Cadden Margaret, Arnett Peter
Psychology Department, The Pennsylvania State University, University Park, PA, USA.
Int J MS Care. 2015 Nov-Dec;17(6):284-91. doi: 10.7224/1537-2073.2014-057.
Unemployment is common in individuals with multiple sclerosis (MS) and is associated with substantial socioeconomic burden. Several MS-related factors have been found to be associated with employment 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.
Fifty-three individuals with MS participating in a research study of cognitive, emotional, and social factors related to MS were examined. Composite scores were created using factor analysis that represented cognition, fatigue, depression, and motor function. These composite scores, along with the Expanded Disability Status Scale score, were explored as predictors of employment status (working, not working) via logistic regression. Models of mediation were also investigated.
A model including composite scores of motor function, cognition, depression, and fatigue significantly distinguished those who are unemployed versus employed. However, only the cognitive, motor, and fatigue composite scores were found to be significantly associated with unemployment individually. RESULTS of a mediation analysis using 1000 bootstrap samples indicated that the cognitive and fatigue composite scores significantly mediated the effect of disability on work status.
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 maintain employment.
失业在多发性硬化症（MS）患者中很常见，并且与巨大的社会经济负担相关。已发现一些与MS相关的因素与就业状况有关，包括疲劳、抑郁、认知问题和运动困难。然而，很少有研究在预测就业时综合考察这些因素。本研究旨在综合探讨这些变量对MS患者就业状况的预测作用。
对53名参与MS相关认知、情感和社会因素研究的MS患者进行了检查。通过因子分析创建了代表认知、疲劳、抑郁和运动功能的综合得分。这些综合得分，连同扩展残疾状态量表得分，通过逻辑回归被用作就业状况（工作、未工作）的预测指标。还研究了中介模型。
一个包含运动功能、认知、抑郁和疲劳综合得分的模型能够显著区分失业者和就业者。然而，仅发现认知、运动和疲劳综合得分分别与失业显著相关。使用1000个自抽样样本进行的中介分析结果表明，认知和疲劳综合得分显著中介了残疾对工作状态的影响。
认知功能和疲劳中介了MS残疾对就业状况的影响。针对MS患者认知困难和疲劳的干预措施可能有助于个体维持就业。
