Predicting Continued Employment in Persons with Multiple Sclerosis

Abstract

Multiple Sclerosis (MS) is one of the most prevalent neurologic diseases in the world and most often (90% of cases) manifests in people between the ages of 15-50 years (LaRocca, Kalb, Scheinberg, & Kendall, 1985; Rumrill, Tabor, Hennessey, & Minton, 2000). The prevalence of MS in women is two to three times that of men (National MS Society, 2005). Common symptoms of MS include fatigue, weakness, mobility disorders, bowel and bladder dysfunction, visual impairments, depression, and cognitive dysfunction (Rumrill, 1996). The physical and psychological stressors of MS can seriously disrupt personal and social functioning for the person with MS because these young adult and middle age years are associated with individual progress in education, career development, and family life (LaRocca et al., 1985). Loss of the ability to work has been associated with decreased quality of life in persons with MS (Aronson, 1997). Understanding the factors that influence job retention in persons with MS could be beneficial for those persons and society. Research in the United States, Norway, Canada, and Spain has shown unemployment rates among persons with MS to vary between 51% to 80% (Gronning, Hannisdal, & Mellgren, 1990; Jackson, Quaal, & Reeves, 1991; Kornblith, LaRocca, & Baum, 1986; Morales-Gonzalez, Benito-Leon, Rivera-Navarro, & Mitchell, 2004). These same reports mention that greater than 95% of participants in their studies had held jobs at some time in their lives. Other studies indicate that 13% to 50% of people unemployed secondary to MS would be willing to work (Kornblith et al., 1986; Gordon, Feldman, Shipley, & Weiss, 1997). Due to the symptoms and stressors of living with a chronic, often disabling disease, factors related to employment are likely to be very different for individuals with MS than for the general population. In general, people with a disability are less likely than others to be working, according to the 2001 National Health Interview Survey (Freedman, Martin, & Schoeni, 2004). Thirty-four percent of adults ages 21 to 64 with a limitation or a disability reported working in the previous week versus 74% of all adults surveyed. Yet persons with MS are generally thought to be healthier, more financially secure, more socially active, and report a higher perceived quality of life when employed rather than unemployed (Johnson, Amtmann, Yorkston, Klasner, & Kuehn, 2004). This paradox may be explained less by individual factors and more by societal or policy barriers, such as the decreased supply of jobs offering full benefits, employer recruitment and accommodation, the availability of vocational rehabilitation programs and community-based employment services, and disincentives in social and health insurance policies (National Center for the Dissemination of Disability Research, 2001). A number of cross-sectional studies have examined factors related to current employment status specifically in persons with MS. Among working-age persons with MS (less than 65 years of age), older age has been repeatedly associated with unemployment (Beatty, Blanco, Wilbanks, Paul, & Hames, 1995; Edgley, Sullivan, & Deboux, 1991; Gronning et al., 1990; Jongbloed, 1996) as has greater disability (LaRocca et al., 1985; Hakim, Bakheit, Bryant, Roberts, McIntosh-Michaelis, & Spackmans, 2000; Busche, Fisk, Murray, & Metz, 2003) and cognitive dysfunction (Hakim, et al., 2000; Roessler, Fitzgerald, Rumrill, & Koch, 2001). Higher educational level has consistently positively influenced employment status, possibly due to the type of work associated with educational preparation or the greater flexibility in jobs held by more highly educated persons (Edgley, et al., 1991; Jackson, et al., 1991; Jongbloed, 1996; Roessler, et al., 2001). A recent cross-sectional study by Roessler, Rumrill, and Fitzgerald (2004) found that 23% of the variance in employment status of their 1,310-person sample of adults with MS was explained by education level, severity of symptoms, persistence of symptoms, and the presence of cognitive impairment. …

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