Mental Health Services Research

, Volume 7, Issue 2, pp 89–101

Employment Outcomes and PTSD Symptom Severity

  • Mark W. Smith
  • Paula P. Schnurr
  • Robert A. Rosenheck
Article

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.

Keywords

posttraumatic stress disorders employment income Veterans Veterans hospitals mental health services 

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References

  1. Anderson, K. H., & Mitchell, J. M. (1992). Effects of military experience on mental health problems and work behavior. Medical Care, 30, 554–563.PubMedGoogle Scholar
  2. Berndt, E. R., Finkelstein, S. N., Greenberg, P. E., Howland, R. H., Keith, A., Rush, A. J., et al. (1998). Workplace performance effects from chronic depression and its treatment. Journal of Health Economics, 17, 511–535.CrossRefPubMedGoogle Scholar
  3. Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Klauminzer, G., Charney, D. S., et al. (1990). A clinician rating scale for assessing current and lifetime PTSD: The CAPS-1. The Behavior Therapist, 18, 187–188.Google Scholar
  4. Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behavioral Research and Therapy, 34(8), 669–673.CrossRefGoogle Scholar
  5. Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A., Meisler, N., Lehman, A. F., et al. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52(3), 313–322.CrossRefPubMedGoogle Scholar
  6. Bound, J., Schoenbaum, M., Stinebrickner, T., & Waidmann, T. (1998). The dynamic effects of health on the labor force transitions of older workers. National Bureau of Economic Research Working Paper, no. w6777.Google Scholar
  7. Bound, J., & Waidmann, T. (2002). Accounting for recent declines in employment rates among working-aged men and women with disabilities. Journal of Human Resources, 37, 231– 250.Google Scholar
  8. Broadhead, W. E., Blazer, D. G., George, L. K., & Tse, C. K. (1990). Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA, 264, 2524–2528.CrossRefPubMedGoogle Scholar
  9. Cohany, S. R. (1992). The Vietnam-era cohort: Employment and earnings. Monthly Labor Review, June, 3–15.Google Scholar
  10. Cook, J. A. (2003). Results of a multi-site clinical trials study of employment models for mental health consumers. Chicago, Ill.: University of Illinois at Chicago. Retrieved from http://www.psych.uic.edu/eidp (accessed Nov., 2003).
  11. Drake, R. E., McHugo, G. J., Bebout, R. R., Becker, D. R., Harris, M., Bond, G. R., et al. (1999). A randomized clinical trial of supported employment for inner-city patients with severe mental disorders. Archives of General Psychiatry, 56(7), 627–633.CrossRefPubMedGoogle Scholar
  12. Drebing, C. E., Rosenheck, R., & Penk, W. (2001). CWT National Survey: Summary of program director responses. West Haven, CT: New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Health Care System.Google Scholar
  13. Drew, D., Drebing, C., Van Ormer, A., Losardo, M., Krebs, C., Penk, W., et al. (2001). Effects of disability compensation on participation in and outcomes of vocational rehabilitation. Psychiatric Services, 52(11), 1479–1484.CrossRefPubMedGoogle Scholar
  14. Greene, W. H. (1993). Econometric analysis (2nd ed.). New York: Macmillan.Google Scholar
  15. Heckman, J. J. (1979). Sample selection bias as a specification error. Econometrica, 47, 153–161.Google Scholar
  16. Keane, T. M., Caddell, J. M., & Taylor, K. L. (1988). Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: Three studies in reliability and validity. Journal of Consulting and Clinical Psychology, 56, 85–90.CrossRefPubMedGoogle Scholar
  17. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.PubMedGoogle Scholar
  18. Lehman, A. F., Goldberg, R., Dixon, L. B., McNary, S., Postrado, L., Hackman, A., et al. (2002). Improving employment outcomes for persons with severe mental illnesses. Archives of General Psychiatry, 59, 165–172.CrossRefPubMedGoogle Scholar
  19. McCarren, M., Janes, G. R., Goldberg, J., Eisen, S. A., True, W. R., & Henderson, W. (1995). A twin study of the association of post-traumatic stress disorder and combat exposure with long-term socioeconomic status in Vietnam veterans. Journal of Traumatic Stress, 8, 111–124.PubMedGoogle Scholar
  20. Mechanic, D., Bilder, S., & McAlpine, D. D. (2002). Employing persons with serious mental illness. Health Affairs, 21, 242–253.CrossRefGoogle Scholar
  21. Noble, J. H., Honberg, R. S., Hall, L. L., & Flynn, L. M. (1997). A legacy of failure: The inability of the federal-state vocational rehabilitation system to serve people with severe mental illnesses. Arlington, VA: National Alliance for the Mentally Ill.Google Scholar
  22. Prigerson, H. G., Maciejewski, P. K., & Rosenheck, R. A. (2001). Combat trauma: Trauma with highest risk of delayed onset and unresolved posttraumatic stress disorder symptoms, unemployment, and abuse among men. Journal of Nervous and Mental Disease, 189, 99–108.PubMedGoogle Scholar
  23. Rogowski, J., & Karoly, L. (2000). Health insurance and retirement behavior: Evidence from the Health and Retirement Survey. Journal of Health Economics, 19, 529–539.CrossRefPubMedGoogle Scholar
  24. Rosenheck, R. A., & Fontana, A. (2002). Black and Hispanic veterans in intensive VA treatment programs for posttraumatic stress disorder. Medical Care, 40, 52–61.CrossRefPubMedGoogle Scholar
  25. Rosenheck, R. A., Frisman, L., & Sindelar, J. (1995). Disability compensation and work among veterans with psychiatric and nonpsychiatric impairments. Psychiatric Services, 46, 359–365.PubMedGoogle Scholar
  26. Rosenheck, R. A., Stolar, M., & Fontana, A. F. (2000). Outcomes monitoring and the testing of new psychiatric treatments: work therapy in the treatment of chronic posttraumatic stress disorder. Health Services Research, 35, 133–151.PubMedGoogle Scholar
  27. Roswell, R. (2002). Posthearing questions concerning July 24, 2002 hearing on “Mental health care: Can VA still deliver?”: Response to Senator Rockefeller. Washington, DC: U.S. Department of Veterans Affairs.Google Scholar
  28. Savoca, E., & Rosenheck, R. (2000). The civilian labor market experiences of Vietnam-era veterans: The influence of psychiatric disorders. The Journal of Mental Health Policy and Economics, 3, 199–207.CrossRefPubMedGoogle Scholar
  29. Schnurr, P. P., Friedman, M. J., Foy, D. W., Shea, M. T., Hsieh, F. Y., Lavori, P. W., et al. (2003). A randomized trial of trauma focus group therapy for posttraumatic stress disorder: Results from a Department of Veterans Affairs Cooperative Study. Archives of General Psychiatry, 60, 481–489.CrossRefPubMedGoogle Scholar
  30. Schnurr, P. P., Friedman, M. J., Lavori, P. W., & Hsieh, F. Y. (2001). Design of Department of Veterans Affairs Cooperative Study No. 420: Group Treatment of Posttraumatic Stress Disorder. Controlled Clinical Trials, 22, 74–88.CrossRefPubMedGoogle Scholar
  31. Stein, M. B., Walker, J. R., Hazen, A. L., & Forde, D. R. (1997). Full and partial posttraumatic stress disorder: Findings from a community survey. American Journal of Psychiatry, 154, 1114–1119.PubMedGoogle Scholar
  32. U.S. Census Bureau. (2002). Statistical abstract of the United States: 2001. Washington, DC: Government Printing Office.Google Scholar
  33. U.S. General Accounting Office. (2002). SSA and VA disability programs: Re-examination of disability criteria needed to help ensure program integrity (Report GAO-02-597). Washington, DC: U.S. General Accounting Office. Weathers, F. W., Keane, T. M., & Davidson, J. R. (2001). Clinician-administered PTSD scale: A review of the first ten years of research. Depression and Anxiety, 13, 132– 156.Google Scholar
  34. Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). PTSD Checklist: Reliability, validity, and diagnostic utility. In Proceedings of the 9th Annual Meeting of the International Society for Traumatic Stress Studies (ISTSS) (p. 8). Chicago, IL: ISTSS.Google Scholar
  35. Zatzick, D. F., Marmar, C. R., Weiss, D. S., Browner, W. S., Metzler, T. J., Golding, J. M., et al. (1997). Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry, 154, 1690–1695.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Mark W. Smith
    • 1
    • 6
  • Paula P. Schnurr
    • 2
    • 3
  • Robert A. Rosenheck
    • 4
    • 5
  1. 1.Cooperative Studies Program and Health Services Research & Development ServiceVA Palo Alto Health Care SystemMenlo Park
  2. 2.National Center for PTSDVA Medical and Regional Office CenterVermont
  3. 3.Department of PsychiatryDartmouth Medical SchoolVermont
  4. 4.Northeast Program Evaluation CenterVA Connecticut Health Care SystemWest Haven
  5. 5.Department of PsychiatryYale Medical SchoolNew Haven
  6. 6.VA Palo Alto Health Care SystemMenlo Park

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