Effort-reward Imbalance Model Research Articles

Correlation analysis of occupational stress and metabolic syndrome among employees of a power grid enterprise in China.

Being in a state of high occupational stress may disrupt the metabolic balance of the body, thus increasing the risk of metabolic diseases. However, the evidence about the relationship between occupational stress and metabolic syndrome was limited. To explore the association between occupational stress and metabolic syndrome (MetS) in employees of a power grid enterprise. A total of 1091 employees were recruited from a power grid enterprise in China. Excluding those who failed to complete the questionnaire and those who had incomplete health check-ups, 945 subjects were included in the study. Assessment of occupational stress was used by job demand-control (JDC) and effort-reward imbalance (ERI) questionnaires, respectively. The information on body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were collected. The levels of high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and fasting blood glucose (FBG) in the fasting venous blood samples were measured. Logistic regression analysis and multiple linear regression methods were used to analyze the correlation between JDC and ERI models of occupational stress, metabolic syndrome, and its components, respectively. The prevalence of MetS was 8.4% and 9.9% in JDC and ERI model high occupational stress employees, respectively. ERI model occupational stress and smoking are significantly associated with the risk of MetS. ERI ratio was significantly associated with lower HDL-C levels. Gender, age, marital status, smoking, high-temperature and high-altitude work were significantly associated with metabolic component levels. Our study revealed a high detection rate of occupational stress in both JDC and ERI models among employees of a power grid enterprise. ERI model occupational stress, demanding more attention, was associated with the risk of MetS as well as its components such as HDL-C.

Effort-reward imbalance and common mental disorders among public sector employees of Iran: a cross-sectional analysis

BackgroundThe effort-reward imbalance (ERI) model is a widely used theoretical model to measure stress in the workplace. The objective of this study was to investigate the relationship between ERI and three common mental disorders: major depressive disorder (MDD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD).MethodsIn this cross-sectional analysis, the study sample consisted of 4453 baseline participants of the Employees’ Health Cohort Study of Iran (EHCSIR). Trained psychologists utilized the Persian version of the Composite International Diagnostic Interview (CIDI-2.1) during the baseline assessment to identify common mental disorders. Additionally, the validated Persian version of the 23-item ERI questionnaire was employed to assess effort, reward, overcommitment, and effort-reward ratio. To examine the association of ERI components with three common mental disorders (MDD, GAD, and OCD) over the past twelve months, multiple logistic regression analyses were conducted.ResultsThe prevalence of effort-reward imbalance in the study sample was 47.1%. Higher ERI score was significantly associated with MDD (OR: 3.43, 95% CI: 2.30–5.13), GAD (OR: 2.42, 95% CI: 1.27–4.63), and OCD (OR: 2.23, 95% CI:1.19–4.19). The study participants who reported higher scores on work overcommitment had a higher likelihood of having MDD (OR: 1.16, 95% CI:1.10–1.23), GAD (OR: 1.07, 95% CI: 1.01–1.14), and OCD (OR: 1.19, 95% CI: 1.09–1.29).ConclusionsAccording to the study’s findings, work-related stress, as determined by the ERI model, is a significant factor in the development of common mental disorders among employees in the public sector.

Job stress and chronic low back pain: incidence, number of episodes, and severity in a 4-year follow-up of the ELSA-Brasil Musculoskeletal cohort.

We investigated the association between job stress, as assessed by the effort-reward imbalance model, and the incidence of chronic low back pain (CLBP) over a 4-year period. A total of 1733 participants from the ELSA-Brasil Musculoskeletal cohort, who were free from LBP at baseline (2012-2014), were included. Episodes of LBP in the past 30 days, intensity, and the presence of disability were investigated in annual telephone follow-ups (2015-2018). Chronic LBP was defined as episodes of LBP lasting >3 months with at least moderate intensity. We analyzed the incidence of at least one episode of CLBP (yes/no), the number of CLBP episodes (0, 1, ≥2), and CLBP severity/disability (absent, nondisabling, severe/disabling). The association between these outcomes and tertiles of the effort-to-reward ratio, as well as each dimension of the effort-reward imbalance model, was investigated using multinomial logistic and Poisson regression models adjusting for sociodemographic and occupational variables. The cumulative incidence of CLBP over 4 years was 24.8%. High effort-reward imbalance increased the chances of experiencing multiple CLBP episodes and severe/disabling CLBP by 67% (95% confidence interval [CI]: 1.12-2.47) and 70% (95% CI: 1.14-2.53), respectively. High overcommitment increased the incidence of CLBP by 23% (95% CI: 1.01-1.50) and the chances of multiple CLBP episodes and severe/disabling CLBP by 67% (95% CI: 1.11-2.50) and 57% (95% CI: 1.05-2.34), respectively. These results indicate that exposure to job stress is associated with a higher incidence, a greater number of episodes, and increased severity of CLBP over a 4-year period. If this association is causal, measures aimed at reducing exposure to job stress are likely to alleviate the burden of CLBP.

The associations of psychosocial work exposures with suicidal ideation in the national French SUMER study

BackgroundThe literature remains scarce on the work-related risk factors for suicide and suicidal ideation. The objectives were to explore the associations of psychosocial work exposures with suicidal ideation in a nationally representative sample of the working population. MethodsThe study was based on the sample of 25,977 employees (14,682 men and 11,295 women) of the national French 2016–17 SUMER survey. The outcome was suicidal ideation assessed using the PHQ-9 instrument. Psychosocial work exposures included various factors from the job strain and effort-reward imbalance models, and other concepts. Statistical analyses were performed using weighted methods, including weighted logistic regression models. Other occupational exposures and covariates were considered. Gender differences were tested. ResultsThe prevalence of suicidal ideation was 3.5 % without any difference between genders. Psychosocial work exposures were found to be associated with suicidal ideation. The strongest association was observed between workplace bullying and suicidal ideation. Associations were also found between job strain model factors, job insecurity, low esteem, work-family conflict, ethical conflict, teleworking, and low meaning, and suicidal ideation. The associations were in general similar for men and women. LimitationsThe study had a cross-sectional design and no causal interpretation could be done. A reporting bias and a healthy worker effect may be suspected. ConclusionPsychosocial work exposures played a major role in suicidal ideation. More research may be needed to confirm our results, as suicidal ideation is an important warning signal for suicide prevention. More primary prevention towards the psychosocial work environment may be useful to reduce suicidal ideation at the workplace.

Review Article] Measurement Tools to Evaluate Psychosocial Factors in a Changing Work Environment: A Rapid Literature Review

This literature review examines the measurement instruments and questionnaires used to assess psychosocial factors in work environments. The focus is on their applicability across diverse professional settings. The review begins with identifying keywords and MeSH/EMTREE terms. Searches were then conducted across multiple databases and grey literature sources. The screening process identified 60 relevant articles. From these, 30 were selected to discuss the validity and reliability of various scales. The Copenhagen Psychosocial Questionnaire (COPSOQ) was found to be the most commonly used instrument, followed by the Job Content Questionnaire (JCQ), the Effort-Reward Imbalance (ERI) model, and the NIOSH General Job Stress Instrument. In Colombia, the evaluation of psychosocial risk factors in organizations is conducted using the _Batería de Instrumentos para la Evaluación de Factores de Riesgo Psicosocial_. This assessment provides a detailed evaluation of both intra-laboral and extra-laboral occupational psychosocial risk factors. Regarding reliability, all instruments identified and reviewed in this article had Cronbach's alpha values ranging from 0.7 to 0.9, indicating acceptable to excellent internal consistency, reliability, and validity for evaluating psychosocial risk factors in a representative work environment sample. Although each instrument is useful, adapting to evolving workplace dynamics is necessary for more comprehensive evaluations. The article emphasizes the impact of the COVID-19 pandemic on work arrangements, specifically remote and hybrid work, and highlights the need to evaluate psychosocial risk factors. The review provides insights into the changing landscape of work and the importance of addressing psychosocial factors to promote employee well-being and organizational effectiveness.

Work stress and changes in heart rate variability among employees after first acute coronary syndrome: a hospital-based longitudinal cohort study.

Work stress is considered as a risk factor for coronary heart disease, but its link with heart rate variability (HRV) among heart attack survivors is unknown yet. The aim of this study was to investigate associations between baseline work stress and the changes of HRV over one-year after onset of acute coronary syndrome (ACS). Hundred and twenty-two patients with regular paid work before their first ACS episode were recruited into this hospital-based longitudinal cohort study. During hospitalization (baseline), all patients underwent assessments of work stress by job strain (JS) and effort-reward imbalance (ERI) models, and were assigned into low or high groups; simultaneously, sociodemographic and clinical data, as well depression, anxiety, and job burnout, were collected. Patients were followed up 1, 6, and 12 months after discharge, with HRV measurements at baseline and each follow-up point. Generalized estimating equations were used to analyze the effects of baseline work stress on HRV over the following 1 year. After adjusting for baseline characteristics and clinical data, anxiety, depression, and burnout scores, high JS was not associated with any HRV measures during follow-up (all p > 0.10), whereas high ERI was significantly related to slower recovery of 5 frequency domain HRV measures (TP, HF, LF, VLF, and ULF) (all p < 0.001), and marginally associated with one time domain measure (SDNN) (p = 0.069). When mutually adjusting for both work stress models, results of ERI remained nearly unchanged. Work stress in terms of ERI predicted lower HRV during the one-year period after ACS, especially frequency domain measures.

Developing a conceptual framework for burnout intervention program in the workplace

This review proposes a comprehensive conceptual framework for developing and implementing burnout intervention programs in the workplace. In recent years, job burnout has become a new and vigorous research hotspot in the field of psychology and human resources management at home and abroad. Job burnout has a serious impact on personal health and performance but also harms the work efficiency, organizational effectiveness, and even social stability of employees. With the escalating concern over employee burnout and its consequent negative impacts on both individual health and organizational productivity, there is a pressing need for effective strategies to mitigate this issue. The framework draws on extensive literature review and theoretical model analysis, integrating key theories such as the Job Strain Model, Effort-Reward Imbalance Model, Conservation of Resources Theory, and the Job Demands-Resources Theory to explore the multifaceted nature of burnout. It identifies critical components of burnout, including symptoms such as emotional exhaustion, depersonalization, and reduced personal accomplishment, and contributing factors such as high job demands, inadequate job resources, and personal traits. Intervention strategies such as exercise have been identified as beneficial in addressing burnout. A systematic review of six studies highlights that aerobic exercise effectively lowers burnout and stress levels among employees. The framework also examines mediating factors such as personality traits and external factors, evaluating outcomes such as improved mental and physical health, enhanced job performance, and better workplace environment. Moreover, this review discusses the sustainability of interventions and emphasizes the importance of tailoring approaches to fit specific organizational contexts. The proposed framework provides a structured approach to understanding and addressing workplace burnout, highlighting the necessity for ongoing research and adaptation of intervention programs to meet evolving workplace dynamics.

Correlation analysis between occupational stress and metabolic syndrome in workers of a petrochemical enterprise: based on two assessment models of occupational stress.

Occupational stress is becoming a common phenomenon around the world. Being in a high occupational stress state for a long time may destroy the metabolic balance of the body, thereby increasing the risk of metabolic diseases. There is limited evidence regarding the correlation between occupational stress and metabolic syndrome (MetS), particularly in the petrochemical workers. A total of 1683 workers of a petrochemical enterprise in China were included in the survey by cluster sampling method. The occupational stress assessment was carried out by the Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire, and the general demographic characteristics, work characteristics, occupational hazards, lifestyle and health examination data of the participants were collected. Logistic regression and multiple linear regression were used to analyze the correlations and influencing factors between occupational stress and its dimensions with MetS and its components. A total of 1683 questionnaires were sent out, and 1608 were effectively collected, with an effective recovery rate of 95.54%. The detection rates of occupational stress in Job Demand-Control (JDC) and Effort-Reward Imbalance (ERI) models were 28.4% and 27.2%, respectively. In this study, 257 participants (16.0%) were diagnosed with MetS. Compared with the non-MetS group, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG) and fasting blood-glucose (FBG) levels were significantly higher in the MetS group, and high density lipoprotein-cholesterol (HDL-C) levels were significantly lower (P < 0.001). The results of multiple linear regression showed that after adjusting for nation, marital status, education, work system, smoking and drinking, and further adjusting for occupational hazards, the D/C ratio was significantly negatively correlated with SBP in the JDC model. Social support was negatively correlated with WC. In the ERI model, there was a significant positive correlation between over-commitment and FBG. The detection rates of occupational stress and MetS were high in workers of a petrochemical enterprise. In the JDC model, occupational stress was negatively correlated with SBP, and social support was negatively correlated with WC. In the ERI model, there was a significantly positive correlation between over-commitment and FBG.

Psychosocial risks of the work environment and metabolic syndrome (literature review)

Introduction. Along with physical, chemical, ergonomic, and biological factors, working psychosocial stress is one of the main risks for the development of metabolic syndrome (MS), system effects of which can cause severe lesions of cardiovascular, endocrine, and hepatobiliary systems.&#x0D; The purpose of the work was to summarize and analyze modern domestic and foreign experience of studying the relationship between categories and factors of psychosocial risks of the working environment and MS and its components in different occupational cohorts.&#x0D; The publications were searched through the RSCI, CyberLeninka, eLibrary, and PubMed databases containing Russian and foreign sources of scientific information for 2006–2023. &#x0D; The article briefly highlights the taxonomy of categories and factors of psychosocial hazards and risks in the workplace, as well as the most popular questionnaires for quantitative assessment of psychosocial stress, based on the requirement/control model (JDC) assessing workload in gradations of high, active, passive, low, and effort-reward imbalance (ERI) model. The close association of JDC and ERI with metabolic syndrome, obesity, blood lipid profile atherogenicity, and hyperglycemia in men and women of different occupational cohorts with high and low socioeconomic status was examined. &#x0D; Conclusion. The analysis of scientific publications has convincingly shown working psychosocial stress to have a causal relationship with MS that regardless of intervening factors (age, gender, socio-economic status, lifestyle, bad habits). At the same time, the statistical significance of stress-realizing effects in relation to MS components is determined by the used model for assessing psychosocial risks and is complementary to the cognitive assessment of perceived stress, which must be taken into account when planning and conducting research.

Putting PhD students front and center: an empirical analysis using the Effort-Reward Imbalance Model

IntroductionA doctorate is associated with numerous challenges for many PhD students, including financial insecurities, little support from supervisors, and time pressure. The present study explores well-being of PhD students via the Effort-Reward Imbalance (ERI) model as well as the potential protective factor resilience.MethodA web-based questionnaire survey was conducted among 1,275 PhD students from Germany. Data was collected at two measurement points over a six-week follow-up period.ResultsAs hypothesized, overcommitment was found to mediate the relationship between ERI and perceived stress while no mediation effect was found for work engagement. Resilience strengthened the relationship between ERI and overcommitment, especially for an increasing unfavorable ERI, and counterintuitively did not act as a protective factor.DiscussionTheoretical and practical implications are discussed, providing a deeper understanding on the ERI model and the negative coping pattern overcommitment in the context of PhD students.

Testing a chain mediation model of effort-reward imbalance, Confucian values, job satisfaction, and intention to quit among Chinese vocational education teachers.

This research delves into the significant impact of Confucian Values on the societal fabric of China, particularly in the realm of vocational education. In this setting, these principles are instrumental in guiding both educators and students. The study employs the Culture-Value Structure (CVS) model to dissect the intricate dynamics between Confucian Values, the Effort-Reward Imbalance (ERI), educators' job satisfaction, and their inclination toward leaving the profession. Teachers in vocational education, who are often regarded as moral guides, play a pivotal role in the ethical and social upbringing of students. Adopting Confucian values not only promotes academic success but also nurtures all-round development, equipping students for conscientious societal roles. In the backdrop of Confucian influence, these educators face substantial stressors in the workplace due to varied demands. The ERI model, proposed by Siegrist, serves as a tool to comprehend the stress experienced when there is a disproportion between efforts and rewards. This study delves into how ERI correlates with job satisfaction among vocational education teachers, with a focus on the modifying effect of Confucian values. Additionally, it examines the potential role of job satisfaction in mediating the relationship between ERI and the tendency to consider leaving the job. The research illuminates the complex interrelation of cultural values, occupational stress, job contentment, and career decision-making in the context of vocational education in China. The research involved a group of 332 Vocational education teachers from diverse Chinese institutions. Through thorough statistical analysis, the study validated the model's effectiveness, notably indicating a substantial direct impact of ERI on the Intention to Quit. The investigation pinpointed Factors I (Integrity), II (Confucian Ethos), and IV (Moderation) as key determinants of job satisfaction. Notably, an increase in job satisfaction was found to inversely relate to the likelihood of leaving the profession, implying it could lessen the propensity to resign. The research applied a Chain Mediation Model to elucidate the influence of ERI on the decision to quit, mediated by various factors. The findings highlight the complex interaction of elements influencing teachers' decisions to leave, showcasing the utility of sophisticated statistical methodologies in decoding complex social dynamics.

Perceived stress and psychological disorders in healthcare professionals: a multiple chain mediating model of effort-reward imbalance and resilience.

Healthcare professionals have shown more psychological disorders such as anxiety and depression due to the nature of work, which can cause job burnout, decrease the quality of medical services, and even endanger medical safety. The aim of the study is to explore the serial multiple mediating role of effort- reward imbalance and resilience between perceived stress and psychological disorders among healthcare professionals. A cross-sectional study was conducted in China from February to April 2023. A total of 2098 healthcare professionals at a tertiary general hospital was investigated by the following self-reported questionnaires: Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), The Effort-Reward Imbalance (ERI), Healthcare professionals Resilience Scale (MSRS). Anxiety and depression are interrelated (r = 0.362, p < 0.01), and they were positively related to perceived stress (r = 0.640/0.607, p < 0.01) and ERI (r = 0.422/0.383, p < 0.01), and negatively related to resilience (r = -0.343/-0.320, p < 0.01). After controlling demographic factors, the variance in anxiety and depression was explained by perceived stress was 37.7 and 35.0%. Bootstrap analyses examining the pathway of perceived stress-ERI-resilience-anxiety revealed significant direct effects [B = 0.560, 95%CI (0.528, 0.591)], as well as indirect effects mediated independently by ERI [B = 0.045, 95%CI (0.029, 0.060)], resilience [B = 0.031, 95%CI (0.017, 0.047)], or a combination of both [B = 0.004, 95%CI (0.002, 0.007)]. Similarly, in the path of perceived stress-ERI-resilience-anxiety-depression, significant direct effects were found [B = -0.310, 95%CI(0.265, 0.351)], along with indirect effects mediated individually by ERI [B = 0.033, 95%CI(0.013, 0.052)], resilience [B = 0.014, 95%CI (0.001, 0.028)], and anxiety [B = 0.218, 95%CI (0.190, 0.246)], or by both or three together (B = 0.032). This study proved the hypothesis that ERI and resilience played a mediating role in perceived stress and psychological disorders, revealed the potential mechanism of anxiety in stress and depression, and proposed a solution for perceived stress to psychological distress, which can provide a basis for the intervention of healthcare professionals in the face of mental health crisis.

Associations of effort-reward imbalance at work and quality of life among workers after stroke: a one-year longitudinal study in Thailand

Stroke incidence is increasing among working-age population, but the role of psychosocial stress in the workplace in predicting quality of life (QoL) after stroke onset is understudied. This longitudinal study aimed to investigate the relationship between work stress, measured by the effort-reward imbalance (ERI) model, and QoL over one-year period among 103 Thai workers who had experienced a stroke. The study evaluated the effort (E)-reward (R) ratio and over-commitment, the extrinsic and intrinsic components of the ERI model, before discharge; QoL was repeatedly measured at baseline, six months, and 12 months after discharge, respectively, using the Short Form Version 2 (SF-12v2) indicators of physical and mental health composite scores. Generalized estimating equations were used to examine longitudinal relationships between work stress at baseline and QoL over one year by testing the hypotheses that E-R ratio and over-commitment would have direct effects on QoL, and potential moderating effects of over-commitment on E-R ratio and QoL. The results supported the ERI model partially, as over-commitment was significantly associated with poor mental health (coefficient − 8.50; 95% CI: -13.79, -3.20) after adjusting baseline sociodemographic, behavioral, and clinical characteristics, while the E-R ratio was not significantly associated with physical or mental health; the interaction between the E-R ratio and over-commitment was also not significant. These findings suggest that more attention should be paid to workers’ personal coping skills and ability to handle work-related problems and prioritize interventions that address over-commitment to promote long-term mental health among workers with stroke.

The stress of nursing: exploring communicatively restricted organizational stress (CROS), effort-reward imbalance, and organizational support among a sample of U.S. working nurses

BackgroundNurses experience a constellation of negative outcomes such as lost productivity, based on their high levels of organizational stress. Following recommendations for best practices in health communication can dramatically improve the organizational climate for nurses and can have a significant effect on patient outcomes. In this study, we evaluate the impact of Communicative Restricted Organizational Stress (CROS) and effort-reward imbalance (ERI).MethodsA mixed-methods approach was employed. A professional survey research vendor was contracted to obtain an appropriate national sample (N = 299) of working nurses in the United States of America. Participants completed an online closed-ended questionnaire for the quantitative portion of the study. Qualitative data were gathered from member-checking follow-up interviews.ResultsResults of the quantitative analysis indicated that nurses experience CROS, that these experiences are distressing, that CROS functions as an effort in the effort-reward-imbalance model, and that CROS and ERI contribute to negative outcomes such as insomnia, productivity lost, and poor general health. Specifically, a moderated moderation model accounted for 53% of the variance [F (7,290) = 47.363, p < .001] indicating that nurses with high levels of CROS distress and low levels of organizational support experienced the highest level of ERI in the presence of high nursing stress, t (296) = 3.05, p = .03, 95% CI [0.0038, 0.0178]. These findings were validated through member-checking qualitative interviews and specific overarching themes were explicated.ConclusionsCROS is an important variable in understanding the experience of nursing stress. Furthermore, CROS serves as an effort in the ERI Model and serves to exacerbate nursing stress. We recommend practical implications for the improvement of psychosocial stress in an occupational environment for nurses.

An integrated perspective of the demand–control and effort–reward imbalance models on burnout among sport coaches: The moderating role of over-commitment and coaching efficacy

The present study aimed to explore the relationship between stress and burnout through an integration of the demand–control (DC) and effort–reward imbalance (ERI) model in the context of sport coaching. This is the first study to integrate these two models to explain burnout experienced by sport coaches, providing a theoretical basis for understanding the development of burnout in this population. A sample of 398 Chinese sport coaches working in the school system participated in the study. Moderated mediation analyses were conducted to test the research model, and results indicated that the data fit the model well and supported all hypotheses. Specifically, the study verified the hypotheses related to the importance of contextual conditions in burnout development (i.e. burnout caused by job stress consistent with ERI) and personal characteristics that regulate these conditions (i.e. over-commitment as the enhancing moderator and coaching efficacy as the buffering moderator consistent with DC). The findings suggest that addressing the social system (i.e. ERI) in which burnout develops and individual responses (i.e. DC) is crucial to prevent burnout among sport coaches.

The association between study conditions and hair cortisol in medical students in Germany – a cross-sectional study

BackgroundMedical students often experience high levels of stress due to adverse study conditions, which may have adverse health consequences. Hair cortisol concentration (HCC) has been described as a physiological marker for chronic stress and might thus help to identify students under stress and examine the study conditions being responsible for long-term physiological stress responses. This study therefore investigated the association between study conditions and HCC in a sample of medical students.MethodsFifty-five students from a medical school in Germany completed a paper-based questionnaire and had hair samples collected between July 2020 and July 2021. Study conditions were assessed with student versions of questionnaires based on the Job-Demand-Control-Support model (StrukStud, 25 items) and Effort-Reward Imbalance model (Student ERI, nine items). HCC of two centimeters closest to the scalp were determined by a cortisol luminescence immunoassay. Linear multiple regression analyses were performed to examine associations between study conditions and HCC.ResultsDemands (B = 0.23, p = 0.002), effort (B = 0.12, p = 0.029) and the effort-reward-ratio (B = 0.28, p = 0.007) were positively associated with HCC in separate regression analyses, adjusted for age and sex. Only the association between demands and HCC remained significant when all components of the respective questionnaire were considered in the same model (B = 0.22, p = 0.003).ConclusionThe results suggest that adverse study conditions may be associated with activation of the hypothalamic-pituitary-adrenal axis stress response as reflected by increased HCC. Longitudinal research is needed to confirm these cross-sectional results and examine effects of more prolonged stress due to adverse study conditions.

Testing the stress of higher status hypothesis. Variation of occupational stress among physicians and nurses at a German university hospital.

Studies show especially for the UK and the US that physicians experience more occupational stress than nurses. It has also been shown that a higher status within the medical and nursing hierarchy is associated with less occupational stress. Our study's aim is to examine whether these results also can be found in the context of the German university hospital sector. Thus, we test the stress of higher status hypothesis in and between the occupational groups of nurses and physicians at a German university hospital. Based on two cross-section surveys in the years of 2016 and 2019 this paper compares the perceived level of occupational stress between physicians (n = 588) and nurses (n = 735). Perceived levels of occupational stress-measured via the effort-reward imbalance model and the job demand-control model-are differentiated by status positions within and between both occupational groups. Descriptive as well as inferential statistics (Mann-Whitney U test, Kruskal-Wallis H test) are used to test the stress of higher status hypothesis. Contrary to the stress of higher status hypothesis, our main result is that physicians and nurses perceive similar levels of occupational stress. Furthermore, within each hierarchy the perceived degree of work stress decreases with increasing status for both groups. Our main conclusion is that the stress of higher status hypothesis must be rejected in the German university hospital context and the competing resources of higher status hypothesis must be assumed. The findings can be explained by the unique relationship between physicians and nurses and the role of New Public Management in the German hospital sector.

Prospective Association of High Effort and Low Reward Imbalance at Work with Risk of Diabetes: A Cohort Study in US Workers.

The contribution of psychosocial stress in the workplace to development of type 2 diabetes mellitus (T2DM) is not well investigated. As most studies were conducted in Europe, a further test from the USA seems well justified. The objective of the current investigation was to examine prospective associations of work stress based on the effort-reward imbalance model with risk of T2DM in a national sample of US workers. Using data from the national population-based Mid-life in the United States (MIDUS) study with a prospective cohort design and a 9-year follow-up period, the effects of a ratio combining data on effort and reward at work (ER ratio) at baseline on risk of T2DM at follow-up were examined in 1493 workers who were free from diabetes at the baseline survey, applying multivariable Poisson regression analysis. During the follow-up, 109 individuals (7.30%) reported onset of diabetes. The analyses demonstrated a significant association between continuous data of the E-R ratio and risk of diabetes (RR and 95% CI = 1.22 [1.02, 1.46]), after adjustment for modifiable and non-modifiable risk factors at baseline. A dose-dependent response was observed with trend analysis when using quartiles of the E-R ratio. In the US workers, high effort in combination with low reward at work was significantly associated with elevated risk of T2DM 9years later. The risk profiles of diabetes should be adapted in consideration of psychosocial work environment and taken into account by conceptualizing prevention programs of chronic non-communicable diseases.

STRESS MANAGEMENT OF SCHOOL HEADS AND THE TEACHERS' PSYCHOSOCIAL WELL-BEING AND INSTRUCTIONAL COMPETENCE

In this study, the researcher sought to determine the relationship of school leaders stress management skills on the teachers instructional performance and psychosocial well-being. It was anchored on Person-Environment Fit Theory, Job-Demand and Support Theory, and Effort-Reward Imbalance Model. The study followed the procedures of descriptive research method. A total of 170 teachers from public elementary and secondary schools in Victoria District were invited to answer the research questions. It was found that the level of school leaders management skills as to assessment of teachers stress, stress management coaching, wellness and health program was high among public schools and teachers have very stable psychosocial well-being as to autonomy, environmental mastery, personal growth, positive relations, purpose in life, and self-acceptance. Teachers were also found at very high level of instructional competence in various aspects. However, there were some areas for improvement identified though not urgent and serious i.e., conduct of periodic stress assessment, conduct of activities that help teachers release stress and budget allotment and monitoring of health and wellness programs. The results of the study led to the conclusion that the school leaders stress management skills has significant relationship with the teachers psychosocial well-being and instructional competence. Thus, leaders who are more skilled in managing workplace stresses could expect healthier and better performing teachers. Among the recommendations were periodic upskilling on stress management in the workplace conduct of periodic stress assessment adoption of a mental health assistance program and investigation of the lived experiences of school heads who manage teachers suffering from excessive stress or depression.

Psychosocial Work Stress and Occupational Stressors in Emergency Medical Services

Emergency medical service (EMS) professionals often experience work stress, which escalated during COVID-19. High job demand in the EMS profession may lead to progressive decline in physical and mental health. We investigated the prevalence of psychosocial job stress in the three levels of EMS: basic, advanced, and paramedic, before and during the COVID-19 pandemic. EMS professionals (n = 36) were recruited from EMS agencies following the Institutional Review Board approval. Participants took surveys on demographics, personal characteristics, chronic diseases, and work schedules. Job stress indicators, namely the effort-reward ratio (ERR) and overcommitment (OC), were evaluated from survey questionnaires using the effort-reward imbalance model. Associations of job stress indicators with age, sex, body mass index, and working conditions were measured by logistic regression. Psychosocial work stress was prevalent with effort reward ratio > 1 in 83% of participants and overcommitment scores > 13 in 89% of participants. Age, body mass index, and work hours showed strong associations with ERR and OC scores. The investigation findings suggested that a psychosocial work environment is prevalent among EMS, as revealed by high ERR, OC, and their correlation with sleep apnea in rotating shift employees. Appropriate interventions may be helpful in reducing psychosocial work stress in EMS professionals.