Employment trajectories following the diagnosis and after long-acting injectable antipsychotic treatment in patients with schizophrenia: A nationwide study

OBJECTIVE: This study examined employment trajectories following the diagnosis and antipsychotic treatment of schizophrenia, with particular focus on transitions to long-acting injectable antipsychotic treatment. METHODS: We conducted a nationwide matched cohort study using Taiwan's National Health Insurance Research Database (2001-2021). Individuals aged 18-64 years with newly diagnosed schizophrenia spectrum disorders were matched 1:1 with individuals without schizophrenia by birth year, sex, and index date. Employment trajectories were analyzed using controlled interrupted time-series models. To evaluate treatment-related transitions, individuals initiating long-acting injectable antipsychotics were compared with matched oral antipsychotic users. Subgroup analyses were conducted by illness duration and baseline medication adherence. RESULTS: The schizophrenia cohort (n = 93,041) showed substantially lower employment odds than matched comparisons (OR = 0.31), with a marked decline around diagnosis (OR = 0.90) and only modest recovery thereafter (post-diagnosis trend OR = 1.09 per year). In the treatment analysis (18,488 matched pairs), long-acting injectable users had lower baseline employment odds than oral antipsychotic users (OR = 0.85) and an immediate decline around long-acting injectable initiation (OR = 0.92), followed by a modestly more favorable post-initiation employment trend (OR = 1.03). More favorable post-initiation trends were observed among individuals with longer illness duration and lower baseline adherence. No meaningful differences in employment trajectories were observed across different long-acting injectable formulations, including flupentixol, risperidone, haloperidol, paliperidone, and fluphenazine. CONCLUSIONS: Employment outcomes in schizophrenia appear shaped by diagnostic and treatment-related transitions rather than static disease status. Stabilization after long-acting injectable initiation may be linked to incremental improvements in employment trajectories for some subgroups, but optimizing long-term vocational outcomes likely requires integrated psychosocial and vocational support.