The Measurement of Effort-Reward Imbalance (ERI) at Work

Occupational stressors and mental illness in healthcare work: An intersection between gender, race, and class

BACKGROUND

Previous studies have supported the relevance of using broad and complex approaches, including multiple explanatory categories, to analyze mental disorders in the working population. This study aimed to assess the direct and indirect effects of gender, race, social class, and occupational stressors on mental health.

METHODS

A cross-sectional study used a random sample of 3343 health workers. The effort-reward imbalance (ERI) scale measured occupational stressors. The World Health Organization Self-Reporting Questionnaire (SRQ-20) evaluated common mental disorders (CMDs) as outcomes. The role of gender, race/color, and class determinants (level of schooling and income) in the relationship between occupational stressors and CMD was assessed. Structural equation modeling was used to determine associations and effects.

RESULTS

Occupational stressors were directly associated with CMD and mediated the relationship between income and CMD. Gender was directly associated with occupational stressors, income, and domestic overload. Race was associated with education and with CMD through indirect paths mediated by class indicators. Class indicators contributed to increasing exposure to occupational stressors and the occurrence of CMD.

CONCLUSION

The results highlight the relevance of gender, race/color, and class in understanding the unequal distribution of work stressors and mental illness in health workers.

Effort-reward imbalance and its association with sociocultural diversity factors at work: findings from a cross-sectional survey among physicians and nurses in Germany

OBJECTIVE

Due to staff shortages and reports of high work stress, work conditions of hospital physicians and nurses receive wide attention. Additionally, sociocultural diversity of the workforce and patient population is increasing. Our study aim is to analyze how individual and organizational diversity-related factors are associated with the experience of staff's work stress.

METHODS

A cross-sectional online survey was conducted with healthcare staff from 22 acute hospitals operated by two healthcare organizations in Germany in 2018. Sociodemographic, occupational and organizational factors were surveyed. Participants further reported work conditions related to the sociocultural diversity of colleagues and patients. Effort-reward imbalance (ERI) was measured with the German short version. Multivariable regression models were calculated with ER ratio as an outcome.

RESULTS

N = 800 healthcare staff were included. Variables associated with higher ERI were longer work experience (β = 0.092, p < 0.05), not holding a leading position (0.122, < 0.01), being a witness (0.149, < 0.001) or victim (0.099, < 0.05) of discrimination at one's own ward, reporting frequent burden due to language barriers with patients (0.102, < 0.01) and colleagues (0.127, < 0.001), and having restricted access to translators at work (0.175, < 0.001). Factors associated with lower ERI were having a first generation migration background (- 0.095, < 0.05) and being a physician (- 0.112, < 0.05).

CONCLUSIONS

Catering to the needs of healthcare personnel in dealing with the additional effort related to language barriers at work, e.g., readily available translator services, and creating non-discriminatory work environments might be one cornerstone for the prevention of work-related ill health and retention of qualified hospital staff.

Cross-sectional associations between effort-reward imbalance at work and oral diseases in Japan

Background

Psychological stress is a potential risk factor for oral diseases. However, evidence for the association between work stress and oral diseases is scarce. We aimed to examine the associations of work stress, according to the effort-reward imbalance model, with dental caries, periodontal status, and tooth loss.

Methods

This cross-sectional study included 184 regular employees at a medical university and 435 registrants of a web research company. Work stress was assessed using the effort-reward imbalance (ERI) ratio. Dental caries and tooth loss were assessed according to the number of decayed, filled, and missing teeth (DMFT) among the set of 28 teeth. Periodontal status was assessed using a self-administered questionnaire. For the DMFT, a linear regression model was used to estimate the unstandardised coefficients. A Poisson regression model was used to estimate the prevalence ratios (PRs) of poor periodontal status.

Results

Among medical university employees and employees enrolled from among the registrants of an online research company, a one-unit increase in the ERI ratio was associated with -2.81 (95% CI [-4.70 to -0.92]; p-value = 0.004) and -0.84 (95% CI [-1.80 to 0.12]; p-value = 0.085) changes in the DMFT from adjusted linear regression models, respectively. In employees enrolled from among the registrants of an online research company, a one-unit increase in the ERI ratio was also associated with 1.55 (95% CI [1.04-2.32]; p-value = 0.032) of the PR for poor periodontal status based on Poisson regression models.

Conclusion

ERI at work was associated with an increased risk of poor periodontal status.

Stressful work in primary health care and mental health: The role of gender inequities in Brazil

BACKGROUND

This study aims to analyze the association between occupational stressors, evaluated by the Effort-Reward Imbalance Model (ERI), and the occurrence of common mental disorders (CMD) among healthcare workers (HCW), additionally considering mediation by over-commitment from work (OW) and mediation of gender effects by work stressors.

METHODS

Cross-sectional study, including a random sample of 3343 HCWs, from six municipalities of Bahia, Brazil. The ERI scale measured the occupational stressors (main exposure), and the Self-Reporting Questionnaire (SRQ-20) was used to screen for CMD. Data analysis used Structural Equation Modeling techniques to understand the relationships between gender, occupational stressors, and the occurrence of CMD.

RESULTS

ERI and OW were associated with CMD. OW mediated the negative effect of ERI on the mental health of HCW. Female workers had higher levels of ERI, OW, and CMD prevalence; the total gender effect on CMD prevalence was mediated by ERI and OW.

CONCLUSIONS

The findings highlight the association of work psychosocial stressors and CMD among HCW, including partial mediation by OW. Gender inequalities persisted among HCW, with women most exposed to occupational stressors and CMD. ERI and OW partially mediated the effect of gender on CMD.

Understanding Reciprocity Among University Students in Low-Resource Settings: Validation and Measurement Using a Mixed-Methods Approach

Objectives

This study aimed to investigate reciprocity among university students in low-resource settings using a convergent mixed-methods approach in Jordan. The study operationalized the effort-reward imbalance (ERI) model which is a sociological framework used to predict occupational-related health outcomes. The basic theory of ERI model assumes that an imbalance of effort and reward predicts adverse health outcomes.

Methods

The research involved two studies, Study I (n = 833) to quantitatively measure ERI and Study II to collect qualitative data (n = 44) on the drivers of ERI among university students. In Study I, a modified Arabic version of the ERI questionnaire was used. The study measured ERI and investigated the reliability and validity of the Arabic version of the ERI model questionnaire. In Study II, data were collected from focus groups and personal interviews and thematic analysis was used.

Results

The results suggested that ERI was associated with poor academic performance (OR=2.31, 95% CI 1.60–3.32), absenteeism (OR=1.66, 95% CI 1.21–2.27), low exercise level (OR=2.02, 95% CI 1.49–2.74) and poor self-reported health (OR=1.12, 95% CI 1.08–1.30). Three major themes emerged, namely high academic load, financial pressures and negative influence on the students' performance, wellbeing and health to explain effort-reward imbalance.

Conclusions

Results suggest that ERI among university students is multi-faceted and is not bound only to academic-related demands and that the extrinsic factors such as the economic context of Jordan is among drivers of ERI.

Gender moderates the association between chronic academic stress with top-down and bottom-up attention

Research on the relationship between chronic stress and cognition is limited by a lack of concurrent measurement of state-anxiety, physiological arousal, and gender. For the first time, we assessed the impact of these factors on top-down/conscious (simple and choice reaction time) and bottom-up/reflexive (saccadic reaction time) measures of attention using CONVIRT virtual-reality cognitive tests. Participants (N = 163) completed measures of academic stress (effort-reward imbalance; ERI) and state-anxiety while heart-rate variability was recorded continuously throughout the experiment. Gender moderated the association between academic stress with the top-down measures (b = -0.002, t = -2.023, p = .045; b = -0.063, t = -3.080, p = .002) and higher academic stress was associated with poorer/slower reaction times only for male participants. For bottom-up attention, heart rate variability moderated the relationship between academic stress and saccadic reaction time (b = 0.092, t = 1.991, p = .048), and only female participants who were more stressed (i.e., ERI ≥ 1) and displayed stronger sympathetic dominance had slower reaction times. Our findings align with emerging evidence that chronic stress is related to hyperarousal in women and cognitive decrements in men. Our findings suggest that higher ERI and sympathetic dominance during cognitive testing was associated with poorer bottom-up attention in women, whereas for men, academic stress was related with poorer top-down attention irrespective of sympathovagal balance.

Job Stress and Burnout Among Employees Working in Terrorist-Ridden Areas

This article examines the relationship of effort-reward imbalance (ERI) on employee stress by considering job burnout (BO), organizational (in)justice (OJ), and sensitivity to terrorism (STT). This study uses the effort-reward imbalance (ERI) framework as a job stress model. After describing terrorism and a brief discussion on organizational justice and some of its challenges, we introduced "sensitivity to terrorism" as a moderator in the ERI framework. Using a 432 sample size of questionnaire data collected from two big cities where terrorist attacks are rampant and received during a period when terrorist attacks were at a peak. After analyzing data in EFA, results from the hierarchical regression analysis provided support for our developed model. Overall, the statistical model is significant (p < 0.05). We found significant relationships between ERI and facets of BO. Organizational (in)justice mediated the influence of ERI on facets of BO. We also found that STT significantly moderated ERI and facets of burnout. The article concludes with some implications and guidelines for future research.

The influence of working conditions on health satisfaction, physical and mental health: testing the effort-reward imbalance (ERI) model and its moderation with over-commitment using a representative sample of German employees (GSOEP)

BACKGROUND

The effort-reward imbalance (ERI) model is well-established in explaining work-related stress and health differences. A lack of reciprocity between efforts and rewards at the workplace is central to the theory. The third component (over-commitment) was defined to be a moderator of high-cost/low gain-working conditions increasing the risk of ill-health. Although the theory has been widely supported empirically, all underlying hypotheses have not been sufficiently tested. This article examines whether the strength of the effect of the effort-reward imbalance ratio on health indicators is bigger than the effects of efforts and rewards individually. Another research gap on the interaction with over-commitment is addressed and health measures are compared.

METHODS

This study applied the effort-reward imbalance model on health satisfaction and the SF-12v2™ indicators physical health composite score (PCS) and mental health composite score (MCS) within a representative sample of German employees. After confirmatory factor analyses of the items of the components effort, reward and over-commitment were applied, multiple linear regression models and interaction effects were calculated for more than 7000 respondents within the German Socio-Economic Panel (GSOEP) study.

RESULTS

Against the model's hypothesis, effort and especially reward had a stronger effect on health satisfaction and mental health individually than the effort-reward imbalance ratio. Over-commitment exerted a negative influence on health indicators and its interaction with the effort-reward imbalance ratio intensified this effect significantly for mental health. Overall, the best model fit was reached for mental health, which is in line with the model's stress theory foundation.

CONCLUSIONS

Although the ERI model has been applied for more than 20 years, theoretical and methodological demands can no longer be neglected. This article contributes to the revision of the effort-reward imbalance (ERI) model and demonstrates possible starting points for prevention programs focusing on rewards.

Effort-Reward Imbalance and Burnout in German Kindergarten Educators

Abstract. Effort-reward imbalance and overcommitment are increasingly identified as work-related risk factors for burnout and somatic symptoms. In order to explore the situation in German kindergarten educators, a cross-sectional study based on questionnaire responses from N = 1,933 was carried out. Burnout was found in 24.4% and somatic symptoms in 47.3% of the study participants. Binary logistic regressions were used to identify effort-reward imbalance (OR = 3.75, 95% CI: 2.85–4.95) and overcommitment (OR = 1.41, 95% CI: 1.34–1.47) as independent predictors for burnout. Results confirm the high relevance of the effort-reward imbalance concept for the health status of kindergarten educators.

Validating the short measure of the Effort-Reward Imbalance Questionnaire in older workers in the context of New Zealand

Objectives:

The objective of this study was to validate a short version of the Effort-Reward-Imbalance (ERI) questionnaire in the context of New Zealand among older full-time and part-time employees.

Methods:

Data were collected from 1694 adults aged 48-83 years (mean 60 years, 53% female) who reported being in full- or part-time paid employment in the 2010 wave of the New Zealand Health, Work and Retirement study. Scale reliability was evaluated by item-total correlations and Cronbach's alpha. Factorial validity was assessed using multi-group confirmatory factor analyses assessing nested models of configural, metric, scalar and strict invariance across full- and part-time employment groups. Logistic regressions estimated associations of effort-reward ratio and over-commitment with poor physical/mental health, and depressive symptoms.

Results:

Internal consistency of ERI scales was high across employment groups: effort 0.78-0.76; reward 0.81-0.77, and over-commitment 0.83-0.80. The three-factor model displayed acceptable fit in the overall sample (X²/df = 10.31; CFI = 0.95; TLI = 0.94; RMSEA = 0.075), and decrements in model fit indices provided evidence for strict invariance of the three-factor ERI model across full-time and part-time employment groups. High effort-reward ratio scores were consistently associated with poor mental health and depressive symptoms for both employment groups. High over-commitment was associated with poor mental health and depressive symptoms in both groups and also with poor physical health in the full-time employment group.

Conclusions:

The short ERI questionnaire appears to be a valid instrument to assess adverse psychosocial work characteristics in old full-time and part-time employees in New Zealand.

Mental health among Norwegian priests: associations with effort-reward imbalance and overcommitment

PURPOSE

The aim of the study was to determine the prevalence of anxiety and depression symptoms among Norwegian priests and to examine their associations with effort-reward imbalance (ERI) and overcommitment.

METHODS

Eight hundred four priests in the Norwegian Church completed the Hospital Anxiety and Depression Scale (HADS), the Effort-Reward Imbalance Questionnaire (ERI-Q), and the Intrinsic Effort Scale, measuring overcommitment.

RESULTS

A significant proportion of the priests (23.4%) had HADS scores indicating a possible anxiety problem. Somewhat fewer had depression problems (9.3%). Both anxiety and depression difficulties were associated with an imbalance between effort given and rewards received at work. Priests characterized by a combination of this imbalance and high scores on overcommitment had more anxiety and depression symptoms.

CONCLUSIONS

There is a higher occurrence of mental health challenges among priests than among the regular population. This applies in particular to anxiety symptoms measured by the HADS. These findings also indicate that it may be fruitful to explore mental health conditions among priests who report different combinations of effort-reward and overcommitment.