Abstract

“A diagnosis of chronic war-related posttraumatic stress disorder (PTSD) has been linked consistently to poor employment outcomes. This study investigates the relation further, analyzing how symptom severity correlates with work status, occupation type, and earnings. Study participants were male Vietnam veterans with severe or very severe PTSD who received treatment in the Department of Veterans Affairs system (N = 325). Veterans with more severe symptoms were more likely to work part-time or not at all. Among workers, more severe symptoms were weakly associated with having a sales or clerical position. Conditional on employment and occupation category, there was no significant relation between PTSD symptom level and earnings. Alternative PTSD symptom measures produced similar results. Our findings suggest that even modest reductions in PTSD symptoms may lead to employment gains, even if the overall symptom level remains severe.”

Implications

For Practice

Among the veterans in this study, those with more severe symptoms of PTSD were more likely to work part-time or not at all. They were also more likely to hold a clerical or sales position, although the association was weak. Even weaker PTSD symptom severity was associated with better employment outcomes. Interventions and rehabilitation programs assist veterans to manage these symptoms. The findings suggest that treating PTSD, even if some symptoms remain, could result in better employment outcomes for veterans.

For Policy

Policies that promote more schooling could affect the occupation type and earnings of veterans with PTSD. The U.S. Bureau of Labor Statistics has charted the strong link between higher levels of education, greater earnings, and lower unemployment (http://www.bls.gov/emp/ep_chart_001.htm). Policy makers should consider providing previously successful programs for veterans with PTSD for individuals with other mental health conditions. One such program is the Employment Intervention Demonstration (EIDP), sponsored by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). This vocational rehabilitation program leads to significant improvements in employment outcomes. Most people enrolled in the program, however, are diagnosed with psychotic or mood disorders, not PTSD. Proven programs such as EIDP could be a basis for new PTSD treatments, especially for veterans with more severe symptoms.

For Future Research

A large, controlled, longitudinal survey would allow researchers to investigate more thoroughly how PTSD symptoms relate to employment. It would enable study of how psychiatric care, medical care, and the work environment interact. Unobserved individual characteristics, such as personality type and traumatic experiences prior to military service, may also contribute to PTSD and to employment patterns. A longitudinal study is needed to explore the effects of such factors. Future studies should include more diverse groups of veterans with PTSD. Researchers should also aim to include younger veteran, women veterans, and veterans who obtain care outside the Veterans Affairs system. Finally, researchers should further investigate the relationship between PTSD symptoms and employment-enabling factors, such as secure housing, access to transportation, and cohabitation with other adults. For example, worsening of PTSD symptoms may cause instability in housing, which may in turn affect veterans’ ability to find and maintain employment. Determining the impact of variation in PTSD symptoms on these enabling factors could further clarify the relationship between PTSD and employment. There have been several research efforts done on the employment of veterans with PTSD, for example impact of supported employment programs, links between PTSD symptoms and work-related quality of life in female veterans, VA’s compensated work therapy program, and the link between work performance and symptoms of PTSD and other mental health conditions. Visit the National Library of Medicine’s PubMed home page (http://www.ncbi.nlm.nih.gov/ pubmed) and search for the words PTSD, employment, veteran* (including the asterisk).