Background: Post-traumatic stress disorder (PTSD) is a mental health condition with symptoms that negatively affect social and work situations, as well as permanent employment and income. A randomized, controlled, multisite clinical trial was carried out by the Veterans Affairs Cooperative Study Program (VACSP) from 2013 to 2017 to compare two different interventions aimed at helping Veterans obtain and maintain competitive employment: the Individual Placement and Support (IPS) intervention, and the Transitional Work (TW) program. The IPS intervention included individual career and job counseling while the TW program provided temporary, ‘set-aside’ employment within VA facilities. The primary outcome was “steady worker” status, defined as holding competitive jobs for at least 50% of the trial follow-up time. The results showed that a higher proportion of participants randomized to IPS gained steady employment compared to those randomized to TW. The primary analysis did not, however, investigate the interactions between the severity of PTSD Symptoms and the participant’s ability to function in social and work settings. In the current analysis we explored the relationships between these aspects and assessed how these relationships varied among groups of Veterans with common baseline characteristics. Method: We conducted a latent profile analysis using data from this trial, searching for possible subgroups of participants with distinct mental health condition patterns. The profiles were determined using scores derived from four baseline assessments designed to measure: (i) the severity of PTSD Symptoms; (ii) the Veteran’s quality of life; (iii) the Veteran’s level of disability, and (iv) the Veteran’s self-esteem prior to the interventions. We subsequently examined the relationships between the resultant profiles and the probability of achieving competitive employment. We also compared the cumulative earnings of Veterans in the different profiles who acquired competitive jobs. Results: We identified three distinct groups: Group 1 was composed of Veterans with severe PTSD Symptoms, high disability, low quality of life and low self-esteem. Group 2 was characterized by Veterans with both a low PTSD Symptoms score and disability score, and good quality of life and self-esteem. Lastly, Group 3 included Veterans with better conditions than Veterans in Group 1 but worse than those in Group 2. Regardless of the treatment, Veterans in Group 3 were more likely to become steady workers compared to Veterans in Group 1 and Group 2. The probability of achieving permanent employment increased for Veterans in Group 3 who were randomized to IPS compared to Veterans randomized to the same intervention but belonging to Group 1 and 2. Coherently, Veterans in Profile 3 worked significantly more hours/days and earned higher incomes from competitive jobs than those in the other two group profiles. Conclusion: Our analysis found a difference in severity of PTSD symptoms and baseline function characteristics among Veterans with lifetime PTSD diagnosis. The identification of such baseline characteristics that increase an individual’s chances of gaining permanent employment can perhaps be used to guide more individualized interventions.
DETERMINING MENTAL HEALTH CONDITION PATTERNS IN VETERANS WITH A LIFETIME PTSD DIAGNOSIS
Domenicano I
Formal Analysis
;
2020
Abstract
Background: Post-traumatic stress disorder (PTSD) is a mental health condition with symptoms that negatively affect social and work situations, as well as permanent employment and income. A randomized, controlled, multisite clinical trial was carried out by the Veterans Affairs Cooperative Study Program (VACSP) from 2013 to 2017 to compare two different interventions aimed at helping Veterans obtain and maintain competitive employment: the Individual Placement and Support (IPS) intervention, and the Transitional Work (TW) program. The IPS intervention included individual career and job counseling while the TW program provided temporary, ‘set-aside’ employment within VA facilities. The primary outcome was “steady worker” status, defined as holding competitive jobs for at least 50% of the trial follow-up time. The results showed that a higher proportion of participants randomized to IPS gained steady employment compared to those randomized to TW. The primary analysis did not, however, investigate the interactions between the severity of PTSD Symptoms and the participant’s ability to function in social and work settings. In the current analysis we explored the relationships between these aspects and assessed how these relationships varied among groups of Veterans with common baseline characteristics. Method: We conducted a latent profile analysis using data from this trial, searching for possible subgroups of participants with distinct mental health condition patterns. The profiles were determined using scores derived from four baseline assessments designed to measure: (i) the severity of PTSD Symptoms; (ii) the Veteran’s quality of life; (iii) the Veteran’s level of disability, and (iv) the Veteran’s self-esteem prior to the interventions. We subsequently examined the relationships between the resultant profiles and the probability of achieving competitive employment. We also compared the cumulative earnings of Veterans in the different profiles who acquired competitive jobs. Results: We identified three distinct groups: Group 1 was composed of Veterans with severe PTSD Symptoms, high disability, low quality of life and low self-esteem. Group 2 was characterized by Veterans with both a low PTSD Symptoms score and disability score, and good quality of life and self-esteem. Lastly, Group 3 included Veterans with better conditions than Veterans in Group 1 but worse than those in Group 2. Regardless of the treatment, Veterans in Group 3 were more likely to become steady workers compared to Veterans in Group 1 and Group 2. The probability of achieving permanent employment increased for Veterans in Group 3 who were randomized to IPS compared to Veterans randomized to the same intervention but belonging to Group 1 and 2. Coherently, Veterans in Profile 3 worked significantly more hours/days and earned higher incomes from competitive jobs than those in the other two group profiles. Conclusion: Our analysis found a difference in severity of PTSD symptoms and baseline function characteristics among Veterans with lifetime PTSD diagnosis. The identification of such baseline characteristics that increase an individual’s chances of gaining permanent employment can perhaps be used to guide more individualized interventions.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
