Factors related to employment across vocational levels in patients with schizophrenia: focus on subminimum wage non-competitive employment

Patients with schizophrenia often face difficulty in employment. Non-competitive supported employment serves as an important option for individuals with schizophrenia, yet research focusing on such type of work is rare. This study aimed to investigate factors related to employment in schizophrenia. We particularly focused on patients engaging in subminimum wage non-competitive supported work by comparing such patients to those receiving minimum wage or above and those unemployed. We recruited 282 outpatients from 16 to 65 years old diagnosed with schizophrenia or schizoaffective disorder. Data were collected from September 2024 to February 2025. Participants were categorized into two groups: employed and unemployed. The employed group consisted of patients with full-time jobs, part-time jobs, those employed through a special system for individuals with disabilities, minimum wage or above non-competitive supported employment, and subminimum wage non-competitive supported employment. We evaluated schizophrenia symptoms using the Brief Evaluation of Psychosis Symptom Domains (BE-PSD), social functioning using the Global Assessment of Functioning (GAF), and collected demographic and clinical data. Comparative and subgroup analyses with focus on subminimum wage non-competitive employment were conducted. Employment was associated with milder negative symptoms (p = 2.64 × 10− 6), less excitement (p = 0.0173), younger age (p = 0.00580), and male sex (p = 0.0274). Additionally, achieving employment paying minimum wage or above was linked to milder negative symptoms (p = 0.00150), disorganization symptoms (p = 0.00271), and depression/anxiety symptoms (p = 0.0389). No significant differences were observed between participants in subminimum wage paying non-competitive employment and those unemployed. Negative symptoms and excitement symptoms may be important clinical correlates of employment among patients with schizophrenia. The lack of significant differences between those engaged in subminimum wage paying non-competitive employment and those unemployed should be interpreted with caution, but it may suggest that subminimum wage paying non-competitive employment represents a level of vocational engagement that remains accessible even for individuals with more severe symptom burden. Not applicable.