Unemployed veterans with post-traumatic stress disorder experience better employment outcomes when they receive individual job placement and support services, compared with standard vocational rehabilitation services, new research shows.
Recipients of evidence-based individual placement and support (IPS) were significantly more likely to gain competitive employment than were recipients of the standard Vocational Rehabilitation Program (VRP) services, Dr. Lori L. Davis of the Tuscaloosa (Alabama) Veterans Affairs Medical Center and her colleagues reported Feb. 2 online ahead of print in Psychiatric Services. Additional employment outcomes, including time worked and total earnings, also favored IPS, they wrote (Psychiatric Serv. 2012 [doi:10.1176/appi.ps.201100340]).
The study is the first to examine employment outcomes for veterans with PTSD who received IPS, compared with those with PTSD enrolled in the VRP, which is offered by the U.S. Department of Veterans Affairs.
For the prospective study, 85 unemployed veterans with PTSD aged 19-60 years at the Tuscaloosa VA Medical Center from 2006 to 2011 were randomized to either IPS-supported employment (42) or VRP treatment as usual (43). The employment rates and occupational outcomes of the veterans were followed for 12 months. All of the subjects were medically cleared to participate in a work activity, were interested in competitive employment, and were planning to remain within a 100-mile radius of the medical center for the duration of the study, the authors wrote.
Excluded from the study were veterans with a severe disorder resulting from severe traumatic brain injury; those diagnosed with schizophrenia, schizoaffective disorder, bipolar I disorder, or dementia; those with an immediate need for alcohol or drug detoxification; or those with pending active legal charges with expected incarceration, the researchers wrote.
The main tenets of the evidence-based IPS supported employment model are client choice, rapid job finding where appropriate, competitive education programs, integrated education and work settings, and follow-along supports. The individualized client-centered services are provided by a multidisciplinary team that integrates and coordinates treatment and rehabilitation, according to the authors. Standard VRP care includes routine prevocational testing and evaluation; vocational rehabilitation therapy comprising a work regimen and the use of special employer incentives; on-the-job training; apprenticeships; and on-paid work experience. Limited supportive rehabilitation and independent living services are also included, they stated.
At baseline, all of the study participants underwent a psychiatric and general medical evaluation, including a medical history, psychiatric history, and family psychiatric history. A clinical research coordinator also evaluated each participant for PTSD and other Axis I disorders using the Mini-International Neuropsychiatric Interview and at baseline and 1-, 2-, 3-, 4-, 6-, 8-, 10- , and 12-month follow-up visits. In addition, the coordinator reviewed subjects’ job logs, which included their employment status, number of hours worked, wages earned, and reasons for missed work.
An analysis of the study results showed that the 85 subjects had been employed for a mean18.9 months and, in addition to PTSD, 89% of the subjects had major depressive disorder, 20% had dysthymia, 54% had agoraphobia, 59% had panic disorder, 28% had social phobia, 42% had alcohol dependence, 21% had alcohol abuse, 37% had drug dependence, and 18% had drug abuse, the authors reported.
With respect to employment outcomes, 32 (76%) of the 42 IPS participants gained competitive employment, compared with 12 (28%) of the 43 VRP participants. Thus, the authors wrote, "... veterans with PTSD who participated in IPS were 2.7 times more likely to gain competitive employment than those who received VRP." The number needed to treat was 2.07, they noted. "In other words, if three individuals received IPS and three received VRP, one more individual in the IPS intervention would get a competitive job."
Of the eligible weeks during the study, IPS participants worked in a competitive job an average of 42%, compared with 16% for the VRP participants, the authors reported. Further, the mean total gross 12-month income for the IPS group was $9,264 – significantly higher than the mean $2,601 earned by the VRP group.
The study findings are limited by the single-site design and the exclusion of nonveterans, the authors acknowledged. "A multisite trial with a larger and more diverse study sample would confirm the results and allow examination of secondary outcomes, such as PTSD symptoms, quality of life, and other such outcomes," they wrote. "In addition, a larger study could evaluate the cost effectiveness of the IPS intervention."
The investigators disclosed financial relationships with AstraZeneca, Sunovion, Pfizer, MedAvante, and Roche.