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IIR 12-345 – HSR&D Study

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IIR 12-345
Work and Family Functioning in Women Veterans: Implications for VA Service Use
Dawne S Vogt PhD BA
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: October 2013 - March 2017

BACKGROUND/RATIONALE:
Both employment and family problems have been identified as key issues for returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) Veterans. Given the role of work and family experiences in Veterans' readjustment to civilian life, it is critical to understand the impact that Veterans' postdeployment mental health has on their functioning in these domains, as well as the representation in the armed forces, their associated risk for posttraumatic stress disorder (PTSD), and the lack of research on their work and family experiences after deployment. Female Veterans represent an underserved and important population for additional investigation. This project builds on a prior study with large implications of Veterans' occupational and work functioning for their need for and use of VA programs and services. With women's increasing national sample and the previous study of female and male OEF/OIF Veterans (HSR&D DHI 09-086), by conducting two follow-up data collections to examine longitudinal relationships involving female Veterans', as compared to male Veterans', we will better understand occupational and family functioning over time. Specifically, this project will examine gender differences in the effects of deployment stressors and their associated mental health sequelae on Veterans' postdeployment functioning in both work and family domains, as well as association between Veterans' postdeployment functioning and their need for and use of a broad range of VA programs and services (i.e., health-care, employment, and education services).

OBJECTIVE(S):
The specific aims of the project are to document: (1) female Veterans' functioning, as it compares to male Veterans' functioning, in work and family domains following return from deployment; (2) gender differences in the role of exposure to potentially traumatic experiences during deployment (e.g., combat and military sexual trauma) and subsequent mental health sequelae (e.g., PTSD) in Veterans' functioning in work and family domains; and (3) gender differences in associations among postdeployment mental health, occupational and family functioning and their complex interplay, and Veterans' use of VA services. The longer-term objective of this project is to provide information that can be applied to better target VA programs and services to the unique needs of female versus male Veterans.

METHODS:
In an earlier study, deployment-related stressors and postdeployment mental health were assessed in a national sample of female and male OEF/OIF Veterans (N=1,046; 54% female Veterans; 46% male Veterans). This project involved recontacting this sample approximately 3.5 years later (T2; N = 524) to assess occupational and family functioning, mental health symptomatology, and VA service use. An additional follow-up (T3; N=455) occurred approximately 1.5 years after the first, yielding 3 total assessment points that allowed for an examination of change over time. Proposed relationships were tested using structural equation modeling (SEM), and supplemented by chi square tests and regression analyses as appropriate. Gender comparisons were also conducted.

FINDINGS/RESULTS:
Overall, both female and male OEF/OIF Veterans reported high work-and family-related quality of life, although women were more likely to report being unemployed than men. PTSD was an important predictor of poorer functioning and satisfaction in work and especially family domains. Several gender differences were found. PTSD was associated with decreased work functioning for men (but not women), and decreased job satisfaction for women (but not men). Further, findings revealed several pathways linking deployment stressors to work and family outcomes for both men and women, with PTSD playing an important role in these associations. Depression also played a significant role, linking the relationship between deployment stressors and work functioning for women, while PTSD linked the relationship for men. PTSD linked deployment exposures and quality of life in romantic relationships for men, while both PTSD and depression played significant roles for women. In the context of parenting, PTSD linked deployment exposures with reduced functioning for both male and female veterans, and depression was the most important mediator in predicting lower satisfaction.

An examination of veterans' T2 service use revealed that 59.1% of the sample had used VA health care since deployment, and 37.2% had used VA mental health care services. T3 results indicated that 50.8% and 31.6% had used VA healthcare and mental healthcare in the past 18 months, respectively. Veterans also reported substantial use of VA educational services. In total, 55.9% of Veterans reported they had used educational services since returning from deployment and 24.7% had used them in the past 18 months. Use of VA work and family services were much lower at both T2 and T3. At T2, only 10% reported using VA family services and 14% reported use of VA work services since returning from deployment. At T3, 21% had used VA family services in the past 18 months, while 15% had used VA work services.

In another set of analyses, we examined mediated and moderated relationships between mental health symptomatology, work and relationship impairment, and use of VA mental health services. With two exceptions, findings revealed that the impact of symptom severity on treatment seeking is not mediated or moderated by functional impairment. One exception was for alcohol misuse, for which work impairment was a key mechanism linking alcohol misuse to increased treatment seeking. The other exception was for depression. Whereas both T2 depressive symptoms and T2 relationship impairment were positively associated with service use, at the highest level of relationship impairment, the association between depression symptoms and service use was no longer significant, suggesting that impaired intimate relationship functioning may curtail treatment seeking among those individuals with depression symptoms.

IMPACT:
Although many work and family programs and services are available to veterans, we do not yet know the extent to which these programs address veterans' most salient needs. Findings suggest that programs focused on mitigating the negative impact of PTSD and other comorbid mental health conditions on veterans' work and especially their family functioning and satisfaction may best meet the needs of post-9/11 veterans. In addition, results suggest the need for additional attention to the role of depression in female veterans' functioning, as well as women's greater unemployment after separating from service.

PUBLICATIONS:

Journal Articles

  1. Maskin RM, Iverson KM, Vogt D, Smith BN. Associations between intimate partner violence victimization and employment outcomes among male and female post-9/11 veterans. Psychological trauma : theory, research, practice and policy. 2019 May 1; 11(4):406-414.


DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Etiology, Diagnosis, Prognosis
Keywords: Depression, Family, Gender Differences, PTSD, Reintegration Post-Deployment, Risk Factors, Sexual Trauma/Assault, Social Support, Socioeconomic Factors, Substance Use and Abuse, Utilization
MeSH Terms: none

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