University of Oulu

Majuri, T., Alakokkare, AE., Haapea, M. et al. Employment trajectories until midlife in schizophrenia and other psychoses: the Northern Finland Birth Cohort 1966. Soc Psychiatry Psychiatr Epidemiol 58, 65–76 (2023).

Employment trajectories until midlife in schizophrenia and other psychoses : the Northern Finland Birth Cohort 1966

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Author: Majuri, Tuomas1; Alakokkare, Anni-Emilia1,2; Haapea, Marianne1,2,3;
Organizations: 1Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland
2Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
3Department of Psychiatry, Oulu University Hospital, Oulu, Finland
4Northern Finland Birth Cohorts, Infrastructure for Population Studies, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
Persistent link:
Language: English
Published: Springer Nature, 2022
Publish Date: 2022-08-23


Purpose: Psychoses are associated with poor labour market attachment, but few studies have compared schizophrenia (SZ) and other psychoses (OP). Moreover, studies on long-term employment trajectories over individuals’ working life courses are lacking. We compared 30 year employment trajectory patterns in a general population sample among individuals with SZ, OP, and those with no psychosis (NP).

Methods: Utilising the Northern Finland Birth Cohort 1966, we collected survey data on employment from ages 16 to 45 and detected individuals with register-based history of SZ (n = 62), OP (n = 87), or NP (n = 6464) until age 46. Through gender-specific latent class analyses on annual employment roles, we identified traditional, highly educated, self-employed, delayed and floundering employment trajectories with distinct socioeconomic characteristics. We addressed attrition by conducting weighted analyses.

Results: Floundering trajectories were common among individuals with SZ (79% of men, 73% of women) and OP (52% of men, 51% of women). In NP, a traditional employee trajectory was most common in men (31%), and a highly educated trajectory in women (28%). A history of psychosis was associated with heightened odds ratios (ORs; 95% confidence intervals (CIs)) for floundering trajectories in both men (SZ: 32.9 (13.3–81.4); OP: 7.4 (4.0–13.9)) and women (SZ: 9.9 (4.6–21.5); OP: 3.9 (2.1–7.1)) compared to NP. Weighted analyses produced similar results.

Conclusion: Most individuals with SZ or OP have floundering employee trajectories reflecting an elevated risk of unemployment and part-time work until midlife. These results indicate the importance of improving labour market attachment during the early phases of psychoses.

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Series: Social psychiatry and psychiatric epidemiology
ISSN: 0933-7954
ISSN-E: 1433-9285
ISSN-L: 0933-7954
Volume: 58
Pages: 65 - 76
DOI: 10.1007/s00127-022-02327-6
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Funding: Open Access funding provided by University of Oulu including Oulu University Hospital. The NFBC1966 46 year follow-up received funding from the University of Oulu Grant no. 24000692, Oulu University Hospital Grant no. 24301140, ERDF European Regional Development Fund Grant no. 539/2010 A31592. T.M. received funding from the Iso-Mällinen Foundation, the University of Oulu Scholarship Foundation and Oulu University Hospital (EVO Funding). J.M. received funding from the Juho Vainio Foundation and the Yrjö Jahnsson Foundation. E.J. received funding from the Academy of Finland (grant number 316563).
Academy of Finland Grant Number: 316563
Detailed Information: 316563 (Academy of Finland Funding decision)
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