Negative work events reported online precede job loss in multiple sclerosis

Highlights

• Multiple sclerosis (MS) patients completed a vocational survey every three months.

• Stably employed patients, those who lost work and healthy controls are compared.

• Before job loss, group differences were noted in clinical and workplace variables.

• MS patients who lost work were more likely to report negative work events.

• Evaluation of negative work events can be used in timely vocational intervention.

Abstract

Purpose

Determine if a recently validated online survey of negative work events can predict future job loss among multiple sclerosis (MS) patients.

Method

Evaluated were 284 employed individuals (63 healthy controls, 221 MS patients), every three months, using an online vocational monitoring tool. Job loss rates in MS patients were compared with the healthy controls. Survey responses from MS patients suffering job loss (n = 23) were then compared to those maintaining employment. Analyses focused on the frequency of negative work events.

Results

While 23 (10%) of MS patients lost their job after baseline, there was no job loss among the healthy controls. Compared to stably employed patients, those suffering job loss had been diagnosed with MS later in life, were more likely to report a progressive disease course, and had greater physical disability as measured by the Patient Derived Disease Steps (PDDS). Declining patients were also more likely to report negative work events within three months of job loss (e.g., verbal criticism for errors or removal of responsibilities). Stepwise logistic regression predicting MS job loss retained the PDDS, age at diagnosis, years working for employer and reporting a negative work event.

Conclusions

The results show that physical disability and patient reported risk factors for job loss can be monitored using an online survey tool. The tool can trigger clinical assessments to help prevent unemployment and assist patients in procuring disability benefits.

Introduction

Diagnosis of multiple sclerosis (MS) is common in mid-life, often halting a person's career in the prime of their profession [1]. One study estimated that half of MS patients become unemployed within just five years of diagnosis [2]. MS unemployment is associated with reduced social engagement, poor self-efficacy and low quality of life [3]. In response, the MS community has called for increased guidance from clinicians regarding the risk of job loss among employed patients and how best to protect patients confronted with the threat of job termination [4], [5].

Identification of clinical risk factors for unemployment would seem to be an important first step to intervene on behalf of the work-challenged MS patient. Cross-sectional studies show that fatigue, cognitive dysfunction, depression and impaired mobility are all associated with unemployment [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. The few longitudinal studies of MS patients transitioning from employed to unemployed status have shown that reduction in cognition and motor functioning are critical factors [19], [20]. These studies distinguished fully employed from disabled patients, and did not examine ways to prevent job loss in employed patients reporting work problems. In this paper we endeavor to discover real life signals in the employed patient that indicate impending job termination.

Toward that end we have proposed that increases in work problems preceding job loss can be detected using online surveys. We have utilized the Buffalo Vocational Monitoring Survey (BVMS) as a means of characterizing work-challenged patients, identifying patients for intervention and referring patients to appropriate vocational and legal services. Our pilot study [10] demonstrated that MS patients who report negative work events perform worse on cognitive and ambulatory measures. Interestingly, despite the correlation between cognitive impairment and negative work events, disclosure status at work was not related to cognition [9], suggesting that patients need help navigating cognitive impairments in the workplace.

Our previous studies were cross-sectional in design, and did not address the predictive validity of a repeatable, online monitoring approach. In the present study we studied the incidence of job loss among employed MS patients and healthy controls (HCs). We then quantified negative work events in employed MS patients and assessed if these events are more prevalent prior to job loss. Lastly, in order to develop future intervention perspectives, a secondary analysis was performed on accommodations before job loss. All analyses compared patients with deteriorating employment status (DES) and patients with stable employment status (SES). We hypothesized that negative work events are elevated in patients with deteriorating employment, signal the need for clinical/vocational intervention.