Comprehensive Examination of Factors Contributing to Employment Status in Multiple Sclerosis

Open Access
Cadden, Margaret Helen
Graduate Program:
Master of Science
Document Type:
Master Thesis
Date of Defense:
June 17, 2015
Committee Members:
  • Peter Andrew Arnett, Thesis Advisor
  • Jonathan Emdin Cook, Thesis Advisor
  • Frank Gerard Hillary, Thesis Advisor
  • Multiple Sclerosis
  • Employment
  • Fatigue
  • Cognition
  • Disability
Objective: Unemployment is common among individuals with Multiple Sclerosis (MS) and is associated with significant socioeconomic burden. Several MS-related factors have been found to be associated with unemployment status including fatigue, depression, cognitive problems, and motor difficulties. However, few studies have examined these factors collectively in predicting employment. The present study aimed to explore these variables together in predicting employment status in MS. Patients and Methods: Fifty-three individuals with MS participating in a research study of cognitive, emotional, and social factors related to MS were examined. Construct scores were created using factor analysis that represented cognition, fatigue, depression, and motor function. These construct scores, along with age and measures of disease burden, were explored as predictors of unemployment status (not working, working) via logistic regression. Models of mediation were also investigated. Results: A model including construct scores of motor function, cognition, depression, and fatigue significantly distinguished those who are unemployed from employed. However, only the cognitive, motor, and fatigue construct scores were found to be significantly associated with unemployment individually. Results of a mediation analysis indicated that the cognitive and fatigue construct scores significantly mediated the relationship of disability (EDSS) on work status. More specifically, processing speed and memory mediated the relationship of overall disability on work status. Conclusion: Cognitive function and fatigue mediate the effect of MS disability on employment status. Interventions targeting cognitive difficulties and fatigue in MS may be effective in helping individuals to maintain employment.