title: Employment status, employment functioning, and barriers to employment among VA primary care patients.
abstract: BACKGROUND
  Prior research found lower employment rates among working-aged patients who use the VA than among non-Veterans or Veterans who do not use the VA, with the lowest reported employment rates among VA patients with mental disorders. This study assessed employment status, employment functioning, and barriers to employment among VA patients treated in primary care settings, and examined how depression and anxiety were associated with these outcomes.
  
  
  METHODS
  The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical Center. Bivariate and multivariable analyses were conducted examining associations between socio-demographic and clinical predictors of six employment domains, including: employment status, job search self-efficacy, work performance, concerns about job loss among employed Veterans, and employment barriers and likelihood of job seeking among not employed Veterans.
  
  
  RESULTS
  54% of respondents were employed, 36% were not employed, and 10% were economically inactive. In adjusted analyses, participants with depression or anxiety (43%) were less likely to be employed, had lower job search self-efficacy, had lower levels of work performance, and reported more employment barriers. Depression and anxiety were not associated with perceived likelihood of job loss among employed or likelihood of job seeking among not employed.
  
  
  CONCLUSIONS
  Single VA primary care clinic; cross-sectional study.
  
  
  CONCLUSIONS
  Employment rates are low among working-aged VA primary care patients, particularly those with mental health conditions. Offering primary care interventions to patients that address mental health issues, job search self-efficacy, and work performance may be important in improving health, work, and economic outcomes.
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, 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. Electronic address: kzivin@umich.edu.
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Matheos
authors.initials: M
authors.lastname: Yosef
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA.
authors.forename: Debra S
authors.initials: DS
authors.lastname: Levine
authors.affiliation: Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA; Department of Psychology, University of Detroit Mercy, USA.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Abraham
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Miller
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Henry
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Mental Health Service, VA Ann Arbor Healthcare System, USA.
authors.forename: C Beau
authors.initials: CB
authors.lastname: Nelson
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Pfeiffer
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA.
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Sripada
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Harrod
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004651:Employment / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007586:Job Application; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D011320:Primary Health Care; D020377:Self Efficacy; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data*; D000066477:Work Performance
keywords: Anxiety; Depression; Employment; Work performance