Depression as a predictor of occupational transition in a multiple sclerosis cohort

In MS, transitions between working and not-working status may occur in association with depression. This can complicate patients' ability to promptly obtain disability support due to an expectation that their functioning will improve after the depression resolves, a viewpoint that sees depression assuming a role as a causal determinant of disability. In this study, prospective data were used to model the relationship between depressive symptoms and the transition out of employment. In unadjusted analyses, depression increased the risk of transition to non-working status, HR = 1.7 (95%CI 1.3-2.3). Adjustments for ambulation status, physical and mental quality of life composite scores and fatigue impact attenuated or eliminated the association. While depression commonly occurs around the time of occupational transitions in MS, it does not appear to be an independent or direct cause of such transitions.