Effort‐Reward Imbalance and Depression in Japanese Medical Residents

Abstract

Effort-Reward Imbalance and Depression in Japanese Medical Residents: Yumi SAKATA, et al. Department of Occupational Mental Health, Graduate School of Medical Sciences, Kitasato University-The effort-reward imbalance is an important psychosocial factor which is related to poor health among employees. However, there are few studies that have evaluated effort-reward imbalance among medical residents. The present study was done to determine the association between psychosocial factors at work as defined by the effort-reward imbalance model and depression among Japanese medical residents. We distributed a questionnaire to 227 medical residents at 16 teaching hospitals in Japan at the end of August 2005. We asked participants to answer questions which included demographic information, depressive symptoms, effort-reward imbalance, overcommitment and social support. Depression was evaluated using the Japanese version of the Center for Epidemiologic Studies-Depression (CES-D) scale. The effort-reward imbalance and overcommitment were assessed by the Effort-Reward Imbalance (ERI) questionnaire which Siegrist developed. Social support was determined on a visual analog scale. Logistic regression analysis was performed to determine the associations between effort-reward imbalance and depressive symptoms. Depressive symptoms were found in 35 (29.2%) 1st-year residents and 21 (27.6%) 2nd-year residents. The effort-reward ratio >1 (OR, 8.83; 95% CI, and low social support score (OR, 2.77, 95% CI, 1.36-5.64) were associated with depressive symptoms among medical residents. Effort-reward imbalance was independently related to depression among Japanese medical residents. The present study suggests that balancing between effort and reward at work is important for medical residents' mental health. (J Occup Health 2008; 50: 498-504)

Hospital Safety Climate, Psychosocial Risk Factors and Needlestick Injuries in Japan

“…Mental stress is an important issue in contemporary occupational health and one that has been receiving increasing attention in Japan during recent years. Potentially high rates of psychosocial stresses suggested in the current study are supported by previous research which found that depressive symptoms affected around 28% of Japanese medical resi- dents 41) . Another study of medical residents also found that depressive symptoms were associated with NSI events 13) , while a Korean investigation revealed that HCW who had sustained an NSI experienced higher scores of depression and anxiety 42) .…”

The association between rotating shift work and increased occupational stress in nurses

“…This is different from studies performed in other countries. For example, Sakata et al 3) reported that 12.2 and 44.4% of medical resi- dents in Japan experienced effort/reward imbalance and overcommitment, whereas Conway et al 8) reported that 16.1 and 26.3% of health-care workers in Italy experienced effort/reward imbalance and overcommitment. A survey of a group of nurses in the ORSOSA study in France identified effort/reward imbalance in 10.7% of the nurses and overcommitment in 40.8% of the nurses 19) .…”

“…(e.g., day shift switched to evening or night shift) (2) How many days off did you receive when you switched from the night shift to other shifts? (3) In the last 2 months, how many night shifts did you work? (4) In the last 2 months, how many times did you work 7 consecutive days per month?…”

“…Stress levels among professional nurses have increased in recent years due to the demands of clinical nursing. Previous studies have shown that work demands and stress are associated with adverse mental health such as emotional exhaustion 1) , depressive disorder 2,3) and fatigue 4,5) , which result in sleep problems and sickness absence 1) . Stress systems in the body, like the sympathetic-adrenomedullary system and the hypothalamic-pituitary-adrenocortical axis, start working, using adapted processes as the stress attracting 6) , and exhaustion tend to result from longterm exposure.…”

Physiological and Neurobiological Aspects of Stress and Their Relevance for Residency Training

“…Due to its unique conditions, however, residency exemplifies the definition of effort-reward imbalance, i.e. high-cost/low-gain conditions, which have been associated with adverse health outcomes [15]. Further discussion of stress effects on attendings is beyond the scope of this article.…”