Protocol for - Association of antipsychotic medication usage and employment outcomes in patients with schizophrenia spectrum disorders: A Danish register-based study

BackgroundSchizophrenia spectrum disorders are associated with higher risk of unemployment for the individual. Antipsychotic usage is linked to less risk of relapse, fewer hospitalisations and lower rates of mortality. This study investigates the use and discontinuation of antipsychotics in individuals with psychosis in relation to employment and other functional outcomes. MethodsUsing Danish nationwide registers, we identify individuals aged [&ge;]18 with first-time nonaffective psychosis diagnosis (ICD-10 F20-F29) during 1995-2024. Antipsychotic exposure is categorised as continuous use ([&ge;]80% coverage), intermittent use (20-80%), sustained discontinuation (<20%), or no use. Functional outcomes include: employment status, benefit code, hospital readmission. Within-subject analyses use each individual as their own control, with time-varying covariates and 6-, 12-, and 24-month lagged effects. Models adjust for treatment sequence, time since diagnosis, and concurrent psychotropic medication use. HypothesesO_LIFor individuals with schizophrenia spectrum disorders, periods of antipsychotic treatment will be associated with higher likelihood of O_LIemployment/ education/training and C_LIO_LIindependent living, relative to periods without such treatment. C_LI C_LI Exploratory hypothesesPeriods of long acting injectables or clozapine treatment will be associated with higher likelihood of employment/ education and independent living relative to periods with other antipsychotic treatment.