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Differences in Mental Health Service Use Among Unemployed Veterans of Different Eras

Levine, Debra S. PhD*†; Valenstein, Marcia MD*†; Yosef, Matheos PhD; Mavandadi, Shahrzad PhD‡§; Oslin, David W. MD‡§; Himle, Joseph A. PhD†∥; Zivin, Kara PhD*†

The Journal of Nervous and Mental Disease: February 2018 - Volume 206 - Issue 2 - p 155–158
doi: 10.1097/NMD.0000000000000771
Brief Reports

Mental disorders have been linked to unemployment among veterans. Improving mental health conditions, such as depression, can improve veteran employment outcomes. This study compared mental health treatment among unemployed Operation Enduring Freedom (OEF; in Afghanistan) and Operation Iraqi Freedom (OIF; in Iraq) veterans and veterans from other service eras. The study included 3165 unemployed veterans from six Veterans Affairs medical centers with a positive screen that indicates a possible mental disorder. Chi-squared tests and logistic regression analyses assessed whether veteran era was associated with mental health treatment. Unemployed OEF/OIF veterans were less likely to receive psychotropic medication and four or more psychotherapy sessions compared to veterans from other eras. Multivariable analyses controlling for age found associations based on younger age rather than era. Younger unemployed veterans received fewer mental health services, which is concerning because reducing mental health symptoms may increase employment and employment may reduce symptoms, which are key factors in reintegration into civilian life.

*VA Center for Clinical Management Research, VA Ann Arbor Health System; †Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; ‡Philadelphia VA Medical Center; §Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; and ∥University of Michigan School of Social Work, Ann Arbor, Michigan.

Send reprint requests to Kara Zivin, PhD, 2800 Plymouth Road, Building 16, Room 228 W, Ann Arbor, MI 48109. E-mail:

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