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Effort-reward imbalance, "locked in" at work and long term sick leave
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
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2009 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 82, no 2, 191-197 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objective was to study the relationship between a situation characterized as being in a "locked-in" position (LIP) in occupation and/or place of work, Effort-reward imbalance (ERI), and long-term sick leave. METHODS: The study population derived from one section of a cross-sectional study SKA (sick-leave, culture and attitudes), and comprised all employees at the Swedish Social Insurance Agency responsible for management and compensation of illness in the working population. The analyses were performed for 2,951 women and 534 men who had complete data. Logistic regression was used to calculate odds ratio (OR) for ERI and sick-leave, the latter only for women. RESULTS: The results showed a strong association between LIP within the place of work and ERI (for women OR = 3.28 95% CI 2.65-4.07, and for men 2.74 1.75-4.30). Also LIP within occupation resulted in high ERI (for women OR = 1.96 1.57-2.41, and for men 1.92 1.22-3.03). In women, ERI (OR = 1.40 1.15-1.70) as well as LIP within place of work (1.88 1.50-2.36) and within occupation (1.48 1.12-1.86) were associated with sick leave. ERI showed a significant mediating effect between LIP and sick leave, within place of work and within occupation (Z value 2.20 and 2.88, respectively). CONCLUSIONS: High ERI is associated with a situation characterized by being locked-in within an occupation or/and within a place of work. The results thereby support the theoretical model of Effort-reward imbalance. The results show that high ERI and being locked in are associated with long-term sick leave. ERI is a potential mediator of the association between being locked in and sick leave.

Place, publisher, year, edition, pages
2009. Vol. 82, no 2, 191-197 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:miun:diva-332DOI: 10.1007/s00420-008-0321-5ISI: 000262412200007PubMedID: 18418625Scopus ID: 2-s2.0-58249143595OAI: oai:DiVA.org:miun-332DiVA: diva2:1942
Available from: 2008-11-29 Created: 2008-11-17 Last updated: 2016-09-26Bibliographically 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
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Available from: 2008-04-18 Created: 2008-04-18Bibliographically approved

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