The Effect of Military Sexual Trauma on Competitive Employment Status Following Veterans Health Administration Supported Employment Services

Military sexual trauma (MST) is prevalent, and some initial evidence suggests it is associated with impaired employment outcomes. The Veterans Health Administration (VHA) offers supported employment (SE) and Community-Based Employment Services (CBES), which consist of individualized employment support integrated with mental health treatment. The objective of this study was to examine the prevalence and effect of MST on competitive employment outcomes following participation in SE or CBES. Participants were a national set of Veterans who participated in VHA SE or CBES services between 2015 and 2019 and whose medical record contained a completed MST screen (N = 12,689). Data were obtained from clinician-administered SE and CBES admission and discharge forms merged with electronic health records. One thousand five hundred fifteen (11.9%) Veterans reported experiencing MST: 6.2% (n = 676) of men and 47.8% (n = 839) of women. Veterans who experienced MST were significantly less likely to hold competitive employment at discharge, 568 (41.0%) versus 4,702 (47.4%) of those without MST history; chi(2) = 19.79, p < .001. In adjusted analyses, MST was associated with lower likelihood of competitive employment over and above psychiatric comorbidities and other variables associated with employment status, such as receipt of disability, previous unemployment, homelessness, incarceration, and medical comorbidity. Findings suggest that Veterans seeking employment services may represent a high-risk group for having experienced MST and reinforce the importance of trauma-informed care. Providers should assess for and incorporate MST into treatment planning and job development when indicated. More work is needed to inform employment support for Veterans who have experienced MST. Impact Statement This study suggests that military sexual trauma is prevalent among Veterans seeking VA supported employment services, and may be associated with lower likelihood of achieving competitive employment. Providers should be aware of military sexual trauma history and incorporate trauma-informed care into employment services.