EMPLOYMENT rates among people with schizophrenia and bipolar disorder remained substantially lower than those of the wider Spanish population in 2023, despite slight increases in recorded employment over the previous five years, according to a national register-based study.
Schizophrenia and bipolar disorder are chronic, severe mental illnesses that can affect cognitive, social and occupational functioning, often limiting participation in the workforce. Employment is a key determinant of recovery in severe mental illness, yet long-term unemployment and reliance on disability benefits remain common among people living with these conditions.
Employment Rates Lag Far Behind Other Diagnoses
Researchers analysed data from Spain’s Primary Care Clinical Database, covering adults aged 20-64 years with schizophrenia (139,594 individuals), bipolar disorder (148,968), or other diagnoses (25.9 million) between 2018 and 2023.
In 2023, employment rates were 15.2% among people with schizophrenia and 38.3% among those with bipolar disorder, compared with 62.5% among individuals with other diagnoses.
Nearly half of people with schizophrenia (49.3%) received a disability pension, while the figure was 26.5% among those with bipolar disorder. In contrast, 6.3% of people with other diagnoses received disability benefits.
Modest Employment Gains Accompanied by Falling Disability Pensions
Recorded employment rose slightly over the study period, with an average annual increase of 2.2% in schizophrenia and 2.4% in bipolar disorder.
At the same time, disability pension receipt declined, falling by 5.5% per year in schizophrenia and 7.2% per year in bipolar disorder, suggesting a gradual shift away from permanent incapacity status.
However, researchers also identified a rapid increase in a residual administrative category labelled “other statuses”. This grouping includes individuals affiliated through non-standard social security arrangements, such as special mutual insurance schemes or undefined categories, rather than conventional employment or benefit pathways.
Administrative Classification Shifts Complicate Interpretation
The “other statuses” category showed the steepest growth across both conditions. While it does not represent employment, unemployment, or disability in the traditional sense, its expansion coincided with declines in disability pensions, raising the possibility that some changes in recorded labour outcomes may reflect administrative reclassification rather than true shifts in workforce participation.
Sex-stratified analyses showed broadly similar trends in men and women. The only notable difference was a steeper decline in economic inactivity among women across both schizophrenia and bipolar disorder.
Limited Progress in Workforce Inclusion for Those with Severe Mental Illnesses
International evidence from Northern Europe has consistently reported similarly low employment levels in severe mental illness, with schizophrenia typically around 10–20% and bipolar disorder around 30–50%. Evidence from Southern Europe, particularly Spain, has been more limited and less frequently updated.
While recorded employment rose slightly over time, the authors caution that the pattern likely reflects a combination of small real changes and administrative shifts within the social security system rather than substantial improvements in labour market integration.
Overall, the findings highlight persistent structural barriers to employment for people living with schizophrenia and bipolar disorder, despite ongoing policy interest in improving social and occupational recovery.
Reference
Llorca-Bofí V et al. Employment trends in schizophrenia and bipolar disorder in Spain: a nationwide register-based study (2018–2023). Eur Arch Psychiatry Clin Neurosci. 2026;DOI:10.1007/s00406-026-02279-x.
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