Table 2_Barriers and facilitators of employment in severe mental illness: an umbrella review.docx

IntroductionEmployment is one of the most important means of meeting an individual's psychological, social, and economic needs. Severe mental health illness (SMI) poses a significant challenge to managing psychological resources, which can further impede one's employability. The purpose of this research is to investigate the contextual factors associated with employment for individuals suffering from SMI, for the benefit of both their well-being, as well as the wider economic and social context they live in.
MethodsThis umbrella review evaluates the available literature from PubMed and PsycINFO. It included systematic reviews, meta-analyses, and scoping reviews, for which a quality appraisal was conducted using the AMSTAR 2 Checklist and the Scoping Review Checklist.
ResultsOur search identified 40 reviews, from which we pulled seven evidence-based factors associated with employment, four facilitators, and three barriers. Receiving individual placement and support represents the facilitator that was most extensively researched, with reported employment rates up to 61%, while negative symptoms represent the most robustly identified barrier.
DiscussionOverall, the synthesis of evidence highlights underlying factors that might shape employment for individuals with SMI and identifies interventions that hold potential for further development. It also underscores the necessity for conceptual consistency and reveals significant heterogeneity in the literature, which diminishes the generalizability of the results.
Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42023460410, PROSPERO CRD42023460410.

引言
就业是满足个体心理、社交与经济需求的最重要途径之一。重性精神疾病（Severe Mental Health Illness, SMI）会对个体心理资源管理造成显著挑战，进而损害其就业能力。本研究旨在探究与重性精神疾病患者就业相关的情境因素，以期改善患者福祉，并优化其所处的宏观经济与社会环境。

方法
本伞状综述对PubMed与PsycINFO数据库中的现有文献进行系统梳理。研究纳入了系统综述、荟萃分析以及范围综述，并采用AMSTAR 2清单（AMSTAR 2 Checklist）与范围综述清单（Scoping Review Checklist）对纳入文献开展质量评价。

结果
本次检索共识别出40篇综述，从中提取出7项与就业相关的循证因素，其中4项为促进因素，3项为阻碍因素。个体化安置与支持（Individual Placement and Support）是被研究最为广泛的促进因素，相关报道的就业率可达61%；而阴性症状则是被证实最为稳定的阻碍因素。

讨论
综上，本次证据综合梳理明确了可能影响重性精神疾病患者就业的潜在因素，并识别出具备进一步开发潜力的干预手段。同时，研究也强调了研究概念一致性的必要性，并揭示了现有文献中存在的显著异质性，这一问题会削弱研究结果的外推性。

系统综述注册信息
https://www.crd.york.ac.uk/PROSPERO/view/CRD42023460410，PROSPERO CRD42023460410。