Work and health in multiple sclerosis: survey insights on varying employment situations

Abstract Background Multiple Sclerosis (MS) is a chronic condition affecting working age adults, causing physical, mental, and cognitive symptoms that impact daily life. While employment is vital for well-being, MS symptoms can hinder job retention, sometimes requiring benefits like sickness absence (SA) or disability pension (DP). This study examines physical, mental, and cognitive outcomes in individuals with MS, focusing on different employment situations. Methods All individuals aged 20-50 in the Swedish MS Registry (SMSreg) were invited to complete a 2021 survey, which was linked to clinical data from SMSreg. Based on reported employment status (n = 4,352; response rate 96.6%), participants were categorized into five groups: 1) Working (69.2%), 2) Other active (not receiving SA or DP; 6.9%), 3) Part-time work with SA (5.7%), 4) Part-time work with DP (6.5%), and 5) Full-time DP or not working for other reasons (11.8%). Health status (EQ-VAS), disability (EDSS), cognition (SDMT), and mental health (Neuro-QoL subscales: depression, anxiety, fatigue) were compared across groups using ANCOVA or non-parametric (Poisson) models. Results After adjusting for age, sex, and time since onset, significant differences were found across groups for all scales: EQ-VAS (Wald χ²(4)=4425.352, p < 0.001), Depression (F(7)=94.490, p < 0.001), Anxiety (F(7)=72.548, p < 0.001), Fatigue (F(7)=148.001, p < 0.001), EDSS (Wald χ²(4)=804.463, p < 0.001), and SDMT (F(7)=37.547, p < 0.001). Worse scores, with gradual declines, were observed in those working part-time with SA, and those on part- and full-time DP. However, the ‘part-time working + DP’ group had better scores than the ‘working + SA’ group across all scales but EDSS. Conclusions Overall, individuals with MS in employment or engaged in other activities had better health and cognitive outcomes compared to those on sickness absence or disability pension, with notable differences in physical disability and mental health scores. Key messages • Health and cognitive outcomes varied by employment status in MS, with better scores in those working or active, compared to individuals on sickness absence or disability pension. • While physical disability is tied to DP, emotional and cognitive issues may relate more to SA; part-time work with DP showed better mental and cognitive scores than full-time SA.