Employment Status of Patients in the VA Health System: Implications for Mental Health Services

Serious Mental Illness Treatment Resource and Evaluation Center, Health Services Research and Development, Department of Veterans Affairs, Ann Arbor, Michigan, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 01/2011; 62(1):35-8. DOI: 10.1176/
Source: PubMed


Most veterans who use Department of Veterans Affairs (VA) health care are not employed. This study evaluated the association between mental disorders and labor force status among VA health care users.
Multinomial logistic regression analyses modeled the relationship between mental disorders and employment among patients aged 18 to 64 who completed the 2005 Survey of Healthcare Experiences of Patients.
Of the 98,867 patients who met eligibility criteria, 36% were disabled, 35% were employed, 20% were retired, and 7% were unemployed. Those with bipolar disorder, depression, posttraumatic stress disorder, schizophrenia, or a substance use disorder were more likely to be unemployed, disabled, or retired than employed.
This study confirmed a negative relationship between having a mental disorder and being employed. Future studies of barriers associated with veterans' employment could help policy makers target mental health treatments and supportive employment services to the unique needs of veterans.

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Available from: Marcia Valenstein, Oct 13, 2015
    • "Second, since Veterans often are underserved and have multiple challenges, it is important to examine factors that may affect employment functioning, which this study does in a unique way by investigating many covariates and barriers. Based on our prior work (Abraham et al., 2014;Zivin et al., 2011Zivin et al., , 2012), we hypothesized that VA patients with depression and anxiety would be less likely to be employed, be lessproductive, and report greater barriers to employment than VA PC patients without these disorders.Shih and Fan, 2008). Of these, 68 (24%) were completed by mail. "
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    ABSTRACT: Background: Prior research found lower employment rates among working-aged patients who use the VA than among non-Veterans or Veterans who do not use the VA, with the lowest reported employment rates among VA patients with mental disorders. This study assessed employment status, employment functioning, and barriers to employment among VA patients treated in primary care settings, and examined how depression and anxiety were associated with these outcomes. Methods: The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical Center. Bivariate and multivariable analyses were conducted examining associations between socio-demographic and clinical predictors of six employment domains, including: employment status, job search self-efficacy, work performance, concerns about job loss among employed Veterans, and employment barriers and likelihood of job seeking among not employed Veterans. Results: 54% of respondents were employed, 36% were not employed, and 10% were economically inactive. In adjusted analyses, participants with depression or anxiety (43%) were less likely to be employed, had lower job search self-efficacy, had lower levels of work performance, and reported more employment barriers. Depression and anxiety were not associated with perceived likelihood of job loss among employed or likelihood of job seeking among not employed. Limitations: Single VA primary care clinic; cross-sectional study. Discussion: Employment rates are low among working-aged VA primary care patients, particularly those with mental health conditions. Offering primary care interventions to patients that address mental health issues, job search self-efficacy, and work performance may be important in improving health, work, and economic outcomes.
    No preview · Article · Dec 2015 · Journal of Affective Disorders
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    • "In light of our daily practice of caring for socially disadvantaged patients, the data on the influence of socioeconomic status on depression led to our interest in finding socioeconomic predictors of depression among HD patients [4,5]. Searching for an appropriate instrument, we found the Social Adaptability Index (SAI) [6]. "
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    ABSTRACT: Background Several aspects linked to social are involved in the onset of depressive feelings. We aimed to find out if social adaptability and substance abuse predict depression among end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Methods We included 145 ESRD patients undergoing HD. Social adaptability was estimated by the Social Adaptability Index (SAI). Substance abuse was defined according to SAI. We screened for depression by applying the 20-item version of the Center for Epidemiologic Studies Depression Scale. A score ≥ 24 classified the patients as depressed. Comparisons between depressed and non-depressed patients were carried out and logistic regression was performed to test gender, age, total SAI, SAI without the substance abuse item, only the substance abuse score and substance abuse as a categorical variable (yes/no) as predictors of depression. Results There were 36 (24.8%) depressed patients. There were no differences regarding demographic and laboratory data between the depressed and non-depressed patients. Mean SAI among depressed and non-depressed patients was, respectively, 6.1 ± 1.6 vs. 6.2 ± 1.9 (p=0.901). The percentage of patients with or without substance abuse among depressed patients was, respectively, 13.8% vs. 13.9% (p=1.000). Gender, age, total SAI, SAI without the substance abuse item, only the substance abuse score and substance abuse as a categorical variable did not predict depression. Conclusions Social adaptability and substance abuse did not predict depression in HD patients. We propose that aspects related to socioeconomic status not comprised in SAI items should be ruled out as predictors of depression.
    Full-text · Article · Jan 2013 · BMC Nephrology
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    ABSTRACT: Social adaptability index (SAI) is the composite index of socioeconomic status based upon employment status, education level, marital status, substance abuse and income. It has been used in the past to define populations at higher risk for inferior clinical outcomes. The objective of this retrospective study was to evaluate the association of the SAI with renal transplant outcome. We used data from the clinical database at the Beth Israel Deaconess Medical Center Transplant Institute, supplemented with data from United Network for Organ Sharing for the years 2001-09. The association between SAI and graft loss and recipient mortality in renal transplant recipients was studied using Cox model in the entire study population as well as in the subgroups based on age, race, sex and diabetes status. We analyzed 533 end-stage renal disease patients (mean age at transplant 50.8 ± 11.8 years, 52.2% diabetics, 58.9% males, 71.1% White). Higher SAI on a continuous scale was associated with decreased risk of graft loss [hazard ratio (HR) 0.89, P < 0.05, per 1 point increment in the SAI] and decreased risk of recipient mortality (HR 0.84, P < 0.01, per 1 point increment in the SAI). Higher SAI was also significantly associated with decreased risk for graft loss/recipient mortality in some study subgroups (age 41-65 years, males, non-diabetics). SAI has an association with graft and recipient survival in renal transplant recipients. It can be helpful in identifying patients at higher risk for inferior transplant outcome as a target population for potential intervention.
    Preview · Article · Mar 2012 · Nephrology Dialysis Transplantation
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