Effort–reward imbalance at work and risk of depressive disorders. A systematic review and meta-analysis of prospective cohort studies

Abstract

Effort-reward imbalance at work and risk of depressive disorders. A systematic review and meta-analysis of prospective cohort studies by Rugulies R, Aust B, Madsen IEH Effort-reward imbalance at work predicted a 1.5-fold increased risk of depressive disorders in this systematic review and meta-analysis of eight prospective cohort studies from Europe, Canada and the USA. This study provides the hitherto strongest evidence for a possible role of effort-reward imbalance in the etiology of depressive disorders. Review Scand J Work Environ Health. 2017;43(4):294-306. doi:10.5271/sjweh.3632 Effort-reward imbalance at work and risk of depressive disorders. A systematic review and meta-analysis of prospective cohort studies Objective The aim of this review was to determine whether employees exposed to effort-reward imbalance (ERI) at work have a higher risk of depressive disorders than non-exposed employees. AffiliationMethods We conducted a systematic review and meta-analysis of published prospective cohort studies examining the association of ERI at baseline with onset of depressive disorders at follow-up. The work was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and a detailed study protocol was registered before literature search commenced (Registration number: CRD42016047581). We obtained a summary estimate for the association of ERI with risk of depressive disorders by pooling the study-specific estimates in a meta-analysis. We further conducted pre-defined sensitivity analyses.Results We identified eight eligible cohort studies, encompassing 84 963 employees and 2897 (3.4%) new cases of depressive disorders. Seven of the eight studies suggested an increased risk of depressive disorders among employees exposed to ERI. The pooled random-effects estimate was 1.49 [95% confidence interval (95% CI) 1.23-1.80, P<0.001], indicating that ERI predicts risk of depressive disorders. The estimate was robust in sensitivity analyses stratified by study quality, type of ERI ascertainment and type depressive disorder ascertainment, respectively. Conclusions Employees exposed to ERI were at increased risk of depressive disorder. Future studies on ERI and depressive disorders should examine if this association is stronger or weaker when ERI is measured repeatedly during follow-up and with other methods than self-report or when depressive disorders are ascertained with clinical diagnostic interviews.

What is a psychosocial work environment?

“…The conceptual framework depicted in figure 1 may be useful for placing studies from different academic disciplines into a bigger picture of psychosocial work environment research, emphasizing the transdisciplinary nature of this type of research. Work environment research that is denoted as "psychosocial" is often focused on how psychosocial working conditions (iii), such as job demands, work organization, job content or social relations at work (1) are affecting psycho-physiological changes (v) (eg, stress axis activation) (31), health-related behaviors (vi) (eg, smoking or leisure time physical activity) (32,33) or risk of diseases and disorders (vii), such as cardiovascular disease (34,35), diabetes (36,37), musculoskeletal disorders (38) or depression (39)(40)(41). In addition to this, the framework in figure 1 suggests that psychosocial work environment research may also include research on the historical origins of contemporary societal structures (i) (42)(43)(44) and on the impact of macro-level phenomena (i) (eg, the global financial crisis of 2007) on workers' health (vii) (45) and how this impact may be explained by changes in workplace structures (ii), for example by staff reductions, or by deteriorating working conditions and reduced job security (iii) (46,47).…”

On effort–reward imbalance and depression

“…The review by Rugulies et al (1) in this issue of the Scandinavian Journal of Work, Environment & Health is published almost at the same time as a Dragano et al article (2) in the journal Epidemiology on effortreward imbalance (ERI) at work and incident coronary heart disease. The latter is based on the European collaborative individual participant data (IPD) cohort.…”

Do resources buffer the prospective association of psychosocial work stress with depression? Longitudinal evidence from ageing workers

“…This disorder is linked to a reduction in the quality of life, premature retirement, and more years with disability (3). With regard to its causes, depression is known to be a multifactorial disorder with biological, environmental, and psychological factors involved in its development (4)(5)(6)(7)(8), including psychosocial work stressors (9)(10)(11). To date, most studies have investigated the association between psychosocial work stressors and depression measuring work stressors according to the models of effort-reward imbalance (ERI) and job strain.…”

“…ERI is based on the notion of failed contractual reciprocity between efforts spent and rewards received at work, where rewards include money, promotion prospects, job security, and esteem (13). The majority of these studies suggest that ERI and job strain or specific components of these stressors are related to the onset of depression (9,10,14).…”