Mental Health Diagnosis and Occupational Functioning in National Guard/Reserve Veterans Returning from Iraq

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INTRODUCTION

A successful transition back into civilian life for returning veterans following combat deployment is a vital concern for the United States and the Department of Veterans Affairs (VA). Our newest generation of combat veterans returning from Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) are faced with reintegrating into potentially disrupted family, social, and occupational roles; this may be even more difficult for National Guard/Reserve (NGR) veterans. Civilian reintegration can also be especially difficult for veterans experiencing mental health impairments (i.e., posttraumatic stress disorder [PTSD], depression, and alcohol or drug use disorders). We examined the role of mental health impairments on employment status and work role functioning in a cohort of NGR servicemembers in the first year following return from OIF combat deployment.

Military personnel returning from OIF/OEF are at increased risk for a range of mental health problems, including PTSD, depression, and alcohol abuse or dependence [1-3]. This risk appears to be greater for NGR veterans than regular Active Duty (AD) veterans [3-5]. Milliken et al. found that rates of PTSD and depressive symptoms more than doubled among NGR servicemembers within 6 months of their initial return from deployment and that this rate of increase substantially exceeded the rate of increase in regular AD servicemembers [5]. In a study examining trends and risk factors for mental health diagnoses among 289,328 OIF/OEF veterans entering VA healthcare from 2002 to 2008, Seal et al. found higher rates for PTSD, depression, and all other mental health diagnoses in NGR veterans seeking care in the VA compared with AD veterans [6]. Seal et al. also found that rates of mental health diagnosis increased over time following return from deployment. Thus, unfortunately, problems continue to develop for veterans in the months and years after returning from OIF.

Explanations for the differences between NGR and AD military personnel in mental health functioning include both deployment-related and postdeployment stressors that apply particularly to NGR servicemembers. Compared with AD military personnel, NGR servicemembers or "civilian soldiers" are more likely to have family and occupational circumstances that are not well-suited for the prolonged absence of a combat deployment. For example, most NGR personnel have civilian jobs and careers that can be disrupted by a yearlong absence. Families may be both less accustomed to and less supported during these absences. In contrast with AD military culture, NGR servicemembers and families may not be integrated into military communities that are understanding and supportive of combat deployments. Thus, NGR servicemembers may face unique reintegration challenges as they move from warfighter to civilian roles, and occupational challenges may represent one key aspect of those challenges [7-8].

The mental health challenges confronting returning servicemembers, and NGR veterans in particular, may have negative implications for occupational functioning. Psychiatric disorders such as PTSD and depression have been associated with impaired occupational functioning in veterans from other conflicts, primarily in Vietnam war veterans. More than 20 years after the end of the Vietnam war, Savoca and Rosenheck found that a lifetime diagnosis of PTSD was associated with a nearly 50 percent lower probability of current employment in Vietnam war veterans [9]. In addition, effects on employment rates were nearly as large for major depressive disorders (MDDs) as well as anxiety disorders. Substance abuse also had a significant, but smaller, negative effect on probability of employment. PTSD and depression were associated with large decreases in hourly wage rates: 16 and 45 percent, respectively. Similarly, in a sample of 325 veterans with PTSD receiving treatment, Smith et al. …