Is effort-reward imbalance at work associated with different domains of health functioning? Baseline results from the French CONSTANCES study

Longitudinal associations of effort and reward at work with changes in cognitive function: evidence from a national study of U.S. workers

PURPOSE

This study aimed to examine longitudinal associations of workplace effort and reward with changes in cognitive function among United States workers.

METHODS

Data from the national, population-based Midlife in the United States (MIDUS) study with a 9-year follow-up were used. Validated workplace effort and reward scales were measured at baseline, and cognitive outcomes (including composite cognition, episodic memory, and executive functioning) were measured with the Brief Test of Adult Cognition by Telephone (BTACT) at baseline and follow-up. Multivariable linear regression analyses based on generalized estimating equations (GEE) examined the longitudinal associations under study.

RESULTS

Among this worker sample of 1,399, after accounting for demographics, socioeconomics, lifestyle behaviors, health conditions, and job control, high reward at baseline was associated with increased composite cognition (regression coefficient: 0.118 [95% CI: 0.049, 0.187]), episodic memory (0.106 [0.024, 0.188]), and executive functioning (0.123 [0.055, 0.191]) during follow-up. The joint exposure of 'high effort and high reward' was also associated with increased composite cognition (0.130 [0.030, 0.231]), episodic memory (0.131 [0.012, 0.250]), and executive functioning (0.117 [0.017, 0.216]), while the combination of 'low effort and high reward' was associated with increased composite cognition (0.106 [0.009, 0.204]) and executive functioning (0.139 [0.042, 0.235]).

CONCLUSION

Findings suggest that workplace high reward is related to improved cognitive scores among United States workers. Future research should investigate larger cohorts over longer timespans and expand into disease outcomes such as dementia. If these findings emerge as causal, relevant workplace rewards to promote worker cognitive health should be considered.

Proportion of At-Risk Alcohol Consumers According to the New French Guidelines: Cross-Sectional Weighted Analyses From the CONSTANCES Cohort

Objective: To estimate the proportion of the participants of the French national population-based CONSTANCES cohort exceeding the new low-risk drinking guidelines according to sociodemographic and clinical factors. Methods: From 34,470 participants with follow-up data in 2019, among volunteers aged 18-69 years and invited to enroll in the CONSTANCES cohort in 2016 and 2017, weighted prevalence and odds ratios with 95% confidence intervals (CI) exceeding the guidelines using logistic regressions were presented stratified for age, gender, education, occupational grade, employment, income, marital status, pregnancy, work stress, depression, alcohol dependence, binge drinking, cannabis use, smoking status, e-cigarette use, cardiovascular diseases, and cancer. Results: The guidelines were exceeded more by men at 60.2% (95%CI: 59.3%-61.0%) than by women at 36.6% (95%CI: 35.9%-37.4%). Exceeding the guidelines increased with age, socioeconomic status, smoking, vaping, using cannabis, binge drinking, and alcohol dependence. Being depressed was associated with exceeding the guidelines in women. Even though pregnant women were less likely to exceed the guidelines, 7.6% (95%CI: 5.4%-10.6%) were at-risk drinkers. Conclusion: These findings highlight the need to implement effective prevention measures for at-risk alcohol use among the French population.

Social inequalities, stressful work and non-fatal cardiovascular disease: follow-up findings from the CONSTANCES Study

BACKGROUND

Studies show that a disadvantaged socioeconomic position (SEP) and psychosocial stress at work are both independently associated with an increased risk of cardiovascular disease (CVD). But it is not clear if the effect of stress at work on CVD varies by SEP.

METHODS

We used baseline and follow-up data from the French population-based cohort study CONSTANCES, including 48 383 employed women and men aged 30-70 years. Three SEP indicators (education, income, occupation), stressful psychosocial work as measured by effort-reward imbalance, pre-existing CVD and confounders were assessed at baseline, and incident non-fatal CVD events reported during annual follow-up (up to five follow-ups) were used as outcomes. The effect modification hypothesis was both investigated on an additive and multiplicative scale.

RESULTS

SEP was inversely associated with CVD risk (eg, for low vs high income, OR 1.28 (95% CI 1.12 to 1.46)), and for all three components of stressful work CVD risks were significantly increased (eg, for effort-reward ratio OR 1.26 (95% CI 1.17 to 1.36)). Employees with a disadvantaged SEP showed moderately increased effect sizes of stressful work on CVD. However, no clear evidence of an effect modification was found.

CONCLUSIONS

Disadvantaged SEP and stressful work contribute to higher CVD risk in this cohort. Despite moderately increased effect sizes for disadvantaged SEP groups, no evidence was found to support an effect modification hypothesis.

Unrewarding work and major depressive episode: Cross-sectional and prospective evidence from the U.S. MIDUS study

Depression is a serious mental health condition and is the leading cause of disability worldwide. Previous research has demonstrated that work stress may contribute to the development of depression through psychophysiological pathways. The present study assessed associations of work stress - in terms of the effort-reward imbalance (ERI) model measuring unrewarding work - with major depressive episode (MDE). Data were from the Mid-life in the United States study, a national, population-based sample of U.S. workers with 9-year follow-up prospective cohort design. The cross-sectional sample at baseline had 2204 workers, and the prospective sample had 1591 workers at follow-up (78.7% follow-up rate). Multivariable Bayesian logistic regression and Poisson regression were applied for examining cross-sectional and prospective associations, respectively. ERI was assessed by a validated 17-item scale at baseline, and MDE in the past 12 months was assessed by the Composite International Diagnostic Interview Short Form at both baseline and follow-up. It was found that ERI at baseline was associated with higher odds of prevalent MDE in the cross-sectional sample (OR = 1.47, HPD interval [1.26-1.69]), and with higher risk of MDE at follow-up in the prospective sample (RR = 1.29, HPD interval [1.01-1.60]). In both cross-sectional and prospective analyses, strongest associations were observed among workers with the highest quartile of ERI, after adjusting for demographic, socioeconomic, lifestyle, and other psychosocial factors. The stable and robust findings strengthen and extend previous findings that unrewarding work is a risk factor of mental health. If confirmed by further evidence, intervention targeting work stress reduction is warranted.

Job exhaustion among assigned and self-initiated expatriates – the role of effort and reward

Purpose

This study explores whether expatriation type (assigned expatriates (AEs) versus self-initiated expatriates (SIEs)) is linked to job exhaustion via possible differences in required efforts for their jobs and the rewards they gain from them, and/or the balance between efforts and rewards. Adopting effort–reward imbalance (ERI) and job demands/resources (JD-R) theories, the authors study the possible role of ERI as a mediator between expatriation type and job exhaustion.

Design/methodology/approach

An online survey was carried out in co-operation with two Finnish trade unions, providing representative data from 484 assigned and SIEs. The authors test this study’s hypotheses through latent structural equation modelling, and the analysis was conducted with Stata 17.0 software.

Findings

The results show that ERI between them are correlated with the job exhaustion of expatriates in general and there are no direct links between expatriation type and job exhaustion. The required effort from AEs was higher than that from SIEs though no difference was found for rewards, and the match between effort demands and rewards is less favourable for AEs than SIEs. AEs experienced higher job exhaustion than SIEs because of the higher effort demands and greater imbalance between efforts and rewards.

Originality/value

The study examines the work well-being of two types of expatriates and explores the underlying mechanisms that may explain why they may differ from each other.

Cannabis Use Increases the Risk of Sickness Absence: Longitudinal Analyses From the CONSTANCES Cohort

Aims

To examine the longitudinal associations between cannabis use and risks of short (<7 days), medium (7-28 days), and long (>28 days) sickness absences at one-year follow-up.

Methods

87,273 participants aged 18-65 years from the French CONSTANCES cohort reported their frequency of cannabis use at inclusion between 2012 and 2018. Sickness absences occurring during one year of follow-up were collected from national medico-administrative registries. Multivariable generalized linear regressions were used to compute the Odds Ratios (OR) with their 95% Confidence Intervals (CI) of having at least one sickness absence at follow-up compared to no sickness absence, while controlling for sociodemographic factors, chronic conditions and occupational factors.

Results

Cannabis use more than once a month was associated with an increased risk of short (OR, [95% CI]: 1.56 [1.32–1.83]) and medium (1.29 [1.07–1.54]) sickness absences at one-year follow-up, with dose-dependent relationships for short sickness absences (1.13 [1.08–1.18], p-for-trend <0.001). In stratified analyses, cannabis use was associated with an increased risk of sickness absences in older individuals, men, participants with good self-rated health, living or having lived as a couple, and having an open-ended contract.

Conclusions

Cannabis use prospectively increased the risk of short and medium sickness absences, even from once a month and with a dose-dependent relationship for short sickness absences. These findings should be considered in information and prevention public health campaigns to alert the general population and workers to this increased risk.

The short form effort-reward imbalance: Measure of occupational stress for firefighters

PURPOSE

The original effort-reward imbalance (ERI) questionnaire has been widely used as a measure of occupational stress. The need for brief measurement of psychosocial stress at work has risen. This study examined the psychometric properties of a 16-item short form ERI (S-ERI) questionnaire.

METHODS

A cross-sectional study was conducted with a convenience sample of 247 career firefighters in the United States. An internet-based survey contained the S-ERI questionnaire, and assessed perceived health, demographics, and work characteristics. Internal consistency was tested by item-total correlation and Cronbach's α coefficients. Factorial validity was assessed by confirmatory factor analysis (CFA), and criterion validity was examined by testing the S-ERI's association with perceived health, controlling for other factors.

RESULTS

The study participants were primarily young and mid-aged White males (mean age = 42 years, 75% White non-Hispanic, 93% males). The S-ERI questionnaire showed satisfactory internal consistency, with Cronbach α coefficients above 0.80 for all three scales: effort 0.82, reward 0.83, and overcommitment 0.81. CFA showed all the S-ERI components had a good fit (goodness-of-fit index = 0.99, comparative fit index = 0.92, root mean square error of approximation = 0.06). In terms of criterion validity, significantly increased odds ratios (ORs) for perceived health (those indicating they were less healthy) were found in firefighters in the lowest tertile of reward (OR = 7.06, 95% confidence interval [CI]: 2.86-17.43), and highest tertile of overcommitment (OR = 2.29, 95% CI: 1.00-5.22), after controlling for other factors.

CONCLUSION

The S-ERI questionnaire is a reliable and valid measure to assess occupational stress. We recommend the use of S-ERI as a measure of occupational stress when initiating efforts to improve firefighters' wellness.

Are there differences between officers and ratings on merchant vessels concerning effort-reward imbalance: a cross-sectional maritime field study

PURPOSE

Today, measures to economise in the operation of ships can cause either an effort-reward imbalance or health impairments. The goal of this study was to assess the risk of effort-reward imbalance including overcommitment among officers and ratings on merchant vessels during their assignments and to evaluate lifestyle factors of seafarers as well as the health-promoting conditions on board.

METHODS

A study sample of 308 male seafarers was examined during a total of 20 sea voyages on German container ships (participation rate 91.9%).

RESULTS

Only 11 seafarers were identified as having an increased health risk of an effort-reward imbalance (ER ratio > 1). Officers tended to have a higher risk of an elevated ratio than ratings (4.4% vs. 3.1%) and also showed a significantly higher risk of an ER ratio above the median (58.8% vs. 41.8%; p = 0.022). Compared to land-based populations, the average overcommitment score of seafarers was high (17.9)-particularly among officers (20.3 vs. 16.5; p = 0.031). This corresponded to an elevated risk of overcommitment among officers compared to ratings (OR 2.14; 95% CI 1.78-2.37). This elevated risk remained significant after adjustment for age (OR 2.11; 95% CI 1.76-2.35) and job-related stressors.

CONCLUSION

Although an elevated risk of effort-reward imbalance was only observed in few seafarers, this study revealed a high prevalence of overcommitment particularly among officers. In the course of time, overcommitment can lead to mental exhaustion. Therefore, shipboard health-promoting conditions need to be optimised.

Adverse employment histories, work stress and self-reported depression in the French CONSTANCES study

BACKGROUND

Job instability and disadvantaged work were shown to be associated with poor mental health, but few studies analyzed these conditions in a life course perspective. In this study, adverse employment histories are retrospectively assessed and linked to self-reported depression. Furthermore, indirect effects of later stressful psychosocial work in terms of effort-reward imbalance are investigated.

METHODS

With data from the French CONSTANCES cohort study of 13 716 male and 12 767 female employees aged 45 and older, we identify adverse employment histories between age 25 and 45, focussing on job discontinuity, job instability and cumulative disadvantage. Direct effects of these conditions on self-reported depression over a period of up to 5 years are analyzed, using discrete-time logistic regression. Indirect effects of stressful work at baseline are examined.

RESULTS

Moderately elevated odds ratios of self-reported depression are observed among participants with discontinued employment histories (number of unemployment periods; years out of work for men). Effort-reward imbalance at work is consistently related to elevated risk of self-reported depression and explains parts of the association between discontinuous employment and depression.

CONCLUSIONS

Applying a life course perspective to occupational health research extends current knowledge. Specifically, adverse employment histories in terms of recurrent job discontinuity are related to the risk of self-reported depression. This association is partly explained by exposure to a stressful psychosocial work environment. These results can instruct labour market policies and the development of targeted worksite interventions that address disadvantage throughout entire employment trajectories.

Effects of cycling workstation to get tertiary employee moving on their overall health: study protocol for a REMOVE trial

BACKGROUND

Sedentary behaviour (SB) and low levels of physical activity (PA) are predictors of morbidity and mortality. Tertiary employees spend a considerable amount of their daily time seated and new efficient strategies to both reduce sedentary time and increase physical activity are needed. In that context, the REMOVE study aims at evaluating the health effects of a 24-week cycling desk intervention among office workers.

METHODS

A prospective, open-label, multicentre, two-arm parallel, randomized controlled trial (RCT) will be conducted in office-sitting desk workers. Office workers (N = 80) who have 0.8 full time equivalent hours (FTE) and 75% of this time in a sitting position will be recruited from tertiary worksites in Clermont-Ferrand, France. Subjects will be randomly assigned to one of the two following interventions: (i) PPM6: performance of two 30 min of cycling desk (using portable pedal exercise machine-PPM) per working day for 6 months or (ii) CTL_PPM3: 3 months with no intervention (control) followed by 3 months during which workers will be asked to complete two 30 min of PPM per working day. At baseline (T0), at 3 months (T1) and at 6 months (T2) after the start of the interventions, primary outcomes; 7-day PA and SB (3D-accelerometers), secondary outcomes; body composition (bioelectrical impedance), physical fitness (aerobic fitness, upper and lower limb strength), metabolic outcomes (fasting blood samples), self-perceived stress, anxiety, quality of life at work and job strain (questionnaires), tertiary outcomes; resting metabolic rate and cycling energy expenditure (indirect calorimetry) and eating behaviours (questionnaires) will be measured. An ergonomic approach based on observations and individual interviews will be used to identify parameters that could determine adherence.

DISCUSSION

The REMOVE study will be the first RCT to assess the effects of cycling workstations on objectively measured PA and SB during working and non-working hours and on key physiological and psychological health outcomes. This study will provide important information regarding the implementation of such cycling workstations in office workers and on the associated potential health benefits.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04153214 . Registered on November 2019, version 1.

Cumulative disadvantage during employment careers - The link between employment histories and stressful working conditions

Accumulated evidence on health-adverse effects of stressful psychosocial and physical work environments is considered a major breakthrough in recent social epidemiological research. However, research on adverse health effects of repeated exposure over time is lacking. In this contribution we analyse associations of characteristics of adverse employment histories with stressful psychosocial and physical current working conditions. We use data from the French CONSTANCES study and restrict the sample to employed men and women aged 45-60 (n = 23652). Current working conditions are assessed by effort-reward imbalance as well as stressful physical working tasks and positions. Previous employment histories (between age 25 and 45) are retrospectively assessed and measured by indicators of precarious, discontinuous and disadvantaged working careers. We found consistent associations of precarious, discontinuous or disadvantaged careers with strenuous physical working conditions and with low occupational rewards. However, low effort rather than high effort was associated with adverse employment histories. Therefore, associations with the effort-reward ratio turned out to be inconsistent. By extending the scope of analysis beyond single time-point measures, we identified three types of adverse employment histories among employees between age 25 and 45 in a stress-theoretical framework, and we demonstrated their associations with employees' current adversity at work between the age of 45-60.

Carpal tunnel syndrome and exposure to work-related biomechanical stressors and chemicals: Findings from the Constances cohort

Objective

To investigate the effects of co-exposure to biomechanical wrist stressors and chemicals on the risk of CTS in a large cohort of French workers.

Methods

Prospective study using the data collected at baseline and at the first 12 month-follow-up for the 18,018 participants included in the population-based Constances cohort between 2012 and 2015. CTS at follow-up and exposure to biomechanical wrist stressors and chemicals at baseline were assessed using a self-administered questionnaire. Associations between CTS and co-exposure to biomechanical wrist stressors and chemicals were studied using multivariate logistic regression models, adjusted for personal/medical factors.

Results

184 men (2.1%, 95%CI 1.8–2.4) and 331 women (3.6%, 3.2–3.9) free from chronic hand symptoms at baseline declared suffering from unilateral/bilateral CTS at follow-up. A potentiating effect of co-exposure to biomechanical wrist stressors and chemicals on the risk of CTS was found for both genders, with higher OR in the co-exposure group (OR = 3.38 [2.29–5.01] in men and OR = 4.12 [2.73–6.21] in women) than in the biomechanical exposure group (OR = 2.14 [1.51–3.03] in men and OR = 2.19 [1.72–2.78] in women) compared to no exposure group.

Conclusions

The study showed an association between CTS and co-exposure to biomechanical wrist stressors and chemicals, after adjustment for the main personal and medical factors. This finding should be confirmed using more objective case definition of CTS and assessment of the chemical exposure before drawing conclusions on the possible synergistic effects of mechanical stressors and chemical on the median nerve.

Adverse Psychosocial Work Environments and Depression-A Narrative Review of Selected Theoretical Models

Far-reaching progress of treatment and prevention of depressive disorders is still limited, mainly due to the multifactorial determinants of these disorders and the restricted knowledge of their aetiology. Stressful socio-environmental conditions represent one of the multifactorial determinants, and in view of the centrality of work and employment for human well-being, research on health-adverse psychosocial work environments turned out to be a promising line of scientific inquiry. During the past three decades, respective research focused mainly on three theoretical models of adverse psychosocial work and their measurement in prospective epidemiologic studies, termed "demand-control," "effort-reward imbalance," and "organizational injustice." This report provides a review of current evidence on their associations with depression, based on several systematic reviews and updated by most recent publications. Moreover, it discusses the conceptual and methodological strengths and weaknesses of these associations. In summary, the results of more than 40 cohort studies from a variety of Western modern societies confirm that stressful work in terms of these models is associated with a moderately increased risk of subsequent onset of depression. While this knowledge is considered robust enough to instruct efforts of primary and secondary prevention, several methodological challenges still need to be resolved by future research.

Stress among university students: factorial structure and measurement invariance of the Italian version of the Effort-Reward Imbalance student questionnaire

Background

In the last decade academic stress and its mental health implications amongst university students has become a global topic. The use of valid and theoretically-grounded measures of academic stress in university settings is crucial. The aim of this study was to examine the factorial structure, reliability and measurement invariance of the short student version of the effort-reward imbalance questionnaire (ERI-SQ).

Methods

A total of 6448 Italian university students participated in an online cross-sectional survey. The factorial structure was investigated using exploratory factor analysis and confirmatory factor analysis. Finally, the measurement invariance of the ERI-SQ was investigated.

Results

Results from explorative and confirmatory factor analyses showed acceptable fits for the Italian version of the ERI-SQ. A modified version of 12 items showed the best fit to the data confirming the 3-factor model. Moreover, multigroup analyses showed metric invariance across gender and university course (health vs other courses).

Conclusions

In sum, our results suggest that the ERI-SQ is a valid, reliable and robust instrument for the measurement of stress among Italian university students.

Effort-reward imbalance and long-term benzodiazepine use: longitudinal findings from the CONSTANCES cohort

OBJECTIVES

To examine the association between effort-reward imbalance and incident long-term benzodiazepine use (LTBU).

METHODS

We included 31 077 employed participants enrolled in the French population-based CONSTANCES cohort between 2012 and 2014 who had not undergone LTBU in the 2 years before enrolment. LTBU was examined using drug reimbursement administrative databases. The effort-reward imbalance was calculated in quartiles. We computed ORs (95% CIs) for LTBU according to effort-reward imbalance over a 2-year follow-up period. We adjusted for age, gender, education, occupational grade, income, marital status, tobacco smoking, risk of alcohol use disorder, depressive symptoms and self-rated health.

RESULTS

Over the 2-year follow-up, 294 (0.9%) participants experienced incident LTBU. In the univariable analysis, effort-reward imbalance was associated with subsequent LTBU with ORs of 1.79 (95% CI 1.23 to 2.62) and 2.73 (95% CI 1.89 to 3.95) for the third and fourth quartiles, respectively, compared with the first quartile. There was no interaction between effort-reward imbalance and any of the considered variables other than tobacco smoking (p=0.033). The association remained significant in both smokers and non-smokers, with higher odds for smokers (p=0.031). In the fully adjusted model, the association remained significant for the third and fourth quartiles, with ORs of 1.74 (95% CI 1.17 to 2.57) and 2.18 (95% CI 1.50 to 3.16), respectively. These associations were dose dependent (p for trend <0.001).

CONCLUSIONS

Effort-reward imbalance was linked with incident LTBU over a 2-year follow-up period after adjustment for sociodemographic and health-related factors. Thus, screening and prevention of the risk of LTBU should be systematised among individuals experiencing effort-reward imbalance, with special attention paid to smokers.