Effort-reward Imbalance Scale Research Articles

Effort–reward imbalance and well-being among psychiatric nurses: the mediating role of burnout and decent work

BackgroundPsychiatric nurses face additional challenges due to negative perceptions, workplace violence, and a lack of respect, impacting their well-being and job satisfaction, which are crucial for improving psychiatric care and patient outcomes.ObjectivesThis study aims to examine the relationship between effort-reward imbalance, well-being, burnout, and decent work among psychiatric nurses.MethodsThis study used a cross-sectional design. Data were collected using a convenience sampling method in February 2024 from 397 psychiatric nurses at two psychiatric hospitals in Hangzhou and Huzhou, Zhejiang Province. The Effort-Reward Imbalance Scale, Decent Work Perception Scale, Maslach Burnout Inventory-General Survey, and General Well-Being Schedule Scale were used for data collection. Data analysis was conducted using SPSS 26.0 and the PROCESS macro.ResultsThe study found that effort-reward imbalance among psychiatric nurses was negatively correlated with decent work (r = -0.564, p < 0.001) and well-being (r = -0.541, p < 0.001), and positively correlated with burnout (r = 0.603, p < 0.001). Burnout mediated the relationship between effort-reward imbalance and well-being (95% CI [-0.386, -0.257]), while decent work also served as a mediator (95% CI [-0.100, -0.012]). Additionally, burnout and decent work were found to mediate the relationship between effort-reward imbalance and well-being (95% CI [-0.050, -0.006]).ConclusionThis study highlights the impact of effort-reward imbalance on well-being, confirming that burnout and decent work serve as mediators. Enhancing support, fair compensation, reasonable work schedules, and professional development can promote psychiatric nurses’ perception of decent work and improve their well-being.

Validation of the Hungarian version of the 6-item turnover intention scale among elderly care workers

This research examines the psychometric characteristics and reliability of the 6-item turnover intention scale (TIS-6) by Bothma and Roodt (SA J Hum Resour Manag 11:a507, 2013) on a Hungarian sample. The internal validity of the TIS-6 was assessed using data from 269 Hungarian elderly care institution workers. Confirmatory factor analysis was performed to analyse the structural validity. Convergent and discriminant validity were examined with questions on job characteristics and using the Maslach Burnout Inventory and Effort-Reward Imbalance Scale. IBM SPSS 28.0 software was used for the statistical analysis, and the results were considered significant at p < 0.05. The internal consistency of the questionnaire's scale proved to be acceptable (α = 0.826). Convergent validity was confirmed by the relationships between the components of the questionnaire and burnout (rs = 0.512; p < 0.001; rs = 0.419; p < 0.001) and workplace stress (rs = 0.565; p < 0.001; rs = 0.310; p < 0.001). There were significant differences between the TIS-6 scores among the groups with different degrees of burnout (p < 0.001), which indicated adequate discriminant validity of the questionnaire. The structural validity of the questionnaire was acceptable, and the scale questions fit well. The Hungarian version of the TIS-6 scale is a valid and reliable tool for assessing turnover intention among elderly care institution workers in Hungary.

Effort–reward imbalance in PhD students: Adaptation and validation of the Effort–Reward Imbalance Scale for doctoral students.

Effort–reward imbalance in PhD students: Adaptation and validation of the Effort–Reward Imbalance Scale for doctoral students.

Gene‒environment interaction effect of hypothalamic‒pituitary‒adrenal axis gene polymorphisms and job stress on the risk of sleep disturbances.

Studies have shown that chronic exposure to job stress may increase the risk of sleep disturbances and that hypothalamic‒pituitary‒adrenal (HPA) axis gene polymorphisms may play an important role in the psychopathologic mechanisms of sleep disturbances. However, the interactions among job stress, gene polymorphisms and sleep disturbances have not been examined from the perspective of the HPA axis. This study aimed to know whether job stress is a risk factor for sleep disturbances and to further explore the effect of the HPA axis gene × job stress interaction on sleep disturbances among railway workers. In this cross-sectional study, 671 participants (363 males and 308 females) from the China Railway Fuzhou Branch were included. Sleep disturbances were evaluated with the Pittsburgh Sleep Quality Index (PSQI), and job stress was measured with the Effort-Reward Imbalance scale (ERI). Generalized multivariate dimensionality reduction (GMDR) models were used to assess gene‒environment interactions. We found a significant positive correlation between job stress and sleep disturbances (P < 0.01). The FKBP5 rs1360780-T and rs4713916-A alleles and the CRHR1 rs110402-G allele were associated with increased sleep disturbance risk, with adjusted ORs (95% CIs) of 1.75 [1.38-2.22], 1.68 [1.30-2.18] and 1.43 [1.09-1.87], respectively. However, the FKBP5 rs9470080-T allele was a protective factor against sleep disturbances, with an OR (95% CI) of 0.65 [0.51-0.83]. GMDR analysis indicated that under job stress, individuals with the FKBP5 rs1368780-CT, rs4713916-GG, and rs9470080-CT genotypes and the CRHR1 rs110402-AA genotype had the greatest risk of sleep disturbances. Individuals carrying risk alleles who experience job stress may be at increased risk of sleep disturbances. These findings may provide new insights into stress-related sleep disturbances in occupational populations.

Development and validation of a questionnaire for measuring team cohesion: the Erlangen Team Cohesion at Work Scale (ETC)

BackgroundTeam cohesion is a crucial factor when it comes to job satisfaction and turnovers. However, in Germany, economic measures for team cohesion are scarce. The aim of this study was to develop and validate an economic self-report questionnaire for measuring team cohesion in a work setting in health care.MethodsThe questionnaire was developed in a stepwise procedure. After item analysis, exploratory factor analysis was conducted to assess factor structure. Reliability was tested via internal consistency. To assess convergent and divergent validity, we applied the Copenhagen Psychosocial Questionnaire (COPSOQ), the Perceived Cohesion Scale (PCS), the ENRICHD Social Support Inventory (ESSI), the Effort-Reward Imbalance Scale (ERI) and the Patient Health Questionnaire (PHQ-4), respectively.ResultsThe pilot version was tested in a sample of n = 126 adult nurses. Item analysis resulted in a total of 13 items for the final version. Exploratory factor analysis indicated a two-factor structure. Internal consistency for the two subscales was good, with α = 0.88 and α = 0.84, respectively. Convergent validity with the subscales of COPSOQ and PCS was moderate to high (r =.26– r =.64). For divergent validity, correlations with the ESSI were low (r =.01– r = -.09). We further found significant correlations with depression symptoms (r=-.22– r=-.37), as well as reward (ERI) (r =.41 -r =.47) and effort (ERI) (r=-.20 - r = -.24).ConclusionsWe developed and validated the Erlangen Team Cohesion at Work Scale (ETC), a self-report measure for team cohesion with very good psychometric properties. Due to its economic deployment, it is suitable for measuring team cohesion in work settings, especially in health care.

The effect of students' effort-reward imbalance on learning engagement: the mediating role of learned helplessness and the moderating role of social support.

To explore the predictive effect of effort-reward imbalance on students' learning engagement and to elucidate the underlying mechanism, 796 students were selected for a survey. The participants were required to complete four scales: the Effort-reward Imbalance Scale, the Learning Engagement Scale, the Learned Helplessness Questionnaire, and the Perceived Social Support Scale. (1) Students' effort-reward imbalance significantly and negatively predicts their learning engagement; (2) Learned helplessness serves as a mediator in the relationship between students' effort-reward imbalance and learning engagement; (3) Social support plays a moderating role in the association between effort-reward imbalance and learned helplessness. High levels of social support can buffer the impact of an effort-reward imbalance on learned helplessness, and the protective effect of social support is more obvious when the effort-reward imbalance is low. The present study revealed how an effort-reward imbalance affects learning engagement among students through the dimensions of learned helplessness and perceived social support. The constructed model not only further clarifies the mechanism underlying the relationship between effort-reward imbalance and learning engagement but also holds significant implications for guiding students' education.

Effort-reward and overcommitment at work and psychiatric symptoms in healthcare professionals: The mediation role of allostatic load

BackgroundDespite decades of advancement to support interventions for managing work-related stress, mental health issues have significantly escalated among healthcare professionals. Effort-reward imbalance (ERI) and overcommitment in the workplace are linked to several psychiatric disorders. However, the underlying biological mechanisms remain unclear. This study investigated whether ERI and overcommitment among healthcare professionals were linked to Allostatic Load (AL) and whether AL mediates the relationship between ERI, overcommitment and mental health issues. MethodsOne hundred forty-two nursing workers (n = 142; 90.1 % female, mean age: 39.5 ± 9.6) were randomly recruited from a university hospital in Sao Paulo, Brazil, and applied the ERI scale that assesses work effort, reward, and overcommitment. The Perceived Stress Scale (PSS), The Beck Depression Inventory (BDI), and the Self-Report Questionnaire for psychiatric symptoms (SRQ-20) evaluated the mental health outcomes. Ten neuroendocrine, metabolic, immunologic and cardiovascular biomarkers were analyzed, and values were transformed into an AL index using clinical reference cutoffs. ResultsLinear regression adjusted for covariates showed that higher scores for overcommitment were associated with higher AL indexes, which in turn were associated with higher SRQ-20, but not with PSS and DBI scores. As expected, higher scores for effort, lower for reward, and higher ERI were associated with higher scores for PSS, SRQ-20, and DBI, but not with AL index. Direct effect estimates showed that overcommitment was directly associated with higher SRQ-20 scores, and indirectly via AL. ConclusionOur study reveals that overcommitment, rather than ERI, was linked to increased AL in healthcare workers. Additionally, AL mediates the relationship between overcommitment and higher psychiatric symptoms, highlighting a key mechanism by which work stress can lead to mental health problems. Individual's responses to high work demands need to be considered when designing predictive models and interventions for mental health issues.

Efeitos combinados de gênero, raça e estressores ocupacionais na saúde mental

Abstract Objective: analyze the isolated and combined effects of gender, race, and occupational stressors on the mental health of healthcare workers. Methods: cross-sectional study with a random sample of health workers in Bahia, Brazil. The primary exposure variables were gender, race, and occupational stressors, assessed using the Effort-Reward Imbalance (ERI) scale. The Self-Reporting Questionnaire (SRQ-20) measured common mental disorders (CMD), the outcome variable. The interaction measures were verified based on the additivity criterion by calculating the excess prevalence, excess prevalence ratio, and relative difference. Results: 3,343 workers participated, 77.9% were female. CMD prevalence was 21.7% higher among women, Black people, and those exposed to work stressors. Among Black women in a situation of ERI, the prevalence of CMD was three times higher compared with white men in a situation of balance (reference group). Discussion: black women workers accumulate social disadvantages and are more susceptible to occupations that require more significant effort and less reward. CMD prevalence was higher at the intersection of exposures. Combined effect of the factors exceeded the sum of the isolated effects, demonstrating an interaction between gender, race, and occupational stressors.

Dimensions of the COVID-19 pandemic: prevalence of common mental disorders in "invisible" health workers and their association with occupational stressors.

To evaluate the association between occupational stressors and common mental disorders (CMD) among "invisible" health workers in the context of the COVID-19 pandemic. Cross-sectional study including a probabilistic sample of 1,014 health workers from three municipalities in Bahia. CMDs were assessed using the SRQ-20. The Effort-Reward Imbalance (ERI) scale and the Demand-Control Model assessed occupational stressors. Descriptive, bivariate, and multiple analysis to evaluate the association between the variables of interest. The global prevalence of CMD was 39.9%; it was higher among CHA/EDCA (47.2%), followed by management and surveillance staff (38.6%), technicians (35.4%), and support/maintenance/cleaning staff (29.9%). The association between occupational stressors and CMD varied among occupations: 1. Excessive work commitment (EWC), effort-reward imbalance (ERI), and psychological demand were associated with CMD among support/maintenance/cleaning workers; 2. EWC and ERI were associated with CMD among CHA/EDCA; 3. EWC, ERI, and low control over work were associated with CMD among technicians; 4. Among management and surveillance workers, only ERI remained associated with CMD. Occupational stressors played a relevant role in mental illness, with variation between occupational strata, demanding attention, monitoring, and control.

Occupational stressors and mental illness in healthcare work: An intersection between gender, race, and class.

Previous studies have supported the relevance of using broad and complex approaches, including multiple explanatory categories, to analyze mental disorders in the working population. This study aimed to assess the direct and indirect effects of gender, race, social class, and occupational stressors on mental health. A cross-sectional study used a random sample of 3343 health workers. The effort-reward imbalance (ERI) scale measured occupational stressors. The World Health Organization Self-Reporting Questionnaire (SRQ-20) evaluated common mental disorders (CMDs) as outcomes. The role of gender, race/color, and class determinants (level of schooling and income) in the relationship between occupational stressors and CMD was assessed. Structural equation modeling was used to determine associations and effects. Occupational stressors were directly associated with CMD and mediated the relationship between income and CMD. Gender was directly associated with occupational stressors, income, and domestic overload. Race was associated with education and with CMD through indirect paths mediated by class indicators. Class indicators contributed to increasing exposure to occupational stressors and the occurrence of CMD. The results highlight the relevance of gender, race/color, and class in understanding the unequal distribution of work stressors and mental illness in health workers.

Differences in Effort, Reward, Grit, Burnout, and Continuous Exercise Intention: Assessing the Effort-Reward Imbalance among Korean Athletes.

Although studies have shown that an imbalance between effort and reward in the workplace negatively affects an individual's physiological and mental health, few have looked at how this imbalance may affect the mental state of athletes. Therefore, this study aimed to evaluate the importance of the effort-reward imbalance (ERI) in athletes by examining whether psychological variables would differ depending on the ERI. To accomplish this, 795 registered collegiate athletes were recruited. Of them, 227 and 230 responses with the ERI in the bottom and in the top 30% of the ERI scale were selected to compare groups with a high and a low ERI. Athletes completed a self-reported 64-item questionnaire (general characteristics: 5; effort: 14; rewards: 14; grit: 12; burnout: 15; and continuous exercise intention: 4 items). Data analysis included reliability and validity using the Jamovi and SPSS/AMOS software. The results showed no significant differences in effort, reward, grit, burnout, and intention to continue to exercise based on gender, weekly training frequency, and hours of training per day. There were differences in effort, reward, grit, burnout, and intention to continue exercising based on the presence of a professional league. Additionally, differences were found in effort, reward, grit, burnout, and intention to continue exercising between the low and high ERI groups. There was a clear difference between the mental state of those who were satisfied with their effort and reward, and those who were not. However, given that the two groups spent approximately the same amount of time exercising each week, the difference may have been more a function of the psychology of athletes than an actual difference in effort and reward. As our findings confirmed that the level of the ERI in athletes is related to their mental state, further research is necessary to identify and control factors that affect the ERI in athletes.

Subjective and objective measurements of nurses’ stress and recovery

Abstract Objectives High workloads and stress of healthcare workforce are global phenomena. We aimed to study work related stress and recovery of nurses with both subjective and objective methods, also aiming to examine if associations exist between subjective high work stress and need for recovery, and objectively measured stress and recovery. Methods Study sample comprised 65 nurses employed in the City of Helsinki. Heart rate variability (HRV) measurements were conducted for 3 consecutive days with ECG-based device in real-life setting, including 2 workdays and 1 day off. Objective stress and recovery were assessed from HRV and HRV-based stress and recovery variables. Participants filled out an electronic survey, where work stress was measured with Effort-reward imbalance scale and recovery after work with Need for recovery scale. Results Proportion of nurses with effort-reward ratio &amp;gt;1, indicating work stress, was high (84.6%), as was proportion of those with high need for recovery (64.6%). High need for recovery (score ≥54.5) was associated with lower RMSSD during sleep (p = 0.014) and higher absolute stress index (p = 0.009) on workdays. In high need for recovery group, stress balance (p = 0.040) and relaxation percentage (p = 0.033) were significantly lower on workdays than day off. In moderate work stress group, stress balance (p = 0.042), relaxation percentage (p = 0.041) and absolute relaxation index (p = 0.035) were lower on workdays than day off. No significant differences were observed within other groups. Conclusions Majority of participants suffered from work stress or high need for recovery. Based on our results, nurses’ high need for recovery is reflected in lower sleep time HRV, indicating worse physiological recovery. In those with high need for recovery, physiological recovery was also worse on workdays when compared with day off. Our findings highlight the importance of recovery, and in the future, nurses’ recovery and work stress should be increasingly monitored. Key messages • Nurses’ high need for recovery is reflected in lower sleep time heart rate variability. • Nurses’ recovery and work stress should be increasingly monitored.

Burnout in mental health services in Ireland during the COVID-19 pandemic.

Burnout is a consequence of chronic occupational stress. Specific work-related factors may contribute to burnout experienced by those working in mental health services (MHS), many of which have increased since the COVID-19 pandemic. To examine personal, work- and patient-related burnout among MHS staff in Ireland during the COVID-19 pandemic, and explore the impact of work-related conditions on burnout. We conducted a cross-sectional survey of three MHS across Ireland utilising a study-specific questionnaire, the Copenhagen Burnout Inventory and the Effort-Reward Imbalance scale. Of 396 participants, 270 (70.6%) were female. Moderate and high personal burnout was experienced by 244 (64.1%) participants; work-related burnout by 231 (58.5%) participants and patient-related burnout by 83 (21.5%) participants. Risk factors for both personal and work-related burnout were female gender, urban service, time spent outside main responsibilities, overcommitment, high score on the Effort-Reward Imbalance scale and intention to change job. Being younger, with high workload and deterioration of personal mental health during the pandemic was associated with higher personal burnout, whereas a lack of opportunity to talk about work-related stress contributed to work-related burnout. Fewer factors were associated with patient-related burnout, namely overcommitment, working in urban services and poorer physical and mental health during the COVID-19 pandemic. High levels of personal and work-related burnout were found among mental health workers. The weak association with COVID-19-related factors suggest levels of burnout predated the pandemic. This has implications for MHS given the recognised additional work burden created by COVID-19.

The impact of COVID-19 lockdown on the quality of life of Chinese football referees: the chain mediating role of occupational stress and job burnout

BackgroundCOVID-19 lockdown measures have had a great negative impact on the development of sports competition in China, as well as on the quality of life of football referees. This study aims to explore the impact of lockdown measures implemented in response to the COVID-19 pandemic on the quality of life of football referees in China and its mechanism of action.MethodsThe Impact of Event Scale-Revised (IES-R), the Effort–Reward Imbalance Scale (ERI), the Maslach Burnout Inventory General Survey (MBI-GS), and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF). The scale was used from August to September 2022. Using an online questionnaire, 350 questionnaires were sent out and 338 were returned, for a return rate of 96.57%. Invalid questionnaires were excluded, and 307 football referees with referee grades in 29 provinces registered with the CFA were surveyed. SPSS 24.0 and Mplus 8.0 were used for data analysis and structural equation model testing in this study.ResultsThe results showed that the COVID-19 lockdown had no significant impact on the quality of life of Chinese football referees. However, the COVID-19 lockdown can affect the quality of life of Chinese football referees through occupational stress or job burnout. Occupational stress and job burnout also play a chain intermediary role between the COVID-19 lockdown and the quality of life of Chinese football referees. In addition, this study further explores the quality of life by dividing it into four dimensions (physical, social, psychological, and environmental). The results show that all four dimensions satisfy the chain mediation model.ConclusionsTherefore, the quality of life of Chinese football referees can be improved by reducing their occupational stress and job burnout during the COVID-19 lockdown.

Overcommitment at work and mental health: the mediation role of Allostatic load

Despite decades of efforts to test interventions to manage stress at work, the prevalence of mental health disorders has increased significantly among workers. The allostatic load (AL) model offers a potential mechanism through which work-related stress impacts workers' mental health. However, the relationship between stress, AL, and mental health disorders does not disentangle critical components that drive stress at work. This study examined the mediation effect of AL in the relationship between work-related stress and mental health among workers. Two hundred two nursing workers (n = 222; 90.1% female, mean age: 39.5 ±9.6) were randomly recruited from a University Hospital in Sao Paulo(Brazil), and applied the Effort-Reward Imbalance scale (ERI) that assesses work effort, reward, and overcommitment. Perceived Stress Scale (PSS), Beck Depression Inventory (BDI), and the Self-Report Questionnaire for psychiatric symptoms (SRQ-20) were the mental health indicators. Ten neuroendocrine, metabolic, immunologic, and cardiovascular biomarkers were analyzed, and values were transformed into an AL index using clinical reference cutoffs. ERI scores were not associated with either the scores on mental health indicators or the AL index (p>0.1). However, overcommitment were associated with higher SRQ-20 scores (r=-.417, p<0.001) and that relationship was mediated by higher AL index (total effect:B=-.482, 95% CI [-0.7195,-0.2463]; p=0.0001). Overcommitment at work, but not effort-reward imbalance, was associated with psychiatric symptoms, and high AL mediates that relationship. Those findings highlight the need to include personal characteristics assessment when designing tailored interventions to manage stress at work.

Managers perception of hospital employees’ effort-reward imbalance

ObjectiveHospitals are frequently associated with poor working conditions that can lead to work stress and increase the risk for reduced employee well-being. Managers can shape and improve working conditions and thereby, the health of their teams. Thus, as a prerequisite, managers need to be aware of their employees’ stress levels. This study had two objectives: At first, it aimed to test the criterion validity of the Effort-Reward Imbalance (ERI) questionnaire measuring psychosocial workload in hospital employees. Secondly, mean scales of the ERI questionnaire filled in by employees were compared with mean scales of an adapted ERI questionnaire, in which managers assessed working conditions of their employees.MethodsManagers (n = 141) from three hospitals located in Germany assessed working conditions of their employees with an adapted external, other-oriented questionnaire. Employees (n = 197) of the mentioned hospitals completed the short version of the ERI questionnaire to assess their working conditions. Confirmatory factor analyses (CFA) were applied to test factorial validity, using the ERI scales for the two study groups. Criterion validity was assessed with multiple linear regression analysis of associations between ERI scales and well-being among employees.ResultsThe questionnaires demonstrated acceptable psychometric properties in terms of internal consistency of scales, although some indices of model fit resulting from CFA were of borderline significance. Concerning the first objective, effort, reward, and the ratio of effort-reward imbalance were significantly associated with well-being of employees. With regard to the second objective, first tentative findings showed that managers’ ratings of their employees’ effort at work was quite accurate, whereas their reward was overestimated.ConclusionsWith its documented criterion validity the ERI questionnaire can be used as a screening tool of workload among hospital employees. Moreover, in the context of work-related health promotion, managers’ perceptions of their employees’ workload deserve increased attention as first findings point to some discrepancies between their perceptions and those provided by employees.

Psychometric properties of the effort-reward imbalance scale in Chinese version for university students.

The main purpose of the study was to translate the Effort-Reward Imbalance Scale for University Students (ERIUS) and assess its psychometric properties in the Chinese cultural context. We translated the original English version of the ERIUS into Chinese and undertook exploratory and confirmatory factor analysis using data collected from university students. The Stress Scale for College Students was selected as the criterion measure to examine the association between psychological stress and effort-reward imbalance. The validity and reliability of the translated version of the ERIUS were also assessed, and a sub-sample of participants (n = 120) completed the measure twice, with a two-week interval to assess test-retest reliability. Results of the exploratory factor analysis using data from 314 students showed that the Chinese version of the ERIUS had 14 items and 3 factors: effort, reward and overcommitment. Confirmatory factor analysis using data from 584 students showed that the Chinese version of the ERIUS had adequate structural validity (χ 2 = 107.10, df = 32, RMSEA = 0.08, NFI = 0.90, CFI = 0.91, GFI = 0.90, PGFI = 0.62). The Chinese version of the Effort-Reward Imbalance Scale for University Students has adequate psychometric properties in the Chinese cultural context and can be used as an effective tool to measure psychosocial stress of university students in China.

O desequilíbrio esforço-recompensa está associado à hipertensão arterial entre servidores públicos brasileiros? Resultados do ELSA-Brasil

Abstract Objectives: to evaluate the association between job stress, according to the effort-reward imbalance (ERI) model, and hypertension (HTN), as well as to investigate the effect modifier role of overcommitment (OC) and sex. Methods: cross-sectional analysis of data from active workers who participated in the second data collection wave (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Job stress was measured by the ERI scale - Brazilian version, comprising three dimensions: effort, reward, and OC. HTN was defined as systolic or diastolic blood pressure levels ≥ 140/90 mmHg or antihypertensive medication use. Associations were estimated by logistic regression, crude and adjusted for potential confounding factors. Multiplicative interactions were investigated. Results: a total of 9,465 civil servants participated in the study, 51.9% females. HTN prevalence was 34.9%. The adjusted model identified borderline associations between ERI (ratio &gt; 1) and higher OC with higher odds of HTN (OR = 1.11, 95%CI = 1.00; 1.24; and OR = 1.13; 95%CI = 1.01; 1.26, respectively). Interaction analysis indicated no differences in associations according to sex and OC. Conclusion: results show that ERI and OC are associated with higher odds of HTN after adjustment. Sex and OC were not effect modifiers.

The Interaction between Occupational Stress and Smoking, Alcohol Drinking and BMI on Hypertension in Chinese Petrochemical Workers

Hypertension is one of the most vital risk factors for cardiovascular diseases, so we wanted to explore the impact of the interaction between occupational stress and smoking, alcohol drinking and BMI on hypertension in Chinese petrochemical workers. A total of 1488 employees participated. Questionnaires included the value of blood pressure, occupational stress (assessed by the effort-reward imbalance scale), demographic factors and work conditions. Multivariable logistic regression was used to explore related factors, and the interactions between occupational stress and smoking, alcohol drinking and BMI on hypertension were analyzed using an additive model. The prevalence of hypertension was 34.3%. Age ≥ 56 (OR = 3.19, 95%CI: 1.841-5.526), male (OR = 1.436, 95%CI: 1.056-1.954), BMI ≥ 25 (OR = 1.86, 95%CI: 1.468-2.346), smoking (OR = 1.52, 95%CI: 1.191-1.951) and alcohol drinking (OR = 1.53, 95%CI: 1.180-1.972), ERI > 1 (OR = 1.50, 95%CI: 1.133-1.960) are risk factors for hypertension, and a higher education level (OR = 0.57, 95%CI: 0.438-0.754) is a protective factor against hypertension. Positive interactions existed between occupational stress and smoking (RERI = 2.134, AP = 0.328, S = 1.635), alcohol drinking (RERI = 2.332, AP = 0.361, S = 1.746) and BMI (RERI = 1.841, AP = 0.340, S = 1.717) on hypertension in petrochemical workers. Age, gender, educational level, BMI, smoking, alcohol drinking and occupational stress are closely related to the risk of hypertension. There are also positive interactions between occupational stress and alcohol drinking, smoking and BMI, which have a certain impact on hypertension.

The relationship between perceived organizational support and insomnia in Chinese nurses: The Serial multiple mediation analysis.

Nurses are in high-pressure, high-load, and high-risk environment for a long time, and their insomnia cannot be ignored. Insomnia not only has a negative impact on the physical and mental health of nurses, but also on the efficiency and quality of nursing work. The purpose of this study was to investigate the multiple mediating effect of psychological capital, effort-reward ratio, and overcommitment in the relationship between perceived organizational support and insomnia among Chinese nurses. A cross-sectional study has been carried out in a tertiary grade A hospital in Shandong Province, China from March 2021 to May 2021. The demographic questionnaire, Perceived Organization Support Questionnaire, Psychological Capital Questionnaire, Chinese version Effort-Reward Imbalance, Questionnaire and Athens Insomnia Scale were used for data collection. SPSS PROCESS 3.4 macro program developed by Hayes was used to test the serial multiple mediation. Descriptive analysis, independent-samples t-test, one-way analysis of variance, Pearson's correlation analyses, ordinary least-squares regression, and the bootstrap method were used for data analysis. 658 valid questionnaires were collected (81.2%). Nurses' perceived organizational support was positively correlated with psychological capital (r = 0.455, p < 0.001), and was significantly negatively correlated with effort-reward ratio (r = -0.318, p < 0.001), overcommitment (r = -0.328, p < 0.001), and insomnia (r = -0.358, p < 0.001); Psychological capital was negatively correlated with effort-reward ratio (r = -0.275, p < 0.001), overcommitment (r = -0.339, p < 0.001), and insomnia (r = -0.402, p < 0.001), respectively; effort-reward ratio and overcommitment were significantly positively correlated with insomnia (r = 0.379, p < 0.001; r = 0.466, p < 0.001), respectively. In the model of perceived organizational support-psychological capital-effort-reward ratio-insomnia, the overall mediating effect was -0.080 (95%CI: -0.109 ~ -0.058), and the mediating effect of psychological capital was -0.050, accounting for 34.30% of the total effect; the mediating effect of effort-reward ratio was -0.024, accounting for 16.49% of the total effect; the chain mediating effect of psychological capital and effort-reward ratio was -0.007, accounting for 4.49% of the total effect. In the model of perceived organizational support-psychological capital-overcommitment-insomnia, the overall mediating effect was -0.085 (95%CI: -0.109 ~ -0.064), and the mediating effect of psychological capital was -0.042, accounting for 28.64% of the total effect; the mediating effect of overcommitment was -0.029, accounting for 19.81% of the total effect; the chain mediating effect of psychological capital and overcommitment was -0.015, accounting for 10.14% of the total effect. Perceived organizational support had direct negative influence on insomnia. Psychological capital and effort-reward ratio/overcommitment acted as chained mediating factor could partially relieve insomnia symptoms related to perceived organizational support. It is suggested to improve the level of organizational support and psychological capital of nurses, and reduce the effort-reward imbalance and overcommitment of nurses, so as to effectively decline and deal with nurses' insomnia.