Disparities in program enrollment and employment outcomes for veterans with psychiatric and co-occurring substance use disorders referred or enrolled for VHA vocational rehabilitation

Matthew E Sprong; Heaven Hollender; Yu-Sheng Lee; Lee Ann Rawlins Williams; Zach Sneed; Amir Garakani; Frank D Buono

doi:10.3389/fpsyt.2023.1200450

Disparities in program enrollment and employment outcomes for veterans with psychiatric and co-occurring substance use disorders referred or enrolled for VHA vocational rehabilitation

Front Psychiatry. 2023 Jul 13:14:1200450. doi: 10.3389/fpsyt.2023.1200450. eCollection 2023.

Authors

Matthew E Sprong^{1

2}, Heaven Hollender³, Yu-Sheng Lee⁴, Lee Ann Rawlins Williams⁵, Zach Sneed⁶, Amir Garakani^{7

8}, Frank D Buono⁸

Affiliations

¹ Edward Hines Jr. VA Medical Center, Hines, IL, United States.
² School of Public Management and Policy, University of Illinois Springfield, Springfield, IL, United States.
³ Department of Health Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States.
⁴ School of Integrated Sciences, Sustainability, and Public Health, University of Illinois Springfield, Springfield, IL, United States.
⁵ Rehabilitation and Human Services, College of Education and Human Development, University of North Dakota, Grand Forks, ND, United States.
⁶ School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, United States.
⁷ Department of Psychiatry and Behavioral Health, Greenwich Hospital, Greenwich, CT, United States.
⁸ Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States.

Abstract

Introduction: The purpose of the study was to investigate factors that influence vocational rehabilitation program enrollment and employment at discharge of veterans with psychiatric and co-occurring alcohol and other substance use disorders enrolled at a veteran health administration (VHA) medical center.

Methods: A sample of 2,550 veteran patients referred for VHA vocational rehabilitation between 2016 and 2021 were examined for the current study. The current study was classified as quality improvement/assurance, thus resulting in exempt research by the U.S. Department of Veteran Affairs Institutional Review Board.

Results: Veterans with active alcohol use disorders (AUDs) and co-occurring depression, anxiety, post-traumatic stress disorder, or bipolar disorders were less likely to be enrolled for vocational rehabilitation program services compared to those without these co-occurring diagnoses. Veterans with AUD (active & in-remission status combined into one category) and a diagnosis of anxiety were less likely to be employed at discharge compared to veterans with AUDs and no anxiety diagnosis (anxiety diagnosis - 3.5% vs. no anxiety diagnosis - 5.8%).

Discussion: VHA vocational rehabilitation can be an effective intervention to assist veterans in reintegrating back into the community. Yet, there appears to be some disparities in the program enrollment and employment at discharge, depending on the nature of the psychiatric diagnosis. Investigating the factors contributing (mediating or moderating) to these discrepancies are needed. Although it appears access is not the issue in being referred for vocational rehabilitation services, other factors are likely contributing to program entry.

Keywords: Department of Veteran Affairs; co-occurring disorders; employment; mental health; psychiatric disorders; substance use disorders; veterans; vocational rehabilitation.