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

对退伍军人医疗保健的预期影响：这项研究将获得数据来定义 退伍军人在退伍军人初级保健(PC)环境中接受治疗后的就业支持需求 抑郁症或焦虑症的临床诊断。它将构成服务的基础 指导项目(SDP)为这些人实施适当的就业支持服务 退伍军人。背景：确保返乡退伍军人的就业需求得到满足是一项 退伍军人事务部的首要任务。我们的研究发现大大降低了 劳动年龄退伍军人患者的就业率高于非退伍军人和退伍军人 不使用退伍军人管理局，在退伍军人管理局有精神障碍的患者中发生率最低。少于一人- 有精神障碍和有书面需求的退伍军人中有三分之一的人 只有不到20%的人得到了所需的帮助。就业状况或需要 在专科精神卫生场所以外接受治疗的退伍军人管理局患者的就业服务 仍然不为人知。我们的长期研究目标是确保访问和维护 工作年龄的退伍军人中常见精神障碍患者的合适工作 工作。我们在这项应用中的目标是确定VA PC患者的水平和性质 就业状况、对支持性服务的需求和偏好。基于我们之前的工作， 我们的中心假设是退伍军人症患者有精神障碍，如抑郁和焦虑， 最常在个人电脑环境中接受治疗的人，不太可能被雇用，并且拥有更多 就业和使用就业服务的障碍比没有这些障碍的退伍军人患者要高 精神错乱。我们进行这项研究的理由是找出护理、治疗障碍、 和服务偏好，然后进行干预，以帮助这些退伍军人 与就业相关的担忧。目的1.评估糖尿病患者的就业状况。 而且没有抑郁和焦虑。目标2.评估感知到的障碍和 有无抑郁和焦虑的PC患者的就业促进者。 目的3.评估PC患者对就业服务的使用和偏好 无论有没有抑郁和焦虑。在探索性目标中，我们将确定 退伍军人抑郁症患者心理卫生服务利用水平及性质研究 和焦虑，包括这些心理问题解决的就业问题的程度 医疗服务。本RRP是在与心理健康密切磋商后制定的 QUERI领导层。它解决了MH-QUERI的战略计划中提出的几个目标，包括 复苏工作组制定战略以改善就业结果的目标。这 建议的目标是QUERI步骤3，即实施前阶段(确定 目前的做法、存在的障碍和干预的可行性评估)。由此得出的结论 研究将指导适应和实施为老年患者提供的就业服务 电脑环境中的抑郁和焦虑。方法：我们将进行邮寄的患者调查和 对最近使用PC的退伍军人退伍军人进行半结构化定性访谈。潜在参与者 将从自动医疗数据中识别。调查问卷将邮寄给902名患者 期望60%的回报率。它将包括衡量就业状况、使用退伍军人管理局和非 退伍军人管理局服务、症状测量以及使用退伍军人管理局就业的偏好和障碍 支持服务。对15-20名患者的采访将确定与体验相关的主题 应对失业、心理健康问题和对额外服务的偏好。

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.