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Mental Disorders and Employment Status in VA Patients
Amy S. B. Bohnert, University of Michigan 
Mark A. Ilgen, Department of Veterans Affairs 
*Khairul Islam, University of Michigan 
Amy M. Kilbourne, Department of Veterans Affairs 
Briana Mezuk, Department of Veterans Affairs 
Marcia Valenstein, University of Michigan 
Kara Zivin, University of Michigan 

Keywords: mental disorders, employment, multinomial logistic regression, repeated measurements, veterans

Background: Many small studies have reported the negative impact of mental disorders on the likelihood of employment and employment performance. The VA has a vast population both at retirement age and age groups with traditionally higher employment rates. Understanding how mental disorders are associated with employment status in VA patients receiving healthcare services is of great importance because these disorders are highly prevalent. Aims: To assess the underlying relationship between mental disorders and employment status among patients receiving care through VA healthcare system. Methods: We used multinomial logistic regression with repeated measurements to model how mental disorders influence employment status among VA patients who completed the Survey of Health Experiences of Patients (SHEP) at least twice during 2003-2005. Results: 91,639 patients met eligibility criteria for the study. In adjusted analyses, VA patients with bipolar disorder, depression, schizophrenia, comorbidity and substance abuse were significantly more likely to be unemployed, disabled, or retired than employed, and people with PTSD were more likely to be disabled or retired than employed. Conclusions: VA patients most often experience mental disorders, and are less often in labor force than the general population. In addition to timely and appropriate treatment, a suitable return-to-work intervention could emphasize the treatment of mental disorders and improve occupational functioning for VA patients.