Skip to main content
SpringerLink
Log in

Correlates of Obtaining Employment among Veterans Receiving Treatment for Severe PTSD in Specialized Intensive Programs

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

Severe Post-Traumatic Stress Disorder (PTSD) has been identified as a significant impediment to employment. However, little is known about correlates of employment recovery after a period of not working among veterans with severe PTSD treated in specialized intensive treatment programs. This study examines rates and correlates of transitioning from not being employed at admission to working four months after discharge using national Veterans Health Administration (VHA) program evaluation data on veterans engaged in specialized intensive PTSD treatment (N = 27,339). Results suggest that only 5.68% of the sample made the transition to employment while 10.6% lost employment, 8.9% worked both at admission and following discharge, and 74.9%, did not work either at admission or following discharge. Multinomial regression analysis found that compared to other groups, veterans who became employed were younger, less likely to receive service-connected disability payments, and experienced a significantly greater reduction in PTSD symptoms. Findings from this study highlight that this distinct population has very poor employment outcomes and deserves more attention, and that reducing PTSD symptoms can lead to improved employment outcomes. Efforts to integrate evidence-based vocational rehabilitation practice into residential PTSD treatment targeting PTSD symptoms is encouraged.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

Data not available.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  2. Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, et al. Brunner/mazel psychosocial stress series, no. 18. Trauma and the Vietnam war generation: report of findings from the national Vietnam veterans readjustment study. Philadelphia: Brunner/Mazel; 1990.

    Google Scholar 

  3. Richardson LK, Frueh CB, Acierno R. Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Australian and New Zealand J of Psychiatry. 2010;44:4–19.

    Article  Google Scholar 

  4. U.S. Census Bureau (2017) American community survey 1-year estimates. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk#. .

  5. Adler DA, Possemato K, Mavandadi S, Lerner D, Chang H, Klaus J, et al. Psychiatric status and work performance of veterans of operations enduring freedom and Iraq freedom. Psychiatr Serv. 2011;62(1):39–46.

    Article  PubMed  Google Scholar 

  6. Erbs CR, Kaler ME, Schult T, Polusny MA, Arbisi PA. Mental health diagnosis and occupational functioning in National Guard/research veterans returning from Iraq. J Rehabil Res Dev. 2011;48(10):1159–70.

    Article  Google Scholar 

  7. Vogt D, Smith BN, Fox AB, Amoroso T, Taverna E, Schnurr, PP (2017). Consequences of PTSD for the work and family quality of life of female and make U.S. Afghanistan and Iraq War Veterans. Soc Psychiatry Psychiatr Epidemiol. 2017; https://doi.org/10.1007/s00127-016-1321-5.

  8. Savoca E, Rosenheck RA. The civilian labor market experience of Vietnam-era veterans: the influence of psychiatric disorders. J of Ment Health Policy Econ. 2000;3:199–207.

    Article  Google Scholar 

  9. Sripada RK, Henry J, Yosef M, Levine DS, Bohnert KM, Miller E, et al. Occupational functioning and employment services use among VA primary care patients with posttraumatic stress disorder. Psychol Trauma Theory Res Pract Policy. 2018;10:140–3. https://doi.org/10.1037/tra0000241.

    Article  Google Scholar 

  10. Zatzick DF, Marmar CR, Weiss DS, Browner WS, Meltzer TJ, Golding JM, et al. Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry. 1997;5(12):1690–5.

    Article  Google Scholar 

  11. Pabayo R, Fuller D, Goldstein RB, Kawachi I, Gilman SE. Income inequality among American states and the conditional risk of post-traumatic stress disorder. Soc Psychiatry Psychiatr Epidemiol. 2017;52:1195–204. https://doi.org/10.1007/s00127-017-1413-x.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Smith MW, Schnuur PP, Rosenheck RA. Employment outcomes and PTSD symptom severity. Ment Health Serv Res. 2005;7(2):89–101.

    Article  PubMed  Google Scholar 

  13. Fontana A, Rosenheck R, Spencer H, Grey S (2007) Long journey home XV: treatment of posttraumatic stress disorder in the Department of Veterans Affairs: fiscal year 2006 service delivery and performance. West Haven: Northeast Program Evaluation Center.

  14. Schinnar AP, Rothbard AB, Kanter R, Jung YS. An empirical literature review of definitions of severe and persistent mental illness. Am J Psychiatry. 1990;147:1602–8.

    Article  CAS  PubMed  Google Scholar 

  15. Hermes E, Rosenheck RA, Desai R, Fontana A. Recent trends in the treatment of posttraumatic stress disorder and other mental disorders in the veterans health administration. Psychiatr Serv. 2012;63(5):471–6.

    Article  PubMed  Google Scholar 

  16. Resnick SG, Rosenheck RA. Posttraumatic stress disorder and employment in veterans participating in veterans health administration compensated work therapy. J Rehabil Res Dev. 2008;45(3):427–36.

    Article  PubMed  Google Scholar 

  17. Bond GR. Supported employment: evidence for an evidence based practice. Psychiatr Rehabil J. 2004;27:345–59. https://doi.org/10.2975/27.2004.345.359.

    Article  PubMed  Google Scholar 

  18. Davis LL, Kyriakides TC, Suris AM, Ottomanelli LA, Mueller L, Parker PE, et al. Effect of evidence-based supported employment vs transitional work on achieving steady work among veterans with posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiat. 2018;75:316–24. https://doi.org/10.1001/jamapsychiatry.2017.4472.

    Article  Google Scholar 

  19. Fontana A, Rosenheck R. A short form of the Mississippi scale for measuring change in combat-related PTSD. J Trauma Stress. 1994;7(3):407–14.

    Article  CAS  PubMed  Google Scholar 

  20. Rosenheck RA, Fontana A. Post-September 11 admission symptoms and treatment response among veterans with posttraumatic stress disorder. Psychiatr Serv. 2003;54(12):1610–7.

    Article  PubMed  Google Scholar 

  21. McLellan AT, Carise D, Coyne TH, Jackson TR. Addition severity index. 5th ed; 1992. https://medicine.yale.edu/psychiatry/research/programs/clinical_people/pdc/resources/ASI_175045_153_46623_v1.pdf.

    Google Scholar 

  22. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates, Publishers; 1988.

    Google Scholar 

  23. Chen H, Cohen P, Chen S. How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Communication in Statistics—Simulation and Computation. 2010;39(4):860–4.

    Article  Google Scholar 

  24. Ferguson CJ. An effect size primer: a guide for clinicians and researchers. Prof Psychol Res Pract. 2009;40(5):532–8.

    Article  Google Scholar 

  25. Marshall T, Goldberg RW, Braude L, Dougherty RH, Daniels AS, Ghose S, et al. Supported employment: assessing the evidence. Psychiatr Serv. 2014;65:16–23. https://doi.org/10.1176/appi.ps.201300262.

    Article  PubMed  Google Scholar 

  26. Sengupta A, Drake RE, McHugo GJ. The relationship between substance use disorder and vocational functioning among people with severe mental illness. Psychiatr Rehabil J. 1998;22(1):41–5.

    Article  Google Scholar 

  27. Drebing CE, Fleitas R, Moore A, Krebs C, Van Ormer A, Penk W, et al. Patterns in work functioning and vocational rehabilitation associated with coexisting psychiatric and substance abuse disorders. Rehabil Couns Bull. 2002;46(1):5–14.

    Article  Google Scholar 

  28. Drebing CE, Rosenheck R, Schutt R, Kasprow WJ, Penk W. Patterns in referral and admission to vocational rehabilitation associated with co-existing psychiatric and substance use disorders. Rehabil Couns Bull. 2003;47(1):15–23.

    Article  Google Scholar 

  29. Moitra E, Beard C, Weisberg RB, Keller MB. Occupational impairment and social anxiety disorder in a sample of primary care patients. J Affective Disorders. 2011;130:209–12. https://doi.org/10.1016/j.jad.2010.09.024.

    Article  Google Scholar 

  30. Drew D, Drebing CE, Van Ormer A, Losardo M, Krebs C, Penk W, et al. Effects of disability compensation on participation in and outcomes of vocational rehabilitation. Psychiatr Serv. 2001;52(11):1479–84.

    Article  CAS  PubMed  Google Scholar 

  31. Rosenheck RA, Frisman L, Sindelar J. Disability compensation and work among veterans with psychiatric and nonpsychiatric impairments. Psychiatr Serv. 1995;46(4):359–65.

    Article  CAS  PubMed  Google Scholar 

  32. Cook JA. Employment barriers for persons with psychiatric disabilities: update of a report for the President’s commission. Psychiatr Serv. 2006;57(10):1391–405.

    Article  PubMed  Google Scholar 

  33. Mares AS, Rosenheck RA. Disability benefits and clinical outcomes among homeless veterans with psychiatric and substance abuse problems. Community Ment Health J. 2007;43(1):57–74.

    Article  PubMed  Google Scholar 

  34. Weathers FW, Blake DD, Schnurr PP, Kaloupek DG, Marx BP, Keane TM (2013) The Clinician-administered PTSD scale for DSM–5 (CAPS-5). www.ptsd.va.gov. .

  35. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP (2013) The PTSD Checklist for DSM–5 (PCL-5). www.ptsd.va.gov. Accessed 20 May 2019.

  36. Resick PA, Schnike MK. Cognitive processing therapy for sexual assault victims. J Consult Clin Psychol. 1992;60(5):748–56.

    Article  CAS  PubMed  Google Scholar 

  37. Foa EB, Hembree EA, Rothbaum BO. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences. Therapist guide. Oxford, England: Oxford University Press; 2007.

    Book  Google Scholar 

  38. Karlin BE, Ruzek JI, Chard KM, Eftekhari A, Monson CM, Hembree EA, et al. Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the veterans health administration. J Trauma Stress. 2010;23:663–73. https://doi.org/10.1002/jts.20588.

    Article  PubMed  Google Scholar 

  39. Kukla M, McGuire AB, Salyers MP. Rural and urban supported employment programs in the veterans health administration: comparison of barriers and facilitators to vocational achievement for veterans experiencing mental illnesses. Psychiatr Rehabil J. 2016;39:129–36. https://doi.org/10.1037/prj0000184.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. VA Bedford Healthcare System, MIRECC Program, 200 Springs Road, Bedford, MA, 01730, USA

    Brian J. Stevenson, Lisa Mueller & Megan M. Kelly

  2. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA

    Brian J. Stevenson

  3. University of Massachusetts Medical School, Worcester, MA, USA

    Megan M. Kelly

  4. VA Connecticut Healthcare System, West Haven, CT, USA

    Robert A. Rosenheck

  5. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Robert A. Rosenheck

Authors
  1. Brian J. Stevenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Megan M. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert A. Rosenheck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian J. Stevenson.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

This secondary analysis was approved and given a waiver of informed consent by the VA Connecticut Healthcare System Institutional Review Board.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Code Availability

Not applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stevenson, B.J., Mueller, L., Kelly, M.M. et al. Correlates of Obtaining Employment among Veterans Receiving Treatment for Severe PTSD in Specialized Intensive Programs. Psychiatr Q 92, 981–994 (2021). https://doi.org/10.1007/s11126-020-09864-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-020-09864-w

Keywords

Search

Navigation