When reciprocity fails: effort-reward imbalance in relation to coronary heart disease and health functioning within the Whitehall II study

Job stress and behavioral characteristics in relation to coronary heart disease risk among Japanese police officers

This study examined the association between job-related behavioral characteristics and the risk of coronary heart diseases (CHD) in Japanese male police officers. Compared to office clerks, police officers exhibited greater age-related increases of the prevalence of CHD risk factors, and a clustering number of CHD risk factors was significantly higher in the group of those over 45 yr of age. Among the police officers, coronary-prone behavior was more frequent than that seen in office clerks. The police officers with coronary-prone behavior tended to engage in shift work and to work overtime more; yet they were less likely to perceive job stress and to express the relevant physical and psychological symptoms than those without coronary-prone behavior. The subjects with such behavioral characteristics had a significantly greater number of CHD risk factors. In a multiple regression analysis, coronary-prone behavior together with age, social support, walking hours per day, and amount of alcohol consumption were selected as significant determinants of a cluster of CHD risk factors. These results suggest that coronary-prone behavior may contribute to the higher prevalence of CHD risk factors in police officers via leading the long working hours and the work-related unfavorable lifestyles, such as alcohol drinking and physical inactivity.

Exposure to Work and Nonwork Stressors and the Development of Heart Disease Among Canadian Workers Aged 40 Years and Older: A 16-year Follow-up Study (1994 to 2010)

OBJECTIVE

The aim of this study was to evaluate the contribution of work, nonwork, and individual factors to self-reported heart disease, and to evaluate gender-related differences over a period of 16 years among Canadian workers aged 40 years and more.

METHODS

Using the National Population Health Survey (NPHS, 1994 to 2010), we estimated multilevel logistic regression models (N = 2996).

RESULTS

Couple-related strains, being a man, age, hypertension, and body mass index, are associated with an increased risk of heart disease. In analysis stratified by gender, physical demands at work and having high child-related strains were associated with heart disease specifically among women. Psychotropic drug use increased the risk of heart disease only in men.

CONCLUSION

Our study suggests that work stressors measured by Statistics Canada NPHS are largely not associated with the risk of heart disease, except in women exposed to physical demands at work.

Job demand-control and job stress at work: A cross-sectional study among prison staff

INTRODUCTION

Job stress can impose significant costs to the workplaces and organizations due to some issues such as absenteeism, less productivity, and medical costs. Job overload and lack of decision latitude can lead to job stress. The current study aimed to investigate the job demands and control as predictor of job stress and its relationship, with some of the demographic characteristics of Iranian prison staff.

MATERIALS AND METHODS

This study was performed on 171 male employees working in four prisons located in Ilam, Iran. The sampling method was census and all four prisons' staff were selected to respond the Job Content Questionnaires. Finally, the data were analyzed using t-test or independent samples test as well as SPSS 20.

RESULTS

The highest amount of job demand (mean = 21.28) and the lowest amount of job control on average (9.76) were reported by those staff working in Darehshahr prison. There was also a significant relationship between job post and job control among the prison staff (β = -0.375, P = 0.001).

CONCLUSION

The level of job stress reported by prison staff was high in this study mainly caused by high job demand and low job control, especially in Darehshahr prison staff.

Chronic exposure to adverse psychosocial work factors and high psychological distress among white-collar workers: A 5-year prospective study

OBJECTIVES

Prospective studies which evaluated whether the effects of chronic exposure to psychosocial work factors on mental health persisted over time are scarce. For the first time, this study evaluated: 1) the effect of chronic exposure to effort-reward imbalance over 5years on the prevalence of high psychological distress among men and women, and 2) the persistence of this effect over time.

METHODS

Overall, 1747 white-collar workers from three public organizations participated in a prospective study. Psychological distress and effort-reward imbalance were measured using validated questionnaires at baseline, and at 3- and 5-year follow-ups. Prevalence ratios (PRs) of high psychological distress were estimated using log-binomial regression according to baseline and repeated exposure.

RESULTS

Compared to unexposed workers, those with repeated exposure to effort-reward imbalance had a higher prevalence of high psychological distress. Workers exposed only at some time-points also had a higher prevalence. The deleterious effect of repeated exposure observed at the 3-year follow-up persisted at the 5-year follow-up among women (PR=2.48 95% confidence interval (CI) 1.97-3.11) and men (PR=1.91 95% CI 1.20-3.04). These effects were greater than those found using a single baseline measurement.

CONCLUSION

The current study supported a deleterious effect of repeated exposure to effort-reward imbalance on psychological distress, and a lack of adaptation to these effects over time among men and women. Since psychological distress may later lead to severe mental problems, current results highlight the need to consider exposure to these adverse work factors in primary and secondary preventions aimed at reducing mental health problems at work.

Student ERI: Psychometric properties of a new brief measure of effort-reward imbalance among university students

BACKGROUND

Psychosocial stress among university students, particularly medical students, is considered a widely prevalent problem. There is a need for valid measurement of an adverse psychosocial stress environment in university settings. The aim of this study was to examine the psychometric properties of a newly developed short student version of the effort-reward imbalance (ERI) questionnaire in a sample of medical students.

METHODS

A cross-sectional survey with a self-administrated questionnaire containing three scales was conducted among 406 medical students. Item-total correlations and Cronbach's alpha were calculated to assess the internal consistency of the scales. Confirmatory factor analysis was applied to test factorial validity of the questionnaire structure.

RESULTS

The student version of the ERI questionnaire provides acceptable psychometric properties. The Cronbach's alpha coefficients for effort, reward, and over-commitment were 0.67, 0.65, and 0.79, respectively. Confirmatory factor analysis displayed a satisfactory fit of the data structure with the theoretical concept (GFI>0.94).

CONCLUSIONS

This student version of the ERI questionnaire provides a psychometrically tested tool for studies focussing on psychosocial environment in university settings. Further applications of this approach in other student groups are needed, in addition to prospective studies assessing associations with health outcomes.

The moderating role of overcommitment in the relationship between psychological contract breach and employee mental health

OBJECTIVES

This study investigated whether the association between perceived psychological contract breach (PCB) and employee mental health is moderated by the cognitive-motivational pattern of overcommitment (OC). Linking the psychological contract approach to the effort-reward imbalance model, this study examines PCB as an imbalance in employment relationships that acts as a psychosocial stressor in the work environment and is associated with stress reactions that in turn negatively affect mental health.

METHODS

The analyses were based on a sample of 3,667 employees who participated in a longitudinal linked employer-employee survey representative of large organizations (with at least 500 employees who are subject so social security contributions) in Germany. Fixed-effects regression models, including PCB and OC, were estimated for employee mental health, and interaction effects between PCB and OC were assessed.

RESULTS

The multivariate fixed-effects regression analyses showed a significant negative association between PCB and employee mental health. The results also confirmed that OC does indeed significantly increase the negative effect of PCB on mental health and that OC itself has a significant and negative effect on mental health.

CONCLUSIONS

The results suggest that employees characterized by the cognitive-motivational pattern of OC are at an increased risk of developing poor mental health if they experience PCB compared with employees who are not overly committed to their work. The results of this study support the assumption that psychosocial work stressors play an important role in employee mental health.

Effort-reward imbalance and self-rated health among Gambian healthcare professionals

Background

The effort-reward imbalance (ERI) model of work stress has been widely applied in investigating association between psychosocial factors at work and health. This study examined associations between perceived psychosocial work stress as measured by the ERI model and self-rated health (SRH) among nurses and environmental health officers (EHOs) working in secondary public healthcare facilities in the Gambia.

Method

A cross-sectional study on a random sample of 287 health care professionals (201 nurses and 86 EHOs). A 22-item ERI questionnaire was used to collect data on the psychosocial factors defined by the ERI model. SRH was assessed using a single item measure.

Results

The distribution of subjective health was not statistically different between nurses and EHOs. However, our study uncovered significant associations between perceived psychosocial work stress and subjective health. Specifically, we found that a perceived high effort-reward imbalance (ER-ratio > 1) is a significant risk factor for poor SRH, in both occupational groups. However, over-commitment was not significantly associated with poor SRH in the two groups. When efforts and rewards were considered as separate variables in the analysis, rewards were inversely associated with poor SRH in both groups.

Conclusion

Because of the high perceived Effort-Reward Imbalance among healthcare professionals at secondary public healthcare facilities, it is necessary to modify working conditions through improvement of psychosocial work environment, such as reasonable allocation of resources to increase pay, incentives or other forms of rewards from government. Interventions that could mitigate and prevent stress at work are worth considering in future healthcare policies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1347-0) contains supplementary material, which is available to authorized users.

Effect of age and social connection on perceived anxiety over radiation exposure among decontamination workers in Fukushima Prefecture, Japan

Objectives:

To reveal the effect of age and other factors on perceived anxiety over radiation exposure among decontamination workers in Fukushima Prefecture, Japan.

Methods:

A survey questionnaire was sent to 1505 workers, with questions regarding age, presence of a written employment contract, previous residence, radiation passbook ownership, presence of close persons for consultation, knowledge of how to access public assistance, and a four-point scale of radiation-related anxiety (1= "Very much," 2= "Somewhat," 3= "A little bit," and 4= "None" ). The relationships between the degree of anxiety and variables were analyzed using the chi-square test and residual analysis.

Results:

In all, 512 participants responded to the questionnaire. The mean age of participants was 46.2 years (SD: 13.1, range: 18-77). Of them, 50, 233, 168, and 61 workers chose "Very much," "Somewhat," "A little bit," and "None," respectively, on the anxiety scale. Chi-square test showed that participants aged 61 years and over had higher degrees of anxiety (p<0.001). Ordinal logistic regression showed that the degree of anxiety increased if they did not have a written contract (p=0.042) or persons to consult (p=0.034) and if they routinely checked the dose rate (p=0.046).

Conclusions:

Decontamination workers who do not have a written contract or who are in socially isolated situations have greater anxiety over radiation exposure. Thus, it is important to both create supportive human relationships for consultation and enhance labor management in individual companies.

Socioeconomic Position and Antidepressant Use as Predictors of Coronary Heart Disease Mortality: A Population-Based Registry Study of 362,271 Finns

OBJECTIVE

The interplay between depression and socioeconomic position (SEP) in predicting cardiovascular outcomes has rarely been examined. We investigated whether SEP modified the effect of antidepressant use on coronary heart disease (CHD) mortality.

METHODS

The data consisted of an 11% random sample of the Finnish population aged 40 to 79 years at the end of 1999 with an oversample of 80% of those who died in 2000 to 2007. Participants free of CHD at baseline (n = 362,271) were followed up for CHD mortality in 2000 to 2007. SEP was assessed via registry-based information on education, occupational position, and income. Antidepressant use served as a proxy for depression and was derived from registry data on prescription medication purchases in the 5-year period preceding baseline. Age- and sex-adjusted Cox regression models with sampling weights were used.

RESULTS

Individuals with antidepressant purchases in any year 1995 to 1999 had a higher risk of CHD deaths (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.62-1.75) than did those without purchases. Basic level of education (HR = 2.09, 95% CI = 2.01-2.17), blue-collar occupations (HR = 1.70, 95% CI = 1.65-1.75), and the lowest income tertile (HR = 2.79, 95% CI = 2.69-2.91) were related to increased relative risks for CHD mortality. No significant (p < .05) interactions emerged between the SEP indicators and antidepressant purchases indicating that the effect of antidepressant use on the relative risk for CHD was similar across varying levels of SEP.

CONCLUSIONS

Our study demonstrates that in a country with tax-funded universal health care services, low SEP does not exacerbate the adverse effects of depression-as measured by antidepressant treatment-on cardiovascular health.

Hair cortisol and self-reported stress in healthy, working adults

Chronic stress can be important in the pathology of chronic disease. Hair cortisol concentrations (HCC) are proposed to reflect long term cortisol secretion from exposure to stress. To date, inconsistencies in the relationship between HCC and self-reported stress have been attributed to variation and limitations of perceived stress measurement. We report data from employees of two large public sector worksites (n=132). Socio-demographic, health, lifestyle, perceived stress scale (PSS), and work-related effort reward imbalance (ERI) were collected at baseline. Participants were asked to respond to mobile text messages every two days, asking them to report current stress levels (Ecological momentary assessment, EMA), and mean stress was determined overall, during work hours, and out of work hours. At 12 weeks, the appraisal of stressful life events scale (ALES) was completed and 3 cm scalp hair samples were taken, from which HCC was determined (to reflect cortisol secretion over the past 12 weeks). Mean response rate to EMA was 81.9 ± 14.9%. Associations between HCC and the various self-reported stress measures (adjusted for use of hair dye) were weak (all<.3). We observed significant associations with HCC for EMA measured stress responses received out of work hours (ρ=.196, p=.013) and ALES Loss subscale (ρ=.241, p=.003), and two individual items from ERI (relating to future work situation). In regression analysis adjusting for other possible confounders, only the HCC-ALES Loss association remained significant (p=.011). Overall, our study confirms that EMA provides a useful measurement tool that can gather perceived stress measures in real-time. But, there was no relationship between self-reported stress collected in this way, and HCC. The modest association between HCC and stress appraisal does however, provide some evidence for the role of cognitive processes in chronic stress.

Association between job strain and risk of incident stroke: A meta-analysis

OBJECTIVE

Prospective cohort studies regarding job strain and the risk of stroke are controversial. This meta-analysis aimed to evaluate the association between job strain and the risk of stroke.

METHODS

The PubMed, Embase, and PsycINFO databases were searched for prospective cohort studies with data on job strain and the risk of stroke. Studies were included if they reported adjusted relative risks (RRs) with 95% confidence intervals (CIs) of stroke from job strain. Subgroup analyses were conducted according to sex and stroke type.

RESULTS

Six prospective cohort studies comprising 138,782 participants were included. High strain jobs were associated with increased risk of stroke (RR 1.22, 95% CI 1.01-1.47) compared with low strain jobs. The result was more pronounced for ischemic stroke (RR 1.58, 95% CI 1.12-2.23). The risk of stroke was significant in women (RR 1.33, 95% CI 1.04-1.69) and nonsignificant in men (RR 1.26, 95% CI 0.69-2.27), but the difference in RRs in sex subgroups was not significant. Neither active (RR 1.07, 95% CI 0.90-1.28) nor passive (RR 1.01, 95% CI 0.86-1.18) job characteristics were associated with an increased risk of stroke compared with low strain jobs.

CONCLUSIONS

Exposure to high strain jobs was associated with an increased risk of stroke, especially in women. Further studies are needed to confirm whether interventions to reduce work stress decrease the risk of stroke.

Perceived Job Stress and Presence of Hypertension Among Administrative Officers in Sri Lanka

A cross-sectional survey was carried out among 275 and 760 randomly selected senior officers (SOs) and managerial assistants (MAs) aged between 30 and 60 years. Sum of scores of efforts, rewards, and overcommitment and effort-reward ratio assessed job stress. Blood pressure was measured and classified using JNC-7 guidelines. The response rates of SOs and MAs were 98.9% and 97.2%, respectively. The prevalence of job stress based on high effort-rewards imbalance among SOs and MAs was 74.6% and 80.5%, respectively. The prevalence of overcommitment among SOs and MAs was 35.3% and 29%, respectively. Statistically significant differences (P = .05) were observed between the prevalence of effort-reward imbalance and overcommitment among SOs and MAs. Multivariate analysis indicated effort-reward imbalance (odds ratio [OR] = 2.8; 95% confidence interval [CI] = 1.1-7.4), high efforts (OR = 2.5; 95% CI = 1.2-5.3), and overcommitment (OR = 2.5; 95% CI = 1.1-5.6) were significantly associated with hypertension among SOs. Similarly, effort-reward imbalance and high efforts increased the risk of hypertension by 2-fold (OR = 2.2; 95% CI = 1.1-4.2) and 3-fold (OR = 3.02; 95% CI = 1.9-4.8), respectively, among the MAs. A significant number of administrators are afflicted by job stress, and job stress was significantly associated with hypertension.

Burnout among psychosocial oncologists: an application and extension of the effort-reward imbalance model

OBJECTIVES

Burnout is a significant problem among healthcare professionals working within the oncology setting. This study aimed to investigate predictors of emotional exhaustion (EE) and depersonalisation (DP) in psychosocial oncologists, through the application of the effort-reward imbalance (ERI) model with an additional focus on the role of meaningful work in the burnout process.

METHODS

Psychosocial oncology clinicians (n = 417) in direct patient contact who were proficient in English were recruited from 10 international psychosocial oncology societies. Participants completed an online questionnaire, which included measures of demographic and work characteristics, EE and DP subscales of the Maslach Burnout Inventory-Human Services Survey, the Short Version ERI Questionnaire and the Work and Meaning Inventory.

RESULTS

Higher effort and lower reward were both significantly associated with greater EE, although not DP. The interaction of higher effort and lower reward did not predict greater EE or DP. Overcommitment predicted both EE and DP but did not moderate the impact of effort and reward on burnout. Overall, the ERI model accounted for 33% of the variance in EE. Meaningful work significantly predicted both EE and DP but accounted for only 2% more of the variance in EE above and beyond the ERI model.

CONCLUSIONS

The ERI was only partially supported as a useful framework for investigating burnout in psychosocial oncology professionals. Meaningful work may be a viable extension of the ERI model. Burnout among health professionals may be reduced by interventions aimed at increasing self-efficacy and changes to the supportive work environment.

Associations between supportive leadership and employees self-rated health in an occupational sample

BACKGROUND

Protecting the health of the work force has become an important issue in public health research.

PURPOSE

This study aims to explore potential associations between supportive leadership style (SLS), an aspect of leadership behavior, and self-rated health (SRH) among employees.

METHOD

We drew on cross-sectional data from a cohort of industrial workers (n = 3,331), collected in 2009. We assessed employees' ratings of supportive, employee-oriented leadership behavior at their job, their SRH, and work stress as measured by the effort-reward model and scales measuring demands, control, and social support. Logistic regression estimated odds ratios (ORs) and corresponding 95 % confidence intervals (CIs) for the association between the perception of poor SLS and poor SRH controlling for work-related stress and other confounders. Sensitivity analyses stratified models by sex, age, and managerial position to test the robustness of associations.

RESULTS

Perception of poor SLS was associated with poor SRH [OR 2.39 (95 % CI 1.95-2.92)]. Although attenuated following adjustment for measures of work-related stress and other confounders [OR 1.60 (95 % CI 1.26-2.04)], the magnitude, direction, and significance of this association remained robust in stratified models in most subgroups.

CONCLUSION

SLS appears to be relevant to health in the workplace. Leadership behavior may represent a promising area for future research with potential for promoting better health in a large segment of the adult population.

The association between education and work stress: does the policy context matter?

OBJECTIVES

Several studies report socioeconomic differences in work stress, where people in lower socioeconomic positions (SEP) are more likely to experience this burden. In the current study, we analyse associations between education and work stress in a large sample of workers from 16 European countries. In addition we explore whether distinct national labour market policies are related to smaller inequalities in work stress according to educational attainment.

METHODS

We use data collected in 2010/11 in two comparative studies ('Survey of Health, Ageing and Retirement in Europe' and the 'English Longitudinal Study of Ageing'; N = 13695), with samples of men and women aged 50 to 64 from 16 European countries. We measure highest educational degree according to the international standard classification of education (ISCED) and assess work stress in terms of the demand-control and the effort-reward imbalance model. National labour market policies are measured on the basis of policy indicators which are divided into (1) 'protective' policies offering financial compensation to those excluded from the labour market (e.g. replacement rate), and (2) 'integrative' policies supporting disadvantaged individuals on the labour market (e.g. investments into active labour market policies or possibilities for further qualification in later life). In addition to country-specific analyses, we estimate multilevel models and test for interactions between the indicators of national policies and individual education.

RESULTS

Main findings demonstrate consistent associations between lower education and higher levels of work stress in all countries. The strength of this association, however, varies across countries and is comparatively small in countries offering pronounced 'integrative' policies, in terms of high investments into measures of an active labor market policy and high participation rates in lifelong learning activities.

CONCLUSIONS

Our results point to different types of policies that may help to reduce educational differences in work stress, in particular policies supporting those who are disadvantaged on the labour market.

Psychosocial stress at work and cardiovascular diseases: an overview of systematic reviews

Purpose

Based on information reported in systematic reviews (SRevs), this study aimed to find out whether psychosocial stress at work leads to cardiovascular (CV) morbidity and mortality.

Methods

A systematic search in PubMed and EMBASE (until 2014) used a string based on PICOS components. A manual search was followed. Applying the predefined criteria, two reviewers independently screened the titles, abstracts, selected full texts, and validated their quality. Discrepancies were resolved by discussion between reviewers. Studies of low quality were excluded. Contents of enrolled SRevs were extracted by one reviewer; a second reviewer evaluated their accurateness.

Results

The search resulted in 462 records. Six SRevs based on 81 studies (total population: ~1,468,670) fulfilled the inclusion criteria, four of “very good” (++) and two of “good” (+) quality. Excluded records were filed, and reasons for exclusion were documented in all cases. Different stress models were used to measure the work-related stress; the “demand-control model” was most commonly used. The two enrolled meta-analysis confirmed a modest (1.32, 95 % CI 1.09–1.59; Virtanen et al. 2013) to moderate evidence (1.45, 95 % CI 1.15–1.84; Kivimäki et al. 2006), predominantly among men, for the association between psychosocial stress at work and CV outcomes. Due to lacking information, it was not possible to give evidence on the dose–response relationship.

Conclusions

Same to a SRev, an overview of SRev is used to summarize literature and identify areas in which research is needed. This overview can be used to: (a) Disseminate an up-to-date information on work-related stress as a risk factors for CV morbidity and mortality to government, health care providers, workers, and other stakeholders; (b) Encourage governments to better regulate the working conditions and consider work-related psychosocial stress as a hazardous factor that leads to CV diseases or mortality; and (c) Analyze gaps in the literature and provide a summary of research needs.

Working conditions and effort-reward imbalance of German physicians in Sweden respective Germany: a comparative study

OBJECTIVE

Work stress among physicians is a growing concern in various countries and has led to migration. We compared the working conditions and the work stress between a migrated population of German physicians in Sweden and a population of physicians based in Germany. Additionally, specific risk factors for work stress were examined country wise.

METHOD

Using a cross-sectional design, 85 German physicians employed in Sweden were surveyed on working conditions and effort-reward imbalance and compared with corresponding data on 561 physicians working in Germany. Multiple linear regression analyses were applied on both populations separately to model the associations between working conditions and effort-reward ratio (ERR), adjusted for a priori confounders.

RESULTS

German physicians in Sweden had a significantly lower ERR than physicians in Germany: mean (M) = 0.47, standard deviation (SD) = 0.24 vs. M = 0.80, SD = 0.35. Physicians in Sweden worked on average 8 h less per week and reported higher work support and responsibility. Multivariate analyses showed in both populations a negative association between work support and the ERR (β = -0.148, 95% CI -0.215 to (-0.081) for physicians in Sweden and β = -0.174, 95% CI -0.240 to (-0.106) for physicians in Germany). Further significant associations with the ERR were found among physicians in Sweden for daily breaks (β = -0.002, 95% CI -0.004 to (-0.001)) and among physicians in Germany for working hours per week (β = 0.006, 95% CI 0.002-0.009).

CONCLUSION

Our findings show substantial differences in work stress and working conditions in favor of migrated German physicians in Sweden. To confirm our results and to explain demonstrated differences in physicians' work stress, longitudinal studies are recommended.

Work organization, job insecurity, and occupational health disparities

BACKGROUND

Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status.

METHODS

A conceptual model was developed to guide the review of 103 relevant articles or chapters on the role of work organization and occupational health disparities identified through a comprehensive search conducted by NIOSH. A second review was conducted of employment and workplace policies and programs designed to reduce the health and safety risks due to job insecurity and other work organization hazards.

RESULTS

There is consistent evidence that workers in lower socioeconomic or social class positions are exposed to greater job insecurity and other work organization hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic minorities and immigrants are exposed to greater job insecurity. Limited research examining the effects of interventions targeting work organization hazards on disparities has been conducted; nonetheless, intervention strategies are available and evidence suggests they are effective.

CONCLUSIONS

Job insecurity and work organization hazards play a role in creating and sustaining occupational health disparities. Employment and workplace policies and programs have the potential to reduce these hazards, and to reduce disparities.

Psychosocial factors at work and the development of mobility limitations among adults in Denmark

AIM

Psychosocial factors in the working environment have been shown to be associated with mobility limitations, but this has not yet been confirmed in a Danish population. We aimed to examine how psychosocial factors at work are related to developing mobility limitations in Denmark.

METHODS

This study is based on data from 2952 middle-aged men and women without mobility limitations in 2000.

RESULTS

We found increased risk of incident mobility limitations during 6-year follow up among men who often perceived high work pace (OR 5.45, 95% CI 1.21-24.52) vs. never, who only sometimes or/never perceived the work to be meaningful (OR 6.54, 95% CI 1.55-27.55) vs. always, and who sometimes perceived high emotional demands at work (OR 7.85, 95% CI 1.78-34.65) vs. never. Among women, lower risk of incident mobility limitations was observed among those who in 2000 perceived high work pace sometimes (OR 0.46, 95% CI 0.24-0.87) or often (OR 0.43, 95% CI 0.22-0.85) vs. never in 2000. Also, women who always or often experienced high emotional demands had an increased risk.

CONCLUSIONS

The most important finding was that high work pace was strongly associated with increased risk of mobility limitations among men, but associated with lower risk of mobility limitations among women. This knowledge may be used to better target interventions among men and women in midlife from physical deterioration later in life.

Longitudinal measurement invariance of the effort-reward imbalance scales in the Young Finns study

OBJECTIVES

In order to make valid conclusions about individual change in work-related risk factors it is important to examine whether these factors are measurement invariant over time. We tested the measurement invariance of the effort-reward imbalance (ERI) scales using the ERI Questionnaire (ERI-Q). Additionally, we examined the criterion validity of the ERI scales.

METHODS

The sample used in this study was population-based and comprised 2128 participants (56.6% women) in full-time employment. Data on effort, reward and self-reported general stress were collected in 2007 and 2012. Measurement invariance was assessed separately for the effort and reward scales, with reward treated as a first-order and as a second-order variable. Criterion validity of the ERI scales was also examined using a single-item measure of general stress.

RESULTS

Effort and reward were found to be measurement invariant over time, that is, they measured the same latent variable across both time points. Furthermore, ERI and its components showed adequate criterion validity, and effort was additionally found to prospectively predict general stress 5 years later (β=0.072, 95% CI 0.013 to 0.131).

CONCLUSIONS

Our results indicate that changes in the scores of the ERI scales are more likely caused by changes in perceptions of work characteristics than by changes in the construct of the scales. Additionally, the results support the criterion validity of ERI and its components.

Musculoskeletal pain and effort-reward imbalance--a systematic review

Background

Musculoskeletal pain may be triggered by physical strains and psychosocial risk factors. The effort-reward imbalance model (ERI model) is a stress model which measures psychosocial factors in the working world. The question is whether workers with an effort-reward imbalance report musculoskeletal pain more frequently than those with no effort-reward imbalance. A systematic review using a best evidence synthesis approach was conducted to answer this question.

Methods

A literature search was conducted for the period from 1996 to 2012, using three databases (Pubmed, Embase and PsycINFO). The research criteria related to psychosocial, work-related stress as per the ERI model and to musculoskeletal pain. A quality score was developed using various quality criteria to assess the standard of the studies. The level of evidence was graded as in (Am J Ind Med 39:180–193, 2001).

Results

After applying the inclusion criteria, a total of 19 studies were included in the review: 15 cross-sectional studies, three prospective studies and one case–control study. 74% of all studies exhibited good methodological quality, 53% collected data using the original ERI questionnaire, and in 42% of the studies, there was adequate control for physical working conditions. Furthermore, different cut-off points were used to classify exposed and non-exposed individuals. On the basis of 13 studies with a positive, statistically significant association, a moderate level of evidence was inferred for the association between effort-reward imbalance and musculoskeletal pain. The evidence for a role of over-commitment and for its interaction with effort-reward imbalance was rated as inconclusive - on the basis of eight and five studies, respectively.

Conclusions

On the basis of the available evidence, no reliable conclusion may be drawn about any association between the psychosocial factors ascertained using the ERI model and musculoskeletal pain. Before a reliable statement can be made on the association between ERI and musculoskeletal pain, additional longitudinal studies must be performed - with a standardised method for recording and classifying exposure, as well as control of physical confounders. Appropriate preventive measures can then be specified.

Work stress and quality of life in persons with disabilities from four European countries: the case of spinal cord injury

BACKGROUND

Evidence on the adverse effects of work stress on quality of life (QoL) is largely derived from general populations, while respective information is lacking for people with disabilities. We investigated associations between work stress and QoL and the potentially moderating role of socioeconomic circumstances in employed persons with spinal cord injury (SCI).

METHODS

Cross-sectional data from 386 employed men and women with SCI (≥18 work h/week) from the Netherlands, Switzerland, Denmark, and Norway were analyzed. Work stress was assessed with the 'effort-reward imbalance' (ERI) model and the control component of the 'demand/control' model. QoL was operationalized with five WHOQoL BREF items. Socioeconomic circumstances were measured by years of formal education and perception of financial hardship. We applied ordinal and linear regressions to predict QoL and introduced interaction terms to assess a potential moderation of socioeconomic circumstances.

RESULTS

Multivariate analyses showed consistent associations between increased ERI and decreased overall QoL (coefficient -1.55, p < 0.001), domain-specific life satisfaction (health -1.32, p < 0.001; activities of daily living -1.28, p < 0.001; relationships -0.84, p = 0.004; living conditions -1.05, p < 0.001), and the QoL sum score (-2.40, p < 0.001). Low job control was linked to decreased general QoL (0.13, p = 0.015), satisfaction with relationships (0.15, p = 0.004), and QoL sum score (0.15, p = 0.029). None of the tested interaction terms were significant.

CONCLUSION

ERI was consistently related to all indicators of QoL, while associations with job control were less consistent. Our results do not support the notion that unfavorable socioeconomic circumstances moderate the association between work stress and QoL among persons with SCI.

The effects of stress on physical activity and exercise

BACKGROUND

Psychological stress and physical activity (PA) are believed to be reciprocally related; however, most research examining the relationship between these constructs is devoted to the study of exercise and/or PA as an instrument to mitigate distress.

OBJECTIVE

The aim of this paper was to review the literature investigating the influence of stress on indicators of PA and exercise.

METHODS

A systematic search of Web of Science, PubMed, and SPORTDiscus was employed to find all relevant studies focusing on human participants. Search terms included "stress", "exercise", and "physical activity". A rating scale (0-9) modified for this study was utilized to assess the quality of all studies with multiple time points.

RESULTS

The literature search found 168 studies that examined the influence of stress on PA. Studies varied widely in their theoretical orientation and included perceived stress, distress, life events, job strain, role strain, and work-family conflict but not lifetime cumulative adversity. To more clearly address the question, prospective studies (n = 55) were considered for further review, the majority of which indicated that psychological stress predicts less PA (behavioral inhibition) and/or exercise or more sedentary behavior (76.4 %). Both objective (i.e., life events) and subjective (i.e., distress) measures of stress related to reduced PA. Prospective studies investigating the effects of objective markers of stress nearly all agreed (six of seven studies) that stress has a negative effect on PA. This was true for research examining (a) PA at periods of objectively varying levels of stress (i.e., final examinations vs. a control time point) and (b) chronically stressed populations (e.g., caregivers, parents of children with a cancer diagnosis) that were less likely to be active than controls over time. Studies examining older adults (>50 years), cohorts with both men and women, and larger sample sizes (n > 100) were more likely to show an inverse association. 85.7 % of higher-quality prospective research (≥ 7 on a 9-point scale) showed the same trend. Interestingly, some prospective studies (18.2 %) report evidence that PA was positively impacted by stress (behavioral activation). This should not be surprising as some individuals utilize exercise to cope with stress. Several other factors may moderate stress and PA relationships, such as stages of change for exercise. Habitually active individuals exercise more in the face of stress, and those in beginning stages exercise less. Consequently, stress may have a differential impact on exercise adoption, maintenance, and relapse. Preliminary evidence suggests that combining stress management programming with exercise interventions may allay stress-related reductions in PA, though rigorous testing of these techniques has yet to be produced.

CONCLUSIONS

Overall, the majority of the literature finds that the experience of stress impairs efforts to be physically active. Future work should center on the development of a theory explaining the mechanisms underlying the multifarious influences of stress on PA behaviors.

Systematic review of the evidence of a relationship between chronic psychosocial stress and C-reactive protein

INTRODUCTION

C-reactive protein (CRP) is an acute-phase reactant with an increasing number of clinical functions. Studies in recent years have identified several social, economic, demographic, and psychological factors that contribute to baseline inflammation. Psychosocial stress represents a significant contributor to baseline inflammation. Given the importance of understanding background drivers of CRP levels, we conducted this review to assess the impact of chronic psychosocial stress on CRP levels.

METHODS

Medline was searched through February 2013 for human studies examining CRP levels with respect to chronic psychosocial stress.

RESULTS

The initial search identified 587 articles from which 129 potentially appropriate articles were reviewed. Of these 129 articles, 41 articles were included in the review. These studies were published between 2003 and 2013. Of these studies, 6 analyzed employment stress, 2 analyzed unemployment stress, 6 analyzed burnout and vital exhaustion, 6 analyzed caregiver stress, 3 analyzed interpersonal stress, 17 analyzed socioeconomic position, and 2 analyzed discrimination.

CONCLUSION

We conclude that psychosocial stress significantly impacts CRP and should be considered when interpreting the meaning of CRP elevations.

Coronary Heart Disease and Emotional Intelligence

BACKGROUND

Coronary Heart Disease (CHD) is associated with emotions, especially negative ones, namely anxiety and depression. Emotional Intelligence (EI) is a psychological model that consists of a variety of emotional skills.

AIMS

The aim of the present study was to examine the relation between different dimensions of Emotional Intelligence and coronary heart disease.

METHODS

A total of 300 participants were studied during a 3-year period in an attempt to partially replicate and further expand a previous study conducted in Greece among CHD patients, which indicated a strong association between certain dimensions of Emotional Intelligence and the incidence of CHD. All participants completed a self-report questionnaire, assessing several aspects of Emotional Intelligence.

FINDINGS

The results showed that there is a link between the regulation of emotions and the occurrence of CHD.

CONCLUSIONS

The evidence reported in the present study makes stronger the claim that EI plays a significant role in the occurrence of CHD.

Optimum cut-off point of the Japanese short version of the effort-reward imbalance questionnaire

OBJECTIVES

The theoretical threshold (effort-reward ratio >1.0) may not be ideal for the Japanese short version of the effort-reward imbalance (ERI) questionnaire. We aimed to seek the optimum cut-off point.

METHODS

We administered the original and short versions of the ERI questionnaire with a psychological distress scale to randomly selected workers (n=1,489) in a web-based survey. We evaluated kappa statistics and conducted receiver operating characteristics curve analyses. Cut-off values of the short version effort-reward ratios at 0.1 intervals in the range of 1.0-1.9 were tested using the criterion of an effort-reward ratio >1.0 for the original version.

RESULTS

The short version questionnaire had acceptable reliabilities. When using the theoretical cut-off point, the prevalence of high-risk groups was 63.2% for the short version compared with 18.9% for the original version, and their agreement was slight. Kappa agreements and receiver operating characteristics curve analyses suggested that a short-version effort-reward ratio of around 1.3 and 1.4 was the most equivalent to the original criterion. Regression equation procedures supported the findings, and ERI defined by the cut-off values showed significant associations with an external criterion (psychological distress) with minimal estimation error. Because the highest but only moderate kappa agreements with the risk group defined by the original criterion were obtained when setting 1.4-1.6 as the cut-offs, we considered >1.4 as optimal.

CONCLUSIONS

This empirical investigation suggests the cut-off value of >1.4 for the Japanese short version of the ERI questionnaire screens out the ERI group with the most compatibility with the original version.

Effort–Reward Imbalance among Nurses in Stable Countries and in Countries in Transition

The effort-reward imbalance (ERI) model was used to analyze burnout and intention to leave the nursing profession (ITL) in nurses (n = 21,229) in seven European countries, as part of the NEXT-Study. Data were gathered using the short form of the ERI questionnaire. Burnout was assessed using the Copenhagen Burnout Inventory. Multivariate logistic regression analysis controlled for age and gender. ERI was very high in Poland, Germany, Italy, and Slovakia. High ERI was associated with burnout. Odds ratios (ORs) ranged from 2.6 to 13.2 for ERI and from 3.0 to 5.5 for overcommitment (OC). Nurses with high ERI also had high ORs for ITL (2.6-5.7). The association of OC and ITL was weaker (1.1-1.7). The strong and consistent associations of ERI model results with psychological health and with ITL support the relevance of the model for examining different outcome levels. Nurses in transitional countries, as expected, experienced high ERI. High ERI in stable countries suggests that their economic sectors, particularly health care, may be in transition.

Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study

AIM

Response to stress can vary greatly between individuals. However, it remains unknown whether perceived impact of stress on health is associated with adverse health outcomes. We examined whether individuals who report that stress adversely affects their health are at increased risk of coronary heart disease (CHD) compared with those who report that stress has no adverse health impact.

METHODS AND RESULTS

Analyses are based on 7268 men and women (mean age: 49.5 years, interquartile range: 11 years) from the British Whitehall II cohort study. Over 18 years of follow-up, there were 352 coronary deaths or first non-fatal myocardial infarction (MI) events. After adjustment for sociodemographic characteristics, participants who reported at baseline that stress has affected their health 'a lot or extremely' had a 2.12 times higher (95% CI 1.52-2.98) risk of coronary death or incident non-fatal MI when compared with those who reported no effect of stress on their health. This association was attenuated but remained statistically significant after adjustment for biological, behavioural, and other psychological risk factors including perceived stress levels, and measures of social support; fully adjusted hazard ratio: 1.49 (95% CI 1.01-2.22).

CONCLUSIONS

In this prospective cohort study, the perception that stress affects health, different from perceived stress levels, was associated with an increased risk of coronary heart disease. Randomized controlled trials are needed to determine whether disease risk can be reduced by increasing clinical attention to those who complain that stress greatly affects their health.

Work characteristics, socioeconomic position and health: a systematic review of mediation and moderation effects in prospective studies

Social inequalities in health persist in modern societies. The contribution of adverse work and employment conditions towards their explanation is analysed by two approaches, mediation and moderation. Yet the relative significance of each approach remains unclear in respective research. We set out to study this question by conducting a systematic literature review. We included all original papers based on prospective observational studies of employed cohorts that were published between January 1980 and October 2012 meeting our search criteria, by using major databases and by observing established quality criteria. 26 reports were included after quality assessment. 17 studies examined the mediation hypothesis and nine studies tested the moderation hypothesis. Moderate support was found for the mediation hypothesis where OR or HR of health according to socioeconomic position (SEP) were reduced in a majority of analyses after introducing work characteristics in multivariate models. Evidence in favour of the moderation hypothesis was found in some studies, demonstrating stronger effects of adverse work on health among people with low SEP. Despite some support in favour of the two hypotheses future research should aim at reducing the heterogeneity in defining and measuring core variables and at applying advanced statistical analyses. Policy recommendations would benefit from a higher degree of consistency of respective research evidence.

[Assessment of the risk of ischemic heart disease and its relevant factors among Japanese police officers]

OBJECTIVES

Compared to other public employees, police officers have higher absence rates due to heart diseases, and ischemic heart disease (IHD) is one of the most frequent causes of death in their occupational life. The aim of this study was to investigate the prevalence of the risk factors for IHD among police officers and to examine its association with working conditions and lifestyles.

METHODS

First, 58 male police officers who developed IHD from 1996 to 2011 and 116 age- and rank-matched controls who were free from cerebro- and cardiovascular diseases were compared with respect to the prevalence of traditional risk factors five years before the onset of IHD. Then, the prevalence of IHD risk factors, and the frequency of metabolic syndrome (MetS) by age group, working condition and lifestyle were investigated in a cross-sectional survey of data of 1,539 male police officers and 153 male office workers in a prefectural police force.

RESULTS

In the case control study, the IHD cases had significantly higher prevalences of hypertension (p<0.001), hyper-LDL-cholesterolemia (p<0.05), glucose intolerance (p<0.05), and hyperuricemia (p<0.05) before the onset of IHD. Multiple logistic regression analysis revealed that hypertension (odds ratio [95% confidence interval] : 3.96 [1.82-8.59]), glucose intolerance (3.28 [1.34-8.03]), hypo-HDL-cholesterolemia (2.26 [1.03-4.97]), and hyper-LDL-cholesterolemia (2.18 [1.03-4.61]) were independently associated with the development of IHD (model chi-square, p<0.001; correct classification rate, 77.0%). In the cross sectional analyses, among the police officers, abdominal obesity (waist circumference of ≥ 85 cm) was significantly more frequent (57.3% vs. 35.3%, p<0.001) and the prevalence of dyslipidemia and glucose intolerance increased with age more remarkably than in the general office workers. In the age-group of 45-59 years, the clustering number of risk factors in individuals (1.8 vs. 1.4, p<0.01) and the frequency of MetS (25.0 vs. 15.5, p<0.1) were greater in the police officers than the office workers. Among the police officers, subjects with MetS had significantly higher rates of shift work (33.6% vs. 25.4%, p<0.01), lack of sound sleep (42.5% vs. 33.7%, p<0.01), and heavy drinking (12.8 vs. 6.3%, p<0.01) than those without MetS.

CONCLUSIONS

In this study, the development of IHD in police officers was significantly associated with traditional risk factors, especially with hypertension, dyslipidemia and glucose intolerance. The increase with age of the prevalence of IHD risk factors and the frequency of MetS were greater in police officers than office workers. Irregular working conditions, such as shift work, long working time, and unfavorable lifestyles, e.g. alcohol drinking and poor sleeping conditions, may influence the higher prevalence of risk factors for IHD in police officers.

Low socioeconomic status and psychological distress as synergistic predictors of mortality from stroke and coronary heart disease

BACKGROUND

The purpose of this study was to test whether lower socioeconomic status (SES) augments the effect of psychological distress on mortality from stroke or coronary heart disease (CHD).

METHODS

We prospectively linked data from 66,500 participants 35 years or older in the Health Survey for England, selected using stratified random sampling from 1994 to 2004, and free of cardiovascular disease and cancer at baseline, with mortality records. The median follow-up time was 7.9 years. SES was indexed by occupational class, and psychological distress was assessed using the 12-item General Health Questionnaire (GHQ-12).

RESULTS

After adjustment for demographic and clinical variables, both psychological distress and low SES were associated with increased mortality: the hazard ratios (HR) for one-category increase in low SES (three categories in total) were 1.15 for stroke-death (95% confidence interval [CI] = 1.00-1.31, p = .043) and 1.24 for CHD-death (95% CI = 1.09-1.41, p = .001); the HR for one-category increase in GHQ-12 (three categories in total) was 1.18 for stroke-death (95% CI = 1.07-1.30, p = .001) and 1.24 for CHD-death (95% CI = 1.13-1.36, p < .001). In stratified analyses, the strongest associations were found in the lowest SES categories: the HR for GHQ-12 toward stroke-death was 1.15 in high-SES participants (95% CI = 0.97-1.37, p = .107) and 1.31 in low-SES ones (95% CI = 1.13-1.51, p < .001); the HR for GHQ-12 toward CHD-death was 1.10 in high-SES participants (95% CI = 0.97-1.25, p = .129) and 1.33 in low-SES ones (95% CI = 1.19-1.48, p < .001).

CONCLUSIONS

People in low socioeconomic circumstances are more vulnerable to the adverse effect of psychological distress. This pattern should be taken into account when evaluating the association between psychosocial variables and health outcomes.

Psychosocial work environment factors and weight change: a prospective study among Danish health care workers

Background

Lifestyle variables may serve as important intermediate factors between psychosocial work environment and health outcomes. Previous studies, focussing on work stress models have shown mixed and weak results in relation to weight change. This study aims to investigate psychosocial factors outside the classical work stress models as potential predictors of change in body mass index (BMI) in a population of health care workers.

Methods

A cohort study, with three years follow-up, was conducted among Danish health care workers (3982 women and 152 men). Logistic regression analyses examined change in BMI (more than +/− 2 kg/m²) as predicted by baseline psychosocial work factors (work pace, workload, quality of leadership, influence at work, meaning of work, predictability, commitment, role clarity, and role conflicts) and five covariates (age, cohabitation, physical work demands, type of work position and seniority).

Results

Among women, high role conflicts predicted weight gain, while high role clarity predicted both weight gain and weight loss. Living alone also predicted weight gain among women, while older age decreased the odds of weight gain. High leadership quality predicted weight loss among men. Associations were generally weak, with the exception of quality of leadership, age, and cohabitation.

Conclusion

This study of a single occupational group suggested a few new risk factors for weight change outside the traditional work stress models.

Job strain, effort-reward imbalance and neck, shoulder and wrist symptoms among Chinese workers

The purpose of this study was to examine the association between psychosocial job stress (by the Job Control-Demand (JCD) model and Effort-Reward imbalance (ERI) model) and musculoskeletal (MS) symptoms among workers in China. Overall, 3,632 male and 1,706 female workers from 13 factories/companies participated in this study. Perceived job stress was evaluated by the Chinese version of the Job Content Questionnaire (JCQ) and ERI Questionnaire. Neck, shoulder and wrist symptoms were assessed by self-report during the past year. Workers reporting high job demands and low job control or high effort and low rewards had moderately increased risk for all MS symptoms. Odds ratios (ORs) were higher in workers reporting both high effort and low rewards. The combination of high physical job demands with low job control showed significant associations with MS symptoms. The effects of psychological demands on symptoms in women, effort and effort-reward imbalance on symptoms among both genders were increased as the number of regions with symptoms increased. These results suggest that high job strain and ERI are associated with neck, shoulder and wrist symptoms in Chinese factory workers independent of individual factors, physical factors, and other psychological variables.

A cross-sectional study of the relationship between job demand-control, effort-reward imbalance and cardiovascular heart disease risk factors

BACKGROUND

This cross-sectional study explored relationships between psychosocial work environment, captured by job demand-control (JDC) and effort-reward imbalance (ERI), and seven cardiovascular heart disease (CHD) risk factors in a general population.

METHOD

The sampled consists of randomly-selected men and women from Gothenburg, Sweden and the city's surrounding metropolitan areas. Associations between psychosocial variables and biomarkers were analysed with multiple linear regression adjusted for age, smoking, education and occupational status.

RESULTS

The study included 638 men and 668 women aged 24-71. Analysis between JDC and CHD risk factors illustrated that, for men, JDC was associated with impaired scores in several biomarkers, especially among those in high strain jobs. For women, there were no relationships between JDC and biomarkers. In the analysis of links between ERI and CHD risk factors, most associations tested null. The only findings were raised triglycerides and BMI among men in the fourth quartile of the ERI-ratio distribution, and lowered LDL-cholesterol for women. An complementary ERI analysis, combining high/low effort and reward into categories, illustrated lowered triglycerides and elevated HDL-cholesterol values among women reporting high efforts and high rewards, compared to women experiencing low effort and high reward.

CONCLUSIONS

There were some associations between psychosocial stressors and CHD risk factors. The cross-sectional design did not allow conclusions about causality but some results indicated gender differences regarding sensitivity to work stressors and also how the models might capture different psychosocial dimensions.

Validation of a short measure of effort-reward imbalance in the workplace: evidence from China

OBJECTIVES

Work stress is an emergent risk in occupational health in China, and its measurement is still a critical issue. The aim of this study was to examine the reliability and validity of a short version of the effort-reward imbalance (ERI) questionnaire in a sample of Chinese workers.

METHODS

A community-based survey was conducted in 1,916 subjects aged 30-65 years with paid employment (971 men and 945 women).

RESULTS

Acceptable internal consistencies of the three scales, effort, reward and overcommitment, were obtained. Confirmatory factor analysis showed a good model fit of the data with the theoretical structure (goodness-of-fit index = 0.95). Evidence of criterion validity was demonstrated, as all three scales were independently associated with elevated odds ratios of both poor physical and mental health.

CONCLUSIONS

Based on the findings of our study, this short version of the ERI questionnaire is considered to be a reliable and valid tool for measuring psychosocial work environment in Chinese working populations.

Perceived unfairness and socioeconomic inequalities in functional decline: the Dutch SMILE prospective cohort study

Background

People in lower socioeconomic positions report worse health-related functioning. Only few examined whether perceptions of unfairness are particularly common in these people and whether this perceived unfairness relates to their subsequent poor health outcomes. We thus set out to examine the contribution of perceived unfairness to the higher risks of physical and mental dysfunction in men and women with a lower socioeconomic position.

Methods

Seven-year prospective cohort data from the Dutch SMILE study among 1,282 persons, 55 years old and older, were used. Physical and mental health-related functioning was measured with the SF-36, socioeconomic status with income and education, and the perception of unfairness with an extended new measure asking for such perceptions in both work and non-work domains.

Results

Perceived unfairness was more common in lower socioeconomic positions. Such perpection was related to both physical (odds ratio = 1.57 (95% confidence interval: 1.17-2.11)) and mental (1.47 (1.07-2.03)) decline, while low socioeconomic position was only related to mental decline (1.33 (1.06-1.67)). When socioeconomic position and perceived unfairness were simultaneously controlled, odds ratios for both determinants decreased only very little. Socioeconomic position and perceived unfairness were for the largest part independently related to longitudinal health-related decline.

Conclusions

The general perception of unfairness, at work and beyond work, might have implications for functional decline in middle and older age. We recommend that – rather than addressing and changing individual perceptions of unfairness – more research is needed to find out whether specific environments can be defined as unfair and whether such environments can be effectively tackled in an attempt to truly improve public health.

Effort-reward imbalance and quality of life of healthcare workers in military hospitals: a cross-sectional study

Background

Taiwan’s National Defense Bureau has been merging its hospitals and adjusting hospital accreditation levels since the beginning of 2006. These changes have introduced many stressors to the healthcare workers in these hospitals. This study investigates the association between job stress, psychological morbidity and quality of life in healthcare workers in three military hospitals.

Methods

We posted surveys to 1269 healthcare workers in three military hospitals located in southern Taiwan. The surveys included the General Health Questionnaire (GHQ), the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), and the Effort-Reward Imbalance (ERI) Questionnaire. High effort-reward (ER) ratio and overcommitment were defined when scores fell into the upper tertile of the total distribution.

Results

The survey was completed by 791 healthcare workers. On average, women reported a higher ERI than men. High ERI was associated with younger age, higher psychological morbidity, and poor physical and psychological QOL domains in this population. High ER ratio and high overcommitment were associated with psychological morbidity and poor QOL in both sexes. However, high ER ratio was not significantly associated with the social QOL domain in either sexes or the physical QOL domain in males.

Conclusions

There was a clear association between ERI and QOL in the healthcare workers in the military hospitals under reorganization and accreditation in this study. We found ER ratio and overcommitment to be suitable indicators of job stress.

Psychometric properties and differential explanation of a short measure of effort-reward imbalance at work: a study of industrial workers in Germany

BACKGROUND

We test the psychometric properties of a short version of the Effort-Reward Imbalance (ERI) questionnaire in addition to testing an interaction term of this model's main components on health functioning.

METHODS

A self-administered survey was conducted in a sample of 2,738 industrial workers (77% men with mean age 41.6 years) from a large manufacturing company in Southern Germany. The internal consistency reliability, structural validity, and criterion validity were analyzed.

RESULTS

Satisfactory internal consistencies of the three scales: "Effort", "reward", and "overcommitment", were obtained (Cronbach's alpha coefficients 0.77, 0.82, and 0.83, respectively). Confirmatory factor analysis showed a good model fit of the data with the theoretical structure (AGFI = 0.94, RMSEA = 0.060). Evidence of criterion validity was demonstrated. Importantly, a significant synergistic interaction effect of ERI and overcommitment on poor mental health functioning was observed (odds ratio 6.74 (95% CI 5.32-8.52); synergy index 1.78 (95% CI 1.25-2.55)).

CONCLUSIONS

This short version of the ERI questionnaire is a reliable and valid tool for epidemiological research on occupational health.