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Effort-reward imbalance, sleep disturbances and fatigue
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
University of Ulm, Germany.
Karolinska Institutet, Stockholm.
Show others and affiliations
2006 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 79, no 5, 371-378 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2006. Vol. 79, no 5, 371-378 p.
Keyword [en]
Work stress, Effort–reward imbalance, Sleep disorders, Fatigue
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:miun:diva-331DOI: 10.1007/s00420-005-0063-6ISI: 000236355600005PubMedID: 16362323Scopus ID: 2-s2.0-33645140555Local ID: 3737OAI: oai:DiVA.org:miun-331DiVA: diva2:1941
Available from: 2008-12-04 Created: 2008-11-29 Last updated: 2016-09-28Bibliographically approved
In thesis
1. Aspects of the Effort-reward imbalance model of psychosocial stress in the working life
Open this publication in new window or tab >>Aspects of the Effort-reward imbalance model of psychosocial stress in the working life
2008 (English)Doctoral thesis, comprehensive summary (Other scientific)
Abstract [en]

Fahlén, G. (2008). Aspects on the Effort-reward Imbalance model of psychosocial stress in the work environments. Sundsvall, Sweden: Mid Sweden University, Department of Health Sciences. ISBN 978-91-85317-94-3.

Since the late 1970s, work related stress has increasingly been recognized as an important determinant for ill-health and disease. One of the most influential stress models is the Effort-Reward Imbalance model (ERI), which stipulates that an imbalance between the perceived effort spent at work and rewards received results in noxious stress. Those with a coping behaviour called Work-related Overcommitment (WOC), including an inability to withdraw from work obligations are especially vulnerable. The model has shown strong explanatory value for a large numbers of harmful health outcomes.

The general aim of this thesis was to contribute to the development of the ERI model by exploring the properties of this model in relation to its theoretical assumptions, construct, and application and to improve the knowledge of validity of the ERI-model.

The study sample that was used in three papers emanated from the WOLF study (Work, Lipids and Fibrinogen). The analyses were confined to the subset of individuals who answered the ERI questions (n=1174) with complete answers. In one paper, data from the SKA study (Sick leave, Culture and Attitudes) were used and they comprised all employees at the Swedish Social Insurance Agency responsible for management and compensation of illness in the working population (n=5700). All data are based on questionnaires.

The results indicate that ERI and WOC are risk factors for sleep disturbances and fatigue. A palpable threshold effect was seen between quartile three and four. Since these symptoms are strongly stress related, our results support the utility of the ERI and WOC scales in assessing stress in working life.

Agreement between single questions in the original and an approximate instrument for measuring ERI were low, whereas the agreement between the two ERI scales was reasonable. When approximate instruments are used, questions and scales must be presented thoroughly to facilitate comparisons and the results should be interpreted with caution. Today there are no reasons to use such instruments in the ERI model.

One statement in the ERI model is that individuals with the coping behaviour characterised as WOC are particularly vulnerable to an imbalance between perceived effort and reward; i.e., that ERI and WOC interact. No such effect was shown in relation to disturbed sleep and fatigue. There is no convincing evidence that ERI and WOC interact in synergy. Analysis demonstrated that WOC was relatively stable in perceived unchanged conditions as measured by the original, more comprehensive instrument as well as by the present, shortened instrument. Positively or negatively perceived changes in ERI correspond to changes in WOC. This result suggests that WOC, at least in part, may act as not only a coping strategy but also as an outcome from ERI. Taken together, these results concerning WOC, suggest that studies to clarify the role of the WOC dimension are needed.

The ERI model states that, when individuals stay in unfavourable conditions characterised as ERI, because there are few alternatives on the labour market or when the individual is at risk of being laid off or of facing downward mobility, they are in a “locked in position” (LIP). A strong association between LIP and ERI was shown, supporting this statement.

Abstract [sv]

Fahlén, G. (2008). Aspects on the Effort-reward Imbalance model of psychosocial stress in the work environments. Sundsvall, Sweden: Mid Sweden University, Department of Health Sciences. ISBN 978-91-85317-94-3.

Arbetsrelaterad stress har sedan slutat av sjuttiotalet alltmer blivit uppmärksammat som en viktig bestämningsfaktor för ohälsa. En av de mest inflytelserika stressmodellerna är Ansträngning-belönings modellen (Effort-reward imbalance, ERI) som stipulerar att en obalans mellan ansträngning och belöning i arbetet orsakar en skadlig stress och att de som har ett särskilt coping-beteende som kännetecknas bland annat av oförmåga att dra sig tillbaka från sitt arbete (Work related overcommitment WOC) är särskilt sårbara. Modellen har visat ett starkt förklaringsvärde för många negativa hälsoutfall.

Det övergripande syftet med avhandlingen var att bidra till utvecklingen av ERI-modellen genom att utforska modellens egenskaper i relation till de teoretiska antagandena, uppbyggnad och tillämpning samt att öka kunskapen om modellens validitet.

Den epidemiologiska studie som användes i tre artiklar var WOLF-studien (WOrk, Lipids and Fibrinogen) där analyserna genomfördes på den delmängd som hade svarat på ERI-frågorna (n=1174) och som hade kompletta svar. För en artikel användes material från SKA-studien (Sjukskrivning, Kultur och Attityder) och omfattade de som arbetade med ohälsoärenden vid Försäkringskassan (n=5700) i samtliga fall användes data från frågeformulär.

Resultaten visade att ERI och WOC utgör riskfaktorer för störd sömn och dagtrötthet. En tydlig tröskeleffekt kunde skönjas mellan tredje och fjärde kvartilen. Eftersom dessa symptom är starkt stressrelaterade, gav resultaten stöd för användbarheten av ERI och WOC instrumenten för att skatta stress i arbetslivet.

Överensstämmelsen mellan enskilda frågor i orginalinstrumentet för ERI och ett approximativt var låg, medan överensstämmelsen mellan de två ERI skalorna bedömdes som rimlig. När approximativa instrument används bör frågor och skalor presenteras utförligt för att jämförelser ska underlättas och resultaten bör tolkas med försiktighet.

En utgångspunkt i ERI-modellen är att individer som har ett coping-beteende som karakteriseras som WOC är särskilt sårbara för en obalans mellan ansträngning och belöning, d.v.s. att ERI och WOC interagerar i synergi. Ingen sådan effekt kunde styrkas i relation till störd sömn och dagtrötthet. Det saknas också övertygande bevis för att en sådan effekt finns. WOC-måttet är relativt stabilt i oförändrade arbetsförhållanden i såväl orginalinstrumentet som i det nuvarande förkortade. Upplevda positiva eller negativa förändringar i ERI påverkade WOC i samma riktning. Resultaten indikerade att WOC, åtminstone delvis kan utgöra ett utfall av ERI, inte endast en copingstrategi. Dessa resultat gör att studier för att tydliggöra WOC-dimensionens roll i ERI modellen är önskvärda.

En annan utgångspunkt i modellen är att en av de situationer man stannar i ogynnsamma arbetsförhållanden kännetecknade av ERI, är att man har små möjligheter att byta arbete beroende på att man har få möjligheter på arbetsmarknaden eller är utsatt för risk att bli uppsagd eller att få sämre arbete, man är ”inlåst”. Resultaten visade på en stark association mellan inlåsning och ERI och gav därmed stöd åt antagandet.

Place, publisher, year, edition, pages
Institutionen för hälsovetenskap, 2008
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 51
Keyword
Psychosocial stress, Effort-reward imbalance, Working life
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-203 (URN)978-91-85317-94-3 (ISBN)
Public defence
2008-05-23, Lubbesalen, 10:15 (English)
Opponent
Supervisors
Available from: 2008-04-18 Created: 2008-04-18Bibliographically approved

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