IntroductionMultiple sclerosis (MS) is a common central nervous system disease among young adults worldwide and Finland is one of the high-risk MS regions in Europe. Fatigue affects around 80% of individuals with MS, with prevalence rising to 95% as the disease progresses. Fatigue significantly limits daily activities and is associated with poorer employment outcomes and reduced quality of life. The objective of this qualitative study is to explore the lived experiences of individuals with MS and conceptions of MS-related fatigue among physiotherapists.Methods and analysisThis qualitative study is part of a larger research project entitled ‘Building conceptualisation and understanding of momentary fatigue and activity-related fatigability in daily life for people with multiple sclerosis’ (EMA-FAMS), consisting of several studies conducted from 2024 to 2028. For this qualitative study, 10 individuals with relapsing-remitting MS will be interviewed using a phenomenological approach to collect their lived experiences of fatigue. Additionally, 15 physiotherapists with experience in MS rehabilitation will be interviewed using a phenomenographic approach to explore their conceptions of MS-related fatigue. All interviews will be conducted remotely during 2025–2026. Interview data will be analysed in two phases using interpretative phenomenological analysis (IPA) and phenomenographic analysis methods.Ethics and disseminationThe EMA-FAMS study project has obtained ethical approval from the Regional Medical Research Ethics Committee of the Helsinki University Hospital District (HUS/10011/2024), and all the participants will provide written consent. Findings of this study will be shared through peer-reviewed articles, at academic conferences and with public healthcare and healthcare professionals.

BackgroundTransition-aged young adults (TAYA) with cognitive disabilities face significant challenges in achieving competitive integrated employment (CIE). Despite being the largest group of vocational rehabilitation (VR) service users, they frequently experience poor employment outcomes at program exit. Limited research has assessed the impact of assistive technology (AT) and supported employment (SE) services on achieving CIE, particularly during and after the coronavirus disease 2019 (COVID-19) pandemic.ObjectiveThis study examined the independent associations of AT and SE services with achieving CIE at program exit and evaluated variations in CIE outcomes across the pre-COVID, during-COVID, and post-COVID periods among TAYA with cognitive disabilities served by state VR programs.MethodsA retrospective cross-sectional analysis of data from the Rehabilitation Services Administration's Case Service Report (July 2017-June 2022) was conducted, involving 238,561 TAYA with cognitive disabilities. Logistic regression analyses examined associations between AT/SE services and CIE outcomes, including interaction terms to assess variations over time.ResultsAmong TAYA with cognitive disabilities, 96.8% had significant disabilities, 90.9% were unemployed, and 83.0% were not enrolled in post-secondary education. Over half of participants (55.9%) did not achieve CIE at program exit. Only 1.4% received AT services and 10.7% received SE services. Both AT and SE services were positively associated with achieving CIE, and the effects of these services varied across the COVID-19-related periods.ConclusionsThe study indicates that AT and SE services were positively associated with achieving CIE outcomes. These findings underscore the importance of prioritizing access to these services through state VR programs to better support employment transitions.

ABSTRACT Objectives Executive dysfunction (ED) following acquired brain injury (ABI) is a well-established predictor of poor functional abilities and employment outcomes. However, there has been a lack of research focusing on the distinct contributions of different ED profiles. This study aimed to determine whether different ED profiles predict difficulties in returning to work for individuals who have suffered an ABI. Methods: Sixty-five working-age individuals who experienced an ABI participated in this study. The FrSBe and the ADLQ-T self-report scales were utilized to assess ED profiles and functional abilities, respectively. These measures were compared between individuals who did and did not return to their jobs. Mediation analysis was conducted to evaluate the contribution of each ED profile and its predictive capacity for return to work. Results Overall measures of ED reliably predicted challenges in performing daily activities and returning to work. Additionally, the predictive relationship between ED profiles and return to work was partially mediated by difficulties in daily activities. Conclusions Various ED profiles (executive cognition, apathy, and disinhibition) contribute predictively to the ability to return to work. These findings suggest that ED profiles offer valuable insights for better characterizing the challenges individuals face in returning to their jobs following an ABI.

IntroductionOne in four cases of asthma in adults is caused or worsened by work (work-related asthma: WRA). Early detection of WRA could prevent poor health and employment outcomes, but clinical diagnosis is often missed or delayed. The standardisation and effectiveness of screening tools have not been well established. We aimed to summarise and compare the performance of screening tools for identifying WRA in both clinical settings and workplaces.MethodsWe searched for studies that used structured questionnaires or prediction models (with/without physiological tests) to identify WRA in clinical settings or workplaces with individuals aged≥16 years in MEDLINE, Embase, other bibliographic databases and grey literature between 1975 and 2024. Two reviewers independently screened titles, abstracts and full texts for inclusion, extracted data and assessed risk of bias using QUADAS-2 tool (Quality Assessment of Diagnostic Test Accuracy 2) or PROBAST (Prediction Model Risk of Bias Assessment Tool). Screening tools and their indices of accuracy were summarised with paired forest plots of sensitivities and specificities.ResultsOf 17 504 identified studies, 7 were included. All were implemented in tertiary hospitals (n=5) and specialist centres (n=2). The screening tools comprised questionnaires alone (individual questions n=3 and multiple questions n=2), questionnaire with methacholine challenge test (n=1) and diagnostic models (n=4). The question ‘improvement off work’ had sensitivity=74–87% and specificity=15–58% for identifying WRA. Multiple questions had sensitivity=80–100% and specificity=8–55%. Addition of the methacholine challenge test to one questionnaire improved specificity to 75% with sensitivity=65%. Diagnostic models reported area under the curve (AUC) between 0.69 and 0.89, and AUC was improved when adding demographic variables or objective tests.DiscussionA single item ‘improvement off work’ and multiple questions have high sensitivity but low specificity for WRA, which are sufficient for screening purposes to enhance WRA diagnosis. Adding demographic variables and objective tests can improve specificity or AUC. However, studies on screening tools for WRA are limited and inadequately reported; further evaluations of performance are needed in primary care populations and workplaces.PROSPERO registration numberCRD42021246031

Education-to-work transition among war-affected youth in post-conflict settings is fraught with challenges, not least compounded by the little attention placed on individual agency and mental health. This review examines the debate on war-affected youth skilling programmes in post-conflict settings, which neglect the roles of individual agency and mental health in the education-to-work transition. Building on Albert Bandura’s Self-Efficacy Theory (SET) and the Cumulative Stress Hypothesis (CSH), the review presents an integrated approach to skills development for improving education-to-work transition among war-affected youth. According to SET, the development of self-efficacy is anchored on enactive mastery, vicarious experience, verbal persuasion, and physiological arousal. Moreover, individual agency factors such as motivation, aspiration, goal orientation, active efforts, and alignment of intentions with skills are protective factors for effective education-to-work transition, but they are also eroded by the adverse consequences of violent conflicts. Similarly, the CSH also suggests that the effects of exposure to protracted violent conflicts are cumulative and may lead, in turn, to a plethora of mental health problems in the aftermath of violent conflicts. Mental health problems like depression, anxiety, and PTSD are linked to, inter alia, behaviours such as aggression, substance abuse, and apathy, all related to poor employment outcomes. To increase the employability of young people affected by war, skills training institutions and work settings need to prioritise the mental health and individual agency of the youth, as well as skills acquisition for specific trades. Consequently, we propose an integrated model of reintegrating war-affected and vulnerable youth anchored on professional technical and vocational skills training; recognition of individual agency; provision of mental and psychosocial support; and life skills training, all nested within the local economic realities.

Background/Objectives: Mental disorders that emerge during adolescence frequently extend into adulthood, predicting poor academic and employment outcomes and heavy societal burdens. Novel efforts to improve youth mental health have transitioned from clinical recovery, typically focused on a cure, to a strength-based approach to wellbeing in supporting youth within mental health services. Mental health scholars have appealed for interventions to adopt an ecological system of care approach that integrates the principal caregivers in a young person's life. Despite preliminary literature indicating the importance of caregivers, little research has focused on the caregiver's role in supporting personal recovery in youth. Methods: This study sought to understand the role of caregivers in youth recovery by employing a qualitative design to inductively analyze the narratives from nine semi-structured interviews with caregivers. Additionally, deductive analysis explored the core five underpinnings of personal recovery connectedness, hope, identity, meaning, and empowerment (CHIME). Results: A thematic analysis of the literature identified five themes: providing unconditional love and positive regard; encouraging connection with peers; co-creating a sense of purpose, meaning, and hope; supporting assertiveness and advocacy; and promoting strength and opportunity for mastery aligning with the CHIME framework. The findings will allow health services to understand caregivers' roles better, thus providing information to guide recovery-oriented and family-centered care.

Functional motor disorder (FMD), a motor-dominant variant of functional neurologic disorder, is a disabling condition associated with high health and social care resource use and poor employment outcomes. Specialist physiotherapy presents a possible treatment option, but there is limited evidence for clinical effectiveness and cost-effectiveness. Physio4FMD is a multicenter randomized controlled trial of specialist physiotherapy for FMD compared with treatment as usual (TAU). The aim of the analysis was to conduct a randomized trial based on economic evaluation of specialist physiotherapy compared with TAU. Eleven centers in England and Scotland randomized participants 1:1 to specialist physiotherapy or TAU (referral to community neurologic physiotherapy). Participants completed the EuroQoL EQ-5D-5L, Client Service Receipt Inventory, and Work Productivity and Activity Impairment Questionnaire at baseline, 6 months, and 12 months. The mean incremental cost per quality-adjusted life year (QALY) for specialist physiotherapy compared with TAU over 12 months was calculated from a health and social care and wider societal perspective. The probability of cost-effectiveness and 95% CIs were calculated using bootstrapping. The analysis included 247 participants (n = 141 for specialist physiotherapy, n = 106 for TAU). The mean cost per participant for specialist physiotherapy was £646 (SD 72) compared with £272 (SD 374) for TAU. Including the costs of treatment, the adjusted mean health and social care cost per participant at 12 months for specialist physiotherapy was £3,814 (95% CI £3,194-£4,433) compared with £3,670 (95% CI £2,931-£4,410) for TAU, with a mean incremental cost of £143 (95% CI £-825 to £1,112). There was no significant difference in QALYs over the 12-month duration of the trial (0.030, 95% CI -0.007 to 0.067). The mean incremental cost per QALY was £4,133 with an 86% probability of being cost-effective at a £20,000 threshold. When broader societal costs such as loss of productivity were taken into consideration, specialist physiotherapy was dominant (incremental cost: £-5,169, 95% CI £-15,394 to £5,056). FMD was associated with high health and social care costs. There is a high probability that specialist physiotherapy is cost-effective compared with TAU particularly when wider societal costs are taken into account. International Standard Randomised Controlled Trial registry, ISRCTN56136713.

Abstract Older adults returning to community settings after incarceration face a number of challenges, including food insecurity, difficulty finding housing, and adverse health outcomes. A number of qualitative studies have suggested poor employment outcomes among formerly incarcerated older adults; however, there have been few quantitative inquiries related to employment outcomes for these older adults. The purpose of this study was to understand associations between history of incarceration and employment outcomes among older adults. We used pooled data from the 2012 and 2014 waves of the Health and Retirement Study to examine associations between history of incarceration and employment outcomes among community-dwelling older adults aged >50 (n=4,985). History of incarceration and employment outcomes were assessed via self-report. While there were no associations between history of incarceration and employment status in the sample, employed older adults with a history of incarceration had more physically demanding jobs and reported more work stress and more work-related discrimination than their counterparts. They also reported less work satisfaction and less supervisor support than never-incarcerated older adults. Gender moderated the association between history of incarceration and several employment outcomes, with associations observed among women but not men. Taken together, our findings suggest that history of incarceration is associated with significant differences in employment outcomes, primarily among women. Future studies should explore factors contributing to poor employment outcomes in order to design interventions that improve outcomes in this population.

Women living with HIV (WLHIV) are particularly vulnerable to poor employment outcomes, impacting their socioeconomic independence and personal sense of empowerment. This article presents the results of a mixed methods study, which examined the personal, clinical, and socioeconomic contexts associated with employment and occupational productivity among employed WLHIV (n = 164) in the Southern United States. The Stanford Presenteeism Scale-6 was used to assess the perceived impact of HIV disease on the ability to maintain focus and complete tasks at work. Correlational and hierarchical regression techniques were applied to examine the relationships between personal, clinical, and socioeconomic contexts and occupational productivity. In this sample, 62% of women perceived no impact on their ability to work or capacity to complete work related to living with HIV. In multivariable modeling, empowerment, neurocognition, socioeconomic status, and psychological health were associated with occupational productivity. In-depth interviews (n = 29) provided rich contexts and meaning surrounding employment among WLHIV, and indicated that quality of life, work-life balance, empowerment, social support, and psychological health influenced the experience of work. Psychosocial and structural interventions are needed to improve occupational outcomes in this vulnerable population.

IntroductionWork-related asthma accounts for ≥25% of asthma in working-age populations, though the relationship between work exposures and symptoms is frequently missed, leading to poor health and employment outcomes. We hypothesised...

College students face uncertainties during job searches due to a lack of career planning, unclear objectives, and ineffective search strategies, leading to poor employment outcomes. Fuzzy Control (FC) based Job Search Strategies (JS2) are proposed in this research as an optimized technique named FC-JS2-TSC. This technique combines Takagi-Sugeno (TS) fuzzy inference with Cuckoo (C) search optimization. The primary goals are improving individualized advice and creating an integrated system to deal with job search concerns. The FC uses fuzzy logic and sets to model uncertainties such as vague job desires and ever-changing market circumstances. Individual student profiles and preferences are used to fine-tune methods by cuckoo search. Through experimental validation, we can see that FC-JS2-TSC outperforms previous methods in terms of both job strategy selection and results. As a measure of system efficacy, the results demonstrate a high Cronbach's alpha reliability of 0.96, a low RMSEA of 0.04 and 96.6% regarding job offers. By adjusting tactics in response to uncertainty, the innovative FC-JS2-TSC algorithm facilitates data-driven, personalized decision-making, ultimately leading to more efficient job searches. It has an integrated design that combines optimization with fuzzy logic's uncertainty handling to ensure students have the best possible chance of success in their job searches.

To examine clinical outcomes and employment status in Veterans with and without a dual diagnosis of traumatic brain injury (TBI) and spinal cord injury (SCI). This cross-sectional study examined a national sample of Veterans enrolled in the VA Million Veteran Program who completed the Comprehensive TBI Evaluation (CTBIE) as part of the Veterans Health Administration's TBI Screening and Evaluation Program. Veterans (N = 12,985) were classified into the following TBI/SCI groups using CTBIE data: those with a dual diagnosis of TBI and SCI (TBI+/SCI+); those with a history of TBI but no SCI (TBI+/SCI-); and those with no history of TBI or SCI (TBI-/SCI-; i.e., the control group). CTBIE-derived outcomes included neurobehavioral symptoms, comorbid psychiatric symptoms, pain and pain interference, and employment status. Chi-square analyses showed significant associations between TBI/SCI group and all clinical outcomes evaluated (all p's < .001; V = 0.07-0.11). In general, the TBI+/SCI+ and TBI +/SCI-groups endorsed comparable levels of neurobehavioral symptoms, psychiatric symptoms, and pain, but significantly greater rates of symptoms and pain relative to the TBI-/SCI- group. Effect sizes for all pairwise comparisons were small (φ = 0.01-0.11). Finally, there was no significant association between TBI/SCI group and employment status (p = .170; V = 0.02), with all three groups showing relatively comparable rates of unemployment. Regardless of SCI status, Veterans with TBI history endorsed poorer clinical outcomes than Veterans without TBI and SCI. However, rates of unemployment were similarly high across all three groups. Findings suggest that any Veteran completing the CTBIE may be at risk for poor clinical and employment outcomes.

There were 9.7 million Native Americans (American Indian, Alaska Native-AI/AN- these acronyms will be used interchangeably with Native Americans throughout the paper) in 2019 comprising 2.9% of the U.S. population. Native American populations have disproportionately higher rates of mental illnesses compared to other racial groups in the U.S. Mental health is a significant public health concern for this population, impacting different areas of their lives including employment. Additionally, Native Americans continue to experience significant disparities in access to Vocational Rehabilitation (VR) services and have poor employment outcomes. However, little is known about the relationships among demographic factors, vocational rehabilitation services, and employment outcomes of Native Americans with mental illness. Consequently, the current study examined how demographic factors and VR services are related to successful employment outcomes for Native American VR clients with mental illnesses using data from the Rehabilitation Services Administration (RSA) program year (2019) Case Service Report (9-11). Both descriptive analysis and data mining approaches were used to answer the research questions. Chi-square Automatic Interaction Detector (CHAID) analysis was used to determine which of the VR services could best predict the successful employment outcome of Native Americans with mental illness. The findings of the data mining approach revealed that among all the vocational rehabilitation services, job placement assistance was the strongest predictor of successful employment among Native American clients with mental illnesses. The second most important service predicting successful employment for those who received job placement assistance was shown to be maintenance. Implications for rehabilitation counselors and future research are discussed.

People with intellectual and developmental disabilities (IDD) tend to have poor employment outcomes relative to the general population, as do people with autism. Research is unclear, however, about how people with IDD with and without autism compare on a variety of employment-related indicators, including desire to work, having work as a goal in their service plans, and being employed. To understand how people with IDD with and without autism compare on important employment related outcomes, based on a matched random sample. Using merged administrative datasets, we used propensity score matching to construct statistically proximate samples of Medicaid waiver users in a single state with IDD both with and without autism, and then tested differences between the two groups on important employment-related indicators. People with IDD and autism were less likely than people with IDD alone to have a goal for employment in their individualized service plans and to hold employment in group community settings. There was no statistical difference between the two groups in terms of desire to have a job or employment in individual community settings. Results reinforce the importance of planning for employment if holding employment is a person's aim, regardless of the presence of autism.

BackgroundFatigue is associated with reduced quality of life and social participation, and poor employment outcomes. However, most studies examining fatigue are limited by small sample sizes or short follow-up periods.ObjectiveTo characterize the natural history of fatigue.MethodsThe North American Research Committee on Multiple Sclerosis Registry participants with ≥7 years of longitudinal data between 2004 and 2019 and a relapsing disease course were included. A subset of participants enrolled within 5 years of diagnosis was identified. The Fatigue Performance Scale assessed fatigue and ≥1-point increase in Fatigue Performance Scale sustained at the next survey defined fatigue worsening.ResultsOf 3057 participants with longitudinal data, 944 were within 5 years of multiple sclerosis diagnosis. Most participants (52%) reported fatigue worsening during follow-up. Median time to fatigue worsening ranged from 3.5 to 5 years at lower levels of index fatigue. Fatigue worsening was associated with lower annual income, increasing disability, lower initial fatigue level, taking injectable disease-modifying therapies and increasing depression levels in the relapsing multiple sclerosis participants.ConclusionMost multiple sclerosis participants early in their disease suffer from fatigue and at least half reported fatigue worsening over time. Understanding factors associated with fatigue may help to identify populations most at risk of fatigue worsening will be informative for the overall management of patients with multiple sclerosis.

Association of neurocognitive function with psychiatric hospitalization and socio-demographic conditions in individuals with bipolar and major depressive disorders

Veterans with mental health and substance use conditions have poor employment outcomes and would likely benefit from integrated career, mental health, and substance use related interventions. However, vocational psychology has overlooked this vulnerable population, and vocational interventions are often relegated as less important than other psychotherapeutic interventions that target substance use or symptom reduction. Drawing upon Social Cognitive Career Theory and Psychology of Working Theory, this qualitative study examined how external and internal factors influenced the vocational trajectories of eight veterans with mental health and substance use conditions. Additionally, this study examined participants’ perspective on the usefulness of improving career outcomes in supporting their lives and recoveries. Using Consensual Qualitative Research methodology, this study uncovered how personal, environmental, relational, mental health, and substance use factors impacted the vocational trajectories of veterans living with mental health and substance use conditions. Findings also highlight that veterans want fulfilling employment and more clarity in their vocational lives to support their mental well-being and prevent substance use. Implications for vocational psychology theory and integrative practice are discussed.

ABSTRACT In 1968, John Kain hypothesized that Black residential suburbanization had not accompanied suburbanizing jobs, leading to poor employment outcomes for young Black men. This paper reinvestigates spatial mismatch in the 2000s and 2010s, focusing on differences between urban and suburban White, Black, and Hispanic residents of the U.S. We find some evidence for spatial mismatch when pooling data across all years, and stronger evidence for mismatch among Black people than among Hispanic people. First, both urban Black and Hispanic people earn lower wages than equivalent suburbanites, all else equal. Second, urban Black people have a higher probability of un- and under-employment relative to their suburban counterparts. Third, Black and Hispanic people have longer commutes than equivalent Whites do, but suburban residence mitigates this effect. Yet we also find evidence that in recent years, spatial mismatch may not be as serious a problem as many people believe. For example, the wage premium for suburban people—White, Black, and Hispanic—has fallen. Further, urban Hispanic people are not more likely to be unemployed than equivalent suburbanites. Finally, urban and suburban Black and Hispanic people do not work in different types of occupations, so location is not associated with suburbanites of color holding more or less “desirable” jobs.

Young adults with autism spectrum disorder (ASD) experience poor employment outcomes. Teaching soft skills and using peer-based interventions improve outcomes for people with ASD. To evaluate the preliminary efficacy of a soft skills intervention and the feasibility of delivery to a group of young adults with ASD by near-peer occupational therapy master's-level students. Pretest-posttest single-group design. College campus. Convenience sample of 14 young adults (M age = 21.57 yr) with ASD. The Assistive Soft Skills and Employment Training (ASSET) program is a 12-session, manualized, soft skills group intervention previously validated with the ASD population. Topics include communication, attitude and enthusiasm, teamwork, networking, professionalism, and stress management. Social functioning, self-efficacy, and adaptive behavior were measured preintervention and immediately postintervention using standardized self-report rating scales. Participant satisfaction and experience were assessed using program-specific measures. Participants made statistically significant improvements, with medium to large effect sizes in social functioning, self-efficacy, and adaptive behavior. They reported high levels of satisfaction and a positive experience with the program content and delivery. This study provides evidence of participant satisfaction and perceived soft skills improvement and confidence, in addition to the preliminary efficacy of master's-level students as near-peer facilitators of the ASSET program with an ASD population. What This Article Adds: The results suggest that trained and supervised master's-level students can effectively deliver a manualized intervention as near-peer facilitators, elicit positive feedback and high levels of participant satisfaction, and replicate and extend previously reported participant gains.

Many former university students on the autism spectrum have poor employment outcomes despite strengths, qualifications, and ability. This article presents findings from a qualitative study of 11 former university students on the spectrum (self-identified: 2 males, 7 females, 2 non-binary, 18-50+ years), and five significant others (2 mothers, 3 spouses), from Australia and New Zealand. We identified issues associated with better and poorer transition to employment experiences (poor mental health, lack of support, poor interview skills). The former students also indicated a belief that it was not the role of a university education to prepare students for employment. This belief may have influenced their discipline choices and attitude towards using career supports and university employability components. The participants who studied non-vocationally specific qualifications described more difficulty with conceptualising their transition to employment, developing an employment goal, and finding work. It was suggested that universities may need to provide comprehensive transition to employment programs that develop the ‘soft skills’ required for employment and offer work placements for both vocationally and non-vocationally oriented courses to help students build skills that increase their employability.