Abraham Kristen M, Ganoczy Dara, Yosef Matheos, Resnick Sandra G, Zivin Kara
University of Detroit Mercy, Department of Psychology, 4001 W McNichols Rd, Detroit, MI 48221-0445.
J Rehabil Res Dev. 2014;51(3):401-14. doi: 10.1682/JRRD.2013.05.0114.
This study examined the population-based reach of Veterans Health Administration (VHA) employment services to VHA patients with psychiatric diagnoses. Reach of services includes the percentage and characteristics of people who accessed services compared with those who did not. Using clinical administrative data, we identified patients with a psychiatric diagnosis among a random sample of all patients who received VHA services in 1 yr. Among VHA patients with psychiatric diagnoses, we examined their likelihood of receiving any VHA employment services and specific types of employment services, including supported employment, transitional work, incentive therapy, and vocational assistance. We identified clinical and demographic characteristics associated with receiving employment services. Results indicated that 4.2% of VHA patients with a psychiatric diagnosis received employment services. After adjusting for clinical and demographic characteristics, VHA patients with schizophrenia and bipolar disorder were more likely to receive any employment services and to receive supported employment than were patients with depression, PTSD, or other anxiety disorders. VHA patients with depression and PTSD were more likely to receive transitional work and vocational assistance than patients with schizophrenia. Future studies should examine system-level barriers to receiving employment services and identify types of employment services most appropriate for Veterans with different psychiatric diagnoses.
本研究调查了退伍军人健康管理局（VHA）就业服务针对患有精神疾病诊断的VHA患者的人群覆盖范围。服务覆盖范围包括接受服务的人群与未接受服务人群相比的百分比及特征。利用临床管理数据，我们在1年内接受VHA服务的所有患者的随机样本中确定了患有精神疾病诊断的患者。在患有精神疾病诊断的VHA患者中，我们研究了他们接受任何VHA就业服务以及特定类型就业服务的可能性，包括支持性就业、过渡性工作、激励疗法和职业援助。我们确定了与接受就业服务相关的临床和人口统计学特征。结果表明，患有精神疾病诊断的VHA患者中有4.2%接受了就业服务。在对临床和人口统计学特征进行调整后，患有精神分裂症和双相情感障碍的VHA患者比患有抑郁症、创伤后应激障碍（PTSD）或其他焦虑症的患者更有可能接受任何就业服务并获得支持性就业。患有抑郁症和PTSD的VHA患者比患有精神分裂症的患者更有可能接受过渡性工作和职业援助。未来的研究应调查接受就业服务的系统层面障碍，并确定最适合患有不同精神疾病诊断的退伍军人的就业服务类型。
