Predicting employment status in multiple sclerosis patients: the utility of the MS functional composite

Abstract

As many as two-thirds of multiple sclerosis (MS) patients are unable to retain employment. Neurological and cognitive status are known to be significant predictors of unemployment, but the relationship between the two is unclear. Furthermore, the association between employment status and depression, anxiety, and personality has not been adequately explored in MS patients. This study examined the demographic, neurological, neuropsychological, and personality factors associated with unemployment in MS. We also sought to determine the utility of the Multiple Sclerosis Functional Composite (MSFC), a measure of MS-related disability incorporating physical and cognitive measures, in predicting employment status. A consecutive sample of 106 MS patients (61.3% unemployed) completed the Brief Repeatable Battery of Neuropsychological Tests (BRBN), Hospital Anxiety and Depression Scale (HADS), and NEO Five-Factor Personality Inventory. The MSFC emerged as the most robust predictor of employment status in MS patients, exceeding the predictive value of the EDSS. Together with NEO "Agreeableness" and HADS Depression subscore, the MSFC accounted for 49.8% of the variance in employment status. Unemployment was also associated with a progressive disease course, longer disease duration, and being female. While Global Cognitive Impairment did not differentiate between groups, unemployed patients scored significantly lower on three of five BRBN indices: Symbol Digit Modality Test, Paced Auditory Serial Addition Test, and Word List Generation. The findings highlight the utility of the MSFC as a predictor of unemployment in MS. Furthermore, a strong association was found between unemployment and the personality construct "Agreeableness", and severity of depression.

Employment retention expectations of working adults with multiple sclerosis: A multinomial logistic regression analysis

“…Those expecting to reduce their job responsibilities perceived themselves as more severely disabled from their MS symptoms and as more constrained by lack of accessible housing. Adults with MS expecting to exit the workforce in 2 to 5 years presented a profile consistent with the literature pertaining to predictors of employment and unemployment (Honarmand, Akbar, Kou, & Feinstein, 2011;Moore et al, 2013;Schiavelin et al, 2013;Smith & Arnett, 2005). They were older and perceived that they were affected more severely by their MS symptoms, particularly as those symptoms affected their mobility, which is consistent with findings that unemployed adults with MS had the highest level of incapacity in comparisons with employed adults with MS (full-time or part-time).…”

High-priority employment concerns of Hispanics/Latinos with multiple sclerosis in the United States

“…Thus, these findings may suggest, in part, alternative explanations for the high jobless rates among Hispanic/Latino adults with MS such as education level, fatigue related to job duties and roles, and overall progression in disability level, particularly in terms of cognitive limitations (Honarmand et al, 2011;Krause, Kern, Horntrich, & Ziemssen, 2013;Moore et al, 2013;Simmons, Tribe, & McDonald, 2010). Others have cited different nonworksite factors as central to leaving the work force such as disincentives in disability benefits programs (Marini, 2003) and more subtle and difficult to verify forms of workplace discrimination (Rumrill et al, 2005).…”

Factors Associated with Employment Status in Individuals with Multiple Sclerosis

“…[6][7][8][9][10][11] Other MS symptom-related factors have also been found to predict employment status, including fatigue, 10,12 depression, [6][7][8] motor difficulties, 13 and cognitive problems. 14,15 More specifically, regarding cognitive problems, scores on tests of processing speed, verbal fluency, working memory, and long-term memory are typically lower in unemployed versus employed individuals with MS. 8,16,17 With all this said, research on cognition and depression has produced inconsistent findings. Regarding cognition, although most studies have found it to be associated with employment status, some have not.…”