Employment support needs of VA primary care patients with depression and anxiety

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Anticipated impact on Veteran's healthcare: This study will obtain data to define the scope of employment support needs among Veterans treated in VA primary care (PC) settings who have a clinical diagnosis of a depression or anxiety disorder. It will form the basis for a Service Directed Project (SDP) to implement appropriate employment support services for these Veterans. Background: Ensuring that the employment needs of returning Veterans are met is a top priority for the Department of Veterans Affairs. Our research found substantially lower employment rates among working-aged VA patients than non-Veterans and Veterans who do not use the VA, with the lowest rates among VA patients with mental disorders. Less than one- third of VA patients with mental disorders and documented needs receive any employment assistance, and less than 20% receive as much help as needed. Employment status or need for employment services among VA patients treated outside specialty mental health settings remains unknown. Our long term research goal is to ensure access to and maintenance of appropriate jobs among working-aged VA patients with common mental disorders who want to work. Our objective in this application is to determine the level and nature of VA PC patient employment status, needs and preferences for supportive services. Based on our prior work, our central hypothesis is that VA patients with mental disorders such as depression and anxiety, who are most often treated in PC settings, are less likely to be employed and have greater barriers to employment and use of employment services than VA PC patients without these disorders. Our rationale for conducting this study is to identify gaps in care, treatment barriers, and preferences for services before conducting an intervention to assist these Veterans with employment-related concerns. Aim 1. To assess the employment status of PC patients with and without depression and anxiety. Aim 2. To assess perceived barriers to and facilitators of employment among PC patients with and without depression and anxiety. Aim 3. To assess use of and preferences for employment services among PC patients with and without depression and anxiety. In an exploratory Aim, we will determine the level and nature of mental health services use among VA PC patients with depression and anxiety, including the extent of employment issues addressed by these mental health services. This RRP has been developed in close consultation with Mental Health QUERI leadership. It addresses several goals set forth in MH-QUERI's Strategic Plan, including the Recovery Workgroup's goal of developing strategies to improve employment outcomes. This proposal is targeted at QUERI Step 3, the pre-implementation stage (identifying determinants of current practice, existing barriers, and assessing feasibility of intervention). Findings from this study will guide the adaptation and implementation of employment services for patients with depression and anxiety in PC settings. Methods: We will conduct a mailed patient survey and semi-structured qualitative interviews of VA patients with recent PC use. Potential participants will be identified from automated medical data. The survey will be mailed to 902 patients expecting a 60% return rate. It will include measures of employment status, use of VA and non- VA services, symptom measures, and preferences and barriers to using VA employment support services. Interviews with 15-20 patients will identify themes related to experiences coping with unemployment, mental health problems and preferences for additional services.