A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

Adults with psychiatric disabilities live with emotional, mental, and behavioral disorders, such as schizophrenia, bipolar disorder, and major depression that can interfere or severely limit an individual’s ability to perform major life activities. Research shows that people with psychiatric disabilities are more likely to experience trauma and develop post-traumatic stress disorder (PTSD). PTSD is a mental health disorder that occurs after a person experiences or witnesses a traumatic event. Symptoms of PTSD can include having flashbacks of the event, negative thoughts, and severe anxiety. As a result, people with PTSD may have difficulty in social and work interactions and performing daily tasks. People with psychiatric disabilities may seek help in finding work through employment programs such as supported employment, which is an evidence-based practice in finding and maintaining employment through community mental health facilities.

In a recent NIDILRR-funded study, researchers wanted to explore the barriers to employment for people living with psychiatric disabilities and PTSD. The researchers wanted to examine how the symptoms of PTSD might interfere with the ability of those with psychiatric disabilities to find and maintain employment.

Researchers at the project, Treating Hidden Barriers to Employment: Integrated Treatment for PTSD in Supported Employment, analyzed the interviews of 119 individuals with psychiatric disabilities who were enrolled in another study--a randomized controlled trial (RCT) studying an intervention for PTSD and supported employment. As part of the RCT study, participants answered questions about how severely they experienced symptoms of PTSD in the previous month, such as repeated, disturbing, and unwanted memories of the stressful experience; having strong physical reactions when something reminded them of the stressful experience; feeling very upset when something reminded them of the stressful experience. They rated their symptoms on a 5-point scale from not at all to extremely. Those whose scores indicated probable PTSD, according to the study’s criterion, were interviewed by a clinician about the onset, frequency, and severity of their PTSD symptoms. During the interview, participants answered questions about how often and how severely their PTSD symptoms impacted their ability to function in work situations.

Researchers reviewed the participants' responses for these questions and identified six themes around barriers to employment as related to PTSD symptoms:

• “I don’t like being around people.” Participants mentioned feeling discomfort around crowds, avoiding people by isolating themselves from others, and reacting to their employers or co-workers with irritation, frustration, distrust, and anger. Participants also said they found it difficult to socialize and communicate with supervisors and were concerned that others were criticizing them.
• “I feel frozen and unable to get started.” Participants shared that they lacked personal agency, confidence, and motivation to pursue employment goals, and engaging in negative self-talk that lowered their self-esteem and confidence.
• “Troubling negative emotions.” Participants described disabling anxiety, depression, anger, and fear. They felt overwhelmed and anxious over interviews and feared the job searching process. For those who experienced trauma, they feared larger males and strangers and worried about feeling safe in the work environment.
• “Mind is scattered and all over the place.” Participants felt their PTSD limited their concentration, performance, reliability, cognitive speed, and memory, which prevented them from remembering which tasks to complete and keeping up with their work.
• “Feeling fatigued all the time.” Participants had trouble sleeping and some had severe depression which left them feeling fatigue and very little energy.
• “Flashbacks and triggers can happen whenever.” Participants also experienced or feared experiencing flashbacks of traumatic events triggered by their coworkers, managers, customers, and other people at work.

According to the authors, the findings showed that most of the symptoms mentioned by the participants corresponded with the clinical criteria for PTSD: unwanted memories or flashbacks; avoiding people, places and/or activities; negative cognition and moods; being hyper aware; and difficulty in social or occupational functioning. They noted the participants felt these symptoms interfered with their ability to find and keep employment. The themes highlight the significant impact that PTSD can have on thriving or feeling at ease in the workplace.

Authors noted that the study findings show a connection between PTSD symptoms of persons with psychiatric disabilities and barriers to seeking and keeping employment, including anxiety and fear of the job search process, workplace anxiety, and others. In addition, employers may mistakenly attribute certain behaviors in people with psychiatric disabilities, such as not showing up to work, as being non-compliant or unmotivated to work when they may be the symptoms of PTSD. Therefore, supported employment providers may need training on the symptoms of PTSD in people with psychiatric disabilities and its impact on the career development process. Employment counselors may want to work with clients to develop techniques and strategies to empower and aid them in working through their symptoms while looking for employment and in the workplace.

To Learn More:

The Rehabilitation Research and Training Center on Pathways to Positive Futures published an issue of its Focal Point journal on trauma-informed care and its growing relevance in research, policy, practice methods, and organizational structure.

The National Center for PTSD at the Department of Veterans offers information about understanding PTSD, treatment options, where to get help, apps, and tools for managing symptoms, and more, for both former and current military members and the general public.

The Substance Abuse and Mental Health Services Administration (SAMHSA) also offers information about PTSD and community resources to find support and treatment, as well as training and resources for mental health providers.

To Learn More About This Study:

Lu, W., Bates, FM., Waynor, WR., Bazan, C., Gao, CE., Yanos, PT. (2021). I feel frozen: Client perceptions of how posttraumatic stress disorder impacts employment. Psychiatric Rehabilitation Journal. (45):136-143.This article is available from the NARIC collection under Accession Number J86804.