1
|
Abraham KM, Dent KR, Resnick SG, McCarthy JF, Zivin K. Associations of Mortality Outcomes With Employment Status at Discharge From VA Vocational Rehabilitation Service Programs. Psychiatr Serv 2024:appips20230489. [PMID: 38693833 DOI: 10.1176/appi.ps.20230489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE The authors evaluated associations between employment at discharge from Veterans Health Administration Vocational Rehabilitation Service (VR) programs and suicide and other causes of death. METHODS For veterans receiving VR between October 1, 2005, and September 30, 2014 (N=78,293), proportional hazards analyses were used to test associations of employment with suicide, drug overdose, and external and natural cause mortality rates over 1 and 5 years postdischarge and through December 31, 2019. The analyses were adjusted for clinical and sociodemographic characteristics and propensity for employment. RESULTS Of the veterans, 94.1% had a psychiatric diagnosis, and 35.5% were employed at VR discharge. In proportional hazards analyses, employment was associated with lower mortality rates through 1 year (suicide, hazard ratio [HR]=0.54; overdose, HR=0.70; external causes, HR=0.62; and natural causes, HR=0.51) and 5 years postdischarge (overdose, HR=0.72; external causes, HR=0.81; and natural causes, HR=0.72). Through December 31, 2019, employment was associated with lower risks for overdose (HR=0.80) and death by external (HR=0.81) and natural (HR=0.80) causes. CONCLUSIONS Employment at VR discharge was associated with lower mortality risk among veterans with psychiatric diagnoses.
Collapse
Affiliation(s)
- Kristen M Abraham
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Ann Arbor (Abraham, Dent, McCarthy); Department of Psychology, University of Detroit Mercy, Detroit (Abraham); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, VA, West Haven, Connecticut (Resnick); Department of Psychiatry, School of Medicine, Yale University, New Haven (Resnick); Suicide Prevention Program, Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (McCarthy); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Zivin)
| | - Kallisse R Dent
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Ann Arbor (Abraham, Dent, McCarthy); Department of Psychology, University of Detroit Mercy, Detroit (Abraham); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, VA, West Haven, Connecticut (Resnick); Department of Psychiatry, School of Medicine, Yale University, New Haven (Resnick); Suicide Prevention Program, Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (McCarthy); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Zivin)
| | - Sandra G Resnick
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Ann Arbor (Abraham, Dent, McCarthy); Department of Psychology, University of Detroit Mercy, Detroit (Abraham); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, VA, West Haven, Connecticut (Resnick); Department of Psychiatry, School of Medicine, Yale University, New Haven (Resnick); Suicide Prevention Program, Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (McCarthy); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Zivin)
| | - John F McCarthy
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Ann Arbor (Abraham, Dent, McCarthy); Department of Psychology, University of Detroit Mercy, Detroit (Abraham); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, VA, West Haven, Connecticut (Resnick); Department of Psychiatry, School of Medicine, Yale University, New Haven (Resnick); Suicide Prevention Program, Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (McCarthy); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Zivin)
| | - Kara Zivin
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs (VA), Ann Arbor (Abraham, Dent, McCarthy); Department of Psychology, University of Detroit Mercy, Detroit (Abraham); Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, VA, West Haven, Connecticut (Resnick); Department of Psychiatry, School of Medicine, Yale University, New Haven (Resnick); Suicide Prevention Program, Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (McCarthy); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Zivin)
| |
Collapse
|
2
|
Stevenson BJ, Kathawalla U, Smith C, Mueller L. Career Development in Transitional Work Settings: A Qualitative Investigation Among Veterans and Vocational Counselors. JOURNAL OF CAREER DEVELOPMENT 2023; 50:947-964. [PMID: 37463233 PMCID: PMC10288654 DOI: 10.1177/08948453221137344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Veterans living with mental health conditions have ambitious career goals and want support to find employment that meets their interests and preferences. Despite calls from researchers to "invest" and "commit" to career development research and practice for individuals living with psychiatric conditions, we still do not have empirically tested models for facilitating career development among individuals with mental health conditions, especially veterans. This qualitative study investigates the career development needs and recommended intervention strategies of veterans living with mental health conditions. Vocational counselors from the Veterans Health Administration (VHA) and veterans receiving vocational rehabilitation services (N = 13) participated in semi-structured focus groups. Findings illuminate the tasks, barriers, interventions, implementation strategies, and transitional work context that hinder and support career development of veterans with mental health conditions. Findings offer theoretical and applied guidance to researchers and counselors regarding career development of veterans living with mental health conditions.
Collapse
Affiliation(s)
- Brian J. Stevenson
- VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | | | | | - Lisa Mueller
- VISN 1 New England Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, USA
| |
Collapse
|
3
|
Perkins DF, Davenport KE, Morgan NR, Aronson KR, Bleser JA, McCarthy KJ, Vogt D, Finley EP, Copeland LA, Gilman CL. The influence of employment program components upon job attainment during a time of identity and career transition. INTERNATIONAL JOURNAL FOR EDUCATIONAL AND VOCATIONAL GUIDANCE 2022; 23:1-23. [PMID: 35194475 PMCID: PMC8853002 DOI: 10.1007/s10775-022-09527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
This study assessed the effectiveness of employment programs components, which resulted in the identification of content and process components that increase employability. Employment program use was studied among 1172 United States of America military veterans to determine which content (i.e., interviewing skills) and process (i.e., working with a mentor/coach) components influence job attainment during a time of career and identity transition. Components were distilled utilizing a common components analysis approach (Morgan et al., 2018). Associations with finding employment up to 15 months after the military-to-civilian transition were explored. Veterans who engaged with employment programs were primarily accessing the following components: career planning, resume writing, and interviewing skills. However, only a few content components were significantly related to obtaining employment: interviewing (with mentor/coach), resume writing (online tools), translating military to civilian work (with mentor/coach), entrepreneurship (with mentor/coach), and virtual career fairs. Furthermore, not all processes or modes of instruction for content components were associated with success in the job market. Having a mentor/coach was one of the most effective delivery strategies. For example, veterans using programs delivered by a mentor/coach that translated military skills to civilian work were more likely to find a job at 6-9-months (84%) and 12-15-months (91%) post military separation. In addition, risks that predicted lower use of employment program components by veterans were identified such as junior enlisted rank, combat exposure, combat arms occupation, and physical health problems. With these findings, program developers, implementers, and funders can channel efforts towards the utilization of employment programs with effective components.
Collapse
Affiliation(s)
- Daniel F. Perkins
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
- Social Science Research Institute, Pennsylvania State University, University Park, PA USA
- Department of Agricultural Economics, Sociology and Education, Pennsylvania State University, University Park, PA USA
| | - Katie E. Davenport
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
| | - Nicole R. Morgan
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
| | - Keith R. Aronson
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
- Social Science Research Institute, Pennsylvania State University, University Park, PA USA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA USA
| | - Julia A. Bleser
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
| | - Kimberly J. McCarthy
- Clearinghouse for Military Family Readiness, Pennsylvania State University (Clearinghouse), University Park, PA USA
| | - Dawne Vogt
- National Center for PTSD at VA Boston Health Care System, Boston, MA USA
- Boston University, Boston, MA USA
| | - Erin P. Finley
- University of Texas Health Science Center at San Antonio, San Antonio, TX USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Laurel A. Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Cynthia L. Gilman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| |
Collapse
|
4
|
Elrond AF, Conway PM, Andersen SB, Karstoft KI, Vedtofte MS, Pedersen J. Deployment experiences and mental health problems as predictors of post-deployment unemployment length: a prospective, register-based study among Danish soldiers. BMJ Open 2020; 10:e040625. [PMID: 33293314 PMCID: PMC7722823 DOI: 10.1136/bmjopen-2020-040625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To test responses of formerly deployed soldiers (FDS) to a questionnaire on deployment experiences in combination with screening levels of post-traumatic stress disorder (PTSD) and depression approximately 6 months after homecoming as predictors of the subsequent probability of gaining employment when unemployed within 5 years post-deployment. DESIGN, SETTING AND PARTICIPANTS Danish FDS responders (n=3935) and non-responders (n=3046) to a 6-month post-deployment screening questionnaire after returning from a first-ever deployment to Kosovo, Iraq or Afghanistan (2002 to 2012) were included in the study and followed in public registers from 6 months to 5 years post-deployment. PRIMARY AND SECONDARY OUTCOME MEASURES We tested Cox regression models including deployment experiences (1a), screening levels of PTSD and depressive symptoms (1b), and their combination (2) for FDS responders. For all FDS, a secondary model included a measure on whether they responded to the questionnaire (3). RESULTS Neither the deployment experiences (1a) of exposure to danger and combat (HR=1.00, 95% CI=0.97 to 1.03) and witnessing consequences of war (HR=1.01, 95% CI=0.96 to 1.06), or the screening levels (1b) of PTSD (HR=1.06, 95% CI=0.84 to 1.33) and depressive symptoms (HR=0.82, 95% CI=0.64 to 1.06) were significant predictors of transitioning from unemployment to employment. Similar results were found for the combined model (2). A tendency among non-respondents (3) to have a lower probability of transitioning from unemployment to employment was found (HR=0.90, 95% CI=0.81 to 1.00). CONCLUSION Deployment experiences, PTSD and depressive symptoms, as measured at 6-month screening questionnaire, did not predict differences in the probability of gaining employment when unemployed within 5 years post-deployment. However, the findings suggest that those with the least probability of transitioning from unemployment to employment can be found among the non-responders to the post-deployment screening questionnaire.
Collapse
Affiliation(s)
- Andreas Friis Elrond
- Research and Knowledge Centre, Danish Veteran Centre, Ringsted, Denmark
- Department of Psychology, University of Copenhagen, Faculty of Social Sciences, Copenhagen, Denmark
| | - Paul Maurice Conway
- Department of Psychology, University of Copenhagen, Faculty of Social Sciences, Copenhagen, Denmark
| | - Søren Bo Andersen
- Research and Knowledge Centre, Danish Veteran Centre, Ringsted, Denmark
| | - Karen-Inge Karstoft
- Research and Knowledge Centre, Danish Veteran Centre, Ringsted, Denmark
- Department of Psychology, University of Copenhagen, Faculty of Social Sciences, Copenhagen, Denmark
| | | | - Jacob Pedersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| |
Collapse
|
5
|
Kukla M, Strasburger AM, Salyers MP, Rollins AL, Lysaker PH. Psychosocial outcomes of a pilot study of work-tailored cognitive behavioral therapy intervention for adults with serious mental illness. J Clin Psychol 2020; 77:488-495. [PMID: 32860466 DOI: 10.1002/jclp.23048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many people with serious mental illness (SMI) continue to struggle with work functioning despite the receipt of supported employment (SE) services. In response, adjunctive interventions to SE have begun to be developed. One such approach, the cognitive behavioral therapy for work success (CBTw) intervention, targets cognitive and behavioral barriers to competitive work success in adults with SMI. Using a pre-post design, this pilot study examined the psychosocial outcomes of the CBTw program in 52 adults with SMI receiving SE. METHOD Recovery attitudes, work-related self-efficacy, self-esteem, and symptom domains (depression, anxiety, psychosis) were measured at baseline and after the 12-week intervention. Paired samples t-tests examined changes in outcomes over time. RESULTS At posttreatment, participants had significant improvements in recovery attitudes, self-esteem, depressive, and negative symptoms. Other psychosocial outcomes did not significantly change. CONCLUSIONS This pilot work demonstrates CBTw is a promising intervention to improve recovery and wellness in SMI.
Collapse
Affiliation(s)
- Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Amy M Strasburger
- Richard L. Roudebush VA Medical Center, Psychiatry Service, Indianapolis, Indiana, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.,ACT Center of Indiana, Indianapolis, Indiana, USA
| | - Angela L Rollins
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.,ACT Center of Indiana, Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Psychiatry Service, Indianapolis, Indiana, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
6
|
Lerner D, Adler DA, Rogers WH, Ingram E, Oslin DW. Effect of Adding a Work-Focused Intervention to Integrated Care for Depression in the Veterans Health Administration: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e200075. [PMID: 32108889 PMCID: PMC7049076 DOI: 10.1001/jamanetworkopen.2020.0075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Thousands of working-age veterans with depression experience impaired occupational functioning. OBJECTIVES To test whether the Veterans Health Administration (VHA) integrated care (IC) program combined with telephonic work-focused counseling, known as Be Well at Work (BWAW), is superior to IC alone for improving occupational functioning and depression, to determine whether these effects persist 4 months later, and to determine whether the return on investment is positive. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted from October 21, 2014, to December 6, 2019, patients undergoing IC at VHA facilities were screened for eligibility and randomized to IC alone or IC plus BWAW. Blinded interviewers administered questionnaires before the intervention, immediately after completion of the intervention at month 4, and at month 8. Eligibility criteria were individuals 18 years or older who were working at least 15 hours per week in a job they had occupied for at least 6 months, were experiencing work limitations, and had current major depressive disorder or persistent depressive disorder. Exclusion criteria were individuals who could not read or speak English, had planned maternity leave, or had a history of bipolar disorder or psychosis. Data analyses were conducted from January 1, 2018, to December 6, 2019. INTERVENTIONS Integrated care is multidisciplinary depression care involving screening, clinical informatics, measurement-based care, brief behavioral interventions, and referral as needed to specialty mental health care. Be Well at Work counseling involves 8 biweekly telephone sessions and 1 telephone booster visit after 4 months. Doctoral-level psychologists helped patients to identify barriers to functioning and to adopt new work-focused cognitive-behavioral and work-modification strategies. MAIN OUTCOMES AND MEASURES The primary outcome was the adjusted mean group difference in changes from before to after intervention (hereafter, adjusted effect) in the percentage of at-work productivity loss, measured with the Work Limitations Questionnaire (range, 0%-25%). The secondary outcome was adjusted effect in the Patient Health Questionnaire 9-item symptom severity score (range, 0-27, with 0 indicating no symptoms and 27, severe symptoms). RESULTS Of 670 veterans referred for participation, 287 veterans (42.8%) consented and completed eligibility screening, and 253 veterans (37.8%) were randomized. Among these 253 patients (mean [SD] age, 45.7 [11.6] years; 218 [86.2%] men; 135 [53.4%] white), 114 (45.1%) were randomized to IC and 139 (54.9%) were randomized to IC plus BWAW. At the 4-month follow-up, patients who received IC plus BWAW had greater reductions in at-work productivity loss (adjusted effect, -1.7; 95% CI, -3.1 to -0.4; P = .01) and depression symptom severity (adjusted effect, -2.1; 95% CI, -3.5 to -0.7; P = .003). The improvements from IC plus BWAW persisted 4 months after intervention (at-work productivity loss mean difference, -0.5; 95% CI, -1.9 to 0.9; P = .46; depression symptom severity mean difference, 0.6; 95% CI -0.9 to 2.1; P = .44). The cost per patient participating in BWAW was $690.98, and the return on investment was 160%. CONCLUSIONS AND RELEVANCE These findings suggest that adding this work-focused intervention to IC improves veterans' occupational and psychiatric outcomes, reducing obstacles to having a productive civilian life. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02111811.
Collapse
Affiliation(s)
- Debra Lerner
- Program on Health, Work and Productivity, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts University School of Medicine and Tufts Graduate School of Biomedical Sciences, Boston, Massachusetts
- Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts
| | - David A. Adler
- Program on Health, Work and Productivity, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts University School of Medicine and Tufts Graduate School of Biomedical Sciences, Boston, Massachusetts
- Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts
| | - William H. Rogers
- Program on Health, Work and Productivity, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts University School of Medicine and Tufts Graduate School of Biomedical Sciences, Boston, Massachusetts
| | - Erin Ingram
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - David W. Oslin
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
7
|
Bennett AS, Watford JA, Elliott L, Wolfson-Stofko B, Guarino H. Military veterans' overdose risk behavior: Demographic and biopsychosocial influences. Addict Behav 2019; 99:106036. [PMID: 31494452 DOI: 10.1016/j.addbeh.2019.106036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND U.S. military veterans face many biopsychosocial (BPS) challenges post-service that may elevate risk for opioid-related overdose including physical pain, mental health concerns and social stressors. Some veterans use opioids to manage pain and cope with social readjustment. This study assessed associations between BPS factors and recent engagement in overdose risk behavior in a community sample of post-9/11 veterans who used opioids in New York City. METHODS Participants (n = 218) were recruited through convenience sampling and completed a baseline assessment including a validated Opioid Risk Behavior Scale (ORBS) that measured past-30-day engagement in 22 opioid-related overdose risk behaviors. Analyses examined associations between ORBS scores and hypothesized demographic, biological/physical, psychological and social predictors. Incident rate ratios estimated the expected relative difference in ORBS score associated with each predictor. RESULTS Participants reported an average of 4.72 overdose risk behaviors in the past 30 days. Significant independent predictors of higher ORBS score, after adjustment for demographics and current prescription medications, were past-30-day: depression symptoms; unsheltered or living in a homeless shelter (vs. private housing); history of mental health treatment; experiencing stressful life events; average pain severity; and pain interference. CONCLUSION Veterans face myriad BPS challenges and, while drug-related overdose risks are well understood, findings suggest that other factors-including mental health, pain and stressful life events-may also be associated with overdose risk among opioid-using veterans. The larger challenges veterans face should be considered in the context of BPS forms of pain management when tailoring and delivering overdose prevention interventions.
Collapse
|
8
|
Aronson KR, Perkins DF, Morgan NR, Bleser JA, Vogt D, Copeland L, Finley E, Gilman C. Post-9/11 Veteran Transitions to Civilian Life: Predictors of the Use of Employment Programs. JOURNAL OF VETERANS STUDIES 2019. [DOI: 10.21061/jvs.v5i1.127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
9
|
Keeling ME, Ozuna SM, Kintzle S, Castro CA. Veterans’ Civilian Employment Experiences: Lessons Learnt From Focus Groups. JOURNAL OF CAREER DEVELOPMENT 2018. [DOI: 10.1177/0894845318776785] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Emerging evidence highlights employment as a key factor influencing the success of transition from military to civilian life. Historically, employment programs have focused on improving skills such as resume writing and interview skills. However, it is likely that employment challenges are more than these practical barriers. Four focus groups with employed and unemployed Gulf War Era II veterans were conducted aimed at moving past a practical perspective by gaining experiential understandings of veterans’ employment. Thematic analysis indicated that the veterans’ employment experiences were best understood temporally in two master themes: pretransition and the divergent experiences of veterans who did and did not plan ahead and living the transition and the veterans’ experiences of employment barriers and facilitators. Further to the two master themes, an underlying thread of the need for self-determination was evident. Interpretation of the results led to the development of recommendations for policy, service provision, and future research.
Collapse
Affiliation(s)
- Mary Elizabeth Keeling
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
| | - Sara M. Ozuna
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
| | - Sara Kintzle
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
| | - Carl A. Castro
- Center for Innovation and Research in Veterans and Military Families, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
10
|
A Pilot Test of Group Based Cognitive Behavioral Therapy to Augment Vocational Services for Persons With Serious Mental Illness: Feasibility and Competitive Work Outcomes. J Nerv Ment Dis 2018; 206:310-315. [PMID: 29485477 DOI: 10.1097/nmd.0000000000000796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Persons with serious mental illness (SMI) struggle with work functioning even with the assistance of vocational services. The current study sought to address this problem by examining a cognitive-behavioral therapy to augment vocational services. Fifty-two adults with SMI receiving vocational services participated in a pre-post feasibility trial of the Cognitive Behavior Therapy for Work Success (CBTw) intervention. CBTw is a 12-week manualized intervention that addresses cognitive and behavioral factors that impact work functioning. Competitive work outcomes were assessed in the 12 weeks preceding baseline and after the intervention. The results demonstrate strong session attendance and a low attrition rate. There were also significant improvements in work outcomes. Specifically, among participants unemployed at baseline, 50.0% attained work during follow-up. These findings provide preliminary evidence that CBTw may be a feasible intervention to augment vocational services; further controlled research should examine its benefit to work outcomes in people with SMI.
Collapse
|
11
|
Harrod M, Miller EM, Henry J, Zivin K. "I've never been able to stay in a job": A qualitative study of Veterans' experiences of maintaining employment. Work 2018; 57:259-268. [PMID: 28582943 DOI: 10.3233/wor-172551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Ensuring Veteran employment needs are met is a top priority for the Department of Veteran Affairs and the United States government. However, Veterans, especially those with mental health disorders, continue to encounter difficulties when employed. While many employment related programs offer numerous services aimed at helping Veterans gain employment, their ability to maintain long-term employment remains unknown. OBJECTIVE The objective of this study was to understand factors that affect the ability of Veterans with mental health disorders to maintain long-term employment. METHODS An exploratory, qualitative study design consisting of semi-structured interviews with 10 Veterans was performed. Inductive thematic analysis was performed to identify salient themes. RESULTS We found that participants' symptoms manifested themselves within the workplace affecting their ability to maintain employment, participants felt as if they had been demoted from what they did in the military, and they felt unable to relate to civilian co-workers. Strategies that helped some transition into the civilian workforce were also identified. CONCLUSIONS A better understanding of the difficulties some Veterans face when trying to maintain employment is needed. Our findings suggest that increasing awareness of existing programs and ensuring that services provide resources and skills that help Veterans maintain long-term employment is critical.
Collapse
Affiliation(s)
- Molly Harrod
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Erin M Miller
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Henry
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Kara Zivin
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
12
|
Moore JT, Skinner MA. Treatment Mechanisms With Homeless Veterans. J Dual Diagn 2017; 13:291-297. [PMID: 29120268 DOI: 10.1080/15504263.2017.1363448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Emotion regulation and social processes that longitudinally predict depressive symptom change have not yet been investigated as mechanisms of change within a residential treatment context for homeless veterans with substance use issues. METHODS A longitudinal data analysis of 186 homeless veterans enrolled in a six-month residential rehabilitation and addiction treatment program was conducted to investigate the role of six different emotion regulation variables as well the impact of two relationship quality constructs when measured at three time points across treatment. RESULTS A large effect size reduction in depressive symptoms occurred during treatment (η2 = .233), and further analyses revealed that early treatment changes in a single subtype of emotion regulation, one's ability to tolerate distress while engaging in goal-directed behavior, was the only mechanism that preceded continued reductions in depressive symptoms later in treatment (β = .13, p < .001). Social mechanisms of change were not strong predictors of depressive symptom reduction. CONCLUSIONS Distress tolerance skills, psychoeducation on the habituation process, and focusing on goal achievement may be particularly beneficial when treating substance use issues in homeless veterans who are also experiencing depressive symptoms during residential treatment.
Collapse
Affiliation(s)
- Jon T Moore
- a Veterans Affairs Puget Sound Health Care System-American Lake Division , Tacoma , Washington , USA.,b Independent practice , Fircrest , Washington , USA
| | - Michelle A Skinner
- c Veterans Affairs Palo Alto Health Care System-Menlo Park Division , Menlo Park , California , USA
| |
Collapse
|
13
|
The relationship between emotion regulation strategies and job search behavior among fourth-year university students. J Adolesc 2017. [PMID: 28651120 DOI: 10.1016/j.adolescence.2017.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The job search process is a stressful experience. This study investigated the effect of emotion regulation strategies on job search behavior in combination with anxiety and job search self-efficacy among Chinese university fourth-year students (N = 816, mean age = 21.98, 31.5% male, 34.9% majored in science, 18.0% from "211 Project" universities). Results showed that cognitive reappraisal was positively related to job search behavior, while expressive suppression was negatively related to job search behavior. Additionally, anxiety was negatively related to job search behavior, while job search self-efficacy was positively associated with job search behavior. Moreover, both anxiety and job search self-efficacy mediated the relationship between emotion regulation strategies and job search behavior. In general, emotion regulation strategies played an important role in job search behavior. Implications include the notion that emotion regulation interventions may be helpful to increase job search behavior among university students.
Collapse
|