Social Work in Mental Health

ISSN: 1533-2985 (Print) 1533-2993 (Online) Journal homepage: http://www.tandfonline.com/loi/wsmh20

Differential association between unemployment

status and mental health among veterans and
civilians

Thanh V. Tran, Julie Canfield & Keith T. Chan

To cite this article: Thanh V. Tran, Julie Canfield & Keith T. Chan (2017) Differential association
between unemployment status and mental health among veterans and civilians, Social Work in
Mental Health, 15:4, 419-434, DOI: 10.1080/15332985.2016.1229714

To link to this article: http://dx.doi.org/10.1080/15332985.2016.1229714

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 SOCIAL WORK IN MENTAL HEALTH
2017, VOL. 15, NO. 4, 419–434
http://dx.doi.org/10.1080/15332985.2016.1229714

Differential association between unemployment status

and mental health among veterans and civilians
Thanh V. Tran, PhDa, Julie Canfield, PhDa, and Keith T. Chan, PhDb
a
School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA; bSchool of Social Welfare,
University at Albany SUNY, Albany, New York, USA

ABSTRACT KEYWORDS
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This study aims to examine the negative effect of unemployment Mental health;
on mental health among 2,762 veterans and 45,095 civilians aged unemployment; veterans
18 to 50 years. The data were from the 2012 Behavioral Risk Factor
Surveillance System (BRFSS) survey. We used ordinary least squares
regression to test the interaction association between employment
status and veteran/civilian status with mental health status.
Findings revealed that long-term unemployed veterans had a sig-
nificantly greater number of days with poor mental health than
long-term unemployed civilians. The study highlights the need for
future research concerning the negative effects of long-term
unemployment on veterans’ mental health as well as the reciprocal
relationships between mental health and occupational functioning
for veterans. The findings challenge researchers to question the
meanings that are associated with employment status for veterans
as compared to those of their civilian peers. In addition to this, the
study raises the need for further exploration into the topics of
identity, self-perception, and the notion often present in the mili-
tary/veteran culture that there is “dignity in labor.”

Introduction
The unemployment rate of veterans during recent times has become a
national concern for both local and federal governments. Congress passed
Public Law 112–56 in 2011 to provide employment support and training to
unemployed veterans and tax credits to private employers who hire veterans
(Public Law 112–56, Nov. 21, 2011). In addition to the financial loss of
income, long-term unemployment is also often associated with housing
insecurity and overall increases in stress levels that can impact individual
and family functioning. Long-term unemployment has been associated with
depression, boredom, irritability, decreased concentration and focus, demor-
alization, social isolation, and other problems that result from the lack of
routine and structure (Brown et al., 2003; Fryer & Fagan, 2003; McGee &
Thompson, 2015). Although there is research to suggest that long-term

CONTACT Thanh V. Tran vantran@bc.edu School of Social Work, Boston College, 140 Commonwealth
Ave., Chestnut Hill, MA 02467.
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/wsmh.
© 2017 Taylor & Francis
 420 T. V. TRAN ET AL.

unemployment is an important risk factor to consider for such mental health

issues (U.S. Dept. of Veteran Affairs, 2015), little is known regarding how
this contextual situation impacts the veteran versus the civilian populations
differently. In order to better understand the impact of unemployment on
veterans as a specific group, we examined the association between employ-
ment status and mental health, as measured in terms of days with poor
mental health, for veterans and civilians.

Employment status among working-age veterans

Although some research has suggested that many veterans, especially those
who are younger, are more likely to be unemployed than their civilian peers
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due to job loss incurred during separation from military service, this gap
narrows with age and time since separation from active-duty military service
(Loughran, 2014). In 2012, the unemployment rate for male veterans aged
18–24 years was 20% compared to 16.4% among non-veterans in the same age
group. The unemployment rate for male veterans aged 25–34 years was 10.4%
compared to 8.1% among non-veterans in the same age group (BLS, 2012).
Among older age groups, employment/unemployment rates were similar
between veterans and non-veterans. One study reported that the unemploy-
ment rate of the age cohort 20–34 years was 20.6% for veterans and 13.2% for
non-veterans. For the age cohort 35–39 years, the veterans’ unemployment
rate was 6.5% compared to 7% among non-veterans. For the age cohort
40–44 years, the veterans’ unemployment rate was 3.4% compared to 6.3%
for non-veterans. For the age cohort 45–49 years, the veterans’ rate of unem-
ployment was 8.2% compared to 6.2% among non-veterans (Syracuse
University Institute for Veterans and Military Families, 2012). There has not
yet been a clear explanation for why long-term unemployment trends higher
among younger veterans than non-veterans, with one explanation being gen-
der selection as the veteran population is a predominantly male-dominated
population group in a current mixed-gender labor force (Loughran, 2014).
Other reasons surmised for high long-term unemployment rates among the
current generation of veterans include a period of slow economic growth in the
civilian labor market, occupational skills mismatch between the military and
civilian sectors, poor health, and employer discrimination (Loughran, 2014).
Marketplace employers hold their own views and interpretations regarding
the employability of veterans based on personal experiences and societal
attitudes of the times that either support or hinder veterans during the hiring
process (Routon, 2014). If employers believe that the majority of veterans
have posttraumatic stress disorder (PTSD), they may be reluctant to hire
them due to a belief that they will be emotionally unstable on the job and
present a safety risk to other employees. Employers may also believe that
contributing to the cost of offering private health care insurance for veterans
 SOCIAL WORK IN MENTAL HEALTH 421

will raise their contributions to company plans/premiums and prove more

costly over time due to physical and behavioral health problems resulting
from military experiences. However, there are employers who have prior
military service themselves and do not believe this association and would be
more likely to hire veterans due to their beliefs about the responsibility,
maturity, and strong work ethic held by military service members. In this
light, veteran status has been associated with higher pay, job growth, and
earning potential as veterans have demonstrated increased wage earnings
over their civilian peers in the civilian marketplace (Routon, 2014). With
respect to gender differences among veterans, female veterans from recent
wars have an unemployment rate of 12.5% compared to 9.5% among male
veterans (Bureau of Labor Statistics: U.S. Department of Labors, 2012).
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Female veterans who are employed are more likely to work in local, state,
or federal government jobs than civilian females and more likely to be in
management and professional occupations. Recent statistics compiled by the
U.S. Department of Veteran Affairs reported that the median age for female
veterans is 49 years compared with 64 for male veterans. Although female
veterans had more formal education than male veterans, they had a lower
median household income. However, compared to non-veteran women,
female veterans were older, more racially and ethnically diverse, more likely
to be married, have a higher household income, more likely to be employed
in government sector, and have a higher education (U.S. Department of
Veteran Affairs, 2014).
The rate of unemployment among veterans improved following the end of
the recent recession; it decreased from 8.3% in 2011 to 7% in 2012. However,
statistics reported by the Bureau of Labor Statistics (BLS) using the data
obtained from the Current Population Survey (CPS) revealed that 2012 the
unemployment rate for the total non-veteran and non-institutional popula-
tion aged 18 and older was 7.9%; the unemployment rate for men was 8.1%;
7.7% for women; 6.9% for male veterans; and 8.3% for female veterans. With
respect to the unemployment rate of the Gulf War-Era II veterans, it was
9.9% for the total population; 9.5% for men; and 12.5% for women (Bureau
of Labor Statistics: U.S. Department of Labors, 2013–2014). However, a
recent study indicated that data from the CPS missed two important points:
veterans are more likely to be U.S. citizens than non-veterans and veterans
are much more likely to have graduated from high school than non-veterans
(Loughran, 2014). Therefore, the BLS statistics on employment status could
be different if the data were adjusted for U.S. citizenship. Among the last 10
economic recessions between the years of 1948–2011, the unemployment rate
of the 2007–2009 recession is notably among the most startling. The trend of
unemployment rates during the recession of 2007–2009 increased from 5% in
2007 to 9.5% in 2008 and then peaked at 10% in 2009. In addition, the long-
term unemployment rate (27 weeks or longer) of the 2007–2009 recession
 422 T. V. TRAN ET AL.

was the highest (Bureau of Labor Statistics: U.S. Department of Labors, 2012)
compared with the previous recessions. In this current study, we examined
the employment status of respondents in the age cohort 18 to 50 years to
focus on the cohort of veterans primarily representative of the military
conflicts from the Post–9/11 Global War on Terror.

Unemployment and mental health

Numerous studies have confirmed that unemployment can cause a wide
range of negative psychological outcomes damaging an individual’s general
well-being (Brown et al., 2003; Fryer & Fagan, 2003). One study found that
unemployed female veterans were more likely to be depressed than employed
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female veterans (Hamilton, Williams, & Washington, 2015). Recent findings

from the California Health Interview Survey revealed that veterans tend to
have a greater risk of suicide ideation than non-veterans (Tran, Grant, &
Aydin, 2016). Data from 2009–2012 revealed that veterans represented 22%
of reported suicides in the United States (Kemp & Bossarte, 2012). There has
also been evidence that unemployment status might lead to depression and at
times completed suicides (Blakely, Collings, & Atkinson, 2003).
A previous meta-analysis on health and mental health consequences of
unemployment indicated that the risk for mental health problems continu-
ously rises throughout the first nine months of unemployment and then
gradually recedes thereafter (Paul & Moser, 2009). This study also found that
losing a job is associated with negative changes in mental health functioning,
and that re-employment following unemployment results in an improvement
in mental health. The risk for distress appeared to be highest for male “blue-
collar” workers with long-term unemployment situations, and that marital
status appeared to have no significant effect on distress. Thus married status
appears to provide no protection or buffer against distress, but may actually
exacerbate symptoms depending on the nature of the relationship. When a
household member is unemployed, household finances suffer, which often
leads to depleted savings, increased debt, and trouble making rent or mort-
gage payments. The financial roller coaster of a job loss can damage an
individual’s physical and mental health, and may negatively affect one’s
children’s academic achievement (Rothstein, 2013; Stevens & Schaller, 2011).
Data from the National Longitudinal Survey of Youth 1979 (NLSY79), a
cohort born in the years 1957–1964, revealed that more than 25% of the men
studied experienced at least one long-term spell of unemployment
(Rothstein, 2013). Moreover, the findings revealed that being black, having
lower educational attainment, and having lower cognitive test scores were
associated with increased odds of having a long-term spell of unemployment.
The first long-term unemployment spell lasted 55 weeks on average and the
majority of the men eventually found another job. However, their hourly
 SOCIAL WORK IN MENTAL HEALTH 423

wages declined more than 17% from two years before the long-term unem-
ployment (Rothstein, 2013).
Unemployment and mental health may affect each other, such that, on one
hand, unemployment can deteriorate mental health functioning, and on the
other hand, individuals with mental health symptoms are at risk for job loss
due to issues of decreased productivity and missed days of work. Moreover,
poor mental health conditions can also negatively impact the occurrence of
re-employment (Paul & Moser, 2009).
There has been concern that veterans’ traumatic experiences such as
combat exposures and posttraumatic stress disorder (PTSD) may lead to
declining productivity (Autor, Duggan, & Lyle, 2011; Possemato,
McKenzie, McDevitt-Murphy, Williams, & Ouimette, 2014; Snyder & van
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der Goes, 2012). Given that previous research suggests unemployment can
damage psychological functioning across the general population (Puig-
Barrachina, Malmusi, Martínez, & Benach, 2011), the question that remains
to be investigated is whether unemployment exerts a differential effect on
mental health status among veterans and civilians. Many veterans have
sustained physical disabilities and behavioral health challenges due to their
military service experiences. Consequently, the presence of long-term unem-
ployment can add multiple layers of complexity and risk to their mental well-
being. Previous research also found that veterans with physical disabilities
may have difficulty sustaining work which can be discouraging and lead
them to either leave the labor force and/or discontinue seeking employment
situations that accommodate their disabilities (MacLean, 2010).
Previous research found that unemployment tends to have differential
impacts for men and women (Blanchflower & Oswald, 2004). Changes in
economic cycles can also impact men differently than women (Peiró, Belaire-
Franch, & Gonzalo, 2012). Moreover, married men suffer from a greater
degree of mental distress than married women (Artazcoz, Benach, Borrell, &
Corte`s, 2004). Recent statistics from the Bureau of Labor Statistics (BLS)
reported a clear association between education achievements and the rate of
unemployment. Among individuals aged 25 years and older, those who had
an education less than high school had an average unemployment rate at 8%
compared to 5.4% among those with a high school education; 5% among
with some college education; 3.8% among with an associate’s degree; 2.8%
among with a bachelor’s degree; 2.4% among with a master’s degree; 1.5%
among with a professional degree; and 1.7% among with a doctoral degree
(BLS, 2016). This data suggests that the presence of education may serve as a
protective factor against the risk of becoming unemployed and furthermore,
protect against some of the accompanying deleterious psychosocial effects
that unemployment can bring. The literature suggests that unemployment
rate varies between the veteran and non-veteran populations and that con-
tributing factors include gender, age, education, and race/ethnicity. Studies
 424 T. V. TRAN ET AL.

also reveal that the effects of unemployment on mental health are also
influenced by interactions between gender, family roles, and social class
with marital status, income, and number of children all significant factors
that influence an individual’s mental health status (Artazcoz et al., 2004;
Interian, Kline, Callahan, & Losonczy, 2012; Peiró et al., 2012; Sayer et al.,
2010, 2010).
Given the strong evidence of an association between unemployment and
negative mental health consequences, together with the presence of risk
factors for unemployment and behavioral health conditions among veterans,
an examination of the interaction effect between unemployment and veteran/
civilian status on mental health status was needed.
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Hypothesis
This study hypothesizes that there is a significant interaction effect between
employment status and veteran/civilian status on mental status as measured
by number of days with poor mental health. More specifically, although
unemployed respondents are expected to experience a significantly greater
number of days with poor mental health than employed respondents, unem-
ployed veterans would experience a significantly greater number of days with
poor mental health than unemployed civilians.

Methods
Data source and sample
This study’s sample came from the 2012 Behavioral Risk Factor Surveillance
System (BRFSS), an annual survey collection initiated by Centers for Disease
Control and Prevention (CDC). BRFSS is a system of health-related tele-
phone surveys that collect state data about U.S. residents regarding their
health-related risk ehaviours, chronic health conditions, and use of preven-
tive services conducted in both English and Spanish. The BRFSS surveys are
continuously administered using Random Digit Dialing (RDD) techniques to
both landlines and cell phones. This study included 47,867 respondents aged
18–50: 45,095 civilians and 2,726 veterans. This sample consisted of complete
data for all variables used in this study.

Measures
Dependent variable
Mental health status was measured by this question: “Now thinking about
your mental health, which includes stress, depression, and problems with
emotions, for how many days during the past 30 days was your mental health
not good?” This single item measure of mental health status correlated
 SOCIAL WORK IN MENTAL HEALTH 425

significantly with the question, “How often did you feel depressed in the last
30 days?” suggesting that it had good concurrent validity (r = 0.46, p < 0.05).

Independent variables
Employment status was coded “1” for currently employed, “2” for being out
of the workforce for more than one year (long-term unemployed status), and
“3” for being out of the workforce for less than one year (short-term
unemployed status). Veteran and civilian status was coded as “1” for veteran
and “0” for civilian.

Control variables
Gender was coded “1” for female and “0” for male. Race was coded “1” for
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White; “2” for Black; and “3” for others. Marital status was coded “1” for
being currently married or living with partner, “2” for being divorced,
separated, or widowed, and “3” for never having been married. Education
was coded “1” for not having graduated from high school, “2” for having
attended some college, and “3” for having graduated from college. The
presence of children was coded “1” for having children living in the house-
hold and “0” for having no children living in the household. Income levels
were coded in brackets from “1” for earning less than $15,000 per year
through “5” for earnings of $50,000 or more per year.

Data analysis
This study hypothesizes that the status of being unemployed had a greater
adverse effect on mental health across the populations and specifically had a
greater negative impact for veterans than non-veterans. To test this hypoth-
esis, we used ordinary least squares (OLS) regression analysis. The interac-
tion effect between employment status and veteran/civilian status was further
explained by visual illustration (graph) along with the estimation of the
predictive margins of the mean of days having poor mental health. We also
used post hoc comparison (contrast of predictive margins) to test for the
significance of the difference of predictive margins of the means of days with
poor mental health to further highlight the specific differences among the
means of the dependent variable (days with poor mental health) based on
employment status and veteran/civilian status (Juul & Frydenberg, 2010).

Results
Table 1 presents the descriptive statistics of the variables used in the study. All
bivariate analyses between veterans and civilians were weighted to account for
complex survey designs. As indicated in Table 1, all results were statistically
significant (p < 0.05). The veteran sample was overrepresented by males
 426 T. V. TRAN ET AL.

Table 1. Weighted descriptive statistics of variables with no missing values used in the study by
veterans and civilians (N = 47,867).
Veterans (N = 2,762) Civilians (N = 45,095)
Variables (Mean or %) (Mean or %) Tests of significance
Sex
Men 80.98% 46.35%
Women 1,902% 53.65% F = 378.98, p = 0.001
Age (years) 37.15 (SE = 0.29) 33.32 (SE = 0.08) F = 100.61, p = 0.001
Race
White 65.67% 60.06%
Black 16.51% 12.29%
Other 17.83% 27.65% F = 18.82, p = 0.001
Marital Status
Married 57.98% 47.41%
Separated/divorced/ 22.37% 13.63%
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widowed
Never married 19.65% 38.95% F = 70.46, p = 0.001
Education
Not graduated high 03.72% 13.57%
school
Graduated high 29.08% 25.83%
school
Attended some 43.17% 31.77%
college
Graduated college 24.02% 28.82% F = 29.26, p = 0.001
Employment
Currently employed 87.92% 84.43%
Long-term 05.81% 07.35%
unemployed
Short-term 06.28% 08.21% F = 3.85, p = 0.01
unemployed
Income
<$15,000 0.06% 14.29% F = 15.78, p = 0.001
$15,000 14.86% 19.81%
$25,000 13.29% 10.78%
$35,000 17.06% 13.71%
≥$50,000 48.13% 41.41%
Having children
No 45.30% 45.98%
Yes 54.70% 54.02% F = 0.15, p = 0.07
Days mental health 10.64 (SE = 0.35) 9.60 (SE = 0.08) F = 8.32, p = 0.001
not good

(80.98% compared to 46.35%) than found in the civilian sample and the average
age of veterans was significantly higher (37.15 years compared to 33.32 years)
than civilians. The percentages of whites (65.67%) and blacks (16.51%) were
significantly greater in the veteran sample than that in the civilian sample. More
veterans were married (57.98%) than civilians (47.41%); however, civilians were
more likely to fall under the category “never married” (38.95%) compared to
veterans (19.65%). A significantly smaller percentage of veterans (0.03%) did
not graduate from high school compared to civilians (13.57%), and more
veterans graduated from high school (29.08%) and attended college (43.17%)
compared to civilians (25.83% and 31.77%), respectively. The civilian sample
 SOCIAL WORK IN MENTAL HEALTH 427

had greater percentage of college graduates (29.82%) than veterans (24.02%),

and veterans were employed at a slightly greater percentage (87.92%) compared
to civilians (84.43%). The veterans had a lower percentage of long-term unem-
ployment than the civilian group (5% compared to 7.35%) and a lower percen-
tage of short-term unemployment than the civilians (6.28% compared to
8.21%). The employment status of veterans and civilians found in the sample
differs from the data reported by the Annual Report of the Bureau of Labor
Statistics BLS (Bureau of Labor Statistics: U.S. Department of Labors, 2012) and
one likely reason being that we restricted our analysis to include respondents
within the age range from 18 to 50 years only.
On average, the average income in the veteran group was higher than in
the civilian group as almost half of veterans (48.13%) had annual incomes of
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more than $50,000 compared to 41.41% among civilians. The percentage of

respondents having children in the household was similar for both groups.
Veterans reported having had approximately 10.64 days of poor mental
health during the previous month compared with civilians who reported
having had 9.60 days with poor mental health during that time period.

Interaction effect of employment status and veteran/civilian status

The results presented in Tables 2 and 3 indicate that the hypothesis of interac-
tion effect between employment status and veteran/civilian status on number of
days with poor mental health is supported by the data (F (5, 338991) = 26.27,
p < 0.001). Table 3 presents both within group and between group comparisons
for the effect of employment status on days of poor mental health.

Within group comparisons

Civilians who experienced long-term unemployment had 3.30 days of poor
mental more than those who were employed (F = 62.15, p < 0.001). Civilians
who experienced short-term unemployment had 2.31 days of poor mental
health than those who were employed (F = 39.23, p < 0.001). Among
veterans, those who experienced long-term unemployment had 6.15 days of
poor mental health compared to those who were employed (F = 16.51,
p < 0.001). There was no statistically significant difference between those
who were short-term unemployed and those who were employed.

Between group comparisons

Among currently employed respondents, veterans experienced an average of
10.79 days of poor mental health compared with 9.49 days among civilians.
The difference of 1.30 days was statistically significant (F = 11.36, p < 0.001).
Among long-term unemployed respondents, veterans experienced an average
 428 T. V. TRAN ET AL.

Table 2. Regression for days with poor mental health status (N = 47,857).
Days with poor mental health status
Independent variables Regression coefficients 95% CI
Employment status (Ref.: Currently employed civilian)
Currently employed veteran 1.30** (0.54, 2.05)
Long-term unemployed civilian 3.33*** (2.50, 4.16)
Long-term unemployed veteran 7.45*** (4.57, 10.34)
Short-term unemployed civilian 2.31*** (1.59, 3.03)
Short-term unemployed veteran 3.24* (0.73, 5.75)
Sex (Ref.:Male)
Female −0.62*** (−0.95, −0.30)
Age 0.04*** (0.02, 0.06)
Race (Ref.: White)
Black 0.21 (−0.34, 0.77)
Other −0.23 (−0.63, 0.18)
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Marital Status (Ref.: Married)

Separated/divorced/widowed 1.47*** (0.97, 1.96)
Never married 0.05 (−0.36, 0.48)
Education (Ref.: Not graduated high school)
Graduated high school −0.97* (−1.70, −0.24)
Attended some college −1.94*** (−2.65, −1.22)
Graduated college −3.48*** (−4.18, −2.77)
Children (Ref.: Not having child)
Having child −0.04 (−0.38, 0.29)
Income (Ref.: <$15,000) −0.76** (−1.43, 0.09)
$15,000—<$25,000 −1.58*** (−2.35, −0.81)
$25,000—<$35,000 −2.11*** (−2.81, −1.42)
$35,000—<$50,000 −3.03*** (−3.69,—2.38)
$50,000>
Cons (intercept) 11.64*** (10.49, 12.79)
*: p < 0.05; **: p < 0.01; ***: p < 0.001.

of 16.94 days with poor mental compared with 12.82 days among civilians.
The difference of 4.11 days was statistically significant (F = 7.35, p < 0.001).
Among the short-term unemployed respondents, veterans experienced an
average 12.73 days, compared with 11.80 days for civilians. The difference
was not statistically significant.
Figure 1 presents the graphical interaction effect of employment status and
veteran/civilian status on poor mental health status. Overall, the pattern of
the association clearly indicates that the association between employment
status and mental health significantly depends on whether the respondents
were veterans or civilians.
The results in Table 2 indicate that with respect to the association between
days with poor mental health status and the covariates, female respondents
had a fewer number of days with poor mental health than males (b = −0.62,
p < 0.001). Older respondents experienced more days with poor mental
health than their younger counterparts (b = 0.04, p < 0.001). Respondents
who were divorced, separated, or widowed had a greater numbers of days
with poor mental health than currently married respondents (b = 1.47,
 SOCIAL WORK IN MENTAL HEALTH 429

Table 3. Predictive margins of the means of days with poor mental health: Interaction effect
between employment status and veteran/civilian status (N = 47,857).
Means of days with poor mental health status
Independent variables Margins 95% CI
(E1) Currently employed civilian 9.49* (9.19, 9.78)
(E2) Currently employed veteran 10.79* (10.01, 11.57)
(E3) Long-term unemployed civilian 12.82* (12.01, 13.64)
(E4) Long-term unemployed veteran 16.94* (14.06, 19.82)
(E5) Short-term unemployed civilian 11.80* (11.07, 12.53)
(E6) Short-term unemployed veteran 12.73* (10.22, 15.24)
Within group comparisons
Civilians
CURR employed vs. long-term unemployed 3.39* 2.50, 4.16
CURR employed vs. short-term unemployed 2.31* 1.59, 3.03
Veterans
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CURR employed vs. long-term unemployed 2.31* 1.59, 3.03

CURR employed vs. short-term unemployed 1.94ns –0.66, 4.55
Between group comparisons
CURR employed: civilians vs. veterans 1.30* 0.54, 2.05
Long-term unemployed: civilians vs. veterans 4.11* 1.14, 7.09
Short-term unemployed: civilians vs. veterans 0.93ns −1.66, 3.52
*: p < 0.001; ns = not significant.

Figure 1. Interaction effect of employment status veteran status on days with poor mental
health.

p ≤ 0.001). Respondents who completed high school (b = −0.97, p < 0.001),

attended college (b = −1.94, p < 0.001), graduated college (b =—3.48,
p < 0.001) were more likely to experience fewer days with poor mental health
than the respondents who had an education lower than high school. Data
form the 2014 report on the profile of veterans revealed that 29% of veteran
aged 17 and older had high school or less education, 40.85% had some
college, 17.9% had bachelor’s degree, and 12% had advanced college degree
(U.S. Department of Veteran Affairs, 2016). Having children had no signifi-
cant association with days with poor mental health. Finally, compared to
respondents who had an income less than $15,000, respondents with higher
 430 T. V. TRAN ET AL.

incomes consistently reported a fewer days with poor mental health: an

income between $15,000-$25,000 (b = -.76, p < 0.001), between $25,000–
$35,000 (b = −1.58, p < 0.001), between $35,000-<$50,000 (b = −2.11,
p < 0.001), and from $50,00 and higher (b = −3.03, p < 0.001).
In summary, the results highlight the negative impact of long-term unem-
ployment on poor mental health status. However, its negative effect on
veterans’ mental health was significantly greater than its effect on civilians’
mental health. Sex, marital status, education, and incomes had significant
associations with mental health status.

Discussion
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Similar to previous research, this study confirms the negative impact of long-
term unemployment on functioning and overall mental health. Individuals
who experience long-term unemployment suffer more depressive symptoms,
more emotional difficulties, lower sense of satisfaction with health, and
mortality (Granados, House, Ionides, Burgard, & Schoeni, 2014; Noelke &
Beckfield, 2014; Puig-Barrachina et al., 2011). Moreover, our study supports
the hypothesis that the negative effect of unemployment on mental health is
greater among veterans than civilians. This difference could be explained
from military cultural perspectives (Kuehner, 2013). Individuals in military
service have been reported to share some common personality traits such as
lower levels of neuroticism and being more flexible regarding new experi-
ences, with military training having impacted their lives even if they never
engaged in combat (Jackson, Thoemmes, Jonkmann, Lüdtke, & Trautwein,
2012). There are common core values shared by all branches of the military
that include honor, courage, loyalty, integrity, and commitment to missions
that guide members in their behavior and in ethical decision-making prac-
tices (Coll, Weiss, & Metal, 2013).
The culture of the military is one that is orderly and controlled by rules,
regulations, and clearly defined tasks and duties. For some veterans, daily life
in the civilian culture can be experienced as being filled with constant
choices, uncertainties, and at time even chaos when compared with the
military environment and structured routines. This cultural divide can
cause veterans who are unemployed to experience significant additional
layers of stress with the lack of structure that comes with any situation of
unemployment. This is especially salient for veterans who are transitioning to
civilian life and are unemployed following a long-term professional career in
the military. For veterans with PTSD, finding employment and maintaining
employment could be difficult (Resnick & Rosenheck, 2008).
Chronic and long-term unemployment impairs mental-health functioning,
and interventions to ameliorate or prevent this should be implemented as
quickly as possible within the first nine months of unemployment (Paul &
 SOCIAL WORK IN MENTAL HEALTH 431

Moser, 2009). Social workers and mental health service providers should find
meaningful approaches to assist veterans and their families adjust to civilian
life. Spelman, Hunt, Seal, and Burgo-Black (2012) suggested that “[p]rimary
care clinicians, in collaboration with mental health and social service provi-
ders, are well-positioned to play a central role in patient-centered, interdis-
ciplinary, and integrated approaches to treatment.” They also offer a list of
clinical guidelines for effective care such as the ability of clinicians to connect
with veterans’ military experiences, the coordination of team efforts for
veteran care, and the necessity for a follow-up of care. Social workers who
serve veterans can draw from the VA guide developed to help veterans make
successful readjustments, including finding regular employment. The guide-
line includes information on helping veterans to expect common mental and
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physical reactions following the trauma of war or deployments, helping with

changes in their family environment, making a successful transition from
military life to civilian life and community, and finding when and where to
seek help and services. (U.S. Dept. of VA, 2014). Veterans with psychological
problems could also benefit from evidence-based employment support pro-
grams (Hamilton et al., 2013; Marie & Castello, 2012; Tsai & Rosenheck,
2013).
As the Veteran’s Administration is the largest employer of social workers
in the United States, schools of social work play pivotal roles in the continu-
ing professional development of students, interns, practitioners, and policy-
makers toward improving and cultivating best practices for veterans and
their families. As the current cohort of veterans from the conflicts in Iraq
and Afghanistan return to local communities and reintegrate into the social
fabric of civilian life, many will seek health and mental health services from
civilian providers. Civilian social workers will need to have an appreciation
for the unique culture and demands of this population to effectively inter-
vene with them (Canfield & Weiss, 2015). Through social work education
and continuing professional development, social workers are able to gain the
knowledge and skills necessary for effective community practice with veter-
ans and military families. Social workers who assist newly-separated veterans
in their transition from active-duty military service to the civilian labor force
can aid in this process by preparing their clients for some of the situational
variables that often accompany prolonged periods of unemployment. These
veterans who are given the opportunity to discuss the factors that might
accompany a period of sustained unemployment such as the lack of struc-
ture, boredom, social isolation, and feelings of demoralization would be
better-equipped to manage such conditions should they arise. In this way,
psychoeducation on the subject matter could be utilized to prevent some of
the negative consequences and mental health problems associated with these
transitionary periods. If the current cohort of veterans and their social
workers are well-prepared to manage the often difficult situation of long-
 432 T. V. TRAN ET AL.

term unemployment, this can offer a sense of hopefulness and normalization

to what otherwise may be a period filled with chaos and uncertainty.
This study has a few limitations, including the lack of data on the number
of military service deployments, the nature of these deployments being
combat or peace-keeping missions, the experiences of the veterans during
combat deployments in terms of amount of exposure to traumatic situations,
and cumulative length of military service. The study is a population-based
study, and therefore, the purpose is not veteran-specific, which can present as
a limitation as well. Despite these limitations, however, the results of the
negative effects of long-term unemployment on mental health between
veterans and civilians warrant further investigations. The study increases
public health awareness of the issue and raises critical questions of how to
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develop effective readjustment programs to assist veterans and their families

in making the transition to civilian life after military service a successful and
healthy process.

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