Participants (n=95) were assessed at the time of discharge and at 4 and 12 months after discharge in regard to work status and psychiatric history both before and after the burn injury. Complex psychiatric comorbidity and substance abuse disorders that occurred before the burn injury each significantly raised the risk of unemployment before the burn injury; preburn substance abuse also affected unemployment at 4 months after the burn injury. Trends for higher unemployment rates at 12 months after discharge also were noted among those with a preburn history of complex psychiatric comorbidity and alcohol use, anxiety, or mood disorder. Preburn substance-use disorder raised the risk of attrition from the 12-month study; whereas, those diagnosed at the time of discharge with post-traumatic stress disorder or with two or more current psychiatric disorders after the burn injury dropped out less often. The greater risk for unemployment and attrition observed among subjects with psychiatric disorders before the burn injury suggests the need for routine screening, tracking, and assistance in accessing supportive or rehabilitative services to remove barriers to employment.