Physical symptoms and poorer coping mechanisms are major risk factors for unemployment in younger and older people with multiple sclerosis (MS), while psychological problems have the greatest impact in middle-aged patients’ unemployment, a study suggests.
These findings highlight that unemployment risk factors vary with age and call for interventions that take into account specific factors that have the greatest impact in the patient’s stage of life.
The study, “Unemployment in multiple sclerosis across the ages: How factors of unemployment differ among the decades of life,” was published in the Journal of Health Psychology.
While most people with MS report being gainfully employed before their diagnosis, it is estimated that 40% to 80% of them become unemployed during their working years due to the disease.
Several risk factors for unemployment in MS patients have been identified, including age (younger and older), being a woman, lower educational level, greater disability, progressive disease, physical symptoms, and cognitive impairment. In addition, person-specific and psychological factors such as coping, personality, self-efficacy, and anxiety, have been shown to influence the work status of people with MS.
However, how these factors may differ with the person’s stage of life, disease, and career remain unclear.
To fill this gap, researchers at the Kessler Foundation’s Center for Neuropsychology and Neuroscience Research evaluated whether disease, psychological, and person-specific risk factors for unemployment varied with age in 221 working-age MS patients.
Participants (aged 20 to 64 years) were recruited through the National Multiple Sclerosis Society website and local MS clinics in the New York/New Jersey metro area. They completed an online survey concerning their work status and related factors of interest, and reported whether they were considering reducing their working hours or leaving the workforce altogether within the upcoming year due to their MS.
Disease factors (fatigue, pain, and sleep disorders), psychological factors (anxiety and depression), and person-specific factors (personality, self-efficacy in managing MS, and coping methods) were assessed through validated measures.
A total of 59 patients (27%) were considering reducing working hours or leaving the workforce (labeled the “considering group”), while 162 patients (73%) were not (the “staying group”). Researchers divided the participants into three groups according to their decade of age: 63 were in their 30s, 93 in their 40s, and 65 in their 50s.
Results showed that the percentage of people in the “considering group” increased with age, with 22% of the younger patients, 26% of the middle-aged patients, and 32% of the older patients considering the reduction of working hours or leaving the workforce.
Researchers found no differences in age, gender, education, or disease duration between the two groups of patients, but there were more people with progressive MS in the “considering group,” regardless of age.
The analysis identified several factors predicting whether participants felt as if they needed to leave the workforce, which were consistent with previous reports. These included pain, fatigue, depressed mood, negative self-evaluation, neuroticism (negative or anxious personality), anxiety, self-efficacy to manage MS, conscientiousness (responsible and organized personality), extraversion (social and positive personality), disengagement (avoiding or ignoring the problematic issues as a coping mechanism), and religious coping.
Also, predictive factors of patients “considering” leaving the workforce varied with age.
Physical symptoms (pain in the younger group and fatigue in the older group), as well as lower perceived self-efficacy to manage MS, and greater use of mental disengagement as a coping mechanism were significantly associated with younger and older patients in the “considering group.”
“This could be a result of adjustment to ones’ disease and symptoms in the younger [group] and a greater disease involvement and/or progression in the oldest [group]; who, on average had a disease duration of 11 years and a greater proportion of individuals with a progressive course,” the researchers wrote.
Patients in their 40s and considering leaving the workforce had significantly more depression and anxiety, as well as higher levels of neuroticism and lower levels of extraversion and conscientiousness.
The impact of psychological problems in middle-aged patients may be linked to what is known as “midlife crisis,” when people go through a series of biological, psychological, and social changes, the team noted.
The “combination of personality, anxiety, and poor self-evaluation among those considering leaving in this stage of life may result in their disengaging from the workforce as a result of psychological crisis or stress as opposed to disease factors,” the researchers wrote.
Overall, “our findings suggest that physical symptoms and how the individual manages them are greater issues for the youngest and oldest decades, while psychological issues predominate among the middle-aged,” Lauren Strober, PhD, one of the study’s authors, said in a press release.
Larger and longitudinal studies are required to confirm these findings, and to better understand the changing weight of these risk factors with age, and to develop age-fitting approaches.
“Professionals who counsel individuals with MS about important decisions such as leaving the workforce need to be aware of the influence of age on employment decisions, within the context of biological and psychosocial factors,” Strober said.
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