Receipt of employment services among Veterans Health Administration users with psychiatric diagnoses
Receipt of employment services among Veterans Health Administration users with psychiatric diagnoses
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DOI：
10.1682/jrrd.2013.05.0114
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发表时间：
2014-01-01
影响因子：
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通讯作者：
Zivin, Kara
中科院分区：
文献类型：
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作者：
Abraham, Kristen M.;Ganoczy, Dara;Zivin, Kara
本研究旨在探讨退伍军人健康管理局（VHA）的就业服务与精神病诊断VHA患者的人口为基础的范围。服务覆盖面包括与未获得服务的人相比获得服务的人的百分比和特点。使用临床管理数据，我们确定了患者的精神病诊断随机样本中的所有患者接受VHA服务在1年。在精神病诊断的VHA患者中，我们研究了他们接受任何VHA就业服务和特定类型就业服务的可能性，包括支持性就业，过渡性工作，激励治疗和职业援助。我们确定了与接受就业服务相关的临床和人口统计学特征。结果表明，4.2%的VHA患者与精神病诊断接受就业服务。在调整临床和人口统计学特征后，患有精神分裂症和双相情感障碍的VHA患者比患有抑郁症、创伤后应激障碍或其他焦虑症的患者更有可能接受任何就业服务和接受支持性就业。与精神分裂症患者相比，患有抑郁症和PTSD的VHA患者更容易接受过渡性工作和职业援助。未来的研究应检查系统层面的障碍，接受就业服务，并确定类型的就业服务最适合退伍军人与不同的精神病诊断。
This study examined the population-based reach of Veterans Health Administration (VHA) employment services to VHA patients with psychiatric diagnoses. Reach of services includes the percentage and characteristics of people who accessed services compared with those who did not. Using clinical administrative data, we identified patients with a psychiatric diagnosis among a random sample of all patients who received VHA services in 1 yr. Among VHA patients with psychiatric diagnoses, we examined their likelihood of receiving any VHA employment services and specific types of employment services, including supported employment, transitional work, incentive therapy, and vocational assistance. We identified clinical and demographic characteristics associated with receiving employment services. Results indicated that 4.2% of VHA patients with a psychiatric diagnosis received employment services. After adjusting for clinical and demographic characteristics, VHA patients with schizophrenia and bipolar disorder were more likely to receive any employment services and to receive supported employment than were patients with depression, PTSD, or other anxiety disorders. VHA patients with depression and PTSD were more likely to receive transitional work and vocational assistance than patients with schizophrenia. Future studies should examine system-level barriers to receiving employment services and identify types of employment services most appropriate for Veterans with different psychiatric diagnoses.