Prospective Study Identifies Factors Associated With Unemployment Among People With MS

Multiple sclerosis (MS) typically affects people in their prime working years, most often striking between the ages of 20 and 50. Rates of unemployment are high. As many as four out of every five people with the neurological condition that affects movement, gait and vision may be unemployed.

A new study published in Multiple Sclerosis and Related Disorders compares two groups of patients with MS to identify the factors that may influence their likelihood of holding a job.

“While much is known about the demographic and disease variables associated with

Lauren Strober

unemployment in MS, less is known about the role of person-specific factors and one's engagement in health-related behaviors,” wrote author Lauren Strober, Ph.D., senior research scientist at the Center for Neuropsychology and Neuroscience Research of the Kessler Foundation in East Hanover, New Jersey. The Kessler Foundation funds research into people with disabilities and the employment issues they face.

Previous studies have examined MS and employment but were retrospective. The press release accompanying the publication of Strober’s findings says hers is the first to study the issue prospectively.

Strober’s study included 252 people with MS and divided them into two groups: “at risk” for leaving the workforce (n = 67) and “not at risk” (n = 185). The participants in the “at risk” group reported that they were considering reducing their hours or leaving the workforce altogether because of difficulties related to their MS.

Participants in the study were between the ages of 20 and 64 and were currently employed. They completed an online survey about a number of topics, including work status and history, disease symptoms, personality, coping, self-efficacy and disease management. Participants also completed the Symbol Digit Modalities Test (SDMT), which measures processing speed.

The “at risk” and “not at risk” groups were similar as far as age, gender, education, and disease duration were concerned. There was, though, a difference in disease course: A greater proportion of patients in the “at risk” group had a progressive course (13% vs 3%).

The “at risk” group also reported greater levels of fatigue, sleep disturbance, pain, depression and anxiety. Based on their survey responses, they also had greater levels of neuroticism; lower levels of extraversion, conscientiousness and agreeableness; lower MS self-efficacy; and a greater use of maladaptive coping.

In addition, they reported lower “locus of control” — how strongly people believe that they have power over situations and experiences that affect their lives. The “at risk” group was also less likely to engage in positive health-related behaviors, such as healthy eating, exercise and social/intellectual activities.

“What is perhaps is more novel and exciting about the present findings is the fact that engagement in health-related behaviors, specifically diet and exercise proved to be a significant predictor even when disease and person-specific factors were taken into account,” Strober wrote.

Among the limitations that she noted was almost all (94%) of the patients in the study had a relapsing-remitting course, which was likely because the individuals recruited were still working and at the early stage of being considered “at risk” for unemployment. The study also did not include a measure of disease severity, because it relied on medical information from the patients’ neurologists, many of which did not report something like the Expanded Disability Status Scale.

"Risk of unemployment is highest during the first three to five years after diagnosis, so we need to be able to intervene early to prevent job losses, and their subsequent impact on physical and mental health, as well as on personal and family finances. This study points to factors related to risk of unemployment that may be amenable to early intervention," Strober said in the press release. "While further research is needed, professionals who provide MS care should be aware of the potential impact of this diagnosis on future employment and be prepared to intervene before individuals leave the workforce."