Employment gaps between refugees and natives are well documented, yet the role of trauma-related mental health in shaping these gaps remains underexplored, partly because most data sources lack measures of symptoms early after arrival. We assess probable PTSD shortly after displacement in an entire refugee arrival cohort and link these data to administrative tax records. We find that PTSD symptoms are associated with lower employment probabilities, explaining roughly one-quarter of the refugee-native employment gap one to two years after arrival. This difference is nearly twice as large as the difference attributable to English proficiency and comparable to the difference linked to pre-displacement employment. Among employed refugees, probable PTSD is associated with fewer hours worked per month, though not with lower hourly wages. Our findings underscore the potential of early psychological screening and support as complements to existing labor market integration policies.