Academic journal article Journal of Rehabilitation Research & Development

Posttraumatic Stress Disorder and Employment in Veterans Participating in Veterans Health Administration Compensated Work Therapy

Academic journal article Journal of Rehabilitation Research & Development

Posttraumatic Stress Disorder and Employment in Veterans Participating in Veterans Health Administration Compensated Work Therapy

Article excerpt

INTRODUCTION

Vocational rehabilitation services for people with serious mental illness, especially supported employment (SE), are increasingly considered to be central features of a "recovery-oriented" service system [1]. While the evidence for SE for people with severe mental illnesses such as schizophrenia and bipolar disorder is strong [2], much less is known about individuals with a primary diagnosis of posttraumatic stress disorder (PTSD) participating in vocational rehabilitation.

Several studies have examined the relationship between PTSD and employment outside of vocational services. One population-based survey of Vietnam-era veterans found that those with combat-related PTSD were significantly less likely to be employed than those without PTSD and PTSD diagnosis was associated with a lower hourly wage among those in the competitive workforce [3]. In a cross-sectional study of veterans with PTSD beginning a clinical trial, increased severity of PTSD was associated with a decreased likelihood of fulltime employment [4]. Magruder et al. also found an association between PTSD severity and unemployment in veterans receiving primary care services [5].

We located only two studies that examined outcomes of individuals with PSTD participating in vocational rehabilitation. In the first, two groups of veterans with PTSD participating in a Department of Veterans Affairs (VA) specialized PTSD treatment program were compared: those enrolled in Compensated Work Therapy (CWT), a VA vocational rehabilitation program, and a matched sample of those not enrolled in CWT [6]. At a 4-month follow-up, no differences existed in employment status between the two groups. Mueser et al. conducted a secondary analysis of data from a randomized trial comparing three different vocational programs for people with severe mental illness [7]. Of the sample, 16 percent (n = 28) met criteria for PTSD in addition to at least one other Axis I psychiatric disorder. Within those randomly assigned to receive SE, individuals with a comorbid diagnosis of PTSD worked significantly less than those without a PTSD diagnosis during the SE intervention [7].

The current study seeks to examine the employment status of veterans with PTSD during participation in and at discharge from CWT. In view of the current interest in veterans returning from Operation Iraqi Freedom and Operation Enduring Freedom, we pay particular attention to service in a theater of operations (war zone), especially among veterans who served in these two conflicts. Recognizing that the phenomenological experience of PTSD may vary by both service era and by war zone service, we have chosen an analytic strategy that allows us to examine the independent effects of all three of these variables (PTSD, service era, and war zone service) in a single model, with adjustment for other potentially influential factors. First, we examined the bivariate relationship between veteran characteristics and competitive employment at discharge. Factors examined include PTSD, service era, service in a wartime theater of operations, sociodemographic characteristics, and disability income. Second, we examined the relationship between competitive employment and the three primary outcome variables of interest in a single multivariate model. Multivariate analysis is preferable to a series of separate models examining PTSD, service era, and war zone service because it allows a more parsimonious analysis of the independent effects of these three variables on employment. Lastly, to further explore these group differences we compared measures of CWT participation between those with and without PTSD diagnoses.

METHODS

Veterans Health Administration CWT Program

The Veterans Health Administration (VHA) CWT program provides diverse vocational approaches, with 163 individual programs in VHA facilities nationwide that follow multiple models of vocational rehabilitation. …

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