Determinants of unemployment in multiple sclerosis (MS): The role of disease, person-specific factors, and engagement in positive health-related behaviors

Abstract

Background: Rates of unemployment among individuals with multiple sclerosis (MS) are as high as 80%. Objective: This study examines disease, person-specific factors (e.g., personality, self-efficacy), and health-related behaviors, which may account for individuals leaving the workforce. Method: 252 individuals with MS were enrolled in a prospective study examining the factors related to unemployment in MS. Sixty-seven were “at risk” for leaving the workforce. These individuals were compared to those “not at risk” on measures of disease, person-specific factors, and health-related behaviors. Results: Certain disease factors differentiated those “at risk” and those “not at risk.” In particular, those “at risk” were more likely to have a progressive course and reported greater fatigue, sleep problems, pain, depression, and anxiety. They also reported lower levels of locus of control and MS self-efficacy and engaging in maladaptive coping. On a measure of personality, they endorsed higher levels of neuroticism and lower levels of conscientiousness, extraversion, and agreeableness. Finally, those “not at risk” reported engaging in more positive health-related behaviors. Taken together, disease course, fatigue, MS self-efficacy, and diet/exercise were the most significant factors, accounting for 16% of the variance. Conclusions: Findings suggest that greater consideration and interventions tailored to these factors is warranted, which may assist individuals with MS staying employed and/or making appropriate accommodations.