PSYCHIATRIC DISABILITY AND THE VETERANS ADMINISTRATION TREATMENT PROCESS

Abstract

The present study examined the impact of the Verterans Administration disability compensation system on the personality and behavior of psychiatrically disabled veterans who receive compensation payments. Weinstein proposed a "disability process" model in which physical illness or injury was unwittingly utilized as a solution to a network of problems centering on frustrated dependency needs, decreased productivity, and faltering self-esteem. An attempt was made to determine whether Weinstein's model applies to the psychiatric disabilities of veterans. Seventy-one male psychiatric outpatients seen at the Tucson Veterans Administration Medical Center participated in the study. Of this total, 26 had been receiving 100 percent service-connected compensation payments ($809 per month) for at least the past five years (100 percent group), 21 had been receiving between 10 percent and 90 percent payments ($44 to $450 per month) during the same period (10-90 percent group), and 24 had received no Veterans Administration compensation for their psychiatric impairments in the apst five years (UNC group). Personality questionnaires, a self-report demographics questionnaire, and a records search were utilized to compare these three groups. The main hypotheses contended that 10-90 percent group members weould be more self-critical and would view themselves as more psychologically disturbed and externally controlled than members of the other two groups, as they were assumed to be unconsciously fighting to establish the validity and extent of their disabilities. Subjects in the UNC group were hypothesized to be the healthiest psychologically because it was assumed that they had not become enmeshed int he "disability process". On 20 of the 21 subscales meauring some form of psychological distress, no significant differences among groups were uncovered. There were also no differences among groups on the internal-external locus of control dimension. These findings failed to support the hypothesis that the 10-90 percent group would see themselves as most psychologically disturbed and externally controlled. The expectation that 10-90 percent group members would be most self-critical was directly contradicted, as on three of ten subscales subjects in the 10-90 percent group reported significantly more positive self concepts than members of the other two groups. Despite the fact that they were rated for compensation purposes as "totally disabled," 100 percent group members reported no more psychological distress than subjects in the other two groups (with the exception that they reported significantly more hostility than UNC group members). However, both the attainment of inital 100 percent compensation status and of a permanent 100 percent rating led to significant reductions in the number of days 100 percent group members spent in the hospital (when the year after the rating change was compared with the year before). In addition, when they worked, subjects int he 100 percent group were employed in lower status occupations than members of the other two groups. UNC group members were shown to be similar to 100 percent group members on most assessment measures. However, during the past five years UNC group members were hospitalized significantly more times and for significantly more days than subjects in either of the other two groups. A direct discriminant function analysis generated two functions which together correctly classified 74.6 percent of the subjects. An unrotated factor analysis yielded factors descriptive of psychiatrically disabled veterans as a group. An alternative disability process model was proposed that may be more applicable to a psychiatrically impaired population. Also, future research projects were suggested including some possible experimental modifications in the Veterans Administration compensation system that might make it more beneficial to the mental health and self-esteem of psychiatrically impaired veterans, while maintaining cost efficiency.