A longitudinal study comparing the effort - reward imbalance and demand - control models using objective measures of physician utilization

Reciprocity and job mobility: The effect of effort-reward imbalance in the employer-employee relationship on turnover intentions and actual job changes

Numerous studies illustrate that a lack of reciprocity between effort and reward in the employer-employee relationship produces negative effects on employees' health and well-being. This might motivate employees to change jobs as a consequence. Based on German panel data with 16,243 observations from 4,641 employees, I analyze the effect of effort-reward imbalance (ERI) on turnover intentions and actual job changes and whether health-threatening ERI exposure affects the realization of job changes. The results indicate more frequent doctor visits, lower job satisfaction, higher turnover intentions, and higher job change probabilities when employees' efforts in relation to rewards increase. The ERI effects on turnover intentions and job changes are both mediated through job satisfaction. Finally, I find no evidence that ERI exposure moderates the relationship between turnover intentions and actual job changes.

Using the Job Burden-Capital Model of Occupational Stress to Predict Depression and Well-Being among Electronic Manufacturing Service Employees in China

BACKGROUND

This study aimed to identify the association between occupational stress and depression-well-being by proposing a comprehensive and flexible job burden-capital model with its corresponding hypotheses.

METHODS

For this research, 1618 valid samples were gathered from the electronic manufacturing service industry in Hunan Province, China; self-rated questionnaires were administered to participants for data collection after obtaining their written consent. The proposed model was fitted and tested through structural equation model analysis.

RESULTS

Single-factor correlation analysis results indicated that coefficients between all items and dimensions had statistical significance. The final model demonstrated satisfactory global goodness of fit (CMIN/DF = 5.37, AGFI = 0.915, NNFI = 0.945, IFI = 0.952, RMSEA = 0.052). Both the measurement and structural models showed acceptable path loadings. Job burden and capital were directly associated with depression and well-being or indirectly related to them through personality. Multi-group structural equation model analyses indicated general applicability of the proposed model to basic features of such a population. Gender, marriage and education led to differences in the relation between occupational stress and health outcomes.

CONCLUSIONS

The job burden-capital model of occupational stress-depression and well-being was found to be more systematic and comprehensive than previous models.

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.

Race-based job discrimination, disparities in job control, and their joint effects on health

OBJECTIVES

To examine disparities between job control scores in Black and White subjects and attempt to discern whether self-rated low job control in Blacks may arise from structural segregation into different jobs, or represents individual responses to race-based discrimination in hiring or promotion.

METHODS

Data from the National Survey of Midlife in the United States (MIDUS) were analyzed by mixed-effects linear regression and variance regression to determine the effects of grouping by occupation, and racial discrimination in hiring or promotion, on control scores from the Job Content Questionnaire in Black and White subjects. Path analyses were constructed to determine the mediating effect of discrimination on pathways from education and job control to self-rated health.

RESULTS

Black subjects exhibited lower mean job control scores compared to Whites (mean score difference 2.26, P < 0.001) adjusted for age, sex, education, and income. This difference narrowed to 1.86 when adjusted for clustering by occupation, and was greatly reduced by conditioning on race-based discrimination (score difference 1.03, P = 0.12). Path analyses showed greater reported discrimination in Blacks with increasing education, and a stronger effect of job control on health in Black subjects.

CONCLUSIONS

Individual racially-based discrimination appears a stronger determinant than structural segregation in reduced job control in Black workers, and may contribute to health disparities consequent on work.

Job strain, health and sickness absence: results from the Hordaland Health Study

OBJECTIVES

While it is generally accepted that high job strain is associated with adverse occupational outcomes, the nature of this relationship and the causal pathways involved are not well elucidated. We aimed to assess the association between job strain and long-term sickness absence (LTSA), and investigate whether any associations could be explained by validated health measures.

METHODS

Data from participants (n = 7346) of the Hordaland Health Study (HUSK), aged 40-47 at baseline, were analyzed using multivariate Cox regression to evaluate the association between job strain and LTSA over one year. Further analyses examined whether mental and physical health mediated any association between job strain and sickness absence.

RESULTS

A positive association was found between job strain and risk of a LTSA episode, even controlling for confounding factors (HR = 1.64 (1.36-1.98); high job strain exposure accounted for a small proportion of LTSA episodes (population attributable risk 0.068). Further adjustments for physical health and mental health individually attenuated, but could not fully explain the association. In the fully adjusted model, the association between high job strain and LTSA remained significant (HR = 1.30 (1.07-1.59)).

CONCLUSION

High job strain increases the risk of LTSA. While our results suggest that one in 15 cases of LTSA could be avoided if high job strain were eliminated, we also provide evidence against simplistic causal models. The impact of job strain on future LTSA could not be fully explained by impaired health at baseline, which suggests that factors besides ill health are important in explaining the link between job strain and sickness absence.

The interaction effect of effort-reward imbalance and overcommitment on hypertension among Chinese workers: findings from SHISO study

BACKGROUND

No previous studies investigated the interaction of effort-reward imbalance (ERI) and overcommitment on blood pressure. Our aim was to investigate associations of ERI and overcommitment (and their interaction) with blood pressure and hypertension within a Chinese population.

METHODS

Seven hundred thirty-four participants from the Stress and Health in Shenzhen Workers study completed a demographics, job stressor and risk factor questionnaire, and their blood pressure was measured by mercury sphygmomanometers. Risk factors for blood pressure were analyzed by multiple linear regression and risk factors for hypertension by Poisson regression.

RESULTS

Overcommitment was associated with diastolic blood pressure after adjustment for confounders and ERI among men (β = 0.17, P < 0.05); ERI was also associated with diastolic blood pressure and systolic blood pressure after adjustment for confounders and overcommitment. High overcommitment (PR 1.91, 95% CI 1.35-2.69), and ERI (PR = 2.47, 95% CI 1.62-3.75) were each associated with risk of hypertension after adjusting for confounders. After adjusting for ERI, the association with overcommitment was no longer significant (PR = 1.24, 95% CI 0.85-1.82) However, after controlling for overcommitment, ERI remained significantly associated with hypertension risk (PR = 2.38, 95% CI 1.53-3.71). When high overcommitment and high ERI was combined, hypertension risk was highest (adjusted PR = 2.99, 95% CI 1.82-4.91, adjusted synergy index 5.85). The interaction was significant when it was tested by an interaction term in the regression (P < 0.001).

CONCLUSIONS

The interaction effect of overcommitment and ERI on hypertension was independent and synergistic.

Psychosocial work environment and ambulatory blood pressure: independent and combined effect of demand-control and effort-reward imbalance models

BACKGROUND

Two main theoretical models have been used to assess the impact of psychosocial work factors on blood pressure (BP): the demand-control model (DC) and the effort-reward imbalance (ERI) model. Little is known about their independent and combined effect.

OBJECTIVE

To examine the independent and combined effect of the DC and ERI models on ambulatory BP (ABP).

METHOD

Data were collected three times over 7 years from 3395 white-collar women and men using a repeated cross-sectional design. On each occasion, psychosocial work factors were measured using validated scales. ABP was measured every 15 min during a working day. Systolic and diastolic ABP means were examined in relation to contemporaneous and past exposure. Both models were mutually adjusted. A combined exposure variable was computed.

RESULTS

In men, high strain, and active, passive and ERI exposure were associated with ABP using contemporaneous exposure. However, the high strain/ABP association was not significant after adjustment for ERI. In women, no association was found with the DC model, while women exposed to ERI had higher ABP. Use of past exposure showed a stronger association between ABP and active exposure in men, while ERI associations were attenuated. Combined exposure to active jobs and to ERI was associated with ABP in both genders.

CONCLUSIONS

In men, associations with the DC model were mixed. Associations between high job strain and ABP were not independent of ERI exposure while both DC intermediate groups were independently associated with ABP. In women, no association was found with the DC model. ERI exposure was independently associated with ABP using contemporaneous exposure, but not using past exposure. Combined active and ERI exposure was also associated with ABP.

Plasma fibrinogen: a possible link between job stress and cardiovascular disease among Chinese workers

BACKGROUND

Little is known about the effect of effort-reward imbalance (ERI) on fibrinogen. We aimed to examine the association between ERI and fibrinogen among Chinese workers.

METHODS

A total of 732 subjects without vascular diseases were analyzed. Associations between job stress evaluated by ERI model and plasma fibrinogen were explored by multiple regression.

RESULTS

Effort, overcommitment, and ERI were significantly positively associated with fibrinogen, while reward was negatively related with fibrinogen both for men and for women. Compared with low level group, high level of effort, overcommitment, and ERI significantly increased risk of elevated fibrinogen (more than mean concentration) with adjusted OR of 3.3, 12.5, and 7.7 for men; 2.9, 7.2, and 7.2 for women, respectively; however, high reward reduced 80% risk for elevated fibrinogen.

CONCLUSIONS

Effort, overcommitment, and ERI are significantly associated with fibrinogen among Chinese workers. High fibrinogen may be a possible link between job stress and cardiovascular disease.

Cortisol variability and self-reports in the measurement of work-related stress

We examined whether a high cortisol awakening response (CAR) and low cortisol decline over the day (CDD) are related to self-reported work stress and well-being, and whether there are gender differences in these relationships. Three hundred eighty-three working men and women responded to a survey measuring job stress factors, mastery at work, symptoms and well-being. Salivary cortisol was sampled at awakening, after 45 min and at 21:00, from which the variables CAR and CDD were defined. A high CAR was associated with lower perceived job control and work mastery, and poorer well-being. Low CDD was associated only with higher job demands, but the self-report scores showed a number of interactions between cortisol group and gender. Among women, those showing a low CDD, compared with those with a higher CDD, had more favourable scores on a number of job stress factors and symptom load. In contrast, among men, a similar comparison showed those with low CDD to have poorer scores on job stress factors and symptom load. We conclude that individuals displaying high CAR or low CDD differ from those not displaying these cortisol profiles in self-report of work stress and well-being, and that gender differences appear in these relationships.

The association between effort-reward imbalance and coronary atherosclerosis in a Chinese sample

BACKGROUND

Previous studies of job strain and coronary heart disease (CHD) have produced mixed findings. We aimed to examine the association between job stress evaluated by the effort-reward imbalance (ERI) model and coronary atherosclerosis assessed by coronary angiography in a Chinese sample.

METHODS

Three-hundred twenty participants accepting coronary angiography for the first time were enrolled in series. Job stressors were evaluated by the ERI model. The presence and severity of CHD were assessed by measuring the coronary artery stenosis (the presence of >50% luminal stenosis in one or more major coronary arteries). The association between job stressors and CHD was examined by multivariate analysis.

RESULTS

Compared with the low-level group, high-level effort, overcommitment, and ERI increased CHD risk with odds ratio (OR) 2.5 (95% confidence interval (CI): 1.2-5.0), 2.5 (95% CI: 1.2-5.0), 2.4 (95% CI: 1.2-4.9), respectively, after adjustment for confounders. They were also significantly positively correlated with the complexity of coronary artery lesions, respectively. Dose-response relationships were observed.

CONCLUSIONS

ERI was associated with coronary artery lesions in a sample of Chinese workers. Longitudinal research and interventional designs are needed to confirm the mechanism and to provide evidence for the prevention of CHD.

Work stress and reduced health in young physicians: prospective evidence from Swiss residents

OBJECTIVES

Job stress, investigated by the effort-reward model in various working environments in different countries, has been widely reported, yet studies addressing physicians are lacking. The present study investigated the perceived job stress, its association with the amount of working hours, and its impact on young physicians' self-reported health and their satisfaction with life during residency.

METHODS

In a prospective study design, a cohort of Swiss medical school graduates was followed up, beginning in 2001. In their second and fourth years of residency, 433 physicians assessed their effort-reward imbalance, overcommitment, physical and mental well-being and satisfaction in life. Taking the longitudinal design into account, four categories of stressed residents were defined: (1) subjects not reporting high work stress at either measurement, (2) subjects reporting high work stress in the second but not in the fourth year of residency, (3) subjects with onset of high work stress in fourth year and (4) residents reporting high work stress at both measurements.

RESULTS

All components of the perceived stress at work were significantly correlated with the amount of working hours, effort showing the highest correlation. While two-thirds of the participants do not report high work stress, assessed by the extrinsic part of the effort-reward imbalance model (the ratio between effort and reward) and 12% show a decrease of stress over time, there are 15% with an increase of stress over time, and 10% with persistently high stress experience. In terms of the intrinsic stress component (overcommitment), 71% show low values, 12% show a decrease, 9% an increase and 8% constantly high values. The groups with constant and increasing extrinsic and intrinsic stress experience exhibit significantly worse health and life satisfaction compared to the remaining groups, after controlling for gender and baseline health.

CONCLUSIONS

Stress at work in young physicians, especially when being experienced over a longer period in postgraduate training, has to be a matter of concern because of its negative impact on health and life satisfaction and the risk of developing symptoms of burnout in the long run.

An international perspective on worker mental health problems: who bears the burden and how are costs addressed?

OBJECTIVE

To discuss the burden of poor mental health in workers, who currently bears it, and how the associated rising costs are being addressed, from an international perspective.

METHOD

We identify the stakeholder groups and the costs they incur as a result of problems related to mental health in 6 different domains. In addition, we offer examples of programs, services, and strategies being used to either decrease costs or enhance benefits.

RESULTS

Mental illness is associated with a wide range of costs distributed across multiple stakeholders including government, employers, workers and their families, and the health care system. The costs incurred by the groups are interrelated; an attempt to decrease the burden for one group of stakeholders will inevitably affect other stakeholders. Thus the answer to the question of who bears the costs of poor mental health is "everyone."

CONCLUSIONS

Everyone could benefit from investment in improved mental health in the workplace. However, because the benefits associated with improved worker mental health are often distributed among several stakeholders, the incentives for any single stakeholder to pay for additional services for workers may be diluted. As a consequence, no one invests. Nevertheless, there is a role for all stakeholders, just as there are potential benefits for all. Along with government, employers, employees, and the health care system must invest in promoting good workplace health.

Psychosocial work environment and mental health: Job-strain and effort-reward imbalance models in a context of major organizational changes

This study explored the association between the two job-stress models, job-strain and effort-reward imbalance, and mental health outcomes in a working population exposed to major organizational changes. The cross-sectional study was based on 680 subjects, 504 men and 176 women. Psychosocial factors at work included: psychological demands, decision latitude, social support, effort, reward, and overcommitment. Mental health outcomes were depressive symptoms (CES-D) and psychiatric disorders (GHQ-12). Job strain, low decision latitude, effort-reward imbalance, and low reward (especially job instability) were found to be associated with depressive symptoms and/or psychiatric disorders among men. Overcommitment at work was a risk factor for both men and women. Social support at work played a role to reduce depressive symptoms for women. These findings emphasize the deleterious effects of psychosocial work environment on mental health during major organizational changes.

Gender differences in job strain, effort-reward imbalance, and health functioning among Chinese physicians

To examine the association between work stress measured by job strain and effort-reward imbalance (ERI) and health functioning in a sample of hospital-based Chinese physicians, a self-reported survey with a standardized questionnaire was conducted in three hospitals in China, among 256 men and 266 women. It was found that both job strain and ERI were associated with impaired health functioning in men and women, but that ERI indicated a stronger association. Men's job control was significantly higher, and was related to men's physical health; whereas women perceived relatively higher job reward which predicted women's mental health. The findings provide evidence of the adverse effects on health functioning of both job strain and ERI, but ERI appears to have more explanatory power as a model of work stress in this sample of Chinese physicians. In addition, gender differences of work stress with respect to health are present.