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Abstract-Few studies have examined employment outcomes in individuals with a primary diagnosis of posttraumatic stress disorder (PTSD). The current study used multivariate modeling to examine the relationship between PTSD, other aspects of military service, and employment among 5,862 veterans in a national Department of Veterans Affairs (VA) vocational rehabilitation program. Veterans with PTSD were 19% less likely to be employed at discharge (odds ratio = 0.81, p = 0.02) after controlling for potentially confounding variables. Individuals with substance use diagnoses or who were homeless at program entry were more likely to be employed at discharge, while receipt of public support income and severe mental illness decreased the likelihood of being competitively employed. This study supports current VA efforts to expand and improve the effectiveness of vocational rehabilitation services for veterans with PTSD.
Key words: CWT, dissemination, employment, implementation, psychiatric rehabilitation, PTSD, supported employment, veterans, vocational rehabilitation, work.
Abbreviations: CWT = Compensated Work Therapy, FY = fiscal year, NEPEC = Northeast Program Evaluation Center, PTSD = posttraumatic stress disorder, SD = standard deviation, SE = supported employment, TWE = transitional work experience, VA = Department of Veterans Affairs, VHA = Veterans Health Administration.
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...