Labor market participation following onset of seizures and early epilepsy: Findings from a UK cohort

Abstract

SUMMARYPurpose: Previous studies have reported a considerable employment disadvantage among people with epilepsy. In a cohort of men and women who had experienced a single seizure or had early epilepsy at study entry we explored employment status and social mobility over 4 years and investigated whether employment outcomes were more disadvantageous for certain social groups. Methods: Analyses were based on 350 individuals of working age identified via the UK Multicentre Study of Early Epilepsy and Single Seizures. Employment rates were calculated for the cohort and general population. Employment trajectories over 4 years were explored according to occupational social class. The relative risk of employment was calculated by clinical features of seizures and social class. Results: Individuals with single seizures or early epilepsy had significantly lower employment rates than the general population at study entry, and 2-and 4-year follow-up. Employment rates of men and women in the cohort did not differ significantly. Although little social class mobility occurred during follow-up, there was evidence of some downward mobility between first seizure(s) and study entry. In the fully adjusted model, nonemployment was predicted at all time points by having fair/poor self-rated health and experiencing four or more seizures. We observed that some individuals continued to work in hazardous occupations or drive professionally within a year of experiencing seizure(s). Discussion: People who have recently experienced a single seizure or who have early epilepsy are exposed to substantial employment disadvantage. Greater efforts are necessary to help these people return to work and stay employed.

Relationship of clinical and quality of life trajectories following the onset of seizures: Findings from the UK MESS Study

“…There were no important within‐group changes over time in the percentages reporting being in paid work. With regard to this aspect of functioning, it is worthy of note that, as shown in our earlier analysis (Holland et al., 2009), employment status at baseline was an important predictor of employment status at both 2 and 4 years, regardless of clinical group membership; those in employment at baseline were 16.75 times and 11.75 times, respectively, more likely to be employed at 2 and 4 years.…”

“…Individuals with subsequently persistent seizures were also less likely to be performing well at baseline in the social context-they were least likely to be in paid employment even at this early stage of their epilepsy ''careers'' and most likely to report significant restrictions on social life. We previously suggested (Holland et al, 2009) that lower rates of employment at study entry across our cohort as a whole, compared to the general population, reflected employment disadvantage as a result of the initial seizure(s). However, even at this early stage, employment disadvantage was differentiated by seizure history, with 62% of the single seizure patients (men and women taken together) reporting being in paid work, compared to only 38% of individuals who experienced multiple seizures prebaseline and 33% of those whose seizures subsequently persisted throughout follow-up.…”

Accounting for comorbidity in assessing the burden of epilepsy among US adults: results from the National Comorbidity Survey Replication (NCS-R)

“…33, 48, 49 Even though this OR decreased substantially when we controlled for comorbidity, the net OR of 3.8 remains very substantial, suggesting indirectly that epilepsy has important adverse effects on employment independent of comorbid disorders. The finding that epilepsy is positively associated with impairments in all WHO-DAS domains is broadly consistent with previous findings of substantial functional impairment in epilepsy.…”

Employability in people with epilepsy: A systematic review

“…Gender (Bishop, 2004;Gopinath et al, 2011;Jacoby, 1995;Komolafe et al, 2012;Lim et al, 2013a;Lim et al, 2013b;Sillanpaa and Schmidt, 2010;Varma et al, 2007) Gender (Al-Saad et al, 2001;Bautista and Wludyka, 2007;Chaplin, 1992;Elwes et al, 1991;George et al, 2009;Haag et al, 2010;Majkowska-Zwolinska et al, 2012) Seizure control (Al-Saad et al, 2001;Baker et al, 1997;Benifla et al, 2008;Callaghan et al, 1992;Chin et al, 2007;De Boer, 2005;Elwes et al, 1991;Geerts et al, 2011;Herodes et al, 2001;Holland et al, 2009;Jacoby et al, 2005;Koponen et al, 2007;Lazow et al, 2012;Lee, 2005;Lim et al, 2013c;Maganti et al, 2003;Majkowska-Zwolinska et al, 2012;Rätsepp et al, 2000;Scambler and Hopkins, 1980;Schwartz et al, 1968) (Reeves et al, 1997;Sillanpaa et al, 2004;…”

“…It was believed that a person with epilepsy should not work outside from home (Jacoby et al, 2008). PWE working in lower non-manual occupations had significantly reduced likelihood to sustain a job compared to professional workers (Holland et al, 2009).…”