Mission Critical: Getting Vets With PTSD Back to Work

Barbara J. Meade, MD, DVM, MPH, PhD; Margaret K. Glenn, EdD; Oliver Wirth, PhD


March 29, 2013

Editorial Collaboration

Medscape &

In This Article

Unemployment and Health

Thousands of service men and women leave active duty every year, returning to claim their place in civilian life. This transition can prove difficult, and for those returning from the recent campaigns of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), it is all too often complicated by mental health disorders, including posttraumatic stress disorder (PTSD). This article stresses the importance of work on health and social reintegration and provides guidance for those in the healthcare sector to assist veterans in returning to employment.

The link between unemployment and health has been long recognized. Studies have found that unemployment is associated with increased somatization, depression, anxiety, suicide, cardiovascular disease, medication use, visits to physicians, and days spent sick in bed. Furthermore, unemployment can lead to increased drug, alcohol, and tobacco use and poor dietary and exercise habits -- all of which may affect the development and progression of chronic disease.[2] Unemployment during the working years has also been associated with poorer mental health of retirees.[3]

In contrast, research has shown that reemployment improves self-reported general and mental health, affecting bodily pain and vitality as well as social and physical functioning within as little as 6 months.[4] The interdependencies among health, work, and life are being increasingly recognized by health professionals and research agencies, such as the National Institute for Occupational Safety and Health (NIOSH), where the concept of Total Worker Health™ has been developed to foster better integration of health protection and health promotion programs.[5] Consistent with this concept, getting veterans back to work may have vast implications not only for their economic and social well-being but also for the positive influences of work on their health.

The concept of primary care teams and the medical home is gaining popularity for all patient populations, but this approach is of particular importance in dealing with the complex medical and social issues facing veterans. Primary care teams, in addition to providing traditional medical care, have an opportunity to improve the overall quality of their patients' lives by participating in their return-to-work efforts.

This article provides an overview of the return-to-work process and addresses the role that primary care teams may play. Resources are listed to further assist the team in providing care for this deserving population.

Employment Status of Veterans

Veterans may face barriers preventing them from successfully reintegrating into society and returning to the workforce; these include lack of requisite job skills, a competitive civilian job market, and mental health issues frequently resulting from their time in service. The 2011 overall unemployment rate for those who served on active duty at any time since September 2001 was 12.1%, with a rate of 29.1% among men aged 18-24 years. The unemployment rate for veterans with a disability was 10.4%-14.4%.[6] These rates are significantly higher than the 8.7% unemployment rate for all nonveteran populations.