Autoimun Cook2023

Received: 28 February 2021 Accepted: 6 February 2023
DOI: 10.1111/apps.12464
SPECIAL ISSUE
Individual health status as a resource:

Analyzing associations between perceived
illness symptom severity, burnout, and
work engagement among employees with
autoimmune diseases
Alexandra (Sasha) Cook1,2 | Alexander Zill3,4
Psychological Research Institute,

1
University of Amsterdam, Amsterdam, Abstract

Netherlands Epidemiological data suggest that the prevalence of
Department of Experimental and
2
autoimmune diseases is increasing. Although evidence
Applied Psychology, Vrije Universiteit
Amsterdam, Amsterdam, Netherlands
implies that people with chronic illnesses experience
Hochschule Mittweida–University of
3 higher levels of burnout, there are few available insights
Applied Science, Mittweida, Germany for developing preventative interventions. This paper
4
Department of Psychology, Chemnitz builds on the conservation of resources (COR) and the
University of Technology, Chemnitz,
job demands–resources (JD-R) framework to investigate
Germany
the association between impaired health, burnout, and
Correspondence work engagement. In two studies, we research the role
Alexandra (Sasha) Cook, Psychology
Research Institute, University of
of health status as a resource, respectively, autoimmune
Amsterdam, Nieuwe Achtergracht 129-B, illness symptom severity as a diminished resource, and
1018WS Amsterdam, Netherlands. investigate its variance explanation in burnout and
Email: [email protected]
work engagement above and beyond the effects of job
demands and resources. Study 1 investigated the hypoth-
eses among 87 employees with inflammatory bowel
diseases. Controlling for job demands and resources,
symptom severity was positively associated with
(exhaustion) burnout and negatively associated with
work engagement. In Study 2, we applied mixed model
analyses using a sample of 129 employees with multi-
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adaptations are made.
© 2023 The Authors. Applied Psychology published by John Wiley & Sons Ltd on behalf of International Association of Applied Psychology.
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2 COOK and ZILL
ple sclerosis. We found significant associations of

symptom severity on burnout and vigor work engage-
ment above and beyond the effects of job demands and
social support. Our studies provide important insights
for employees with chronic illnesses and the organiza-
tions in which they work and give indica tions for theory
development, future research, and the development of
interventions.
KEYWORDS
burnout, chronic illness, job demands, job resources, work
engagement
HEALTH AS A RESOURCE: ANALYZING ASSOCIATIONS BETWEEN

PERCEIVED ILLNESS SYMPTOM SEVERITY, BURNOUT, AND
WORK ENGAGEMENT AMONG EMPLOYEES WITH AUTOIMMUNE
DISEASES
When I raised concerns about how I was doing, my doctor told me, “This may just be
how it's going to be. You may always feel like you're eighty per cent.” She intended, I
think, to help me adjust to a new reality, but the effect was the opposite. The prospect
was unbearable. I began to deflate like a punctured pool float.
(O'Rourke, 2013)
In her 2013 essay “What's wrong with me?” the author Megan O'Rourke describes how she
experienced the onset and diagnosis of Hashimoto's, an autoimmune thyroid disease. She elab-
orates how symptoms of the illness, such as fatigue and “brain fog,” impact seemingly mundane
activities, such as sitting upright at a birthday party or taking the subway (O'Rourke, 2013). The
author's description represents the reality of many people living and working with a chronic
medical condition. Population-based estimates indicate that the incidence and prevalence of
autoimmune illnesses have steadily increased in the past 30 years and that the incidence and prev-
alence rates of many autoimmune diseases are still increasing word wide (Lerner et al., 2016).
Autoimmune diseases are characterised by high activity of the human immune system, which
attacks “one or more tissues or organs, resulting in functional impairment, inflammation, and
sometimes permanent tissue damage” (National Research Council, 1992, p. 2).
People with autoimmune illnesses may experience work difficulties. Depending on the exact
disease and the severity, autoimmune diseases are associated with outcomes such as reduced
work effectiveness and productivity, presenteeism, and absenteeism (Allen et al., 2012; Boussaid
et al., 2021; De Boer et al., 2016), causing a socioeconomic burden (Jacobs et al., 2011). Employees
with chronic diseases are generally more likely to leave the workforce early, leading to personal
financial strain, reduced quality of life, and the possible loss of a sense of normality and iden-
tity (De Jong et al., 2015). Substantive insights into ways and means to improve or maintain the
well-being of employees with chronic illnesses are vital for organizations and managers to plan
effective, adequate, and accessible interventions and measures. As existing chronic conditions
INDIVIDUAL HEALTH STATUS AS A RESOURCE 3
are rarely accounted for in intervention studies on employee health and empiric research on the
effects of work on well-being (Boelhouwer et al., 2020; Feltner et al., 2016), it is crucial to investi-
gate how healthy work can be facilitated for people with impaired health. Current evidence indi-
cating associations between illness-related distress and work-related strain, as well as somatic
complaints and work engagement (Cook & Zill, 2021; Sautier et al., 2015), provide a good starting
point for investigations.
The job demands–resources (JD-R) model attempts to explain how the combination of job
demands and resources leads to employee well-being, conceptualised by the two core outcomes
of job strain (i.e. burnout) and motivation (i.e. work engagement) (Demerouti et al., 2001). Both
outcomes are essential predictors of job performance, job satisfaction, and turnover intentions
(Borst et al., 2020; Schaufeli & Taris, 2014; Swider & Zimmerman, 2010). However, the inclusion
of health within the JD-R framework has been almost exclusively focused on health as the main
outcome, and considerations on different health statuses (e.g. chronic illnesses) have not taken
place.
This paper investigates health status, respectively health impairments as a predictor of burn-
out and engagement. Referring to the conservation of resources (COR) theory (Hobfoll, 1989;
Hobfoll & Freedy, 1997; Holmgreen et al., 2017), we state that health is an energetic individual
resource that explains variance in well-being outcomes above and beyond the working condi-
tions outlined in the JD-R model. This view of impaired health as a diminished resource is not
unique to academic theory but can also be found in lay theories and metaphors used in chronic
illness communities (Kattari & Beltrán, 2022; Miserandino, 2003).
This paper adds to theory and research on occupational health and employee well-being by
extending the view of employee health from an outcome to a relevant input or predictor and
emphasising the relevance of individual differences in baseline health status. At the same time,
we contribute to the conversation about inclusion and diversity at work and in society. We argue
that viewing health solely as an outcome of work falls short as it fails to consider the fact that
not every person enters the workforce or a job with the same baseline health and evidence that
implies that past health is one of the strongest predictors of future health. Omitting pre-existing
health problems in research on employee well-being runs the risk of promoting an ableist view
of occupational health and a sole focus on interventions that may not be appropriate, accessible,
or effective for a significant amount of the workforce. Thus, we argue that the inclusion of people
with existing health impairments, such as employees with autoimmune illnesses, has to occur
very early in developing evidence-based interventions, namely at the stage of theory develop-
ment and empiric research.
HEALTH, ILLNESS, BURNOUT, AND WORK ENGAGEMENT
Burnout and work engagement are two crucial outcomes of employee well-being and motivation
(Boelhouwer et al., 2020). The concept of burnout includes feelings of (emotional) exhaustion and
cynicism or disengagement toward work, whereas work engagement is a state of high activation in
which the employee feels excited, energised, and enthusiastic at work (Bakker et al., 2011, 2014).
The JD-R model (Demerouti et al., 2001) explains the underlying processes leading to burnout
and work engagement through the effects of job characteristics, particularly the combina-
tion and interplay of job resources and job demands (Schaufeli & Taris, 2014). Within the JD-R
model, burnout is a (negative) well-being outcome mainly predicted by job demands, that is
“physical, social, or organizational aspects of the job that require sustained physical or mental
4 COOK and ZILL
effort” (Demerouti et al., 2001, p. 501) in the health impairment process. Parallel to the effects
of job demands, job resources help the employee achieve goals, have a health-protecting effect,
and predict work engagement. In the so-called motivational process, job resources predict work
engagement (Bakker & Demerouti, 2008; Demerouti et al., 2001).
In research on burnout and work engagement, issues relating to health and illness have been
included several ways. The core strain component of burnout, emotional exhaustion, is often
conceptualised as a health outcome in itself, with studies investigating associations between burn-
out and general or physical health or health complaints (Bakker & Demerouti, 2014). Researchers
often conceptualise health problems (e.g. general ill health, depressive symptoms, musculoskel-
etal disorders, somatic problems, and type 2 diabetes) as a distal outcome of job characteristics
and burnout (Ahola & Hakanen, 2014). Although it is also assumed that the association between
burnout and (physical) health and illness is not one-sided (Ahola & Hakanen, 2014), the effects
of health status on burnout have been investigated to a far lesser degree to this point (Cook &
Zill, 2021). A longitudinal study showed that burnout at baseline predicted a decrease in self-rated
health status at follow-up (Vinokur et al., 2009), and there is evidence showing higher burn-
out levels among people with health impairments compared with employees without chronic
diseases (Armon et al., 2014; de Boer et al., 2018; Ozkur et al., 2019). Regarding work engage-
ment, research focusing on people with chronic health conditions is sparse. A cross-sectional
study conducted in the Netherlands found that the combination of chronic physical diseases and
mental disorders was associated with lower work engagement (Boelhouwer et al., 2020).
Although there is limited research into the associations between chronic health conditions,
burnout, and work engagement, insights into the difficulties of employees with autoimmune
illnesses do exist. Although the exact nature of the experienced work difficulties may vary
depending on the specific diagnosis, common problems among working people with autoim-
mune illnesses include fatigue, pain, but also depression, and anxiety symptoms that affect
productivity and sickness absence (Enns et al., 2018).
INCLUDING HEALTH STATUS AS A RESOURCE—A COR APPROACH
Viewing health status or “good health” as a resource can help explain how a chronic illness may
also directly impact well-being and motivation. According to the COR theory (Hobfoll, 1989;
Hobfoll & Freedy, 1997), resources are “entities that either are centrally valued in their own right,
or act as means to obtain centrally valued ends” (Hobfoll, 2002, p. 307). COR states that humans
generally try to accrue or maintain their resources as much as possible. A loss of resources weighs
heavier than a resource gain, and resources need to be invested “to protect against resource loss,
recover from losses, and gain resources” (Hobfoll, 2001, p. 349). Problems arise when there are
few or diminished resources in the first place, as “those with fewer resources are more vulnerable
to resource loss and less capable of resource gain” (Hobfoll, 2001, p. 349), which can lead to loss
spirals. Loss spirals are exacerbated when individuals with a predisposing lack of resources may
not be able to manage upcoming potentially stressful events (Holmgreen et al., 2017).
Personal health has been included as a resource in research based on COR (Hobfoll, 2001) and
can be categorised as an energy resource. Energy resources (e.g. well-being, time, and money)
facilitate access to other types of resources and are volatile (Russell et al., 2022), which means
that they deplete when used (Ten Brummelhuis et al., 2011). Evidence supports this categorisa-
tion as the perceived illness symptom severity affects the experience of a loss of other resources
such as financial security, confidence, intimate relationships, and sense of self and identity
(Dischinger et al., 2019). Impaired health due to an autoimmune illness has been conceptu-
alised as diminished or lack of resources in previous studies (Cook & Zill, 2021; McGonagle
et al., 2015). Several potential reasons support this rationale and provide arguments for linking
health status to burnout and work engagement.
First, in people with chronic autoimmune illnesses, the physiological reactions to stress-
ors can be impaired, which increases the risk of experiencing more stress-related symptoms
(Leidy Kline, 1989). The subjective perception of illness symptoms can also affect the overall level
of energy and stamina, for example due to fatigue. Fatigue is, by definition, a lack of energy that
is not relieved by periods of rest (Nocerino et al., 2019) and is a central symptom of many auto-
immune disorders (AARDA, 2015; Zielinski et al., 2019). As a commonly stated work difficulty
(Honan et al., 2012), fatigue may lead to a higher risk of work-related exhaustion as resources
cannot be used to manage work demands.
Second, COR posits that not only the actual loss of resources is stressful but also the threat of
such a loss (Hobfoll, 1989). Even when illness symptoms are not immediately or currently pres-
ent, for example in an illness such as MS that is characterised by episodic progression, there may
be an ongoing threat perception, especially when the condition is “characterized by uncertainty”
(Beatty & McGonagle, 2018, p. 19), which is the case for several autoimmune illnesses.
Third, the necessity to allocate time and energy differently compared with people without
chronic illnesses may cause a resource depletion in employees with autoimmune illnesses.
According to COR theory, individuals invest resources in a way that protects them against future
resource losses. For many people with chronic autoimmune illnesses, disease management is
a vital part of their life and requires the interaction of clinical, social, and personal resources
(Ørtenblad et al., 2018). The burden of treatment concept describes the self-management of
chronic medical conditions as workload. The workload of a chronic illness includes all self-care
and self-monitoring activities, management of treatments, and the organisation of meetings with
physicians and other healthcare providers. As neglecting these activities can lead to severe conse-
quences such as hospitalisation (Eton et al., 2012), employees with chronic conditions often need
to invest enough resources into illness management to avoid future loss of resources due to a
worsened medical status.
Health impairments due to a chronic health condition can lead to diminished energy and
time resources, which should be most pronounced when the individual experiences many or
more severe symptoms. A depletion of resources can directly affect workability but also cause
interferences between work and illness management (McGonagle et al., 2015, 2020). Therefore,
high symptom severity is a resource loss that may lead to a higher level of exhaustion, deple-
tion, and withdrawal from work (McGonagle et al., 2020), which could manifest in lower levels
of work engagement. We posit that employees with an autoimmune illness and high symptom
severity experience a resource lack, which makes them vulnerable to resource loss, which height-
ens the risk of experiencing burnout due to a loss spiral. As energy resources are located on the
individual level, their depletion should explain incremental variance burnout above and beyond
working conditions.
Hypothesis 1. Autoimmune illness symptom severity explains variance in employee burnout

above and beyond the effects of job demands and resources.
Moreover, the experienced resource lack can prevent employees experiencing high auto-
immune illness severity from investing resources into their occupation to receive a potential
resource gain. Experiencing more severe symptoms may diminish the personal capacity to invest
6 COOK and ZILL
in engagement. It may lead to a higher likelihood to “exit engagement processes in favor of meet-
ing survival demands, or even the demands of a serious challenge” (Hobfoll, 2010, p. 17).
Thus, we hypothesise:
Hypothesis 2. Autoimmune illness symptom severity explains variance in work engagement
above and beyond the effects of job demands and resources.
OVERVIEW OF STUDIES
We conducted two studies among employed people with autoimmune illnesses to test our hypoth-
eses. Each study focuses on one illness, respectively group of illnesses, to gain detailed insights
into the specific effects of the symptom severity. Both studies apply longitudinal research designs
with two measurement points. To investigate the effects of autoimmune illness symptom severity
above and beyond the effects of the working conditions, we included specific job demands and
resources as covariates in the analyses.
STUDY 1
In Study 1, we analyzed the associations between symptom severity, burnout, and work engage-
ment in a sample of employed adults with chronic inflammatory bowel diseases (IBD). We
included participants with Crohn's disease (CD) or ulcerative colitis (UC). IBD affects around 1.5
million Europeans and a similar number of people in the United States (Sans & Figueroa, 2008).
Whereas CD is more frequent in women, the sex ratio among people diagnosed with UC is rela-
tively equal. UC is frequently diagnosed between the ages of 30 and 40, and CD is frequently diag-
nosed somewhat earlier, between the ages of 20 and 30 (Burisch & Munkholm, 2015). IBD are
characterised by long-lasting inflammation in the large intestine and rectum (UC), respectively,
the lining of the digestive tract (CD). Both CD and UC are very heterogeneous in their clinical
manifestations and symptomology. Symptoms include diarrhea, abdominal pain, fever, weight
loss, and hematochezia (bleeding in the colon), which mostly manifest in so-called flares, which
are episodes of high symptom intensity (Sans & Figueroa, 2008).
Methods
Procedure
We recruited German adult employees with a CC or UC diagnosis with the help of the German
Crohn's and Colitis Society (DCCV e.V.), which published our call for participants both online and
in the printed member's magazine. The study included a baseline measurement point (T0) and a
follow-up measurement after 6 months (T1). Both assessments were carried out using the online
survey tool LimeSurvey. After finishing the baseline questionnaire, participants could register an
email address for the invitation to the follow-up assessment. The email addresses were stored in a
separate database, so no connection between the questionnaire data and the email address was possi-
ble. To merge the data of measurement points, we asked the participants to generate a unique code.
Participants received no compensation for their participation but could participate in a raffle to win
gift certificates for an online shop. All participant email addresses were deleted after the comple-
tion of the dataset. The study design and all study documents were reviewed by the Ethics Review
Board of the Faculty of Social and Behavioral Sciences at Chemnitz University of Techology and
received a positive vote. Before starting the baseline questionnaire, participants had to confirm
that they fulfilled the following inclusion criteria: They had to be at least 18 years old, have a medi-
cal diagnosis of CD or UC, and must be working as an employee with at least 20 h per week.
Participants were excluded from participation if they were suspected of having an IBD but did not
receive a diagnosis from a medical professional, if they were unemployed, mostly self-employed,
on maternity leave, or on long-term sick leave.
Data and sample
After recruiting N = 137 participants at T0, N = 123 people took part in the follow-up assessment
(T1). Only N = 112 data entries from T1 could be allocated to the baseline data using the code.
We omitted another 25 participants from the dataset because they had experienced a change in
their employment situation (e.g. retirement and job change) in the preceding 6 months, leading
to a final sample of N = 87. Of the final sample, N = 60 participants had a CD diagnosis, and
N = 27 reported having a UC diagnosis. Most of the sample identified as female (N = 64, 73.6%),
with the rest identifying as male. The mean age was 39.6 years (SD = 10.15). Thirty-four partici-
pants (39.08%) reported being employed in public or other, and 17 (19.54%) did not specify their
field of work. The rest of the participants were distributed between other fields of work, namely
manufacturing (N = 11), trade, logistics, real estate, and hospitality (N = 7); business and finan-
cial services (N = 13); and information and communication (N = 5). The mean age at diagnosis
was M = 24.91 (SD = 9.11). More than half of the participants (N = 73, 83.91%) reported taking
medication to treat or manage their IBD.
Measures
We assessed the perceived illness symptom severity of the IBD at baseline (T0) using items of
the German Short Inflammatory Bowel Disease Questionnaire (Rose et al., 2000). The 10-item
questionnaire includes items regarding problems with bowel function, systemic problems (e.g.
fatigue), emotional problems, and functional problems regarding the illness in the last 2 weeks.
Following the recommendations by the authors, we calculated a mean score instead of using the
subscales separately. Participants were asked to rate the frequency of the described symptoms
and problems within the past 2 weeks on a scale from 1 (= never) to 7 (= always). The scale
showed good internal consistency, with α = .88 and ωRT = .91.
We assessed quantitative and cognitive job demands and two job resources, namely control
over working time and social support at T0, using the eponymous subscales from the Copenha-
gen Psychosocial Questionnaire (COPSOQ, Nübling et al., 2005). We chose the respective job
resources and quantitative job demands based on previous research on working with chronic
illnesses (Cook & Zill, 2021; De Jong et al., 2015; McGonagle et al., 2015) and added cognitive
demands to gain more detailed insights. The quantitative job demands scale (seven items) showed
good internal consistency, with α = .89 and ωRT = .93. A sample item is “Do you have to work
very fast?”. The cognitive demands scale (six items) also showed good reliability, with α = .87
and ωRT = .92. An example item is “Do you have to keep your eyes on lots of things while you
8 COOK and ZILL
work?”. Control over working time was assessed with four items: for example “If you have some
private business, is it possible for you to leave your place of work for half an hour without special
permission?”. The internal consistency of the scale was good, with α = .83 and ωRT = .85. The
social support scale assesses perceived support from colleagues and the immediate supervisor.
An example item is “How often do you get help and support from your colleagues if needed?”.
The four-item scale showed good internal consistency, with α = .82 and ωRT = .94. Participants
responded to both scales using a 5-point Likert scale from 1 = never/hardly ever to 5 = always.
At follow-up (T1), we assessed burnout and work engagement. We assessed burnout with the
German translation of the Oldenburg Burnout Inventory (OLBI; Demerouti et al., 2003; Reis
et al., 2015), which assesses exhaustion and disengagement burnout. Both subscales consist of
eight items; each answered on a 4-point Likert-type scale from 1 = strongly disagree to 4 = strongly
agree. The internal consistency of the exhaustion scale was good, with α = .85 and ωRT = .89. The
internal consistency of the disengagement scale was also good, with α = .82 and ωRT = .87. In
addition to the subscales, we computed a total burnout scale with the items of both subscales.
The internal consistency of the total burnout scale was also in the good range, with α = .88 and
ωRT = .92.
We used the nine-item form of the Utrecht Work Engagement Scale (UWES; Schaufeli
et al., 2006) to assess work engagement. The scale assessed three forms of work engagement,
namely vigor, dedication, and absorption, in three-item subscales. An example item assessing
vigor is “At my work, I feel bursting with energy,” and an example item for dedication is “I am
enthusiastic about my job,” and an example item assessing absorption is “I am immersed in my
work.” All items were answered on a Likert-type scale from 0 = never to 6 = always. The subscales
showed good internal consistencies, with α = .84 and ωRT = .84 (vigor), α = .86 and ωRT = .86
(dedication), and α = .80 and ωRT = .80 (absorption). In addition to the three subscales, we calcu-
lated a total work engagement scale, including all items. The internal consistency of the total
work engagement scale was excellent, with α = .94 and ωRT = .98.
Results
Preliminary analyses
Because of the high drop-out rates between T0 and T1, we tested for differences in baseline
variables between the drop-out group and the participants participating in the follow-up. The
results of the t-tests for the numeric variables (Appendix A) indicated no significant differences
between the participants included in the final sample and the participants not included in the
final sample (lost-to-follow-up, changes in the employment situation). We also tested for differ-
ences in age, outcomes, and predictors between participants with UC and CD (Appendix B). We
did not find any statistically significant differences between the groups and thus did not control
for the specific diagnosis in the further analyses.
Descriptive analyses
We used the psych package (Revelle, 2021) for the R data analysis environment (R Core
Team, 2022) for all analyses in Study 1. The bivariate correlations of the study variables are
reported in Table 1. Male participants reported both higher quantitative work demands and
TA B L E 1 Study 1 descriptive statistics and bivariate correlations between the study variables.
M (SD) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

1. Gender
2. T0 Quantitative demands 3.14 (.83) −.05
3. T0 Cognitive demands 3.90 (.76) −.27* .41**
INDIVIDUAL HEALTH STATUS AS A RESOURCE
4. T0 Control over working time 3.44 (1.01) −.07 −.28* −.02

5. T0 Social support 3.05 (1.00) −.04 −.14 .10 .51**
6. T0 Symptom severity 3.85 (1.08) .03 .15 −.01 −.19 −.16
7. T1 Exhaustion 2.86 (.54) −.04 .35** −.08 −.20 −.30** .57**
8. T1 Disengagement 2.22 (.54) −.22* −.02 −.32** −.16 −.32** .16 .53**
9. T1 Burnout 2.54 (.47) −.15 .18 −.22* −.21 −.36** .42** .88** .88*
10. T1 Vigor 3.19 (1.10) .12 .03 .26* .05 .18 −.29* −.56** −.79** −.77**
11. T1 Dedication 3.71 (1.11) .12 .09 .34** .07 .22* −.16 −.44** −.79** −.70** .83**
12. T1 Absorption 3.28 (1.11) .21 .05 .23* .12 .21 −.20 −.46** −.76** −.70** .85** .81**
13. T1 Work engagement 3.25 (1.07) .19 .04 .25* .10 .21 −.24* −.51** −.80** −.75** .93** .84** .98**
Note: N = 87. Gender coded 1 = male, 2 = female.
*p < .05.
**p < .01.
9
10 COOK and ZILL
higher disengagement burnout. Participants identifying as female reported higher levels of cogni-
tive demands at baseline, r = .37, p = .01, and reported higher levels of disengagement burnout,
r = .22, p = .04. Perceived severity of the IBD at baseline was significantly correlated with exhaus-
tion burnout, r = .57, p < .01; the total burnout score, r = .42, p < .01; vigor, r = −.29, p = .01; and
total work engagement, r = −.24, p = .03 at follow-up. There were no significant correlations
between perceived symptom severity and the other two types of work engagement, job demands,
and job resources.
Hypotheses testing
We conducted stepwise regression analyses for exhaustion burnout and the dimensions of work
engagement, regressing the outcomes on the control variables in models 1a to 7a and adding the
perceived symptom severity in models 1b to 7b. Table 2 shows the results of the regression anal-
yses of the burnout outcomes.
When controlling for job demands and resources, perceived symptom severity was signifi-
cantly related to exhaustion burnout 6 months later β = .51, p < .001. Perceived symptom severity
explained 25% of the variance of exhaustion burnout, which is more than the joint explanation
of variance of all control variables. Perceived symptom severity was not related to disengagement
burnout. However, regarding the total burnout score, we found a significant association with
symptom severity, β = .35, p < .001, explaining 12% of the variance in general burnout. Thus, our
results confirm Hypothesis 1, but not for the disengagement dimension.
Table 3 shows the results of the regression analyses of the work engagement outcomes. Base-
line perceived symptom severity had a significant negative effect on the vigor dimension of work
engagement, β = −.27, p = .008, and the total work engagement score at follow-up, β = −.21,
p = .04. There was no significant effect on the dedication dimension, and a negative effect the
absorption dimension was not significant, β = −.18, p = .08. Therefore, we found some support
for Hypothesis 2 but only for the vigor dimension of work engagement and total work engage-
ment, explaining 6% of the variance in vigor and 3% of the variance in total work engagement.
T A B L E 2 Study 1 regressing standardised burnout and work engagement on the standardised covariates
and symptom severity.
Outcome: T1 Outcome: T1 Outcome: T1

Exhaustion Disengagement Burnout
Variable Model 1a Model 1b Model 2a Model 2b Model 3a Model 3b
Intercept .15 .16 .58** .58** .42* .42*
Gender −.21 −.22 −.78** −.79** −.57* −.58**
T0 Quantitative demands .42** .35* .08 .07 .29* .24*
T0 Cognitive demands −.25* −.22* −.42** −.41** −.38** −.36**
T0 Control over working time .03 .08 −.04 −.02 −.01 .03
T0 Social support −.24* −.19* −.26* −.25* −.29* −.26*
T0 Symptom severity .51** .11 .35**
R 2
.19 .44 .25 .26 .23 .35
*p < .05.
**p < .01.
T A B L E 3 Study 1 regressing standardised burnout and work engagement on the standardised covariates
Outcome: T1 Outcome: T1 Outcome: T1 Outcome: Work

Vigor Dedication Absorption engagement
Model Model Model Model Model Model Model Model
Variable 4a 4b 5a 5b 6a 6b 7a 7b
Intercept −.35 −.36 −.39 −.39 −.50* −.51* −.44* .45*
Gender .48 .49* .53* .53* .69** .69** .60* .61*
T0 Quantitative −.09 −.06 −.04 −.02 −.02 <.01 −.05 −.03
demands
T0 Cognitive .34** .33** .40** .40** .31** .30** .37** .36**
demands
T0 Control over −.03 −.06 −.01 −.03 .06 .04 .01 −.02
working time
T0 Social support .26 .13 .19 .18 .16 .14 .18 .16
T0 Symptom severity −.27** −.14 −.18 −.21*
R2 .09 .15 .15 .16 .12 .14 .14 .17
*p < .05.
**p < .01.
Whereas quantitative demands had a significant positive effect on exhaustion burnout and
the total burnout score, they were not significantly associated with the work engagement subdi-
mensions. Cognitive job demands were negatively associated with burnout and positively asso-
ciated with all three work engagement dimensions, and baseline social support was significantly
and negatively associated with all burnout outcomes.
Discussion Study 1
In Study 1, baseline symptom severity was a strong predictor of exhaustion burnout at follow-up,
explaining the more variance in burnout as job demands, job resources, and gender. This result
implies that the perceived severity of the symptoms of an existing health impairment plays a
crucial role in the health impairment process above and beyond the effects of job characteristics.
However, we could not find the same associations between symptom severity and disengagement
burnout in the sample. Regarding work engagement, we found a significant impact of symptom
severity on the vigor dimension only. This result implies that the perceived symptom severity
impacts the motivational process of employees with an IBD above and beyond the effects of job
demands and job resources. Employees experiencing more IBD symptoms feel less energised and
perceive lower degrees of mental resilience.
STUDY 2
In Study 2, we aimed to replicate the findings from Study 1 among employed people with multi-
ple sclerosis (MS). MS is an inflammatory disease that affects the central nervous system and
12 COOK and ZILL
is “the most common, primary neurogenic cause of disability among young adults” (Koziarska
et al., 2018, p. 1). The inflammations cause demyelination, axonal loss, and the formation of
plaques. Many people with MS experience a relapsing–remitting course where the symptoms
develop within hours or days. They can persist for several days to weeks before gradually residing
but can leave residual symptoms. Approximately 15% of people with MS experience a primary
progressive course with a gradual worsening of symptoms. Over time, a relapsing–remitting
course can change into a gradually progressing course. The illness usually manifests between 20
and 40 years of age and is more common among women than men. Initial symptoms often include
sensory problems, weakness in one or more limbs, and visual problems (Milo & Miller, 2008).
However, the symptoms of MS vary strongly, both on the interpersonal and intrapersonal levels,
over time. Compared with the general working population, employed people with MS rate their
work ability and physical work functioning lower (van Gorp et al., 2018). Employed people work-
ing with MS can experience problems at work related to physical barriers (e.g. problems with
movement and mobility, and bladder and bowel difficulties) and psychological and cognitive
barriers (e.g. cognitive difficulties, fatigue, and memory difficulties (Honan et al., 2012).
Methods
Procedure
We recruited a sample of adult employees with an MS diagnosis. We assessed longitudinal data

using online questionnaires with the online survey tool Qualtrics. We advertised the study on
social media and online discussion boards to acquire the sample. All questionnaires were available
in English, German, and Dutch. When a translation of the surveys was unavailable, we translated
the items using a two-step process by two native speakers. The study included a baseline measure-
ment point (T0) carried out in April 2020 and a follow-up measurement after 1 month (T1).
The study was carried out in the scope of a larger project on the topic of working with MS.
After finishing the baseline questionnaire, participants could register an email address for the invi-
tation to the follow-up assessment. Contrary to Study 1, we used the participants' email addresses
to connect the data from both measurement points. Participants were informed about the process
in the participant information and gave consent to the storage of the email address in the data-
set. All email addresses were permanently deleted from the dataset after a descriptive analysis
of the data was sent to all participants. The study design, study documents, and the data stor-
age protocol were reviewed by the Ethics Review Board of the Faculty of Behavioral and Move-
ment Sciences at the VU Amsterdam before the data assessment and received a positive vote.
Before participating in the study, participants had to confirm that they fulfilled the following
inclusion criteria: They had to be at least 18 years old, have a medical diagnosis of MS, and must
be working as an employee with at least 20 h per week. Participants were excluded from partic-
ipation if they did not receive a diagnosis from a medical professional (yet), if they were unem-
ployed, mostly self-employed, on maternity leave, or on long-term sick leave.
Data and sample
Of N = 213 participants that took part in the baseline assessment (T0), N = 139 took part in the
follow-up 1 month later. Ten of these participants reported a significant change in their job since
the baseline assessment (e.g. change of employer) and were omitted from the dataset, leaving a
final sample of N = 129. The mean age was 40.05 years (SD = 10.15), and 76.7% of the sample
identified as female (N = 99), with the rest of the sample identifying as male (N = 30). Sixty-one
participants (47.29%) answered the English version of the survey, N = 55 (25.82%) the Dutch
version, and N = 13 (6.10%) the German version. The largest group of participants stated living in
the Netherlands (N = 53, 41.08%), followed by the United States (N = 34, 26.36%). The rest of the
participants stated living in Germany (N = 9), Canada (N = 8), Belgium (N = 5), England (N = 6),
Australia (N = 4), New Zealand, Slovenia, South Africa, Brazil, Switzerland, Finland, Portugal,
and Austria (N = 1 each). Two participants did not specify the country in which they lived.
Thirty-three participants (25.58%) reported being employed in healthcare, N = 27 (20.93%)
in technology/telecommunication, N = 15 (11.62%) in financial or consulting services, N = 14
(10.85%) in education/culture, N = 4 (3.1%) in the industrial or consumer products industry,
and N = 36 (27.91%) participants did not further specify their field of work and ticked the box
“other.” Mean tenure (in years) was M = 8.20 (SD = 7.83), and participants worked for M = 33.64
(SD = 8.98) hours per week.
Most participants reported having a relapsing–remitting MS course (N = 119, 85.27%). Seven
participants reported having primary progressive MS, N = 6 secondary progressive MS, and one
participant stated having progressive relapsing MS. Three participants stated that it was still
unknown or unclear which type of MS they had. Two participants did not specify the MS type.
Most participants (N = 105, 81.40%) were taking disease-modifying medication (e.g. Terifluno-
mide, Interferon beta-1a, Dimethyl fumarate, Ocrelizumab, and Natalizumab) at the time of the
study. The participants reported a mean onset age of M = 29.74 (SD = 8.89) and a mean age of
diagnosis of M = 33.55 (SD = 9.43).
Measures
We assessed perceived symptom severity at baseline (T0) using the SymptoMScreen (Green
et al., 2017). The SymptoMScreen is a 12-item questionnaire that asks the participants to rate
different physical and cognitive MS-related symptoms (e.g. hand tremors, muscle cramps, numb-
ness, concentration problems, and vertigo) in the past 4 weeks on a 7-point Likert-type scale from
1 = not affected at all to 7 = total limitation. The scale showed good internal consistency, with
α = .85 and ωRT = .88.
We again assessed burnout using the Oldenburg Burnout Questionnaire (Demerouti
et al., 2003) at baseline and follow-up. We calculated the exhaustion and disengagement subscales
and a total burnout scale, including all 16 items. The internal consistency of the exhaustion burn-
out scale was acceptable to good, with α = .79 and ωRT = .84 (T0) and α = .78 and ωRT = .85 (T1),
as was the reliability of the disengagement scale, with α = .80 and ωRT = .86 (T0) and α = .75 and
ωRT = .85 (T1). The full burnout scale also showed good reliability indicators, with α = .86 and
ωRT = .89 (T0) and α = .85 and ωRT = .89 (T1). We assessed work engagement with the full version of
the UWES (Schaufeli & Bakker, 2004).1 In the full version of the UWES, the vigor and absorption
subscales are assessed with six items, and the dedication subscale with five items. Furthermore,
we calculated a total work engagement score of the means of all items. The internal consistency
of the work engagement scales was good, with α = .83 and ωRT = .90 (T0 vigor), α = .86 and
ωRT = .91 (T1 vigor), α = .85 and ωRT = .90 (T0 dedication), α = .90 and ωRT = .93 (T1 dedication),
α = .85 and ωRT = .90 (T0 absorption), and α = .90 and ωRT = .93 (T1 absorption).
At baseline, we assessed the covariates quantitative job demands, cognitive job demands, and
social support as a job resource using scales from the COPSOQ (Nübling et al., 2005). In contrast
to Study 1, we used the short forms of the scales with four items for each job demand. Whereas the
quantitative job demands scale showed acceptable to good reliability, with α = .75 and ωRT = .80,
14 COOK and ZILL
the cognitive job demands scale's reliability was questionable, with α = .69 and ωRT = .74. We
assessed social support with the same four items that we used in Study 1. The scale showed good
internal consistency with α = .84 and ωRT = .91.
Because MS is more common among women, with previous evidence showing differences in
symptoms between men and women (Miller & Dishon, 2006), we included gender as a control
variable. Age was also included as a covariate because of evidence showing a correlation between
age and work-related difficulties in people with MS (Raggi et al., 2019). We included the type of
MS (relapsing–remitting MS vs. other types of MS) as a covariate, as previous research indicates
an association between MS types and employment status (Sterz et al., 2016).
Additions related to the Covid-19 pandemic
The planning of this study started in early 2020 with the plan to assess the data in Spring 2020.
In light of the progression of the Covid-19 pandemic and the implementation of measures and
restrictions to work in several countries, we decided to include several measures related to the
pandemic and work situation for exploratory analyses at both measurement points. We included
a single item asking the participants whether their working conditions had significantly changed
compared with before the Covid-10 outbreak (e.g. switch to remote work/home office, changes in
shift work, and changes regarding working hours). Furthermore, we asked them how many days
of the week, on average, they had been working remotely before the pandemic (baseline only)
and in the past 4 weeks (both baseline and follow-up).
Results
Preliminary analyses
First, we analyzed whether there were significant differences in the baseline variables between
the final sample and the 74 participants who were not included in the final sample (Appendix C).
Participants in the final sample reported significantly lower symptom severity, t(211) = 3.037,
p = .003, and significantly lower cognitive job demands, t(211) = −2.090, p = .04.
Descriptive analyses
We used the psych (Revelle, 2021), multilevel (Bliese et al., 2022), and MuMIn packages
(Bartoń, 2022) for data analysis. Table 4 shows the means and standard deviations of the study
variables and the results of paired t-tests comparing the burnout and work engagement varia-
bles between baseline and follow-up. There were significant differences in all repeated measures
across time, except for the composite burnout score. Whereas exhaustion burnout, vigor, dedica-
tion, absorption, and the composite work engagement score were significantly lower at follow-up
compared with baseline, disengagement burnout increased between baseline and follow-up.
The bivariate correlations of the study variables are reported in Table 5. Participants with
other course types than relapsing–remitting MS (i.e. progressive MS course types) were signifi-
cantly older and reported higher MS symptom severity. Baseline perceived symptom severity was
positively and significantly correlated to baseline quantitative job demands, exhaustion burnout,
and the vigor dimension of work engagement.
TA B L E 4 Study 2 means, standard deviations, and pairwise t-test for repeated measures.
Baseline (T0) Follow-up (T1)

M SD M SD t(128)
Quantitative work demands 2.53 .73
Cognitive work demands 3.78 .63
Social support 3.84 .87
Symptom severity 2.26 .75
Exhaustion 2.55 .39 2.43 .39 3.91**
Disengagement 2.16 .51 2.28 .46 −4.38**
Burnout 2.35 .39 2.36 .37 −.20
Vigor 4.67 1.01 4.40 1.05 4.16**
Dedication 5.10 1.06 4.83 1.17 3.94**
Absorption 4.65 .96 4.35 1.03 4.28**
Work engagement 4.79 .92 4.51 .99 4.78**
Note: N = 129.
*p < .05.
**p < .01.
Hypothesis testing
We fit mixed models to account for the clustering of the repeated data assessment at baseline and
follow-up (Level 1) within individuals (Level 2). Mixed models allow the differentiation between
the fixed effects of the study variables and the random effects. Through the stepwise determina-
tion of the best-fitting model type, we determined that, for all outcome variables, models with
random intercepts and slopes did not fit the data significantly better compared with the random
intercepts-only models. Hence, we fitted random intercept models, allowing the outcome varia-
bles' intercepts to vary freely between individuals. All models accounted for time, coded 0 = base-
line and 1 = follow-up, as a predictor variable and for the autocorrelation of the time-varying data
within persons.
We regressed the outcomes on the standardised covariates, job demands, and social support
(models 1a to 7a). We then added standardised perceived symptom severity (models 1b to 7b).
The results of the regression analyses are stated in Tables 6 and 7. Models 1b, 2b, and 3b
show that perceived MS symptom severity at baseline is associated with exhaustion, b = .35,
p > .001; disengagement, b = .21, p = .01; and the total burnout variable, b = .32, p = .0001,
thus supporting Hypothesis 1. According to the differences in the marginal pseudo R 2, which
indicates the variance explained by the model's fixed effects, adding perceived symptom
severity explained 10% of the variance in exhaustion, 3% of the variance in disengagement,
and 8% of the variance of the total burnout score above and beyond the effects of job demands
and social support.
Symptom severity was significantly and negatively associated with the vigor dimension of
work engagement, b = −.17, p = .04, above and beyond the effects of the covariates, job demands,
and social support. Adding symptom severity to the model resulted in an additional 2% of the
variance explained by the fixed effects. Symptom severity was not significantly associated with
the dedication subdimension (b = −.05, p = .54) or the absorption subdimension (b = −.05,
p = .50) of work engagement. Regarding the total work engagement score, there was no negative
16
TA B L E 5 Study 2 bivariate correlations between the study variables.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
1. Gender
2. Age −.14
3. MS course type −.13 .35**
4. Quant. demands (T0) .08 .02 .06
5. Cogn. demands (T0) .13 −.08 −.14 .32**
6. Social support (T0) .21* −.09 −.11 −.15 −.03
7. Symptom severity (T0) −.01 .17 .33** .25** .06 −.18*
8. Exhaustion (T0) .12 −.04 −.01 .28** .00 −.26** .40**
9. Disengagement (T0) −.11 −.10 .01 .02 −.19* −.40** .21* .47**
10. Burnout (T0) −.01 −.09 .00 .16 −.13 −.39** .34** .81** .90**
11. Vigor (T0) .08 .03 −.14 .03 .36** .35** −.18* −.36** −.59** −.57**
12. Dedication (T0) .12 .06 −.08 .10 .35** .37** −.05 −.22* −.63** −.53**
13. Absorption (T0) .12 −.06 −.09 .16 .41** .27** −.05 −.15 −.52** −.42**
14. Work engagement (T0) .11 .01 −.12 .11 .41** .36** −.10 −.27** −.63** −.55**
15. Exhaustion (T1) .13 −.04 −.15 .26** .11 −.18* .31** .63** .29** .51**
16. Disengagement (T1) −.06 −.04 −.04 .09 −.24* −.33** .19* .54** .78** .79**
17. Burnout (T1) .03 −.04 −.11 .19* −.09 −.30** .29** .68** .65** .77**
18. Vigor (T1) .01 −.01 −.10 −.08 .28** .20* −.21* −.46** −.49** −.56**
19. Dedication (T1) .08 .12 .06 −.05 .26** .35** −.06 −.35** −.62** −.58**
20. Absorption (T1) .00 −.06 −.04 .07 .33** .19* −.06 −.27** −.48** −.45**
21. Work engagement (T1) .03 .02 −.03 −.02 .32** .27** −.12 −.40** −.58** −.58**
Note: N = 129. T0 = Baseline measurement, T1 = follow-up measurement; gender coded 1 = male, 2 = female; MS course type coded 1 = relapsing–remitting, 2 = other types.
*p < .05.
**p < .01.
COOK and ZILL
TA B L E 5 (Continued)
11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
1. Gender
2. Age
3. MS course type
4. Quant. demands (T0)
5. Cogn. demands (T0)
6. Social support (T0)
7. Symptom severity (T0)
INDIVIDUAL HEALTH STATUS AS A RESOURCE
8. Exhaustion (T0)
9. Disengagement (T0)
10. Burnout (T0)
11. Vigor (T0)
12. Dedication (T0) .76**
13. Absorption (T0) .76** .73**
14. Work engagement (T0) .92** .90** .91**
15. Exhaustion (T1) −.23* −.12 −.10 −.17
16. Disengagement (T1) −.53** −.56** −.44** −.56** .47**
17. Burnout (T1) −.46** −.41** −.33** −.44** .83** .88**
18. Vigor (T1) .74** .57** .55** .68** −.28** −.53** −.49**
19. Dedication (T1) .59** .76** .55** .69** −.20* −.64** −.51** .72**
20. Absorption (T1) .62** .60** .69** .70** −.08 −.51** −.37** .77** .77**
21. Work engagement (T1) .71** .70** .65** .76** −.21* −.61** −.49** .91** .90** .93**
Note: N = 129. T0 = Baseline measurement, T1 = follow-up measurement; gender coded 1 = male, 2 = female; MS course type coded 1 = relapsing–remitting, 2 = other types.
*p < .05.
**p < .01.
17
18 COOK and ZILL
T A B L E 6 Study 2 random intercept models regressing burnout on the standardised covariates and
symptom severity.
Outcome: Exhaustion Outcome: Disengagement Outcome: Burnout

Model 1a Model 1b Model 2a Model 2b Model 3a Model 3b
Fixed effects
Intercept .22 .29 −.36 −.32 −.12 −.05
Time −.29** −.29** .25** .25** .01 .01
Gender .33 .30 .01 −.01 .18 .15
Age −.02 −.04 −.10 −.12 −.07 −.09
MS type −.11 −.57* −.18 −.35 −.26 −.52*
Quantitative demands .25** .18* .09 .04 .19* .12
Cognitive demands −.06 −.08 −.27** −.27** −.21* −.22**
Social support −.22** −.18* −.37** −.35** −.36** .32**
Symptom severity .35** .21* .32**
Random effects
Intercept (individuals) .72 .64 .77 .75 .78 .72
Residual .60 .60 .47 .47 .48 .48
AIC 680.12 665.65 617.95 616.72 630.75 620.64
BIC 718.86 707.86 656.69 658.93 669.49 662.85
Marginal pseudo R 2 .15 .25 .21 .24 .18 .26
Conditional pseudo R 2
.65 .65 .79 .79 .77 .77
Note: N = 129 (Level 2), N = 258 (Level 1). Time coded 0 = T0, 1 = T1, Gender coded 1 = male, 2 = female, MS course type coded
1 = relapsing–remitting, 2 = other types, all fixed effects variables assessed at T0, outcome variables assessed at T0 and T1, all
models accounted for autocorrelation.
*p < .05.
**p < .01.
association with symptom severity, with b = −.10, p = .21. Thus, Hypothesis 2 was only supported
for the vigor dimension of work engagement.
Furthermore, people with relapsing–remitting MS experienced higher levels of exhaustion
burnout, b = −.57, p = .01, and the total burnout score, b = −.52, p = .02. Social support at base-
line was positively and significantly associated with all burnout and work engagement variables.
Cognitive demands at baseline were negatively related to disengagement, b = −.27, p < .01, and
the total burnout score, b = −.22, p = .005, and positively associated with all work engagement
outcomes. Whereas time had a negative effect on all work engagement outcomes, indicating a
general increase across the measurement points, exhaustion burnout seemed to decrease over
time. In contrast, time had a positive effect on disengagement.
Additional analyses regarding the Covid-19 pandemic
As the data assessment was carried out in April and May 2020, we conducted exploratory analyses,
including the Covid-related variables. At baseline, most participants (N = 123, 88.49%) stated that
there had been a significant change in their work life since the pandemic outbreak. At follow-up
(T1), 40.3% (N = 56) stated that there had been a significant change in their working conditions
T A B L E 7 Study 2 random intercept models regressing work engagement on the standardised covariates
Outcome: Outcome: Outcome: Work

Outcome: Vigor Dedication Absorption engagement (total)
Model Model Model Model Model Model Model Model
4a 4b 5a 5b 6a 6b 7a 7b
Fixed effects
Intercept .26 .23 .11 .10 .23 .22 .22 .20
Time −.27** −.27** −.24** −.24** −.30** −.30** −.29** −.29**
Gender −.13 −.11 <−.01 <.01 −.12 −.11 −.09 −.08
Age .08 .09 .14 .14 −.02 −.02 .07 .08
MS type −.19 −.05 .10 .13 .05 .09 −.02 .06
Quantitative −.09 −.06 −.03 −.02 .04 .05 −.03 −.01
demands
Cognitive .36** .36** .34** .34** .37** .37** .39** .40**
demands
Social support .28** .26** .38** .37** .25** .25** .33** .32**
Symptom −.17* −.05 −.05 −.10
severity
Random effects
Intercept SD .75 .74 .73 .72 .71 .72 .73 .73
(individuals)
Residual .51 .53 .50 .55 .56 .56 .49 .49
AIC 638.03 657.27 620.87 625.76 654.80 659.57 621.42 625.08
BIC 676.77 699.487 659.61 667.97 693.54 701.78 660.15 667.29
Marginal pseudo R 2
.21 .23 .25 .25 .21 .21 .25 .26
Note: N = 129 (Level 2), N = 258 (Level 1). Time coded 0 = T0, 1 = T1, Gender coded 1 = male, 2 = female, MS course type coded
1 = relapsing–remitting, 2 = other types, all fixed effects variables assessed at T0, outcome variables assessed at T0 and T1, all
models accounted for autocorrelation.
*p < .05.
**p < .01.
compared with the baseline survey. Before the pandemic outbreak, participants had worked for
a mean of M = 1.29 days per week (SD = 1.84). However, only N = 116 participants responded to
the question. At baseline (T0, April 2020), they reported working remotely for M = 3.49 days per
week (SD = 2.13). N = 132 participants responded to the question. At follow-up (T1, May 2020),
participants reported working remotely for M = 3.3 days per week (SD = 2.3) (137 responses).
We calculated the difference between the days per week worked remotely before the pandemic
and the days per week worked remotely reported at baseline and follow-up. There was a mean
difference in days per week working remotely of M = 2.14 (SD = 2.42) at baseline and M = 2.25
(SD = 2.44) at follow-up.
We conducted t-tests comparing all study variables between participants who had reported
differences in working conditions compared with before the pandemic outbreak at baseline. We
also checked for differences in follow-up variables between participants reporting a change in
working conditions at follow-up (compared with the working conditions at baseline). We did not
20 COOK and ZILL
find significant differences between the groups (Appendix D). T-tests comparing people report-
ing changes between baseline and follow-up showed no significant differences (Appendix E).
We subsequently analyzed the bivariate correlations between the study variables, the days
worked remotely during the pandemic, and the differences in remote work compared with the
time before the pandemic (Appendix F). We found a significant correlation between the days
per week worked remotely at follow-up and exhaustion burnout at follow-up, r = −.18, p = .04.
Also, people who reported more remote work at follow-up than before the pandemic reported
lower exhaustion burnout at follow-up, r = −.25, p = .01. We repeated the analysis of the mixed
models using the hours of remote work reported at T0 and T1 as a Level 1 covariate, which did
not change the study's main findings. The hours worked remotely per week did not significantly
affect burnout and work engagement outcomes.
Discussion Study 2
To a large degree, the results of Study 2 replicated and supported the findings of Study 1. The
results imply that people experiencing more severe symptoms experience more exhaustion and
overall burnout. However, Study 2 also shows that people with MS perceiving more severe symp-
toms also feel more disengaged. Thus, symptom severity plays a particular role in the JD-R health
impairment process among employed people with MS. Regarding work engagement, we found
that people perceiving their MS symptoms as more severe experienced lower levels of vigor work
engagement.
GENERAL DISCUSSION
Employees with chronic illnesses are part of almost every workforce in any organisation. This
paper aimed to investigate the role of individual health status, defined as the perceived symptom
severity of a chronic illness, in the experience of burnout and work engagement. We focused
our investigations on employees with autoimmune illnesses, a group of non-communicable
diseases with increasing worldwide incidence rates (Lerner et al., 2016). Our findings show that
for employees with MS and IBD, the perceived illness or symptom severity impacts higher levels
of exhaustion and general burnout, as well as the vigor dimension of work engagement, incre-
mentally explaining variance in the outcomes above and beyond the effects of job demands and
job resources. Moreover, we found symptom severity associated with disengagement burnout
among people with MS.
Theoretical implications
Although our findings suggest that some basic assumptions described in the JD-R model apply
to employees with chronic autoimmune illnesses, such as the effects of certain demands and
resources, the individual health status of employees seems to play an essential role. The most
important contribution of our studies is that viewing and conceptualising health as an outcome
only bears the risk of overlooking important effects and processes and may bias the interpretation
of results by working under the assumption that everyone enters the workforce with the same
baseline health status. In other words, “the normative assumption is that people are physically
and mentally able to perform their work roles and functioning bodies and are taken for granted”
(Beatty, 2018, p. 36). Our findings suggest that this consideration should be updated, considering
the high prevalence of chronic health conditions (European Commission Eurostat, 2019).
Our results contribute to the further development of the JD-R model by conceptualising
health status, respectively, the absence of health impairments and illness symptoms as an indi-
vidual resource that affects both the health impairment and motivational processes. We thus
challenge assumptions on the directionality of effects between health, well-being, and motiva-
tion. Our research is based on the idea that the severity of autoimmune illness symptoms reflects
an impaired energy resource. According to the COR theory, energy resources facilitate the acqui-
sition of other types of resources, such as objects. Similar to personal resources, another cate-
gory of resources outlined in the COR theory, energy resources are located in the individual or
employee and can be integrated into the JD-R framework in multiple ways. Our findings support
the idea that the resource lack due to more severe symptoms may lead to burnout because of the
primacy of loss and a higher sensitivity to daily stressors of people with diminished resources
(Hobfoll & Freedy, 1997).
A consistent finding in both studies was that symptom severity explained exhaustion and
general burnout variance in participants with autoimmune illness, independent of the actual
demands of the job. Only Study 2 showed a significant relationship between disengagement and
symptom severity. Exhaustion is often seen as the more immediate response to prolonged stress
in burnout research (Block et al., 2020) and the central strain dimension linked to energy (Bakker
et al., 2014). Given that disengagement may be a less central and more distal burnout outcome,
the limitations in the sample size of Study 1 may have led to insufficient power to detect a small
effect. Moreover, the symptoms of MS include cognitive difficulties (Green et al., 2017), which
may be more likely to lead to disengagement than IBD symptoms.
Our findings also support the notion that as a resource loss, symptom severity may decrease
the capacity of employees with autoimmune illnesses to “navigate and succeed at their engage-
ment” (Hobfoll, 2010, p. 17). However, we only found significant associations regarding the vigor
dimension of work engagement. Vigor is characterised by “high levels of energy and mental
resilience while working, the willingness to invest effort in one's work, and persistence in the face
of difficulties” (van den Heuvel et al., 2010, p. 136) and is the dimension of work engagement
most closely connected to the investment of energy into work. The fact that we could not find
significant associations with the absorption dimension can be explained by evidence suggesting
that absorption is a less central indicator for work engagement, not necessarily unique to the
construct of work engagement (Mazzetti et al., 2021) and, in contrast to vigor and dedication,
has been unrelated to somatic symptoms in previous research (González-Gancedo et al., 2019).
High levels of dedication imply “being strongly involved in one's work and experiencing a sense
of significance, enthusiasm, and challenge” (Bakker et al., 2014, p. 391). The fact that we did not
find an association of symptom severity with dedication could imply that the work engagement
process linked to identification and enthusiasm about work is less or not affected by impaired
health or that we should consider lower vigor as a more proximal outcome and potential medi-
ator for effect on dedication. However, the associations between illness severity and dedication
deserve more attention in future research.
Previous literature on work engagement suggests that engaged workers perform better
because work engagement is associated with better health (Bakker & Demerouti, 2008). Our
results indicate that there is still a strong necessity for longitudinal studies on the association
between work engagement on health to investigate reciprocal effects. In light of our results and
the examination of past evidence, we feel that the statement “engaged workers experience good
22 COOK and ZILL
health” (Langseth-Eide & Vittersø, 2021, p. 10) could also be rephrased to state that employees
who are in good health also experience higher work engagement. Although we do not deny the
potential health-improving effects of work engagement, it is important to investigate the causal
relationships further and carefully consider the causality directions when planning and evaluat-
ing interventions to increase work engagement.
Our results show consistent associations between the exhaustion dimension of burnout and
the vigor dimension of work engagement. Exhaustion and vigor are related and are considered
to be the two opposites of a spectrum named “energy” (Bakker et al., 2014; González-Romá
et al., 2006). Our findings indicate that the consequences of impaired health as a diminished
energy resource may be more pronounced on the energy spectrum compared with the identi-
fication spectrum (cynicism/disengagement and dedication). As exhaustion is a more general
and immediate stress reaction, it may be more affected by health impairments. However, “even
slightly elevated but prolonged exhaustion can lead to the erosion of vigor” (Mäkikangas
et al., 2017, p. 52). Evidence indicates that there is some degree of independence in the construct,
indicating that vigor and exhaustion are not necessarily mutually exclusive (Mäkikangas
et al., 2017). Hence, future research should investigate a potential mediating effect of exhaustion
on vigor work engagement in longitudinal studies.
Previous research on the JD-R model in the context of MS also implies that the effect of health
status on burnout and work engagement may be mediated through illness-specific work prob-
lems (e.g. Lehmann et al., 2021). As many chronic illnesses require constant illness management,
another possible mediator could be work-health management interference, that is “experiencing
competing, incompatible pressures from the need to manage one's health condition and the need to
manage one's work responsibilities” (McGonagle et al., 2020, p. 445), which predicts burnout. Both
illness-specific work problems and work-health management interference should be integrated
and investigated into the JD-R framework, taking into consideration that they may also be affected
by job characteristics and thus possibly mediate both the effects of health status and the effects of
job demands and resources on well-being and motivational outcomes (Lehmann et al., 2021).
Analyzing the bivariate correlations in Study 2 showed that there were significant relations
between symptom severity and quantitative job demands and social support. Parallel to work
conducted on the effects of personal resources (Schaufeli & Taris, 2014), this can imply that indi-
vidual health status as an energy resource may impact how employees perceive their working
conditions in the first place. Health status affects perceived work ability (McGonagle et al., 2015),
which may indicate that it also influences how the respective employee perceives to be able to
deal with job demands and whether they perceive job resources as adequate for their needs. This
is highly relevant as studies usually assess job demands through employee self-reports. Future
research should consider research designs in which the objective job characteristics are kept rela-
tively constant and the health status varies to investigate this proposed effect. A possible research
design could investigate pairs of employees working in highly similar, if not the same, jobs in
which one employee has a health impairment and the other employee is “healthy” to provide
detailed insights into how health and illness shape our perceptions of the work environment.
Future research should investigate to which degree impaired health and working conditions
interact, that is if employees with impaired health experience stronger negative effects toward
jobs with high demands. For personal resources, there is evidence that individual resources and
job demands interact as they moderate the effects of job demands on exhaustion (Schaufeli &
Taris, 2014). However, in supplemental exploratory analyses of interactions between job demands,
resources, and symptom severity, we could not find any indications of interaction effects, which
may be due to the limitations of the samples (Data S1). It is, however, possible that heath consti-
tutes a preceding or primary personal resource that interacts with working conditions through
its effect on other resources, for example, personal resources such as self-efficacy and resilience.
Our findings also have implications for the theoretical conceptualisation and investigation
of job demands and their role in predicting burnout and work engagement. We found quantita-
tive job demands to be a consistent predictor of exhaustion. This finding is in line with previous
meta-analyses showing that workload is a crucial factor in the development of emotional exhaus-
tion (Alarcon, 2011). Furthermore, both studies found cognitive demands to have positive effects
on work engagement and negative effects on disengagement and general burnout. This result
mirrors previous findings on positive associations between cognitive demands and motivation
(Bakker et al., 2005). It implies that not all job demands can be assumed to have the same effects
on employee well-being. Van den Broeck et al. (2010) distinguish job demands as hindrances
and challenges. They theorise that cognitive demands pose a job challenge, that is which require
energy but are stimulating to the employee and, therefore, positively affect health and well-being
by providing opportunities for need satisfaction. Even though autoimmune illnesses are often
accompanied by fatigue and cognitive difficulties (Zielinski et al., 2019), we found that cognitive
demands had these protective effects. This raises the question of whether cognitively demanding
work can give employees with autoimmune illnesses a feeling of purpose, even when faced with
possible cognitive impairments. Therefore, future research should differentiate different types of
job demands and investigate how cognitive demands positively affect employee well-being.
Finally, our findings support the assumption that social support is crucial for people with
chronic illnesses (de Boer et al., 2018) and is positively associated with employee well-being.
Participants that felt that their social environment at work was more supportive reported less
burnout (both studies) and higher levels of work engagement (Study 2). A possible reason for the
effect of social support on employee motivation in Study 2 is the context of the Covid-19 pandemic
and the increase in working from home as the feeling of social isolation is associated with lower
work engagement among people working remotely during the pandemic (Galanti et al., 2021).
Future research should explore how and when colleagues and leaders support employees with
chronic illnesses in more detail. Insights into how social support prevents burnout and facilitates
motivation among employees with chronic illnesses can provide starting points for interventions
on the leader and team level and help researchers and practitioners understand how social work-
ing conditions affect work life with a health impairment.
Limitations
This paper has several strengths but also limitations. We tested hypotheses among two specific
samples of people with medically diagnosed chronic illnesses. Both studies included two
measurement points with two different time lags. However, this still prevents us from gaining
insights into causal and reciprocal effects. Further studies with longitudinal and crossed-lagged
designs should investigate various chronic illnesses over longer periods to better understand the
interaction between job characteristics, health status, and employee well-being.
Second, although our theoretical considerations apply to a wide range of chronic health condi-
tions, the current studies only covered a specific type of chronic illness—autoimmune illnesses—
limiting our findings' generalizability. Nevertheless, both studies show that the perceived severity of
chronic illnesses is a fundamental impact factor on burnout and work engagement among two differ-
ent autoimmune illnesses. This common effect is an important starting point for further research in
occupational health and should be replicated in other areas of chronic illnesses. Apart from basic
24 COOK and ZILL
communalities, future research should also examine the specifics of various chronic illnesses and
their impact on work life. Additionally, our sample only allows us to test the assumptions of a direct
effect of health status on employee well-being to a certain degree, as the variance in health was
restricted. Although several participants reported no symptoms in both studies, comparing people
with different health statuses (i.e. healthy, illness with low symptom severity, and illness with high
symptom severity) could provide valuable insights into whether health status as a personal resource
can moderate the effects of job characteristics on well-being (Schaufeli & Taris, 2014).
Third, our studies investigated the role of health status exclusively among people with health
impairments. Although people with autoimmune illnesses vary greatly in their perception of
symptom severity, further studies should compare employees with a greater variance in health
impairments, from “good health” to strongly impaired health.
Fourth, although we assessed illness-related information in both samples, we did not collect
data on comorbidities. Chronic illnesses are sometimes accompanied by psychiatric comorbid-
ities, which may also be important determinants of occupational health. Depression and anxi-
ety are prevalent among people with IBD and MS (Boeschoten et al., 2017) and predict paid
employment among people with autoimmune illnesses (De Boer et al., 2016). Moreover, recent
investigations on burnout suggest that the distinction between depression and burnout is not
clear enough because of the conceptual and theoretical overlaps. Treating burnout as a form of
depression (Bianchi et al., 2015) would imply that future research on chronic illnesses should
include comorbidity and multimorbidity, including both somatic illnesses and mental disorders,
and conduct high-resolution analyses of the differences and similarities between specific comor-
bidities, psychological symptoms of physical illnesses, and well-being outcomes.
Fifth, the sample sizes in this paper are small to moderate, which restricts the power of the
sample size to detect smaller effects. Researching chronic illnesses in work settings can be chal-
lenging, as employees with chronic illnesses may not trust the analyses' anonymity, so they do
not report their chronic illnesses. If research is carried out through employee surveys, employee
representatives may consent to the assessment illness related questions to protect employees
from possible disadvantages. Research on volatile topics, therefore, requires other strategies in
acquiring participants, such as contact with illness-related societies (without which this research
would not have been possible). Further studies should increase the effort to get more employees
with chronic illnesses to participate in this research area.
Sixth, all measures in our studies rely on self-report and not clinical objective measures of
health status or illness severity. Although the instruments used to assess symptom severity are
frequently used in clinical practice to measure changes and progressions in illness severity and
show good validity (Fitzgerald et al., 2019; Jowett et al., 2001) and capture the perceived reality of
people living and working with IBD and MS, future studies should strive to also include objective
measures of health and illness.
Practical and societal implications
Previous studies on the associations described in the JD-R model concluded that organizations
have to ensure that their employees have adequate job resources to perform well and perceive
high levels of well-being (Demerouti & Nachreiner, 2019). Our results challenge these conclu-
sions to a certain degree, as they indicate that more fine-tuned interventions regarding specific
aspects of health status diversity among the staff may be necessary. As a minimum requirement,
practitioners must carefully examine the accessibility of existing interventions to consider that
some employees may not have the same level of individual resources in terms of energy and time
because of existing health impairments.
Work adjustments are related to decreased sick leave among employed people with chronic
diseases (Boot et al., 2013). They can buffer or inhibit possible negative effects of an illness
on work ability (Torp et al., 2012). Examples of work adjustments include the availability of
specific devices or furniture, change of job tasks, adjusted working hours, adjustments in the
quantity of work, adjustments in office accessibility, and education and retraining opportunities
(Boot et al., 2013). As our findings emphasise the role of illness severity on employee well-being
outcomes, organizations should consider implementing more individually tailored work adjust-
ments in their occupational health programs focusing on employee mental health and motiva-
tion. In Europe, work adjustments are included in the European Strategy for the Rights of Persons
with Disabilities 2021–2030 (European Union, 2021), which states that people with disabilities
have the right to experience good conditions in the workplace and equal opportunities for partic-
ipation in life. Both illnesses included in the studies are strongly associated with (legal) disability
status (Feagan et al., 2005; Pugliatti et al., 2006), with MS being “the most common cause of
neurological disability in young adults worldwide and approximately half of those affected in
Europe” (Kingwell et al., 2013, p. 128). Providing work adjustments for people with autoimmune
illnesses in line with the European Union's aim to “unlock the potential and talents of persons
with disabilities (…) for the benefit of the individuals, the economy and for the cohesion of the
society as a whole” (European Union, 2021, p. 13 f.)
Insights and knowledge on the effects of autoimmune severity on work life and work-related
outcomes are valuable for both employees and employers to create awareness and caution
regarding potential issues that can occur. Several illness-related associations offer short guides
and comprehensive information sheets on employment issues targeted specifically at employees
with a specific chronic disease or their employers (e.g. Crohn's & Colitis UK, 2021; Vereniging MS
Nederland, 2021) and research on psychosocial aspects of illness at work can make an important
contribution to these offers. Having accurate information on and knowledge about the illness can
signal a supportive environment and reduce the probability of false assumptions on the employ-
er's side that could make the employee not taken seriously or even feel stigmatised. Starting a
conversation with employees with chronic illnesses can also help evaluate existing occupational
health measures to reduce stress and prevent burnout. This way, organizations can ensure that
the occupational health measures they invest in do not exclude employees with chronic illnesses
or disabilities.
Connecting research to lay theories: The Spoon Theory
The core idea of conceptualising life with a chronic illness in terms of resources (or a loss or
limitation thereof) also exists beyond psychological research, as it can be found in a popular
metaphor used by people with chronic diseases. The essay “The Spoon Theory” by Christine
Miserandino (2003) explains how a chronic illness leads to energy depletion throughout the day.
The author represents the limited energy available for the day through a fixed number of spoons.
She explains: “when you are healthy you expect to have a never-ending supply of ‘spoons’. But
when you have to now plan your day, you need to know exactly how many ‘spoons’ you are
starting with. It doesn't guarantee that you might not lose some along the way, but at least it helps
to know where you are starting” (Miserandino, 2003, para. 9). The author explains that almost
every activity, even seemingly small actions such as standing on the train, cost a spoon, some-
times leaving her with a severely depleted number of spoons before she even arrives at work. The
26 COOK and ZILL
limitation forces one to make choices: “Its hard, the hardest thing I ever had to learn is to slow
down, and not do everything. I fight this to this day. I hate feeling left out, having to choose to stay
home, or to not get things done that I want to” (para. 15).
The metaphor described in Miserandino's blog post has become extremely popular in social
media discourses among people with chronic illnesses and invisible disabilities, represented
among others through the use of the word “Spoonie” to self-describe as a person with a chronic
illness or mark posts about the topic on Twitter and Instagram (Hale, 2018; Isika et al., 2020;
Kattari & Beltrán, 2022). Essentially, Miserandino describes a basic resource concept that aligns
with the assumptions of COR theory that form the basis of this paper and is in line with our
findings. Thus, as a final contribution, this research confirms and validates a lay theory from the
chronic illness online community, which people with health impairments can use to explain the
challenges of their daily lives.
CONCLUSION
Chronic illnesses can be viewed as a unique category of diversity in organizations often overlooked
in theory, research, and practice (Beatty & Joffe, 2006). By excluding interindividual differences
in baseline health status in theory and research, organizational psychology and occupational
health research run the risk of overlooking essential individual-level factors that may influence
the effects of work on well-being and motivation and promoting a perspective on employee life
in which the specific issues of people with chronic illness remain invisible. Assuming that people
enter the workforce as healthy individuals, tailoring occupational health measures according to
this view may lead to employers' negligence in attending to those employees for which health may
have a different personal meaning, and health-related measures might be particularly important.
It is the task of occupational health researchers to identify factors that improve or complicate
work life for employees with chronic illnesses and to provide evidence-based suggestions for
inclusion and the successful management of a health-diverse workforce.
CONFLICT OF I NTEREST STATEMENT

The authors report that there are no competing interests to declare.
ETHICS STATEMENT
The study documents and designs were reviewed and approved by Ethics Review Boards at Chem-
nitz University of Technology (Faculty of Behavioural and Social Sciences) and VU Amsterdam
(Faculty of Behavioral and Movement Sciences).
DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding
author. The data are not publicly available due to privacy or ethical restrictions.
ORCID
Alexandra (Sasha) Cook https://orcid.org/0000-0002-8565-6361
Alexander Zill https://orcid.org/0000-0002-9424-3876
ENDNOTE
1
The reason for choosing to use the full scale in this study was based on a student's thesis carried out in the scope
of the project.
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SUPPORTING INFORMATION
Additional supporting information can be found online in the Supporting Information section at
the end of this article.
How to cite this article: Cook, A. (. S.)., & Zill, A. (2023). Individual health status as a
resource: Analyzing associations between perceived illness symptom severity, burnout,
and work engagement among employees with autoimmune diseases. Applied Psychology,
1–36. https://doi.org/10.1111/apps.12464
APPENDIX A
T-tests investigating differences in baseline variables between participants included in the sample
and baseline participants not included in the final sample (lost-to-follow-up and employment
changes) (Study 1).
Lost-to follow-upM Final sampleM df t

Age 37.16 39.60 135 −1.332
T0 Symptom severity 3.87 3.85 135 −.102
T0 Quantitative demands 3.16 3.14 135 .164
T0 Cognitive demands 3.87 3.90 135 −.274
T0 Control over working time 3.56 3.44 135 .675
T0 Social support 2.90 3.05 132 −.825
Note: N = 137.
APPENDIX B
T-tests investigating differences between participants with Crohn's disease and participants with
ulcerative colitis (Study 1).
Crohn's disease (N = 60)M Ulcerative colitis (N = 27)M df t

Age 39.67 39.44 85 −.094
T0 Symptom severity 3.98 3.58 85 1.596
T0 Cognitive demands 3.94 3.82 85 .697
T0 Control over working 3.34 3.67 85 −1.391
time
T0 Social support 2.98 3.19 85 −.870
T1 Exhaustion 2.88 2.81 85 .569
T1 Disengagement 2.24 2.22 85 .142
T1 Burnout 2.56 2.51 85 .405
T1 Vigor 3.23 3.10 85 .502
T1 Dedication 3.76 3.60 85 .582
T1 Absorption 3.34 3.16 85 .693
T1 Work engagement 3.30 3.14 85 .652
Note: N = 87.
APPENDIX C
T-tests investigating differences in baseline variables between participants included in the sample
and baseline participants not included in the final sample (lost-to-follow-up and employment
changes) (Study 2).
Not included in the final Included in the final

sampleM sampleM df t
Age 37.61 40.05 211 −1.702
T0 Symptom severity 2.58 2.57 211 3.037*
T0 Cognitive demands 3.57 3.78 211 −2.090*
T0 Social support 3.49 3.67 211 −1.587
*p < .05.
34 COOK and ZILL
APPENDIX D
T-tests comparing participants reporting significant changes in their working conditions due to
Covid to participants reporting no changes (Study 2).
Changes due to the No changes

pandemic (N = 123)M reported (N = 16)M df t
T0 Symptom severity 2.25 2.32 127 −.339
T0 Quantitative 2.52 2.62 127 −.497
demands
T0 Cognitive 3.78 3.79 127 −.017
demands
T0 Social support 3.82 4.00 127 −.710
T0 Exhaustion 2.56 2.47 127 .767
T1 Exhaustion 2.43 2.42 127 .046
T0 Disengagement 2.16 2.16 127 −.006
T0 Burnout 2.36 2.31 127 .382
T1 Burnout 2.36 2.32 127 .357
T0 Vigor 4.68 4.60 127 .311
T1 Vigor 4.41 4.29 127 .426
T0 Dedication 5.13 4.91 127 .699
T1 Dedication 4.82 4.80 127 .105
T0 Absorption 4.69 4.37 127 1.163
T1 Absorption 4.38 4.11 127 .941
T0 Work 4.81 4.61 127 .785
engagement
T1 Work 4.53 4.37 127 .544
engagement
Note: N = 129.
APPENDIX E
T-tests comparing participants reporting significant changes in their working conditions due to
Covid between baseline and follow-up to participants reporting no changes (Study 2).
Changes between baseline No changes

and follow-up (N = 53)M reported (N = 76)M df t
T1 Exhaustion 2.40 2.46 127 −.889
T1 Burnout 2.36 2.36 127 .016
T1 Vigor 4.43 4.38 127 .283
T1 Dedication 4.84 4.82 127 .085
T1 Absorption 4.39 4.33 127 .312
T1 Work engagement 4.84 4.76 127 .455
Note: N = 129.
APPENDIX F
Bivariate correlations between Covid-related variables and study variables (Study 2).
(T0) Days/ (T0) Difference in (T1) Days/ (T1) Difference in

week remote days/week remote week remote days/week remote
work (N = 122) work (N = 118) work (N = 127) work (N = 106)
T0 Symptom severity .03 −.07
T0 Quantitative demands .17 .08
T0 Cognitive demands .08 .11
T0 Social support −.07 .02
T0 Exhaustion −.03 −.14
T1 Exhaustion −.08 −.16 −.18* −.25*
T0 Disengagement .01 −.03
T1 Disengagement −.01 −.10 −.01 −.13
T0 Burnout −.01 .10
T1 Burnout −.05 −.15 −.10 −.22*
T0 Vigor −.12 −.10
T1 Vigor −.11 −.03 −.10 .03
T0 Dedication −.08 −.08
T1 Dedication −.04 .00 −.10 .02
T0 Absorption −.03 .02
T1 Absorption .02 .02 .04 .04
T0 Work engagement −.08 −.06
T1 Work engagement −.05 .00 −.03 .03
*p < .05.
36
APPENDIX G
Regressing standardised burnout and work engagement on the standardised covariates, symptom severity, and remote work (Study 2).
Exhaustion Disengagement Burnout Vigor Dedication Absorption Work engagement

Fixed effects (Level 2)
Intercept .31 −.30 −.02 .57** .35 .54** .54**
Time −.29** .24** <.01 −.30** −.25** −.30** −.31**
Gender .27 −.03 .13 −.13 .02 −.11 −.08
Age −.06 −.13 −.12 .08 .14 −.02 .07
MS type −.51* −.32* −.48* −.02 .11 .07 .06
Quantitative demands .19* .06 .14 −.06 −.03 .04 −.02
Cognitive demands −.06 −.28** −.22** .37** .34** .38** .40**
Social support −.18* −.32** −.31** .24** .35** .22** .30**
Symptom severity .34** .21* .31** −.18* −.04 −.05 −.10
Fixed effects (Level 1)
Hours/week remote work −.09 −.02 −.06 −.08 .01 <−.01 −.02
Random effects
Intercept SD (Individuals) .63 .77 .73 .73 .75 .72 .73
Residual .50 .51 .49 .57 .51
AIC 652.16 613.51 618.06 625.47 619.67 654.41 620.92
BIC 697.35 658.71 663.25 670.66 664.86 699.60 666.12
2
Marginal pseudo R .26 .23 .26 .23 .24 .20 .25
Conditional pseudo R 2 .64 .79 .76 .75 .77 .69 .76
Note: N = 129 (Level 2), N = 249 (Level 1). Time coded 0 = T0, 1 = T1, Gender coded 1 = male, 2 = female, MS course type coded 1 = relapsing–remitting, 2 = other types, outcome variables
assessed at T0 and T1, all models accounted for autocorrelation.
*p < .05.
**p < .01.
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Received: 28 February 2021 Accepted: 6 February 2023

Individual health status as a resource:

Alexandra (Sasha) Cook1,2 | Alexander Zill3,4

Psychological Research Institute,

University of Amsterdam, Amsterdam, Abstract

Applied Psychology. 2023;1–36. wileyonlinelibrary.com/journal/apps 1

ple sclerosis. We found significant associations of

HEALTH AS A RESOURCE: ANALYZING ASSOCIATIONS BETWEEN

HEALTH, ILLNESS, BURNOUT, AND WORK ENGAGEMENT

INCLUDING HEALTH STATUS AS A RESOURCE—A COR APPROACH

Hypothesis 1. Autoimmune illness symptom severity explains variance in employee burnout

Data and sample

M (SD) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

4. T0 Control over working time 3.44 (1.01) −.07 −.28* −.02

Outcome: T1 Outcome: T1 Outcome: T1

Outcome: T1 Outcome: T1 Outcome: T1 Outcome: Work

We recruited a sample of adult employees with an MS diagnosis. We assessed longitudinal data

Data and sample

Additions related to the Covid-19 pandemic

Baseline (T0) Follow-up (T1)

TA B L E 5 Study 2 bivariate correlations between the study variables.

Outcome: Exhaustion Outcome: Disengagement Outcome: Burnout

Additional analyses regarding the Covid-19 pandemic

Outcome: Outcome: Outcome: Work

Practical and societal implications

Connecting research to lay theories: The Spoon Theory

CONFLICT OF I NTEREST STATEMENT

DATA AVAILABILITY STATEMENT

Lost-to follow-upM Final sampleM df t

Crohn's disease (N = 60)M Ulcerative colitis (N = 27)M df t

Not included in the final Included in the final

Changes due to the No changes

Changes between baseline No changes

(T0) Days/ (T0) Difference in (T1) Days/ (T1) Difference in

Exhaustion Disengagement Burnout Vigor Dedication Absorption Work engagement

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