C. (1998). Two-year outcome in first-episode schizophrenia: Predictive value of symptoms for quality of life. American Journal of Psychiatry, 155, 1196- 1201.

43.

Hoffmann, H., & Kupper, Z. (1997). Relationships between social competence, psychopathology and work perfomance and their predictive value for vocational rehabilitation of schizophrenic outpatients. Schizophrenia Research, 23, 69-79.

44.

Jacobs, H. E. (1988). A skills-oriented model for facilitating employment among psychiatrically disabled persons. Rehabilitation Counseling Bulletin, 28, 87-96.

45.

Kay, S. R., Fiszbein, A., & Opler, L. A. (1991). 양성 및 음성 증상척도 평가지침서 (한국얀센, 역). 서울: 중앙문화사. (원서출판 1987).

46.

Kirsh, B. (2000). Work, wokers, and workplaces: A qualitative analysis of narratives of mental health consumers. Journal of Rehabilitation, 66, 24-30.

47.

Liberman, R. P., Muser, K. T., Wallace, D. J., Jacobs, M. E., Eckman, T., & Massel, H. K. (1986). Training skills in the psychiatrically disabled: Learning coping and competence. Schizophrenia Bulletin, 12, 631-647.

48.

MacDonald-Wilson, K. L., Rogers, E. S., Massaro, J. M., Lyass, A., & Crean, T. (2002). An investigation of reasonable workplace accommodations for people with psychiatric disabilities: Quantitative findings from a multi-site study. Community Mental Health Journal, 38, 35-50.

49.

Mancuso, L. L. (1990). Reasonable accommodation for workers with psychiatric disabilities. Psychosocial Rehabilitation Journal, 14, 3-19.

50.

Massel, K. H., Lieberman, R. P., Mintz, J., Jacobs, H. E., Rush, T. V., Giannini, C. A., et al., (1990). Evaluating the capacity to work of the mentally ill. Psychiatry, 53, 31-43.

51.

Michon, H. W. C., Kroon, H., Weeghel, J. van., & Schene, A. H. (2004). The generic work behavior questionnaire (GWBQ): Assessment of core dimensions of generic work behavior of people with severe mental illnesses in vocational rehabilitation. Psychiatric Rehabilitation Journal, 28, 40-47.

52.

Mueser, K. T., & Gingerich, S. (1999). 정신분열병을 어떻게 극복할 것인가: 환자 가족들을 위한 안내서. (이성동, 김상준, 역). 서울: 하나의학사. (원서출판 1995).

53.

Neff, W. S. (1985). Work and human behavior (3rd ed.). New York: Aldine.

54.

Overall, J. E., & Gorham, D. R. (1962). The Brief Psychiatric Rating Scale. Psychological Report, 10, 799-812.

55.

Rapp, C. A., & Goscha, R. J. (2006). The strengths model: Case management with people with psychiatric disabilities. Oxford University Press.

56.

Rioux, M. H. (1996). Overcoming the social construction of inequality as a prerequisite to quality of life. In R. Renwick, I. Brown, & M. Nagler (Eds.), Quality of life in health promotion and rehabilitation: Conceptual approaches, issues, and applicants (pp. 119-131). CA: Sage Publications.

57.

Rogers, E. S., Anthony, W. A., Cohen, M., & Davies, R. R. (1997). Prediction of vocational outcome based on clinical and demographic indicators among vocationally ready clients. Community Mental Health Journal, 33, 99-112.

58.

Rogers, E. S., Sciarappa, K., Anthony, W. A. Development and evaluation of situational assessment instruments and procedures for persons with psychiatric disability. Vocational Evaluation and Work Adjustment Bulletin, 24, 61-67.

59.

Solinski, S., Jackson, H. J., & Bell, R. C. (1992). Prediction of employability in schizophenic patients. Schizophrenia Research, 7, 141-148.

60.

Strauss, J. S., & Carpenter, W. T. (1974). The prediction of outcome in schizophrenia: II. Relationships between predictor and outcome variables. Archives of General Psychiatry, 31, 37-42.

61.

Streiner, D. L., & Norman, G. R. (2003). Health measurement scales: a practical guide to their development and use (3rd ed.). New York: Oxford University Press.

62.

Trach, J. S. (1997). Analysis of the types of natural supports utilized during job placement and development. Journal of Rehabilitation, 63, 43-48.

63.

Tsang, W. H. H., Chiu, I. Y. (2000a). Development and validation of the workshop behavior checklist: A scale for assessing work peformance of people with severe mental illness. International Journal of Social Psychiatry, 46, 110-121.

64.

Tsang, W. H., Lam, P., Ng, B., & Leung, O. (2000b). Predictors of employment outcome for people with psychiatric disabilities: A review of the literature since the mid 80's. Journal of Rehabilitation, 66, 19-31.

65.

Tsang, W. H. H., & Pearson, V. (1996). A conceptual framework for work-related social skills in psychiatric rehabilitation. Journal of Rehabilitation, 62, 61-67.

66.

Wolf, F. M. (1986) Meta-analysis: Quantitative methods for research synthesis. Beverly Hills, CA: Sage.

67.

Wehman, P., Revell, W. G., Kregel, J., Kreutzer, J., Callahan, M., & Banks, P. D. (1990). Supported employment: An alternative model for vocational rehabilitation of persons with severe neurologic, psychiatric, or physical disabilities. In J. Kregel, P. Wehman, & M. S. Shafer (Eds.), Supported employment for persons with severe disabilities: From research to practice (pp. 101-114). Richmond: Rehabilitation Research and Training Center on Supported Employment, Virginia Commonwealth University.

68.

Zuckerman, D. (1993). Reasonable accommodations for people with mental illness under the ADA. Mental and Physical Disability Law Reporter, 17(3), 311-319.

69.

http://www.eeoc.gov

70.

http://www.jan.wvu.edu

71.

http://www.bu.edu/cpr/reasaccom/

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논문 상세

Vol.27 No.2

정신의학적 증상과 직업수행에 대한 직장편의의 조절효과

Psychiatric Symptoms and Work Performance: the moderating effect of job accommodations

초록

Abstract

참고문헌

한국심리학회지: 일반