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Gulf War and Health, Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress
Mississippi Scale for Combat-Related PTSD. The employment probability equation was estimated by using a probit: hourly earnings and hour-worked were estimated via ordinary least squares conditioned on being employed. The comparison group was white veterans without a history of psychiatric disorder, who had served in the military, but not in Southeast Asia, for less than one year and had low levels of war-related stress. The presence of any of four psychiatric diagnoses had a statistically significant negative effect on the probability of being employed: anxiety disorder, −0.415 (p < 0.01); substance abuse or dependence, −0.233 (p < 0.01); major depression, −0.390 (p < 0.01); and PTSD −0.498 (p < 0.01). However, none of the psychiatric disorders had an effect on the usual number of hours worked per week. Veterans with lifetime PTSD were 8.6% less likely to be working and, if working, earned 16% less per hour than veterans without PTSD. Veterans with major depression or substance use or dependence, but not anxiety disorders, also had lower hourly wages, although the lower wages are not significant for those with substance abuse or dependence. For men with depression, there was as 45% decrease in hourly wages (p ≤ 0.01), whereas for men with anxiety disorders, there was a 31% increase (p ≤ 0.01). In summary, combat-related PTSD significantly lowered the likelihood of working and the hourly wage. The authors noted that PTSD had a greater effect on reducing the likelihood of working and on the hourly wage than did deployment to Vietnam itself.
Similar results were seen by Jordan et al. (1992). Using data from the NVVRS, they found that Vietnam veterans with PTSD were five times more likely to be unemployed than veterans without PTSD (13.3% vs 2.5%).
The three secondary studies (Prigerson et al. 2001, 2002; Smith et al. 2005) reported similar results. Prigerson et al. (2001) used a subsample of 1703 men from the 1990-1992 NCS who reported experiencing a traumatic event to assess the impact of combat exposure on employment. They found that the 96 men who reported combat as their worst trauma had the highest rates of unemployment (20%) or having been fired in the last year (13%) compared with the highest rates for men who reported one of eight other traumas as their worst (13.4% and 9.7%, respectively). Using a different subsample of 2248 men from NCS, 179 of whom reported combat exposure data, Prigerson et al. (2002) estimated that 11.7% of 12-month job loss (relative risk 2.90, 95% CI 1.70-4.70, p < 0.001) and 8.9% of current unemployment (relative risk 2.37, 95% CI 1.55-3.44, p < 0.001) could be attributed to combat exposure.
Among 325 male Vietnam-era veterans being treated in 10 VA medical centers for severe or very severe PTSD symptoms, veterans with more severe PTSD symptoms (based on responses to the CAPS) were more likely to work part-time or not at all. A 10-point increase in CAPS score was associated with an almost 6% increase in the probability of not working, a 2% decrease in the likelihood of part-time work, and almost a 4% decrease in having full-time work (Smith et al. 2005).
Summary and Conclusions
Both primary studies considered by the committee indicated that veterans with PTSD are at greater risk for being unemployed and, if they are employed, are at risk for receiving lower wages than their counterparts without PTSD. However, the conclusions that can be drawn from the studies are limited in that they did not assess whether deployment itself had the same effect. Furthermore, all the primary studies were conducted in Vietnam veterans; none assessed the effect of Gulf War or other deployment on the later employment status of veterans. The secondary studies also indicated that veterans with combat exposure had poorer employment outcomes than those who experienced other or no traumas, particularly if they had PTSD.