The role of socioeconomic and structural vulnerability risk factors in employment outcomes for individuals with Schizophrenia and other psychotic disorders.

Individuals with schizophrenia and other psychotic disorders face substantial employment challenges, particularly in wage attainment, despite the availability of vocational rehabilitation (VR) services. This study examines the association between socioeconomic and structural vulnerability risk factors, VR service engagement, and hourly wage at exit among individuals with schizophrenia and other psychotic disorders. Using data from the Rehabilitation Services Administration Case Service Report (RSA-911) database, this study analyzed a sample of 13,098 individuals with schizophrenia and other psychotic disorders who received VR services. A hierarchical regression analysis was conducted to examine the sociodemographic variables, disability-related characteristics, and VR engagement predictive of hourly wage at exit. Findings indicate that race (Black or African American) was a significant negative predictor of hourly wage at exit (β = -0.050, p<.001). The presence of a secondary disability (β = -0.031, p<.01) and severity of disability (β = -0.047, p<.001) were negatively associated with hourly wage at exit. Importantly, the total number of VR services received emerged as the strongest positive predictor (β = 0.242, p<.001), suggesting that increased engagement with VR services improves wage outcomes. The socioeconomic and structural vulnerability index score was significantly associated with lower wages at exit (β = -0.066, p<.001). Based on our results, we suggest that VR service providers should expand structurally and socioeconomically responsive outreach, addressing basic skill deficits, housing instability, language limitations, childcare needs, and other structural and socioeconomic risk factors, which may eventually improve equitable resources allocation, service planning, and overall employment outcomes.