Unstable hours, unequal health: Gendered occupational health costs of work-hour volatility in the U.S.

The relationship between trauma-related disorders and functional impairment (FI) has been well established, with increases in symptom severity associated with increases in FI (; ; ; ; ). However, these analyses have been predominantly conducted using posttraumatic stress disorder (PTSD) criteria defined by the Diagnostic Statistical Manual (DSM). A diagnosis of PTSD may be determined by either ICD-11 or DSM-5 diagnostic criteria and these criteria differ between diagnostic systems (; ). The DSM-5 describes PTSD as a single diagnosis with twenty symptoms grouped into four symptoms clusters: re-experiencing, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity. The ICD-11 presents two related diagnoses: PTSD and complex PTSD (CPTSD). The PTSD diagnosis requires endorsement of re-experiencing, avoidance, and a sense of threat, representing the well-established triad of fear-based responses (). The CPTSD diagnosis requires the three PTSD symptom clusters along with endorsement of disturbances in self-organization (DSO), which consists of three symptoms clusters: problems with affective dysregulation, negative self-concept, and disturbances in relationships. Both PTSD and CPTSD are associated with FI (; ; ). Little is known about the relative contribution of PTSD and DSO symptom profiles, as well as PTSD and CPTSD diagnoses, to different aspects of functioning. Functional impairment is often understood as prevalent disability associated with physical and mental health concerns (). One of the most frequently used FI measures is the World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0; ) which includes six different functional domains: cognition (difficulties with memory and executive functioning); mobility (ability to get around); self-care (daily living activities such as eating, bathing, dressing, etc.); life activities (daily living activities that require more complex planning and thinking at home, school, or work); getting along with others (social functioning) and; participation in society (community involvement and participation) (). These domains offer specificity in impairment for those struggling with FI. Previous research probing the link between trauma-related disorders and FI has focused mainly on DSM conceptualizations of PTSD. Clusters of PTSD symptoms as defined by the DSM are differentially associated with FI domains (). Re-experiencing symptoms are associated with impairment in occupational functioning (), as well as areas related to creativity and learning (). Re-experiencing symptoms may be particularly difficult to manage in task-oriented environments as they are associated with disrupted attention in cognition (). Avoidance has been associated with substantial social impairment including parenting difficulties () as well as physical health problems (; ), though research suggests PTSD is generally associated with impaired social functioning (). Arousal symptoms, or sense of threat, are associated with deficits in occupational functioning and employment (; ; ), as well as overall disability severity, including physical health problems (; ; ). These findings suggest that the type of symptoms experienced may differentially contribute to various types of FI.