Abstract
BACKGROUND:
Understanding vocational interests in individuals with multiple sclerosis (MS) is essential for informing vocational rehabilitation efforts.
OJBECTIVE:
Describe the vocational interests of those with MS and identify patterns related to sex and race.
METHODS:
Participants (n = 133) were identified through specialty hospital records in the southeastern United States. Participants completed the Strong Interest Inventory, which includes six General Occupational Themes (GOTs), 30 Basic Interest Scales (BIS), and five Personal Style Scales.
RESULTS:
Male participants scored highest on the Realistic GOT, followed by the Investigative and Conventional GOTs. Female participants scored highest on the Social GOT, followed by Artistic and Enterprising GOTs. Black participants scored highest on the Social, Conventional, and Enterprising GOTs. White participants scored highest on the Artistic and Social GOTs. Statistically and clinically significant sex differences were seen on two of the GOTs (Realistic and Investigative) and five of the BIS. No racial differences were identified on the GOT.
CONCLUSIONS:
For males with MS, who express preference in Realistic and Investigative vocational themes, the physical and cognitive symptoms of MS may be incompatible with interest-congruent work environments. Early identification of vocational interests in the context of individual MS symptom experiences is essential to individualize rehabilitation efforts.
Introduction
Multiple sclerosis (MS) is a neurologic disease characterized by debilitating physical symptoms (e.g., muscle weakness, coordination difficulties) and cognitive impairments (National Institute of Neurological Disorders and Stroke, 2019). Age of onset of MS symptoms commonly occurs between the ages of 20 and 40 (National Institute of Neurological Disorders and Stroke, 2019), often coinciding with peak career development and frequently affecting career and earnings trajectories in individuals diagnosed with MS. Although the majority of people with MS have a work history prior to receiving an MS diagnosis (Moore et al., 2013; Pearson et al., 2017), unemployment rates following MS diagnosis are generally greater than 50% (Dorstyn, Roberts, Murphy, & Haub, 2019; Raggi et al., 2016). Unemployment in this population appears to have multifactorial influences including demographic (e.g., being male, older age, lower education; Raggi et al., 2016), clinical (e.g., more severe disease progression, persistence of symptoms, greater subjective pain; Roessler et al., 2004; Schiavolin et al., 2013; Shahrbanian et al., 2013), and psychological/neuropsychological characteristics (e.g., greater fatigue, depressive symptoms, and worse cognitive functioning; Clemens & Langdon, 2018; Dorstyn et al., 2019; Honan et al., 2015; Krause et al., 2019; Roessler et al., 2004).
Vocational interests, reflective of personality types and related to vocational choice, may further elucidate employment considerations in persons with MS. Holland’s theory of vocational choice (Holland, 1997) suggests maintaining long-term employment is a product of congruence between vocational interests and vocational environments. Conversely, incongruence between interests and environments will lead to dissatisfaction. Holland’s theory proposes six personality types, or General Occupational Themes (GOTs) reflective of vocational environments of interest (i.e., Realistic, Investigative, Artistic, Social, Enterprising, and Conventional; RIASEC). Given the physical and cognitive symptoms frequently associated with MS, these impairments may impact one’s ability to engage in certain job tasks, potentially limiting the congruence between the work environment and one’s vocational interests. For example, for a person with high interest on the Realistic GOT, a GOT characterized by preference of working with objects and having mechanical ability, MS symptoms may limit his/her ability to engage in a physically demanding manual labor work environment. This, in turn, may lead to incongruence between work environment and vocational interests, thus leading to dissatisfaction.
Although not specifically assessed using a vocational interest inventory, recent research has supported a significant relationship between worse perceived “job/person match” and worse job satisfaction in individuals with MS (Li et al., 2017). Vocational interests, as assessed by validated interest inventories, have been described in other neurological condition populations (e.g., spinal cord injury; Clark & Krause, 2017; Krause & Ricks, 2012); however, to our knowledge, these methods have not been utilized in the MS literature. Understanding career interests in individuals with MS is essential for informing vocational rehabilitation efforts. Our purpose was to provide descriptive information regarding vocational interests in individuals with MS, using the current Strong Interest Inventory (SII), and to compare the profiles as a function of sex and race.
Methods
Participants
All study procedures were approved by the Institutional Review Board. Potential participants were identified through record review at a large specialty hospital in the southeastern United States. Eligibility criteria included: 1) diagnosed with MS, 2) 18 years or older at the time of the study, and 3) less than 65 years old at time of MS diagnosis. Additional criteria included race/ethnicity of White or Black, non-Hispanic origin due to inadequate sample size of other racial/ethnic groups for analyses. One hundred forty-two participants completed the SII, 9 of whom were eliminated due to missing data on race/ethnicity eligibility.
Procedures
Potential participants were sent cover letters announcing a study of vocational outcomes, followed by actual materials 2 to 4 weeks later. Non-respondents were mailed follow-up packets, followed by a phone call. Participant remuneration was $50 to complete a detailed vocational history. Prospective participants were additionally given the option of completing the SII in exchange for a copy of the SII profile. A total of 184 participants requested the SII, 142 of whom returned the completed SII. We discontinued this option just under one third of the way through the study to reduce participant burden and because we had sufficient pilot data on the SII.
Measures
The most recent 291-item SII (Donnay et al., 2004) was used to examine vocational interests. The SII includes six GOTs (Realistic, Investigative, Artistic, Social, Enterprising, and Conventional), 30 Basic Interest Scales (BIS), and five Personal Style Scales. The number of items per GOT scale range from 21 to 31 items. The GOT scales have high internal reliability (Cronbach’s α ranging from 0.90 to 0.95) and high test-retest reliability (ranging from 0.84 to 0.89). Standard scores for the SII were computed by comparing individual raw scores to the scores of the General Representative Sample (GRS), consisting of 1,125 women and 1,125 men. Each GOT and BIS scale of the SII has a standard score mean of 50 and SD of 10. Sex-specific GRS means were used to determine interpretative boundaries for the GOT and BIS male and female standard scores. The Personal Style Scales reflect bipolar scales of preference, with scores 45 and below and scores 55 and above reflecting preference for each pole. The midrange (46–54) of the Personal Style Scales suggest no predominant preference.
Analysis
IBM SPSS Statistics for Windows, version 24 was used for all data analyses. Descriptive statistics were performed to explore participant characteristics and SII scores. Dependent variables were examined for normal distribution using skewness and kurtosis data. Eight variables were transformed using log and square root transformations (Table 1). Subsequent to these transformations, these data were normally distributed. Seventeen separate two-way multivariate analyses of variance (MANOVAs) were performed to determine significant differences in GOT, BIS (grouped by GOT), and Personal Style Scales on the SII by sex and race. Overall statistical significance was identified using Pillai’s trace statistic. Follow-up analysis of variance (ANOVA) tests were used to explore differences between sex and race secondary to significant omnibus tests. A minimum 3-point mean difference on the SII scales has been suggested as indicative of clinical significance (Campbell, 1977). Follow-up ANOVA tests were interpreted as significant if statistical significance at α= 0.05, and there was a minimum of a 3-point difference in mean scores.
Scores on GOT, BIS, and Special Scales by Gender and Race
Scores on GOT, BIS, and Special Scales by Gender and Race
Note: Descriptive mean and standard deviation data is based on actual scores. Inferential analysis results are based on *log base 10 transformation or †square root transformation of variables where indicated. ‡p < 0.05, §p < 0.01, ||p < 0.001.
Participant characteristics
The majority of participants were female (82.0%) and White (69.9%). Participants had a mean age of 52.70 years (SD = 11.70) and 15.34 years (SD = 2.48) of education at the time of the survey. The mean age at MS diagnosis was 39.25 years (SD = 10.92), and the median years post-MS diagnosis was 12.00. The primary course of MS reported by participants was relapsing-remitting (75.6%), followed by primary progressive (8.4%), secondary progressive (7.6%), and progressive relapsing (3.8%). Participant age at MS diagnosis was significantly different by sex, with females (M = 38.31, SD = 10.91) younger at time of diagnosis than males (M = 43.50, SD = 10.08; t = –2.14, p = 0.035). Sex differences were not evident based on age, years of education, or time since MS diagnosis. No differences based on race were identified on chronological age, years of education, age at MS diagnosis, or time since MS diagnosis.
Participant mean scores for GOT and BIS are presented in Table 1. Male participants scored highest on the Realistic GOT, followed by the Investigative and Conventional GOTs. Female participants scored highest on the Social GOT, followed by Artistic and Enterprising GOTs. Black participants scored highest on the Social, Conventional, and Enterprising GOTs. White participants scored highest on the Artistic and Social GOTs.
Scale comparisons
GOT
Both sex (V = 0.23, F6,124 = 6.19, p≤0.001, partial η2 = 0.23) and race (V = 0.10, F6,124 = 2.29, p = 0.040, partial η2 = 0.10) MANOVA main effects were statistically significant. Results did not support an interaction effect (V = 0.03, F6,124 = 0.53, p = 0.785, partial η2 = 0.03). Statistically and clinically significant differences by sex were shown on two of the six GOTs (Realistic and Investigative), with male participants scoring higher on both of these interest themes (Table 1). Furthermore, a disproportionate percentage of female participants had lower scores or more frequently endorsed “very little” for the Realistic and Investigative GOTs than GRS females (Table 2). Follow-up ANOVAs examining differences in GOT scores by race were not statistically significant.
Participant Distribution across GOT Interpretive Standard Score Boundaries by Sex
Participant Distribution across GOT Interpretive Standard Score Boundaries by Sex
Note. GOT = General Occupation Themes; GRS = General Representative Sample.
When examining Realistic-oriented BIS, MANOVA results indicated significant main effects for both sex (V = 0.18, F6,124 = 4.53, p≤0.001, partial η2 = 0.18) and race (V = 0.20, F6,124 = 5.03, p≤0.001, partial η2 = 0.20). An interaction effect was not supported (V = 0.05, F6,124 = 1.14, p = 0.343, partial η2 = 0.05). Follow-up univariate analyses suggested males scored significantly higher on two of the 30 BIS (Mechanics and Construction, Computer Hardware and Electronics), and White participants had higher interest scores in Nature and Agriculture.
Significant MANOVA main effects for sex (V = 0.07, F4,126 = 2.46, p = 0.049, partial η2 = 0.07) but not race (V = 0.05, F4,126 = 1.53, p = 0.196, partial η2 = 0.05) were found for Investigative-oriented BIS. An interaction effect also was not found (V = 0.03, F4,126 = 0.98, p = 0.422, partial η2 = 0.03). Univariate analyses indicated male participants had higher interest scores on Science and Mathematics BIS.
A significant main effect of race was found on the Social-oriented BIS (V = 0.10, F6,124 = 2.38, p = 0.033, partial η2 = 0.10), with follow-up univariate analyses suggesting Black participants had higher interest scores on the Religion and Spirituality BIS. MANOVA results did not support a significant main effect of sex (V = 0.04, F6,124 = 0.85, p = 0.533, partial η2 = 0.04) or an interaction effect (V = 0.04, F6,124 = 0.93, p = 0.477, partial η2 = 0.04).
MANOVA results supported a significant main effect of sex on the Conventional-oriented BIS (V = 0.09, F4,126 = 3.21, p = 0.015, partial η2 = 0.09). The main effect of race (V = 0.04, F4,126 = 1.15, p = 0.336, partial η2 = 0.04) and the interaction effect were not significant (V = 0.01, F4,126 = 0.36, p = 0.835, partial η2 = 0.01). Follow-up ANOVAs indicated males had significantly higher scores on the Finance and Investing BIS. MANOVA main and interaction effects were not significant for any of the Artistic-oriented or Enterprising-oriented BIS.
Personal Style Scales
MANOVA results suggested both sex and race main effects were significant (V = 0.20, F5,125 = 6.20, p≤0.001, partial η2 = 0.20 and V = 0.11, F5,125 = 3.06, p = 0.012, partial η2 = 0.11, respectively). The interaction effect was not significant (V = 0.05, F5,125 = 1.44, p = 0.215, partial η2 = 0.05). Females scored significantly higher on Work Style, whereas males scored significantly higher on Risk Taking. Black participants scored significantly higher on Work Style than White participants.
Discussion
The current study describes vocational interests in individuals with MS using the current SII. Further, the study provides an exploration of differences in vocational interests as a function of sex and race. Results support both statistically and clinically significant sex differences in the Realistic and Investigative GOT, with men scoring higher than women on both. The greater score on the Realistic GOT, indicating a male preference for a hands-on, object-focused work environment, is consistent with literature of male vocational interests in other neurological condition populations (Clark & Krause, 2017; Krause & Ricks, 2012; Krause et al., 2011; Rohe & Athelstan, 1985) and in the general population (Fouad, 2002; Su et al., 2009). Results from this study also highlight highest scores for females on the Social GOT, indicating preference for working with other people, and are consistent with prior literature (Clark & Krause, 2017; Su et al., 2009). These results may be driven by the high, disproportionate percentage of female participants who endorsed the Realistic and Investigative GOTs “very little”.
In the context of literature indicating males with MS are at greater risk for unemployment (Raggi et al., 2016) and poorer disease prognosis (Voskuhl & Gold, 2012), our results offer one potential explanation of sex disparity in employment outcomes. In persons with MS, limited ability to maintain functioning in work environments congruent with the Realistic GOT (e.g., manual labor) may be related to both physical and cognitive limitations (e.g., impaired processing speed) secondary to disease processes. Similarly, decreased ability to function satisfactorily in an environment congruent with the Investigative GOT (e.g., scientific job) may be taxing of a variety of cognitive function domains, including higher level cognitive functions (e.g., executive functioning), all of which may be impaired secondary to MS. It is plausible that quicker decline in both physical and cognitive functioning in males with MS (Beatty & Aupperle, 2002) may be related to greater job dissatisfaction and reduced job retention due to incongruence with vocational interests.
Implications for vocational rehabilitation
Early identification of vocational interests is essential for rehabilitation counselors to individualize vocational rehabilitation efforts based on the individual’s emerging MS symptoms. An approach that incorporates consideration for the individual’s vocational interests may foster a satisfactory work environment and may bolster successful employment outcomes. Further research is needed to examine the relationship between vocational interests and employment outcomes in individuals with MS.
Study strengths and limitations
The primary strength of this study is that, to our knowledge, this is the first description of vocational interests utilizing a current interest measure in individuals with MS. Further, the sample was diverse based on sex and race. On the other hand, the sample size was relatively small, which limited further exploration of interests in relation to key outcome variables. For example, we did not explore sample sex differences (e.g., age at MS diagnosis) in relation to vocational interest differences. Furthermore, our racial groups were limited to White, non-Hispanic and Black, non-Hispanic, so the generalizability of the results to other racial/ethnic groups is cautioned. These data determine vocational interest via validated self-report inventory items rather than expressed interests. This distinction should be considered when utilizing the data to inform clinical rehabilitation approaches. Lastly, participants were self-selected volunteers who represent a subset of MS study participants. Therefore, the findings should be considered preliminary and of greatest value in raising potential issues for vocational counseling and additional research.
Conclusion
We explored vocational interests, a potential contributing factor related to employment that should be considered by rehabilitation counselors when working with individuals with MS. This initial descriptive study highlights sex and race differences in vocational interests, primarily the greater interest reported by men on the Realistic and Investigative GOTs. Given the greater risk of unemployment for males with MS, rehabilitation counselors should identify individuals expressing high interest in these domains and consider intervention approaches if employment satisfaction may be limited due to potential physical or cognitive limitations experienced secondary to MS.
Conflict of interest
The authors declare that they have no conflict of interest.
Footnotes
Acknowledgments
This publication was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; grant no. 90RT5035). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.