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2023 HSR&D/QUERI National Conference Abstract

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4067 — Labor force participation among Post-9/11 Women Veterans: The impact of military sexual trauma

Lead/Presenter: Mary Jo Pugh,  COIN - Salt Lake City
All Authors: Pugh M (IDEAS COIN, VA Salt Lake City), Kroll Desrosiers AR (VA Central Western Massachusetts) Bouldin E (IDEAS COIN, VA Salt Lake City) Hansen JL (IDEAS COIN, VA Salt Lake City Vogt DS (National Center for PTSD; VA Boston Healthcare System)

Objectives:
Employment after military transition is a critical functional outcome and led to a requirement in the 2021 National Defense Authorization Act (NDAA) to identify health factors associated with unemployment in Post-9/11 Veteran women. While unemployment is a critical outcome, it excludes people who are out of the labor force (not working or looking for paid work)—a potentially vulnerable population. We used longitudinal data from The Veterans Metrics Initiative (TVMI) to examine labor force participation in the first three years after military discharge among Post-9/11 era Veterans among women Veterans with and without military sexual trauma (MST) exposure.

Methods:
This secondary data analysis of TVMI data collected from newly separated U.S. Veterans (2016-2019) included 1741 (18.2%) women, 93% of whom were under the age of 50. Veterans received a web-based survey every six months over the three years following separation. Outcome measures were based on self-reported employment status at each time point. Consistent with Department of Labor definitions, those who reported not currently working for pay or looking for work were considered not in the labor force. MST was defined by self-reported experiences of unwanted sexual attention found to be threatening (e.g., touching, cornering, pressure for sexual favors, sexual texts) or unwanted sexual contact against will (or when unable to say no) that occurred during military service. We examined trajectories of labor force participation at each time point over three years for women who reported MST (MST(+)) and those who reported no MST (MST(-)).

Results:
Among the women included in the TVMI survey, labor force participation was highest at the first survey administration (baseline), decreased at one year, and plateaued through year 3. Labor force participation was significantly lower for MST(+) compared to MST(-) women at all time points. For MST(-) women, labor force participation was 82% at baseline and declined to 79% at year 3. For MST(+) women baseline labor force participation was 74% at baseline and declined to 69% at year 3. This represents a significantly lower rate of labor force participation of ~10%-13% at baseline year 3 respectively for MST(+) women.

Implications:
Prior research has demonstrated higher unemployment rates among Veteran women with MST history. This analysis further demonstrates the potential impact of MST exposure on labor force participation which is hidden by analyses of unemployment which are generally among those in the labor force.

Impacts:
Employment is a key social determinant of health in which those who are unemployed report worse health and wellbeing. Studies suggest that those out of the labor force experience even more decrements in health and wellbeing. The decrease in labor-force participation for MST(+) women deserves further investigation to better understand the complex interactions among MST exposure, physical and mental health, other social determinants of health and longer term trajectories of labor-force participation using both survey data such as TVMI, and qualitative data that provide insights for "Why" that are not available in structured data. Multifaceted data are needed to develop interventions/approaches that meet the work-related needs of women Veterans with MST and optimize health outcomes.