Running head: Motivation to obtain and sustain employment Title
Evaluating the motivation to obtain and sustain employment in people with psychiatric disabilities
Disclosures of Conflicts of Interest: None for any author.
Abstract
The motivation to work is an important predictor of employment success in the general population as well as in mentally ill individuals. The present article examines the issue of motivation to get and maintain employment in people with psychiatric disorders. Two studies were conducted in order to determine the validity of the Motivation to Find a Job Scale (N = 366 Canadian people with severe mental illness registered in supported employment
programs) and the Motivation to Keep a Job Scale (N = 268 Italian people with psychiatric disorders employed in social enterprises). The two questionnaires showed satisfactory psychometric proprieties and showed links with important vocational outcomes, such as getting competitive employment. Those instruments indeed may facilitate the estimation of people’s willingness to find a job and to remain at work after the onset of a mental illness and can be used as a significant tool to predict vocational success.
Keywords: mental illness; motivation; validation of scales; intention to work; vocational outcomes.
Work has been shown to be of great significance in mental health and a very meaningful and desirable activity for people suffering from a severe mental illness . Unfortunately,
employment rates for people with mental illness are still unacceptably low and significantly lower than those for the general population or those of persons with physical disorders . Furthermore, job tenure tends to be particularly brief for this population, often less than six months . The challenge of supporting people in getting and maintaining jobs has led in recent years to the development of a range of employment support models and to a proliferation of programs to help people with severe mental illness gain and maintain employment . Among these, supported employment programs have been particularly effective in helping people quickly obtain a regular job in the community . Another model, social enterprises, has been identified by several authors as offering a context (e.g., flexible environment, social support, work accommodations) that seems to help people with mental illness maintain their
employment.
One of the major themes in the literature identified as being important in helping participants return to work or remain employed following the onset of a severe mental illness is the motivation to work . Motivation is the expression of the forces that lead a person to perform a particular action in order to meet a goal or to satisfy certain needs (i.e., biological or psychological needs). By definition, motivation refers to what activates and directs human behavior and how this behavior is sustained to achieve a particular goal . Motivation has been found to be a predictor of employment success in the general population . It is also generally agreed that the motivation to work has a significant influence on whether people with severe mental illness gain competitive employment . For people with a severe mental illness, being motivated to work means that they have a personal quality that pushes them to take advantage of the work opportunities that bump into. In contrast, the lack of motivation is a negative symptom associated with schizophrenia and major depression, and it has been found in the
literature to be a prevalent barrier to employment and one of the most frequent reasons for job separation .
Thus, these studies suggest that the motivation to work is an important factor in employment success for people with severe mental illness and it is one of the individual characteristics that play a part in determining whether a person with mental illness will find and keep employment. Indeed, people with low motivation may be less likely to put in the necessary efforts to move to competitive employment and to maintain their job once gained. It is important to notice that motivation is not a fixed trait, as it could change with changes in personal, psychological, financial, social or environmental factors . Thus, given the positive impact of work on the persons’ well-being and integration in society, it becomes relevant to explore the motivation to work, especially in this vulnerable population of workers, i.e. individuals with mental illness, who find it difficult to fully integrate into work. Exploring their motivation to work and how this factor relates to vocational success might be a valuable first step in order to support this population in getting and keeping successfully jobs.
While the issues of motivation seem important, to our knowledge no measures of self-assessed motivation to find and to keep a job have been used with people with severe mental illness. The overall objective of the present study is to determine the validity of the
Motivation to Find a Job and the Motivation to Keep a Job scales in individuals with mental illness in two different context: (a) supported employment programs, as they are reported in the literature as being effective in helping individuals with mental disorders to obtain a job; and (b) social enterprises, as there is growing evidence of their important role in facilitating job tenure in vulnerable populations of workers. Our two specific objectives are: (a) to validate the Motivation to find a job scale for people with mental disorders registered in supported employment programs; and (b) to validate the Motivation to keep a job scale for people with mental disorders employed in social enterprises.
To achieve the main objectives of this paper, we performed two studies. In Study 1 we aimed to validate the Motivation to Find a Job (MTFJ) scale with people with severe mental illness enrolled in supported employment programs located in Canada. In Study 2 we aimed to validate the Motivation to Keep a Job (MTKJ) scale with people with severe mental illness employed in social enterprises located in Italy.
Study 1 Method
Data were collected from a larger Canadian study related to work integration of people with mental disorders registered in Supported Employment programs located in the Greater Vancouver area in Canada . The participants answered a battery of questionnaires (including demographics, severity of symptoms, and motivation to find a job) at their entry into
supported employment programs and took part in a phone interview on work outcomes (i.e. employment status) as a nine-months follow-up. The research project was reviewed and approved by the ethic boards of the University of British Columbia as well as of the Health Authorities and Hospitals in British Columbia. Participants received a compensation for their time and were recruited through their employment specialist who briefly presented the study to clients who fit the research criteria.
A total of 366 participants (181 women and 185 men, average age of 40.1 years, SD = 10.6) accepted and signed a consent form to participate in the study. Eligibility criteria for participants were as follows: looking for a job, having a psychiatric diagnosis, being 18 years or older, having basic written and spoken English. Most of the participants were single (N = 233; 63.7%). As for the educational level, 57 (15.6%) completed some high school or less, 148 (40.4%) completed a high school degree, 63 (17.2%) completed a collegial degree, and 90 (26.2%) attained a university-level education. In terms of mental illness, 205 (56%) suffered from mood disorders, 102 (27.9%) reported psychotic disorders in the schizophrenia
spectrum, 35 (9.6%) reported anxiety disorders and finally 24 (6.6%) reported having other types of psychopathology.
For the purpose of this article, we will focus only on the data stemming from the Motivation to Find a Job Scale (MTFJ), from the Brief Symptom Inventory , assessing participants’ severity of symptoms, and from the follow-up. The MTFJ was designed by with the aim to better understand and explore the conditions that could increase or reduce the motivation to find a job in people with mental illness. The questionnaire consists of seven items measuring motivation to obtain a job, measured on a seven-point Likert scale from 1 (Completely disagree) to 7 (Completely agree). The items of the MTFJ scale aim to measure motivation relating to obtaining a job through different angles such as: intention, self-efficacy to overcome obstacles putting the necessary efforts and the importance and centrality of work.
Two separate factor analyses were conducted on two distinct randomly-computer-selected samples from the original Canadian sample (N = 357). A Principal Component Analysis (PCA) was carried out on the first sample (N = 189) to explore potential emerging dimensions of the seven items of the scale, and different indices were considered such as scree plot (number of breaks), eigenvalues (> 1), percentage of variance on each emerging factor (minimum of 50% for total variance). A Confirmatory Factor Analysis (CFA) was then carried out on the second sample (N = 168) to verify the unidimensional factor structure obtained from the PCA. In order to explore the predictive validity of the MTFJ scale, and in particular to predict getting competitive employment, a logistic regression was conducted including individual variables that have been identified in the literature as being related to vocational outcomes (i.e., gender, age, motivation to find a job, severity of symptoms). Results
Considering all indices (i.e. scree plot, eigenvalue, and percentage of variance), the PCA suggested a one-dimension scale explaining 55.1% of the total variance (see Table 1).
The scale showed an internal consistency alpha coefficient of .85.The CFA was conducted on the MTFJ to verify the one-factor model with 7 items (see Table 1). CFA was performed using LISREL 8.7 , with the covariance matrix as input and Maximum Likelihood as the estimation method. Assessment of fit was based on several indices: Chi-square Test; Normed Chi-square (χ²/df`) ; Comparative Fit Index (CFI) ; Non-Normed Fit Index (NNFI) , and Root Mean Square Error of Approximation (RMSEA) . The model showed good fit indices (see Table 2).
To predict vocational successes--i.e. getting competitive employment--a logistic regression analysis was carried out. Only participants who completed the follow-up were included. We excluded from the analyses those who had obtained transitional employment instead of competitive employment (n = 21).Consequently, the final sample size was made of 281 participants. In order to explore the relationship between individual characteristic and the work outcome, a model was tested including gender, age, motivation to find a job, and
severity of symptoms (see Table 3). The logistic regression generated a model in which the motivation to find a job was the only significant predictor of getting a competitive
employment. In particular, people with high scores obtained at the MTFJ scale was 1.3 times as likely to obtain a competitive job (OR = 1.346, 95% CI 1.02-1.78).
Study 2 Method
A cross sectional research related to work integration of people with mental illness employed in Social Enterprises was conducted in Italy. Several Social Enterprises offering work integration services to physically and mentally disadvantaged people located in Northern Italy took part in this study. Participants were recruited through the “Responsabile Sociale”, who is the person in charge of following the work integration of disadvantaged
workers (e.g., people with mental illness) in the social enterprise. Eligibility criteria for participants were the following: having a psychiatric diagnosis, being 18 years or older, and being employed in a Social Enterprise.
Two-hundred and sixty-eight participants (177 men) registered in 33 Social
Co-operatives located in Northern Italy accepted to participate to the study. Participants ranged in age from 20 to 64 years (M = 41.23; SD = 8.58). As for the psychiatric diagnosis,
self-reported by the participants: 64 (23.9%) self-reported psychotic disorders in the schizophrenia spectrum, 34 (12.7%) reported having mood disorders, 25 (9.3%) reported personality disorders, 15 (5.6%) reported substance misuse disorders, and eight (3.0%) reported anxiety disorders. As for the educational level, 145 (55.2%) completed middle school or less, 97 (36.2%) completed some high school and 10 (3.7%) attained a university-level education. In terms of marital status, 213 (79.5%) were single or separated, widowed or divorced, and 33 (12.3%) were married or with a domestic partner.
With the aim to better understand and explore the conditions linked to the motivation to keep a job in people with mental illness, the Motivation to Find a Job scale has been adapted to the context of maintaining employment. The resulting Motivation to Keep a Job scale (MTKJ) is also available in English and French and has been translated in Italian . In order to validate the Motivation To Keep A Job (MTKJ) scale, data collected at baseline from this prospective study were used (N = 268). Data were collected through a battery of
questionnaires including demographics, and measures of motivation to keep a job , severity of symptoms , work engagement , organizational constraints and an ad-hoc scale developed to learn more regarding future working plans of participants, i.e. the intention to stop working or continue working. Participants received a compensation for their time. The research project was reviewed and approved by the Ethics Committee of University of Trento and founded by
the Municipality of Rovereto (TN). After a complete description of the study to the participants, written informed consent was obtained.
The MTKJ scale translated in Italian consists of 7 items measuring the motivation to keep the job once obtained. The items are measured on a seven-point Likert scale from 1 (Completely disagree) to 7 (Completely agree). The items of the MTKJ scale measure the same conceptual dimensions as those found in the MTFJ scale, but are linked to the motivation of keeping the job. A CFA was conducted on the Italian sample (N = 268) to validate the adaptation of the MTFJ to the context of keeping a job. CFA was performed using LISREL 8.7 , with the covariance matrix as input and Maximum Likelihood as the estimation method. Assessment of fit was based on the same statistics we used in Study 1 Satisfactory fit was obtained when the Chi-square test was non-significant, but given the dependence of the Chi-square Test on sample size, it was advisable to inspect other indices . The Normed Chi-square measure (2/df) for values between 1.0 and 5.0 were considered to fall within acceptance levels . The CFI and NNFI indicated an acceptable fit of the model to the data if they were ≥ .90. RMSEA index values in the range of .05 to.08 indicated a fair fit . Correlation analysis was conducted with the aim of verifying the convergent and discriminant validities of the Motivation to Keep a Job scale.
Correlation analyses using variables related to the work integration process (i.e., plan to stop working, severity of symptoms, work engagement, organizational constraints, plan to work in the same social enterprise) were used to verify the convergent and discriminant validities of the MTFJ scale.
Results
The CFA was conducted on the MTKJ to verify the one-factor model with seven items. The model showed satisfactory fit indices except for the RMSEA index (Table 2).
would improve, suggesting that these two items are linked. The revised model showed better fit indices, particularly as concerns the RMSEA index (see Table 2).
Table 1 shows the standardized parameter estimates for the confirmatory factor analysis model revised. In accordance with the findings reported in previous studies, we expected motivation to be positively related to an important job-related attitude, i.e. work engagement. Table 4 shows the correlations between the variables. The motivation to keep a job positively and significantly correlated with work engagement, r = .46, p < .01 and with planning to continue working in the same Social Enterprise in which they were currently employed, r = . 25, p < .01. Moreover, the motivation to keep a job showed a negative correlation with organizational constraints, r = -.23, p < .01, and severity of symptoms, r = -.27, p < .05). Finally, scores at the MTKJ scale were negatively related to the intention to stop working in the future, r = -.25, p < .01).
General discussion
Predicting employments’ outcomes is difficult in the field of mental illness and empirical evidence offers limited guidance about factors related to getting and to sustaining competitive employment . Given the importance of motivation in helping people return to work or remain employed following the onset of a severe mental illness , the goal of this research was to validate two similar measures of work motivation, the Motivation to Find a Job scale and the Motivation to Keep a Job scale.
Findings reported in Study 1 and Study 2 supported the internal validity of both scales, the former with a sample of people with severe mental illness enrolled in Supported
Employment programs in Canada, and the latter with a sample of people with severe mental illness employed in Italian Social Enterprises. As found in other studies, we did not find any association between age, gender and clinical variables, such as severity of symptoms on employment outcomes. To address convergent validity and discriminant validity of the
Motivation to Keep a Job (MTKJ) scale a correlation matrix was calculated on different variables, such as work engagement and motivation to keep a job. As expected, all the variables taken in account were significantly correlated with the motivation to keep a job. In addition, we found the motivation to be negatively correlated with organizational constraints and severity of symptoms. This highlighted the fact that motivation is an individual
characteristic that is not a stable trait, as it can be influenced by different types of factors, such as clinical (e.g., symptoms) and organizational variables, on which different stakeholders can intervene. Results also showed that people with high scores at the MTKJ scale were unlikely going to stop working in the future. Results from our research were consistent with the literature, confirming motivation (either to obtain employment and to keep the job in time) as a key concept to predict work outcome such as get employment and job tenure.
Both motivation scales validated in the study are brief, easy to use, with useful clinical implications. A major strength of our study is that the variables assessed (motivation to find and to keep a job) will allow the researcher to capture significant aspects of work integration in people with severe mental illness. Moreover, the use of sophisticated statistical analyses with two separate and international samples (Canadian and Italian) gave strong support to the validity of our findings. Another strength of the study was that we have examined the
motivation to work in two different vocational contexts: the supported employment programs and the social enterprises. In particular, the first is known as being an efficient strategy to help people with severe mental illness obtain employment, and the second is increasingly being investigated as a potential alternative context to help people with severe mental illness sustain employment. Thus, from an applicative and clinical point of view, the new measure of motivation presented in this study can assist employees and clinicians in helping people with low motivation to benefit from specific training programs or interventions with the aim of helping them in the elaboration of their awareness in being workers. Indeed, the MTFJ and
MTKJ scales should not be seen as a screening tool useful to employees seeking to hire only the most motivated people, but as a starting point for implementing strategies to help increase motivation, thus improving people’s level of engagement and vocational outcome in terms of productivity.
On the negative side, the present study had some limitations we would like to address. Study 1 included different types of supported employment programs (e.g., IPS and Choose-Get-Keep models), which can somehow have an impact on vocational outcomes. Moreover, the two studies have been performed non non-representative samples. Furthermore, in Study 2 we could not manage longitudinal data enabling us to assess the enduring relation between the motivation to keep a job and long-term job tenure for people with mental disorders.
The demonstration of the relevance of motivation in successful vocational outcome is an important first step in examining work integration of people with severe mental illness, but it is certainly not the last step. Future research might perform multidimensional longitudinal studies to gain further insights. Indeed, the next steps in the validation process of the scales we analyzed in this article will be to consider longitudinally the predictive validity of the instrument related to the motivation to keep the job. Moreover, further investigations are needed in order to establish the actual benefits of motivation on the work integration process within longitudinal design as well as the potential fluctuations of the motivation across time. Yet, variations in terms of motivation to get competitive employment could be investigated to learn what are the external and internal reasons associated to these changes. In fact, changes regarding motivation to maintain employment could be related to psychosocial variables such as accommodations; thus, interventions could be implemented in the social enterprise to facilitate the work pace of people with severe mental illness. Other reasons of these changes could be inherent to the employee’s need of integrating the regular job market or a level of
self-efficacy to do work tasks. Consequently, changes regarding motivation (getting and maintaining employment) could be investigated to better intervening on people with severe mental disorder. Studies performed by integrating organizational (e.g. accommodations) and individual (e.g., self-efficacy) aspects of the work integration of people with severe mental disorders, in a longitudinal perspective will be particularly interesting.
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Table 1.
Exploratory Factor Analysis (EFA;N = 189) and Confirmatory Factor Analysis (CFA; N=168) of Motivation to Find a Job; and Confirmatory Factor Analysis (CFA; N=268) of Motivation to Keep a Job(Italian version in italics).
Motivation to Find a Job EFA CFAlambda-x(theta-delta)
1. Right now, getting a job is one of my main objectives .86 .78 (.39)
2. I am determined to get a job regardless of potential obstacles .83 .78 (.38)
3. I really feel motivated to find a job .80 .82 (.33)
4. Presently, I firmly intend to obtain a job .79 .59 (.66)
5. I am willing to put in the necessary efforts in order to get a
job
.68 .65 (.58) 6. I currently feel able to enter in the workplace .68 .71 (.50) 7. I would be very disappointed if I were not able to get a job in
weeks to come
.50 .45 (.80)
Motivation to Keep a Job Revised CFAlambda-x(theta-delta)
1. Right now, maintaining my job is one of my main objectives;
Al momento, mantenere il mio lavoro è uno dei miei principali obiettivi
.81 (.34)
2. I am determined to continue working regardless of potential
obstacles; Sono determinato a continuare a lavorare qualunque siano gli eventuali ostacoli
.76 (.42)
3. I really feel motivated to keep my job; Mi sento realmente
motivato a tenere il mio lavoro
.87 (.24)
4. Presently, I firmly intend to continue working; Attualmente,
sono fermamente intenzionato a continuare a lavorare
.70 (.51)
5. I am willing to put in the necessary efforts in order to
maintain my job; Sono disposto a fare gli sforzi necessari per mantenere il mio lavoro
.85 (.27)
6. I currently feel able to remain at work; Attualmente mi sento
in grado di rimanere al lavoro
.79 (.38)
7. I would be very disappointed if I were not able to keep my
job; Sarei molto deluso se non fossi in grado di tenere il mio lavoro
.50 (.75)
Note. Standardized parameter estimates are showed for the confirmatory factor analysis; lambda-x, p< .01
Table 2.
Goodness-of-Fit Indices
χ² p df N χ²/df NNFI CFI RMSEA
CFA-Motivation to Find a Job 12.77 .54 14 168 .91 1.00 .1.00 .0 CFA-Motivation to Keep a Job 50.81 .00 14 268 3.63 .97 .98 .09 Revised CFA-Motivation to Keep a Job 33.39 .00 13 268 2.57 .98 .99 .07
Note. χ² = Chi-square Test; χ²/df = Normed Chi-square; NNFI = Non-Normed Fit Index; CFI = Comparative Fit Index; RMSEA = Root Mean Square Error of Approximation.
Table 3.
Patient characteristics predictor models (Study 1)
Predictors OR(95%CI) P
1. Gender 0.86 (0.524-1.412) 0.55
2. Age 1.00 (0.97-1.02) 0.70
3. Motivation to find a job 1.35 (1.02-1.78) 0.04
Table 4.
Means, Standard Deviations, and Correlations between variables (Study 2)
M SD 1 2 3 4 5
1. Motivation to keep a job 5.97 1.31
-2. Plan to stop working 2.88 1.51 - .25**
-3. Severity of the symptoms 1.95 0.74 - .27* .09
-4. Work engagement 4.31 1.52 .46** -.24** -.18**
-5. Organizational constraints 1.64 0.73 -.23** 0.10 .27** -.12
-6. Plan to work in the same social
enterprise 3.73 1.49 .25** -.01 -.07 .20** -.18**
Note: N = 268. Organizational constraints, severity of the symptoms, plan to stop working and to work in the same social enterprise were on 5-point Likert scales. Motivation to keep a job (1-7) and work engagement (0-6) were on 7-5-point Likert scales. * p < .05. ** p < .01.
