Impact on Family and Relationships

The patient’s family and partner are negatively impacted by the patient’s illness. Since most MS patients are diagnosed at a relatively young age, parents’ anxiety, denial and fear must also be taken into account.1,14 Divorce rates are also higher in patients with MS15 A recent study found that partners of individuals with MS reported “being unsure of what the future might hold and feeling helpless and out of control…and that other people could not understand and support them, which led to a feeling of social isolation.”16 A collaborative family-centered intervention model including a psychoeducational component, has been shown helpful for families of those with MS.17

Impact  of MS on Employment

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MS has an adverse effect on the capacity of patients to remain employed.18 Fatigue is the most common symptom that causes patients to leave work or reduce employment hours. Discontinuing employment can lead to a worsening of other MS symptoms.19 Advancing age, longer disease duration and progressive course, deteriorating cognition, and maladaptive coping mechanisms (such as behavioral disengagement or substance use) also play a role.20

Comprehensive symptom management, with particular emphasis on fatigue, may be helpful in enabling patients to preserve their employment status.19 Other helpful interventions include encouraging patients to utilize coworkers as a source of support, and providing education in adaptive coping skills.20

Interventions for fatigue include psychoeducation, addressing lifestyle factors (eg, diet and exercise), pacing (eg, rest breaks between activities), energy conservation and work simplification strategies (eg, use of assistive devices, adaptive equipment, and gait aids), supplementation with vitamin D, and structured exercise programs (eg, aerobic exercise and yoga).21-23  

The Role of Social isolation

Social isolation is common in individuals with MS for a variety of reasons, including declining ability to engage in physical activity, cognitive changes, changes in relationships and employment, and depression. Interventions oriented toward improving depression, increasing positive social interactions, expressed affection, working with families surrounding issues of emotional support, and providing psychoeducation may be helpful.14,24