A-132 Long-Term Vocational Outcomes Following Cognitive Rehabilitation for Mild Traumatic Brain Injury (mTBI): 5-Year Follow-Up of a Cohort from the SCORE Randomized Clinical Trial

Objective Vocational functioning was examined in a cohort of military service members 5 years after completing a randomized, 4-arm controlled trial (RCT) exploring the efficacy of cognitive rehabilitation (CR) for persistent cognitive symptoms following mTBI. Methods Inception cohort design included 69 of the 103 participants (67%) who completed both the study intervention and a 6-week follow-up, contacted by phone at 5-year follow-up. Outcome measures included post-concussive symptoms, emotional distress, functional cognitive complaints, and occupational status. Participants were dichotomized into good and poor occupational outcome groups (Good — returned to duty or retired at the end of the term of service; Poor — medically retired or found unfit for duty by a medical evaluation board). Results Results of a 2X4 contingency table analysis (good/poor occupational outcome by CR treatment group) found 44% of the sample had good occupational outcomes at 5 years. Good outcomes did not significantly differ by CR treatment arm: psychoeducation 56%, computer-directed 18%, therapist-directed 43%, therapist-directed plus psychotherapeutic intervention 50%, χ2(3) = 4.213, p = 0.239. Logistic regression predicting occupational outcome by CR treatment arm found no significant findings of treatment arm (Computer vs. Psychoeducation β = −1.755, p = 0.059; Therapist-directed vs Psychoeducation β = −0.514, p = 0.434; Integrated vs. Psychoeducation β = −0.251, p = 0.716). Psychoeducation treatment arm was coded as the reference group. Conclusions Contrary to our hypotheses, long-term vocational outcomes were lower than expected, despite reductions in overall post-concussive complaints, functional cognitive difficulties, and emotional distress, underscoring the complexity of vocational functioning in post-deployment service members.

307 Sleep and occupational wellbeing in active duty U.S Army Soldiers

Introduction Insufficient sleep is ubiquitous among active duty service members in operational settings. Although insufficient sleep has been linked to poor cognitive, psychological, and physiological outcomes in military populations, little research has investigated the impact of insufficient sleep on Soldier occupational wellbeing. This study examined the longitudinal association between sleep quality and occupational functioning in a population of active duty U.S. Army Soldiers. Methods Sixty male Soldiers (age 25.41±3.74 years) participated. Sleep quality and occupational outcomes were assessed four weeks apart (before and after an annual training mission). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Occupational outcome measures included the Emotional Exhaustion Scale, Walter Reed Functional Impairment Short Scale, Role Overload Scale, and Perceived Stress Scale. Linear regressions assessed the prediction of PSQI Global Score on occupational outcome scores. Student’s t-tests compared occupational outcomes between “good” and “poor” sleepers (PSQI Global Score > 5 = poor sleeper). Results Poorer sleep quality at baseline broadly predicted poor occupational outcomes post-training. Specifically, higher PSQI Global Scores predicted higher emotional exhaustion (B = 1.6, p < 0.001, R2 = 0.25), functional impairment (B = 0.29, p < 0.03, R2 = 0.14), role overload (B = 28, p < 0.008, R2 = 0.12), and perceived stress (B = 0.34, p < 0.004, R2 = 0.2). Furthermore, occupational outcome scores were significantly higher in poor sleepers than good sleepers: emotional exhaustion: (t(58) = -4.18, p < .001); functional impairment: (t(59) = -3.68, p = .001); role overload (t(58) = -3.20, p = .002); and perceived stress (t(58) = -2.43, p = .02). Conclusion This study identified a longitudinal relationship between sleep quality and occupational outcomes, suggesting that service members with poor sleep may be at risk for experiencing poor workplace wellbeing. Given the association between service member wellbeing and likelihood to re-enlist, insufficient sleep may negatively impact Soldier attrition. Future studies should aim to augment sleep quality and track occupational outcomes in this population. Support (if any) This work was funded by the Military Operational Medicine Research Program of the United States Army Medical Research and Development Command.

Age profile of NHS workers in occupational physician clinics

Background The population in the UK is predicted to increase in size and age. The National Health Service (NHS) is the largest employer in the UK and demographic changes in the working population would be expected to be reflected in the NHS workforce. Such changes may present different challenges to an NHS occupational physician (OP). Aims To evaluate how the age profile of an NHS workforce is reflected in referral patterns, diagnoses and occupational outcomes for workers assessed by OPs. Methods NHS workers employed by a large acute Trust who were referred to an OP for assessment during 2011–12 were identified. Occupational health data relating to their assessment were analysed to investigate relationships with age. Results Seven hundred and two workers were identified; they were from all staff and age groups employed by the NHS Trust. The highest referral rate to an OP was in staff aged between 41 and 60 years. There was no evidence that workers with long-term conditions assessed by an OP were likely to be older. The occupational outcome of ill-health retirement was linked to age. Conclusions This study suggested that older workers, aged between 41 and 60 years, may be more likely to be referred for assessment by an OP than younger workers. The only occupational outcome linked to age was ill-health retirement, which was more likely for workers over 50 years of age.

M131. RETURN TO LABOUR MARKET IN SCHIZOPHRENIA AND OTHER PSYCHOSES – THE NORTHERN FINLAND BIRTH COHORT 1966

Background People with psychotic disorders typically have the poorest rate of employment compared to other mental disorders. However, the chances of returning back to labour market and work after long-term work disability is unclear. Aim of this study was to study proportion of persons who can return to labour market after they have received disability pension. We also aim to study potential predictors for return to work. Methods The study was based on the Northern Finland Birth Cohort 1966 (NFBC1966) (N=12 058) which is an unselected, general population-based sample. NFBC1966 offers us a unique way to examine return to labour market and its predictors in general population sample with true prospectively collected data with 50-years follow-up. Different national registers were utilized in the study (information about psychiatric diagnoses and occupational outcomes). Occupational outcomes until end of the 2016 were measured by information about disability pension, disability benefits and employment contracts. The sample included 232 schizophrenia patients, 208 persons with other psychosis and 1927 persons with non-psychotic psychiatric disorder diagnosed until the end of 2016. There is also large amount of predictor data (for occupational outcomes) collected since birth until recent years. Results Of the 141 (61%) persons with schizophrenia who had been on disability pension due to psychiatric reason, disability pensions of 16 (11%) persons had ended due to return to labour market. Of the 74 (32%) persons in the other psychosis subgroup and 180 (9%) in the non-psychotic psychiatric disorder subgroup who had been on disability pension due to psychiatric reason, corresponding numbers of pension’s ending due to return to labour market were 18 (24%) and 56 (31%), respectively. Disability pensions of 14 (10%) persons in schizophrenia group, 3 (4%) persons in other psychosis subgroup and 4 (2%) persons in non-psychotic psychiatric disorder subgroup had ended due to death. Disability pensions of 111 (79%) persons in schizophrenia group, 53 (72%) persons in other psychosis subgroup and 120 (67%) persons in non-psychotic psychiatric disorder subgroup were still running. Later, also sociodemographic information, psychiatric and somatic comorbidity and age at the onset of disease as predictors for the good occupational outcome (i.e. return to work) will be analysed and presented. Discussion Our results indicate that having schizophrenia diagnosis often means relatively poor occupational outcome compared to other psychiatric disorders and ending up on disability pension. Besides of that some people with psychosis manage to maintain their working ability, some people also manage to return to labour market after being on disability pension. Finding the predictors for returning back to labour force in long-time follow-up can help us to cut off the long-term disability periods and support people back to work in the future.

T223. MULTIVARIATE PREDICTION OF FOLLOW UP SOCIAL AND OCCUPATIONAL OUTCOME IN CLINICAL HIGH-RISK INDIVIDUALS BASED ON GRAY MATTER VOLUMES AND HISTORY OF ENVIRONMENTAL ADVERSE EVENTS

Background Functional deficits associated with the Clinical High Risk (CHR) status very often lead to inability to attend school, unemployment, as well as social isolation, thus calling for predictors of individual functional outcomes which may facilitate the identification of people requiring care irrespective of transition to psychosis. Studies have revealed that a pattern of cortical and subcortical gray matter volumes (GMV) anomalies measured at baseline in CHR individuals could predict their functional abilities at follow up. Furthermore, literature is consistent in revealing the crucial role of several environmental adverse events in increasing the risk of developing either transition to psychosis, or a worse overall personal functioning. Therefore, the aim of this study is to employ machine learning to test the individual and combined ability of baseline GMV data and of history of environmental adverse events in predicting good vs. poor social and occupational outcome in CHR individuals at follow up. Methods 92 CHR individuals recruited from the 7 discovery PRONIA sites were included in this project. Social and occupational impairment at follow up (9–12 months) were respectively measured through the Global Functioning: Social (GF:S) and Role (GF:R) scale, and CHR with a follow up rating of 7 or below were labeled as having a poor functional outcome. This way, we could separate our cohort in 52 poor outcome CHR and 40 good outcome CHR. GMV data were preprocessed following published procedures which allowed also to correct for site effects. The environmental classifier was built based on Childhood Trauma Questionnaire, Bullying Scale, and Premorbid Adjustment Scale (childhood, early adolescence, late adolescence and adulthood) scores. Raw scores have been normalized according to the psychometric properties of the healthy samples used for validating these questionnaires and scale, in order to obtain individual scores of deviation from the normative occurrence of adverse environmental events. GMV and environmental-based predictive models were independently trained and tested within a leave-site-out cross validation framework using a Support Vector Machine algorithm (LIBSVM) through the NeuroMiner software, and their predictions were subsequently combined through stacked generalization procedures. Results Our GMV-based model could predict follow up social outcome with 67.4% Balanced Accuracy (BAC) and significance (p=0.01), while it could not predict occupational outcome (46.6% BAC). On the other hand, our environmental-based model could discriminate both poor vs. good social and occupational outcomes at follow up with, respectively, 71% and 66.4% BACs, and significance (both p=0.0001). Specifically, the most reliable features in the environmental classifier were scores reflecting deviations from the normative values in childhood trauma and adult premorbid adjustment, for social outcome prediction, and in bullying experiences and late adolescence premorbid adjustment, for occupational outcome prediction. Only for social outcome prediction, stacked models outperformed individual classifiers’ predictions (74.3% BAC, p=0.0001). Discussion Environmental features seem to be more accurate than GMV in predicting both social and occupational outcomes in CHR. Interestingly, the predictions of follow up social and occupational outcomes rely on different patterns of occurrence of specific environmental adverse events, thus providing novel insights about how environmental adjustment disabilities, bullying and traumatic premorbid experiences may impact on different bad outcomes associated with the CHR status.

Characterizing Engineering Work in a Changing World: Synthesis of a Typology for Engineering Graduates' Occupational Outcomes

The 21st century has brought an expansion in the variety of occupational roles associated with product, service, and technological development. As a result, it has become more challenging to assess the occupational choices of engineering graduates over time. This paper introduces an engineering graduates’ occupational outcomes typology designed to facilitate consistency among researchers who employ occupational outcome as a dependent variable in original research, such as in studies of underrepresented groups’ persistence in engineering. The typology is synthesized from the results of a systematic literature review aimed at establishing which work attribute(s) have most consistently united those practicing engineering. The review identifies “design responsibility” – responsibility for the outcomes of design implementation, inclusive of safety, ethicality, and general effectiveness of designs – as an enduring commonality among engineers. Subsequent stages of the review then uncover how this design responsibility has often manifested in engineering practice. Based on the literature review, we present a series of propositions that underpin general definitions of three types of occupational outcomes – engineering work, engineering-related work, and other work – showing how the types can be distinguished based on the nature of design responsibility associated with each. These definitions thus serve as the foundation for a stratified typology of occupations’ engineering-relatedness. We conclude by discussing how utilization of this stratified approach for measuring engineering graduates’ occupational outcomes can enhance transparency and consistency among studies that examine such outcomes. By building the typology upon a distilled notion of fundamental job responsibility, rather than upon job titles, it is our hope that the typology can serve in a meaningful, enduring occupational benchmarking capacity as new job titles, role formulations, or entire technology areas, come and go.