Associations of effort-reward imbalance at work and quality of life among workers after stroke: a one-year longitudinal study in Thailand

Stroke incidence is increasing among working-age population, but the role of psychosocial stress in the workplace in predicting quality of life (QoL) after stroke onset is understudied. This longitudinal study aimed to investigate the relationship between work stress, measured by the effort-reward imbalance (ERI) model, and QoL over one-year period among 103 Thai workers who had experienced a stroke. The study evaluated the effort (E)-reward (R) ratio and over-commitment, the extrinsic and intrinsic components of the ERI model, before discharge; QoL was repeatedly measured at baseline, six months, and 12 months after discharge, respectively, using the Short Form Version 2 (SF-12v2) indicators of physical and mental health composite scores. Generalized estimating equations were used to examine longitudinal relationships between work stress at baseline and QoL over one year by testing the hypotheses that E-R ratio and over-commitment would have direct effects on QoL, and potential moderating effects of over-commitment on E-R ratio and QoL. The results supported the ERI model partially, as over-commitment was significantly associated with poor mental health (coefficient - 8.50; 95% CI: -13.79, -3.20) after adjusting baseline sociodemographic, behavioral, and clinical characteristics, while the E-R ratio was not significantly associated with physical or mental health; the interaction between the E-R ratio and over-commitment was also not significant. These findings suggest that more attention should be paid to workers' personal coping skills and ability to handle work-related problems and prioritize interventions that address over-commitment to promote long-term mental health among workers with stroke.

Working conditions in primary care: a qualitative interview study with physicians in Sweden informed by the Effort-Reward-Imbalance model

BACKGROUND

Many problems with primary care physicians' psychosocial working conditions have been documented. Many studies on working condition have used the Effort-Reward-Imbalance (ERI) model, which posits that poor health and well-being may result from imbalances between the level of effort employees perceive that they put into their work and the rewards they receive. The model has not been used in qualitative research or applied to investigate primary care physicians' working conditions. The aim of this study was to apply the ERI model to explore the perceived efforts and rewards by primary care physicians in Sweden and approaches they take to cope with potential imbalances between these efforts and rewards.

METHODS

The study has a qualitative design, using semi-structured interviews. A purposeful sampling strategy was used to achieve a heterogeneous sample of primary care physicians who represented a broad spectrum of experiences and perceptions. We recruited 21 physicians; 15 were employed in public health care and 6 by private health care companies.

RESULTS

The analysis of the interviews yielded 11 sub-categories: 6 were mapped to the efforts category, 3 were attributed to the rewards category and 2 were approaches to coping with effort/reward imbalances. Many of the statements concerned efforts in the form of high workload, restricted autonomy and administrative work burden. They also perceived resource restrictions, unpredictability of work and high expectations in their role as physicians as efforts. Three types of rewards emerged; the physicians found their job to be stimulating and meaningful, and the work climate to be supportive. The physicians coped with imbalances by means of job enrichment and using decisional latitude.

CONCLUSIONS

Primary care physicians perceive numerous types of efforts in their job, which is consistent with research concerning work stress and associated consequences, such as poor subjective health and well-being. There are also rewards according to primary care physicians, but the findings suggest a lack of reciprocity in terms of efforts and rewards although firm conclusions cannot be drawn since the study did not investigate the magnitude of the various efforts and rewards or the effectiveness of the approaches the physicians use to cope with imbalances. The ERI model was found to be useful to explore physicians' primary care work and working conditions but its applicability likely depends on the type of work or professions being studied.

Does cognitive function predict changes in perception of stressful working conditions?

Cognitive health is a key resource for individuals to nurture their employability. We studied the longitudinal association of cognitive function with changes in stressful working conditions, testing a possible reversed causation. We used a sample of employees (N=1,355) participating in two surveys (2006 and 2011) within a German national representative study (GSOEP). Cognitive function was captured by perceptual speed (Symbol Digit Test) and word fluency (Animal Naming Test). Stressful working conditions were measured by the validated short version of the effort-reward imbalance questionnaire. Multivariate linear regression models assessed the impact of perceptual speed and verbal fluency in 2006 on changes in participants' perceptions of effort, reward, effort-reward ratio, and over-commitment between 2006 and 2011, adjusting for socio-demography, behaviours, physical and mental health at baseline. Neither perceptual speed nor verbal fluency was significantly related to changes in perceived working conditions. Our findings did not support the notion of reversed causation.

[Mediating role of over-commitment in the relationship between effort, reward and burnout]

Objective: To explore the mediating role of over-commitment in the relationship between occupational stressors and job burnout, and to offer more specificevidence-based information in exploring the work related health effects of over-commitment. Methods: A total of 1994 samples from electronic manufacturing service industry were collected in Guangdong province based on self-rated questionnaire after written consent from June to July, 2015. The Effort-Reward Imbalance questionnaire and Maslach Burnout Invertory-General Survey were used for the measurement of occupational stress and job burnout. And hierarchical regression and Bootstrap test were conducted for data analysis. Results: High effort (0.28, 0.24-0.33) and low reward (-0.37, -0.42--0.33) were significantly associated with high over-commitment when gender, age and position had been controlled. Standardizedregression coefficient of effort to emotional exhaustion, depersonalization and personal accomplishment were 0.63 (95%CI: 0.54-0.71) 、0.18 (95%CI: 0.10-0.26) 、0.32 (95%CI: 0.21-0.43) , P<0.05; and standardized regression coefficient of reward to emotional exhaustion, depersonalization and personal accomplishment were-0.60 (95%CI: -0.68--0.52) 、-0.93 (95%CI: -1.01--0.86) 、-0.46 (95%CI: -0.35--0.58) , P<0.05. Bootstrap test indicated the mediation of over-commitment were statistically significant, and mediating effect ranges from 0.093 to 0.218 (P<0.05) . Conclusion: Over-commitment can mediate the relationship between occupational stressors (job effort and reward) and burnout, and the effect varies from different workingconditions.

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.

A systematic review and meta-analysis of the effort-reward imbalance model of workplace stress with indicators of immune function

OBJECTIVE

Despite considerable research into associations between the effort reward imbalance (ERI) model and various health outcomes over the past 20years, the underlying mechanisms responsible for the association remain unclear. Recently, ERI investigations have examined associations with immune sub-systems (e.g., leukocytes, cytokines and immunoglobulins). Synthesis of the amalgamated research evidence will aid clarity to this field of enquiry. We conducted a meta-analysis and reviewed the associations of ERI and over-commitment (OC) in the workplace with immunity.

METHOD

Electronic databases were searched with the phrase 'effort reward imbalance' which initially yielded 319 studies leading to 57 full text studies being screened. Seven studies that met inclusion criteria were combined using mixed and random effects models.

RESULTS

Greater ERI was associated with lower immunity (r=-0.09, CI -0.14, -0.05, p<0.001). Sub-group analyses revealed the effect with mucosal immunity was stronger (r=-0.33, CI -0.47 to -0.18) than trends between both cytokine (r=-0.04, CI -0.07, -0.01) and leukocyte sub-groups (r=-0.02 CI -0.04, 0.01) respectively (k=7, N=9952). Over-commitment was also associated with lower immunity (r=-0.05, CI -0.09, 0.01, p=0.014); subgroup (leukocytes, cytokines, mucosal immunity) associations, however, were homogenous (Q=1.83, df=2, p=0.400, k=6, N=2358).

CONCLUSIONS

Greater ERI and OC were both associated with lower immunity. The association between mucosal immunity and ERI was stronger than the cytokine and leukocyte sub-groups. OC moderated the relationship between ERI and immunity.