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RRP 08-385 – QUERI Project

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RRP 08-385
Impact of Psychiatric Diagnoses and Injury on Vocational Outcomes in OIF Veterans
Christopher R. Erbes PhD
Minneapolis VA Health Care System, Minneapolis, MN
Minneapolis, MN
Funding Period: November 2008 - April 2009

BACKGROUND/RATIONALE:
Successful transition of returning soldiers back into civilian life following deployment is a vital concern for the nation and the VA. Civilian reintegration is especially difficult for veterans suffering from physical injuries such as those due to blasts as well as mental health impairments (i.e., PTSD, depression and alcohol or drug addictions), and can also be particularly challenging for National Guard and Reserve soldiers. A return to successful occupational functioning, including the successful return to work or school (RTW/S), represents both a vital outcome for all returning veterans and an important predictor of long-term mental health functioning and disability. The identification of veterans at risk for vocational dysfunction is a high priority.

OBJECTIVE(S):
The objective was to determine pre-deployment, deployment-related, and post-deployment predictors of occupational functioning in a cohort of National Guard soldiers who returned from a combat deployment to Iraq by examining demographic variables, personality, psychiatric diagnosis, trauma exposure, and injury.

METHODS:
This project involved the coding and analysis of an existing data set of self-report and clinical interview responses from a group of National Guard soldiers who provided Time 1 data one month prior to a 16 month deployment to Iraq and again 3-6 months after returning home (Time 2). Of the original sample of 522, 355 participated in full post-deployment data collection. Participants completed measures of personality and demographic/historical variables during pre-deployment data collection. At post-deployment, participants again provided self report data but also completed structured clinical interviews for PTSD, other psychiatric conditions, and occupational functioning. Veteran reports of their most severe stressors were content coded to characterize their deployment experiences and evaluate their relationship with post-deployment occupational functioning. Occupational functioning was operationalized as successful RTW/S (having a job or being enrolled in school and not reporting impaired job functioning) as well as self reported Work/School Role functioning.

FINDINGS/RESULTS:
Rates of unemployment rose from 8% (pre-deployment) to 16% (post-deployment). Two thirds (65%) of respondents met criteria for successful RTW/S. Post-deployment diagnoses included PTSD and subthreshhold PTSD (13%), Depressive Disorders (15%), and Alcohol Use Disorders (13%). Diagnostic status was not related to occupational status (working versus unemployed) but was related to successful RTW/S, job satisfaction and work/school role functioning. Deployment experiences, including combat exposure, other types of severe stressors identified from content coding, injury, and reported mild TBI were not related to occupational status, successful RTW/S, or job/school role functioning. Gender, race, previous work history, and marital status all predicted indices of occupational functioning.

IMPACT:
This study has demonstrated a link between post-deployment mental health diagnoses/symptoms and reduced job satisfaction and successful work or school role functioning among veterans of OIF. Findings indicate a need for further longitudinal study in this area.

PUBLICATIONS:

Journal Articles

  1. Meis LA, Erbes CR, Kramer MD, Arbisi PA, Kehle-Forbes SM, DeGarmo DS, Shallcross SL, Polusny MA. Using reinforcement sensitivity to understand longitudinal links between PTSD and relationship adjustment. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2017 Feb 1; 31(1):71-81.
  2. Kramer MD, Arbisi PA, Thuras PD, Krueger RF, Erbes CR, Polusny MA. The class-dimensional structure of PTSD before and after deployment to Iraq: Evidence from direct comparison of dimensional, categorical, and hybrid models. Journal of anxiety disorders. 2016 Apr 1; 39:1-9.
  3. Shallcross SL, Arbisi PA, Polusny MA, Kramer MD, Erbes CR. Social Causation Versus Social Erosion: Comparisons of Causal Models for Relations Between Support and PTSD Symptoms. Journal of traumatic stress. 2016 Apr 1; 29(2):167-75.
  4. Koffel E, Krebs EE, Arbisi PA, Erbes CR, Polusny MA. The Unhappy Triad: Pain, Sleep Complaints, and Internalizing Symptoms. Clinical psychological science : a journal of the Association for Psychological Science. 2016 Jan 16; 4(1):96-106.
  5. Koffel E, Kramer MD, Arbisi PA, Erbes CR, Kaler M, Polusny MA. Personality traits and combat exposure as predictors of psychopathology over time. Psychological medicine. 2016 Jan 1; 46(1):209-20.
  6. Finn JA, Arbisi PA, Erbes CR, Polusny MA, Thuras P. The MMPI-2 Restructured Form Personality Psychopathology Five Scales: bridging DSM-5 Section 2 personality disorders and DSM-5 Section 3 personality trait dimensions. Journal of personality assessment. 2013 Dec 30; 96(2):173-84.
  7. Arbisi PA, Rusch L, Polusny MA, Thuras P, Erbes CR. Does cynicism play a role in failure to obtain needed care? Mental health service utilization among returning U.S. National Guard soldiers. Psychological assessment. 2013 Sep 1; 25(3):991-6.
  8. Lancaster SL, Erbes CR, Kumpula MJ, Ferrier-Auerbach A, Arbisi PA, Polusny MA. Longitudinal predictors of desire to re-enlist in the military among male and female national guard soldiers. Military medicine. 2013 Mar 1; 178(3):267-73.
  9. Erbes CR, Polusny MA, Arbisi PA, Koffel E. PTSD symptoms in a cohort of National Guard soldiers deployed to Iraq: evidence for nonspecific and specific components. Journal of affective disorders. 2012 Dec 15; 142(1-3):269-74.
  10. Arbisi PA, Kaler ME, Kehle-Forbes SM, Erbes CR, Polusny MA, Thuras P. The predictive validity of the PTSD Checklist in a nonclinical sample of combat-exposed National Guard troops. Psychological assessment. 2012 Dec 1; 24(4):1034-40.
  11. Koffel E, Polusny MA, Arbisi PA, Erbes CR. A preliminary investigation of the new and revised symptoms of posttraumatic stress disorder in DSM-5. Depression and anxiety. 2012 Aug 1; 29(8):731-8.
  12. Erbes CR, Kaler ME, Schult T, Polusny MA, Arbisi PA. Mental health diagnosis and occupational functioning in National Guard/Reserve veterans returning from Iraq. Journal of rehabilitation research and development. 2012 May 18; 48(10):1159-70.
  13. Kehle SM, Reddy MK, Ferrier-Auerbach AG, Erbes CR, Arbisi PA, Polusny MA. Psychiatric diagnoses, comorbidity, and functioning in National Guard troops deployed to Iraq. Journal of psychiatric research. 2011 Jan 1; 45(1):126-32.
Conference Presentations

  1. Erbes CR, Polusny MA. Gender, war and sexual harassment. Sexual harassment and assault in military and civilian populations. Paper presented at: Society for the Scientific Study of Sexuality MidContinent Region Symposium; 2013 Apr 20; Minneapolis, MN.
  2. Polusny MA, Erbes CR. A prospective study of pre-deployment personality, combat-related PTSD, and physical health complaints among deployed soldiers. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2012 Nov 3; Los Angeles, CA.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: none
Keywords: Mental Health Care, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms: none

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