{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T16:36:15Z","timestamp":1782837375163,"version":"3.54.5"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"9-10","funder":[{"name":"VHA Health Services Research and Development","award":["LIP-41-129; IIR 17-262; RCS 21-138; PI: Zivin"],"award-info":[{"award-number":["LIP-41-129; IIR 17-262; RCS 21-138; PI: Zivin"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,28]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Although the benefits of employment for veterans with mental health conditions are well-known, the effect of veterans\u2019 employment on a health system has not been evaluated. The purpose of this study was to evaluate the effect of veterans\u2019 employment (versus unemployment) on subsequent health care utilization in the Veterans Health Administration (VHA).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>This study used a sample of 29,022 veterans with mental health and substance use disorders who were discharged from VHA\u2019s employment services programs between fiscal years 2006 and 2010. Veterans\u2019 employment status (employed\/unemployed) upon discharge from VHA employment programs was ascertained from program discharge forms and linked with VHA administrative health care utilization data for the subsequent 1- and 5-year periods.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Multivariable ordinary least-squares and logistic regression models adjusted for site clustering and covariates indicated that employment (versus unemployment) predicted less health care utilization 1\u2009year and 5\u2009years post-discharge from employment services, including fewer outpatient mental health visits, homelessness services visits, employment services visits, primary care visits, and lower odds of mental health hospitalizations, mental health or vocational rehabilitation residential stays, and medical hospitalizations. Employment did not predict emergency department visits.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>VHA\u2019s investment in employment services for veterans with mental health and substance use disorders could reduce health care utilization system wide.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usab113","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T21:18:58Z","timestamp":1617830338000},"page":"850-857","source":"Crossref","is-referenced-by-count":15,"title":["Employment After Vocational Rehabilitation Predicts Decreased Health Care Utilization in Veterans With Mental Health Diagnoses"],"prefix":"10.1093","volume":"186","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4725-3078","authenticated-orcid":false,"given":"Kristen M","family":"Abraham","sequence":"first","affiliation":[{"name":"Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor, MI 48105, USA"},{"name":"Department of Psychology, University of Detroit Mercy, Detroit, MI 48221, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Un Myron","family":"Chang","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Van","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra G","family":"Resnick","sequence":"additional","affiliation":[{"name":"Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, West Haven, CT 06516, USA"},{"name":"Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara","family":"Zivin","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA"},{"name":"Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,28]]},"reference":[{"issue":"1","key":"2021082810513228000_R1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1176\/ps.62.1.pss6201_0035","article-title":"Employment status of patients in the VA health system implications for mental health services","volume":"62","author":"Zivin","year":"2011","journal-title":"Psychiatr Serv"},{"issue":"3","key":"2021082810513228000_R2","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/NMD.0b013e318247cb29","article-title":"A prospective investigation of work and nonvocational outcomes in adults with severe mental illness","volume":"200","author":"Kukla","year":"2012","journal-title":"J Nerv Ment Dis"},{"issue":"3","key":"2021082810513228000_R3","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1037\/0022-006X.69.3.489","article-title":"Does competitive employment improve nonvocational outcomes for people with severe mental illness?","volume":"69","author":"Bond","year":"2001","journal-title":"J Consult Clinical Psychol"},{"issue":"6","key":"2021082810513228000_R4","first-page":"540","article-title":"The benefits of paid employment among persons with common mental health problems: evidence for the selection and causation mechanism","volume":"43","author":"Schuring","year":"2017","journal-title":"Scand J Work Environ 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programme","volume":"47","author":"Killian","year":"2012","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"2-3","key":"2021082810513228000_R11","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.schres.2014.09.010","article-title":"Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research","volume":"159","author":"Luciano","year":"2014","journal-title":"Schizophr Res"},{"key":"2021082810513228000_R12","article-title":"Psychosocial rehabilitation and recovery services","volume-title":"Veterans Health Administration Directive 1163","author":"Department of Veterans Affairs, Veterans Health Administration","year":"2019"},{"issue":"9","key":"2021082810513228000_R13","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1176\/appi.ps.201600412","article-title":"Competitive employment outcomes among veterans in VHA therapeutic and supported employment services programs","volume":"68","author":"Abraham","year":"2017","journal-title":"Psychiatr Serv"},{"issue":"4","key":"2021082810513228000_R14","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1001\/jamapsychiatry.2017.4472","article-title":"Effect of evidence-based supported employment vs transitional work on achieving steady work among veterans with posttraumatic stress disorder: a randomized clinical trial","volume":"75","author":"Davis","year":"2018","journal-title":"JAMA Psychiatry"},{"key":"2021082810513228000_R15","volume-title":"Therapeutic and Supported Employment Services (TSES) Transformation Plan","author":"Implementation Guidance","year":"2016"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/9-10\/850\/40078048\/usab113.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/9-10\/850\/40078048\/usab113.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T10:52:38Z","timestamp":1630147958000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/186\/9-10\/850\/6214211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,28]]},"references-count":15,"journal-issue":{"issue":"9-10","published-online":{"date-parts":[[2021,8,28]]},"published-print":{"date-parts":[[2021,8,28]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usab113","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,9,1]]},"published":{"date-parts":[[2021,8,28]]}}}