Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor, MI 48105, USA.
Department of Psychology, University of Detroit Mercy, Detroit, MI 48221, USA.
Mil Med. 2021 Aug 28;186(9-10):850-857. doi: 10.1093/milmed/usab113.
Although the benefits of employment for veterans with mental health conditions are well-known, the effect of veterans' employment on a health system has not been evaluated. The purpose of this study was to evaluate the effect of veterans' employment (versus unemployment) on subsequent health care utilization in the Veterans Health Administration (VHA).
This study used a sample of 29,022 veterans with mental health and substance use disorders who were discharged from VHA's employment services programs between fiscal years 2006 and 2010. Veterans' employment status (employed/unemployed) upon discharge from VHA employment programs was ascertained from program discharge forms and linked with VHA administrative health care utilization data for the subsequent 1- and 5-year periods.
Multivariable ordinary least-squares and logistic regression models adjusted for site clustering and covariates indicated that employment (versus unemployment) predicted less health care utilization 1 year and 5 years post-discharge from employment services, including fewer outpatient mental health visits, homelessness services visits, employment services visits, primary care visits, and lower odds of mental health hospitalizations, mental health or vocational rehabilitation residential stays, and medical hospitalizations. Employment did not predict emergency department visits.
VHA's investment in employment services for veterans with mental health and substance use disorders could reduce health care utilization system wide.
尽管就业对有心理健康问题的退伍军人有诸多好处，但退伍军人就业对卫生系统的影响尚未得到评估。本研究的目的是评估退伍军人就业（相对于失业）对退伍军人健康管理局（VHA）后续医疗保健利用的影响。
本研究使用了一个样本量为 29022 名患有精神健康和物质使用障碍的退伍军人，他们在 2006 年至 2010 年期间从 VHA 的就业服务项目中出院。退伍军人在从 VHA 就业项目中出院时的就业状况（就业/失业）从项目出院表中确定，并与 VHA 行政医疗保健利用数据相关联，用于随后的 1 年和 5 年期间。
多变量最小二乘法和逻辑回归模型调整了地点聚类和协变量，表明与失业相比，就业（相对于失业）预测了就业服务后 1 年和 5 年的医疗保健利用减少，包括减少门诊心理健康就诊次数、无家可归服务就诊次数、就业服务就诊次数、初级保健就诊次数，以及心理健康住院、心理健康或职业康复住院和医疗住院的几率降低。就业并没有预测急诊就诊次数。
VHA 对有心理健康和物质使用障碍的退伍军人的就业服务投资可能会降低整个卫生系统的医疗保健利用。
