The Effort-Reward Imbalance model of psychosocial stress at the workplace—a comparison of ERI exposure assessment using two estimation methods

Preliminary study about occupational stress of physicians and nurses in pediatric and neonatal intensive care units: the balance between effort and reward

This study compared the balance between effort (E) and reward (R) among physicians and nurses working in pediatric (PED) and neonatal (NEO) Intensive Care Units. This descriptive cross-sectional study was carried out with 37 physicians and 20 nurses. The Effort-Reward Imbalance Questionnaire was used. Statistically significant differences were not found among physicians (p>0.05) or nurses from PED and NEO in relation to E and R (p>0.05). No statistically significant differences were found between physicians and nurses in PED in the several studied variables. Comparison between the professionals working in NEO revealed that physicians presented more over-commitment than nurses (p=0.01). The organizational setting of NEO proved to be more demanding for physicians, exacting a greater commitment to their work, while demands presented in both units seemed to be the same for nurses.

Effort-reward imbalance, heart rate, and heart rate variability: the Cardiovascular Risk in Young Finns Study

BACKGROUND

Work stress indicated by effort-reward imbalance is hypothesized to cause autonomic arousal, which, if prolonged or frequent, could contribute to cardiovascular pathology. However, only limited empirical evidence on this mechanism is available.

PURPOSE

This study examined associations between effort-reward imbalance, heart rate (HR), and heart rate variability (HRV).

METHOD

The participants were 457 women and 406 men (mean age 32.3 years) derived from the population-based Young Finns Study. Effort-reward imbalance was defined as the ratio between effort and reward, higher efforts compared to rewards indicating greater imbalance.

RESULTS

In age-adjusted regression models, higher effort-reward imbalance was associated with lower HRV, and lower reward was associated with higher HR among women. These associations were not attenuated after additional adjustments for demographic characteristics and coronary risk factors. No significant associations of effort-reward imbalance or its components with HR and HRV were found in men.

CONCLUSION

Our finding of lower HRV and higher HR in young healthy women with high effort-reward imbalance and low rewards provides evidence of a potential mechanism that may link effort-reward imbalance to the development of coronary heart disease (CHD) in women.

Work Stress and New-Onset Migraine in a Female Employee Population

This prospective cohort study examined whether work stress, as indicated by the job strain model and the effort-reward imbalance model, predicts new-onset migraine among 19 469 female employees with no history of migraine at study entry. A baseline survey between 2000 and 2002 assessed work stress and demographic factors. Self-reported newly diagnosed migraine was measured at follow-up between 2004 and 2005 and 1281 new cases of migraine were detected. In logistic regression analysis adjusted for age, socioeconomic position and depression at baseline, no association between job strain and migraine was found. In contrast, high effort-reward imbalance was associated with slightly increased risk of migraine at follow-up, odds ratio 1.23 (95± confidence interval 1.04, 1.45). The proportion of new migraine cases attributable to high effort-reward imbalance was 6.2±. If the observed association is causal, our findings suggest that high effort-reward imbalance might function as a modifiable risk factor for new-onset migraine.

Preemployment Family Factors as Predictors of Effort/Reward Imbalance in Adulthood: A Prospective 18-year Follow-Up in the Cardiovascular Risk in Young Finns Study

OBJECTIVE

We prospectively examined whether preemployment family factors predict adulthood work stress manifested as effort-reward imbalance (ERI).

METHODS

The study sample comprised 746 participants from the Cardiovascular Risk in Young Finns Study. Data were collected by questionnaires. The parents reported their socioeconomic position and life satisfaction in 1983 when the participants were at age 6 to 21. The participants reported ERI in 2001 at age 24 to 39.

RESULTS

High rewards were predicted by high parental life satisfaction in men and by high parental socioeconomic position in women. The association between higher parental socioeconomic position and higher efforts was mediated by participant's education. Preemployment family factors were not associated with the total ERI.

CONCLUSIONS

Although preemployment family factors were associated with the reward and effort components, they seemed to have little effect on the total ERI.

Effort-reward imbalance at work and the co-occurrence of lifestyle risk factors: cross-sectional survey in a sample of 36,127 public sector employees

BACKGROUND

In occupational life, a mismatch between high expenditure of effort and receiving few rewards may promote the co-occurrence of lifestyle risk factors, however, there is insufficient evidence to support or refute this hypothesis. The aim of this study is to examine the extent to which the dimensions of the Effort-Reward Imbalance (ERI) model--effort, rewards and ERI--are associated with the co-occurrence of lifestyle risk factors.

METHODS

Based on data from the Finnish Public Sector Study, cross-sectional analyses were performed for 28,894 women and 7233 men. ERI was conceptualized as a ratio of effort and rewards. To control for individual differences in response styles, such as a personal disposition to answer negatively to questionnaires, occupational and organizational-level ecological ERI scores were constructed in addition to individual-level ERI scores. Risk factors included current smoking, heavy drinking, body mass index > or =25 kg/m2, and physical inactivity. Multinomial logistic regression models were used to estimate the likelihood of having one risk factor, two risk factors, and three or four risk factors. The associations between ERI and single risk factors were explored using binary logistic regression models.

RESULTS

After adjustment for age, socioeconomic position, marital status, and type of job contract, women and men with high ecological ERI were 40% more likely to have simultaneously > or =3 lifestyle risk factors (vs. 0 risk factors) compared with their counterparts with low ERI. When examined separately, both low ecological effort and low ecological rewards were also associated with an elevated prevalence of risk factor co-occurrence. The results obtained with the individual-level scores were in the same direction. The associations of ecological ERI with single risk factors were generally less marked than the associations with the co-occurrence of risk factors.

CONCLUSION

This study suggests that a high ratio of occupational efforts relative to rewards may be associated with an elevated risk of having multiple lifestyle risk factors. However, an unexpected association between low effort and a higher likelihood of risk factor co-occurrence as well as the absence of data on overcommitment (and thereby a lack of full test of the ERI model) warrant caution in regard to the extent to which the entire ERI model is supported by our evidence.

Effort–reward imbalance, sleep disturbances and fatigue

OBJECTIVES

The objective of this study was to investigate the validity of the effort-reward imbalance (ERI) model in relation to disturbed sleep and fatigue.

METHODS

The study population derived from a subset of the WOLF (WOrk, Lipids, Fibrinogen) cohort study of cardiovascular risk in a working population who replied to the ERI-questionnaire comprising 789 men and 214 women. Cox regression analysis was used to calculate the prevalence ratio (PR) for sleep disorders and fatigue in relation to the components of ERI.

RESULTS

As sleep disturbances and fatigue, based on literature, were defined to be represented by the uppermost quintile, 14% of the men and 23% of the women were affected by sleep disturbances while 14 and 26%, respectively, were affected by fatigue. Higher levels of exposure for the ERI components were associated with increased prevalence of sleep disturbances and fatigue. For men, the strongest association was seen between high overcommitment and fatigue (PR 5.77, 95% confidence interval 2.89-11.5). For women, high effort and sleep disturbances (PR 4.04, CI 1.53-10.7), high effort/reward ratio and sleep disturbances (PR 4.13, CI 1.62-10.5), and between low reward and fatigue (PR 4.36, CI 1.79-10.6) yielded the most obvious associations.

CONCLUSIONS

The present study adds sleep disturbances and fatigue to the list of adverse consequences of effort-reward imbalance.

Reviewing the effort–reward imbalance model: drawing up the balance of 45 empirical studies

The present paper provides a review of 45 studies on the Effort-Reward Imbalance (ERI) Model published from 1986 to 2003 (inclusive). In 1986, the ERI Model was introduced by Siegrist et al. (Biological and Psychological Factors in Cardiovascular Disease, Springer, Berlin, 1986, pp. 104-126; Social Science & Medicine 22 (1986) 247). The central tenet of the ERI Model is that an imbalance between (high) efforts and (low) rewards leads to (sustained) strain reactions. Besides efforts and rewards, overcommitment (i.e., a personality characteristic) is a crucial aspect of the model. Essentially, the ERI Model contains three main assumptions, which could be labeled as (1) the extrinsic ERI hypothesis: high efforts in combination with low rewards increase the risk of poor health, (2) the intrinsic overcommitment hypothesis: a high level of overcommitment may increase the risk of poor health, and (3) the interaction hypothesis: employees reporting an extrinsic ERI and a high level of overcommitment have an even higher risk of poor health. The review showed that the extrinsic ERI hypothesis has gained considerable empirical support. Results for overcommitment remain inconsistent and the moderating effect of overcommitment on the relation between ERI and employee health has been scarcely examined. Based on these review results suggestions for future research are proposed.