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Objectives This study examines work participation (WP) and disability pension (DP) among patients diagnosed with post-traumatic stress disorder (PTSD) at Danish Departments of Occupational Medicine. The aim was to identify WP trajectories and determine whether occupation is associated with poor labour market attachment.Methods A nationwide longitudinal study was conducted on register data from patients diagnosed with PTSD at Departments of Occupational Medicine in Denmark from 2000 to 2015. WP was operationalised as a score (WPS, Work Participation Score) derived from the proportion of weeks in employment relative to the possible number of work weeks per year. WPS is dichotomised as low (≤75%) or high (>75%). Group-based trajectory models were used to identify patterns of WP. Logistic regression was used to investigate the effect of occupation on WPS and DP.Results Among 1187 patients, 68% had low WPS and 43% entered DP after 3 years. Three trajectories were identified from prediagnosis to postdiagnosis: sustained low WPS (12.5%), shift from high to low WPS (50.7%) and near-full recovery (36.8%). Patients in the occupations ‘plant and machine operator and assemblers’ (OR=3.25; 95% CI: 1.28 to 8.23) and ‘prison guards’ (OR=2.50; 95% CI: 1.23 to 5.08) had higher odds of low WPS, but only ‘prison guards’ (OR=1.84; 95% CI: 0.97 to 3.49) had potentially higher odds of receiving DP after 3 years.Conclusions Work-related PTSD is associated with a high risk of low WPS after 3 years. Specific occupations are associated with poorer labour market attachment, underscoring the need for prevention and recovery interventions.Trial registration number NCT04459793.