Effort-Reward Imbalance, Over-Commitment and Depressive Episodes at Work: Evidence from the ELSA-Brasil Cohort Study

Abstract

A growing burden of mental illness, and in particular depression, among workers is a concern of occupational public health. Scientific evidence has revealed consistent associations of work-related stress, as measured by theoretical models, with depression, but mostly so in developed countries. This contribution explores these associations in a developing Latin American country, Brazil, by applying an internationally established work stress model, the effort-reward imbalance (ERI). This model focuses on the work contract where unjust exchange between high efforts spent and low rewards received in turn contributes to stress-related disorders. The model’s extrinsic (‘effort’, ‘reward’) and intrinsic components (‘over-commitment’), as well as their combination, are hypothesized to be related to a higher risk of depressive episodes (DE). Using cross-sectional data from the ELSA-Brasil study, including 10,034 workers from the public sector, we observed increased prevalence ratio (PR) of DE according to ERI scales. The quartiles of highest ‘effort’ (PR = 1.85; 1.44–2.37), highest ‘over-commitment’ (PR = 3.62; 2.80–4.70) and lowest ‘reward’ (PR = 3.44; 2.55–4.64) were associated with DE, on adjusted models, as well was the E–R ratio (PR = 2.47; 1.92–3.17). An additive interaction was identified between the E–R ratio and ‘over-commitment’. The results support the use of ERI as a screening tool for work stress in the Brazilian context and will offer guidance for worksite health promotion programs.

A Cross Sectional Study Evaluating Psychosocial Job Stress and Health Risk in Emergency Department Nurses

“…The ERI model is a validated approach to measure psychosocial work stress by identifying non-reciprocity between occupational efforts spent and rewards received, and has the ability to predict poor health outcomes [17]. ERI and OC were shown to be strongly associated with depressive episodes at work in Brazilian and New Zealand studies [18,19]. The ERI model was also successfully applied to measure occupational stress and burnouts in physicians and nurses working in intensive care units [20,21].…”

“…Psychological stress has been implicated in the elevated production of reactive oxygen species (ROS) causing oxidative stress [13,14,15,16]. Oxidative stress (OS) has been identified as a major risk factor for cardiovascular diseases (CVD) and cancer [17,18,19,20]. Job stress has been recognized as one of the major risk factors for coronary heart disease (CHD) [21,22].…”

Predictors of stress among emergency medical personnel during the COVID-19 pandemic

“…Increased levels of stress may lead to extremely serious health problems and to the occurrence of many diseases such as cancer or psychiatric disorders. Stress at work has been directly linked to the occurrence of cardiovascular diseases, diabetes, depression and occupational burnout, resulting in a drop in the quality of services [11][12]. During the study period, the average number of diagnosed cases of COVID-19 in Poland was 338/day, and the number of active cases at the end of the study was 8080 [13].…”

Associations of occupational stress, workplace violence, and organizational support on chronic fatigue syndrome among nurses

“…Sustained occupational stress will lead to chronic health problems, such as depression, anxiety, insomnia, cardiovascular, and cerebrovascular diseases and even chronic fatigue (Chen et al, ; Huang et al, ; Steege et al, ; Welsh, ). The Effort‐Reward Imbalance model (ERI) reveals that these adverse health outcomes are probably due to high effort and low rewards (de Araújo et al, ; Siegrist et al, ). The ERI model includes another dimension of overcommitment.…”