Abstract
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. Methods 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.
Highlights
High or moderate quality # Kivimäki et al 2007 [39] FHPS # Wang et al 2012 [40] LCWPA # Juvani et al 2014 [43] FPSS # Nielsen et al 2016 [44] DWECS Subtotal (I-squared = 79.5%, p = 0.002)
We identified one study [40] that may have been overlooked by Theorell et al and two studies [43, 44] that were published after Theorell et al had conducted their literature search
Depressive disorders are highly disabling and a leading cause of years of life lost to disability [6]
Summary
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 conducted this review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [26]. We excluded studies that had a cross-sectional, case–control, case study or intervention design, did not exclude or adjust for baseline cases and did not analyze onset of depressive disorders but instead examined depressive symptoms as a continuous variable.
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