Employment trends in schizophrenia and bipolar disorder in Spain: a nationwide register-based study (2018-2023).
Source: PubMed, NCBI / U.S. National Library of Medicine
Employment is a key determinant of recovery in severe mental illness, yet longitudinal evidence from Southern Europe is limited. We aimed to examine national trends in employment status among individuals with schizophrenia and bipolar disorder in Spain between 2018 and 2023. We conducted a register-based trend study using the Spanish Primary Care Clinical Database (BDCAP), including adults aged 20-64 years with schizophrenia (n = 139,594), bipolar disorder (n = 148,968), or other diagnoses (n = 25,953,622). Employment status was classified as employed, unemployed, economically inactive, disability pensions, or other statuses. Trends were analysed with Joinpoint regression, reporting Average Annual Percent Change (AAPC) with 95% CIs. In 2023, 15.2% of people with schizophrenia and 38.3% with bipolar disorder were employed, versus 62.5% with other conditions. Disability pensions were received by 49.3% and 26.5%, compared with 6.3% in other diagnoses. Between 2018 and 2023, employment rose modestly in schizophrenia (AAPC =  + 2.2; 95% CI 0.8-3.6; p < 0.001) and bipolar disorder (+ 2.4; 95% CI 1.6-3.2; p < 0.001), while disability pensions declined (-5.5; 95% CI - 8.9 to - 2.1; p = 0.003; and - 7.2; 95% CI - 9.4 to - 5.1; p < 0.001). The "other statuses" category grew sharply
Abstract
Employment is a key determinant of recovery in severe mental illness, yet longitudinal evidence from Southern Europe is limited. We aimed to examine national trends in employment status among individuals with schizophrenia and bipolar disorder in Spain between 2018 and 2023. We conducted a register-based trend study using the Spanish Primary Care Clinical Database (BDCAP), including adults aged 20-64 years with schizophrenia (n = 139,594), bipolar disorder (n = 148,968), or other diagnoses (n = 25,953,622). Employment status was classified as employed, unemployed, economically inactive, disability pensions, or other statuses. Trends were analysed with Joinpoint regression, reporting Average Annual Percent Change (AAPC) with 95% CIs. In 2023, 15.2% of people with schizophrenia and 38.3% with bipolar disorder were employed, versus 62.5% with other conditions. Disability pensions were received by 49.3% and 26.5%, compared with 6.3% in other diagnoses. Between 2018 and 2023, employment rose modestly in schizophrenia (AAPC =  + 2.2; 95% CI 0.8-3.6; p < 0.001) and bipolar disorder (+ 2.4; 95% CI 1.6-3.2; p < 0.001), while disability pensions declined (-5.5; 95% CI - 8.9 to - 2.1; p = 0.003; and - 7.2; 95% CI - 9.4 to - 5.1; p < 0.001). The "other statuses" category grew sharply (schizophrenia + 52.8; bipolar disorder + 35.4; both p < 0.001). Sex-stratified analyses showed parallel trends, except for economic inactivity, which declined more steeply among women (Δ trend =  + 3.1, p = 0.029; + 2.7, p = 0.031; + 3.2, p = 0.008). Employment outcomes remain poor for people with schizophrenia and bipolar disorder in Spain. Most improvements likely reflect administrative changes rather than genuine integration into work.