Potential Explanatory Factor Research Articles

Neighborhood poverty and hopelessness in older adults: The mediating role of perceived neighborhood disorder.

Hopelessness is one of the strongest predictors of health and mortality, particularly for older populations. Prior research has found associations between individual-level socioeconomic factors and hopelessness, but less is known about the potential importance of neighborhood-level socioeconomic contexts for hopelessness. In particular, the role of neighborhood disorder as a potential explanatory factor for poor psychological well-being remains underexplored. This study investigates whether neighborhood poverty is associated with a sense of hopelessness among older adults and if perceived neighborhood disorder mediates the link between poverty and hopelessness. Individual-level data came from the 2014/2016 Health and Retirement Study and were merged with neighborhood-level poverty data from the 2012-2016 and 2014-2018 American Community Survey. Linear regression models were employed to examine the association between neighborhood poverty, disorder, and hopelessness. Respondents in neighborhoods with higher poverty levels reported a greater sense of hopelessness (b = 0.11, 95% CI = 0.08, 0.15, p < .001), controlling for individual-level sociodemographic and health characteristics. Greater perceived neighborhood disorder was also positively associated with a sense of hopelessness (b = 0.16, 95%CI = 0.14, 0.18). When we included both neighborhood poverty and disorder in the same model, the association between neighborhood poverty and hopelessness was reduced by two thirds (b = 0.04, 95%CI = 0.0003, 0.07), while the association between perceived disorder and hopelessness remained robust (b = 0.16, 95%CI = 0.14, 0.18). We further examined the formal mediating effects of neighborhood disorder using structural equation modeling. The total effect of neighborhood poverty on hopelessness was significant (β = 0.08, bootstrapped 95%CI = 0.05, 0.10). The direct effect of neighborhood poverty was not significant (β = 0.02, bootstrapped 95% CI = -0.01, 0.04), while the indirect effect through neighborhood disorder was significant (β = 0.06, bootstrapped 95% CI = 0.05, 0.07). Neighborhood disorder mediated 75% of the association between neighborhood poverty and hopelessness. In light of these findings, improving neighborhood conditions, such as signs of disorder, may alleviate feelings of hopelessness in older adults residing in impoverished neighborhoods.

Experiences of sexist discrimination as a potential explanatory factor for alcohol and drug misuse among Latina young adult women

RationaleMarianismo beliefs, or traditional female gender role beliefs among Latinas, have been found to serve as risk or protective factors linked with health risk behaviors in prior studies, including alcohol and drug misuse. However, limited research has examined potential factors that may contribute to or explain these associations. Sexist discrimination, which can serve as a significant stressor that may contribute to substance misuse, is one potential factor that may link marianismo beliefs and substance misuse among Latina young adult women. ObjectiveThis study examined sexism as a potential mediator of hypothesized negative associations between five marianismo beliefs (Family Pillar, Virtuous and Chaste, Subordinate to Others, Silencing Self to Maintain Harmony, and Spiritual Pillar) and alcohol and drug misuse using structural equation modeling. MethodParticipants included 611 cisgender Latina full-time college student young adult women in the U.S. ages 18–26 who participated in an online cross-sectional survey about their health and behaviors. ResultsResults delineated experiences of sexism as a significant risk factor for alcohol and drug misuse and as a potential explanatory factor that may partly explain associations between certain marianismo beliefs (i.e., Virtuous and Chaste beliefs) and substance misuse. Specifically, experiences of sexism partially accounted for the negative association between endorsement of the Virtuous and Chaste belief and increased alcohol and drug misuse among Latina young adults. ConclusionsPrevention and intervention efforts should take a culturally responsive, gender-informed approach to address substance misuse among Latina young adults and address the negative influence of sexism on health.

Depressive symptoms in mothers of preterm infants before and during COVID-19 restrictions in neonatal intensive care units.

Little is known about the specific restriction measures used in intensive care units (NICUs) during the COVID-19 pandemic and their impact on parental well-being. Hence, this study aimed to assess the association between restriction measures and mothers' post-partum depressive symptoms. This comparative cohort study included mothers who gave birth before 35 weeks of gestation in Estonia. The outcome measure was mothers' post-partum depressive symptoms at the time of infant discharge, evaluated using the Edinburgh Postnatal Depression Scale (EPDS). In addition to the pandemic itself, the number of restriction measures in the NICUs was analysed as a potential explanatory factor for depressive symptoms. The study included 55 mothers before the pandemic in 2018-2019 and 54 mothers during the COVID-19 pandemic in 2021. No significant difference was found in the median EPDS scores between the cohorts: 7.0 [interquartile range (IQR): 4.0-12.0] and 8.0 (IQR: 5.0-12.8) respectively. The number of restriction measures was not associated with mothers' EPDS scores in either unadjusted or adjusted models. The COVID-19 pandemic or the number of restriction measures used in Estonian NICUs did not associate with mothers' post = partum depressive symptoms.

Role of advanced theory of mind in teenagers’ evaluation of source information

ABSTRACT With the development of the Internet as a main source of information, teenagers are increasingly faced with multiple documents which may contain contradictory statements, and whose reliability must be assessed. One way to assess information reliability is to evaluate the source of the information (e.g., author expertise, intention). However, teenagers rarely engage in such a sourcing process. The present study aims to explore the role of a potential explanatory factor of teenagers’ sourcing abilities: Advanced Theory of Mind (AToM). We hypothesized that AToM would be significantly related to teenagers’ evaluation skills when reading multiple documents, and in particular to their attribution of sources’ intentions and benevolence. We also hypothesized that this contribution will occur over and above teenagers’ word reading and textual inferencing skills. Seventy-two students in Grade 8 read a set of online documents about a fictitious socio-scientific controversy and answered comprehension and evaluation questions. AToM was a significant predictor of comprehension and evaluation performance. The role of AToM was especially important for the source’s evaluation and intentions questions. This study thus contributes to a better understanding of the possible factors of teenagers’ developing sourcing skills.

COVID-19 hospitalizations and patients' age at admission: The neglected importance of data variability for containment policies.

An excess in the daily fluctuation of COVID-19 in hospital admissions could cause uncertainty and delays in the implementation of care interventions. This study aims to characterize a possible source of extravariability in the number of hospitalizations for COVID-19 by considering age at admission as a potential explanatory factor. Age at hospitalization provides a clear idea of the epidemiological impact of the disease, as the elderly population is more at risk of severe COVID-19 outcomes. Administrative data for the Veneto region, Northern Italy from February 1, 2020, to November 20, 2021, were considered. An inferential approach based on quasi-likelihood estimates through the generalized estimation equation (GEE) Poisson link function was used to quantify the overdispersion. The daily variation in the number of hospitalizations in the Veneto region that lagged at 3, 7, 10, and 15 days was associated with the number of news items retrieved from Global Database of Events, Language, and Tone (GDELT) regarding containment interventions to determine whether the magnitude of the past variation in daily hospitalizations could impact the number of preventive policies. This study demonstrated a significant increase in the pattern of hospitalizations for COVID-19 in Veneto beginning in December 2020. Age at admission affected the excess variability in the number of admissions. This effect increased as age increased. Specifically, the dispersion was significantly lower in people under 30 years of age. From an epidemiological point of view, controlling the overdispersion of hospitalizations and the variables characterizing this phenomenon is crucial. In this context, the policies should prevent the spread of the virus in particular in the elderly, as the uncontrolled diffusion in this age group would result in an extra variability in daily hospitalizations. This study demonstrated that the overdispersion, together with the increase in hospitalizations, results in a lagged inflation of the containment policies. However, all these interventions represent strategies designed to contain a mechanism that has already been triggered. Further efforts should be directed toward preventive policies aimed at protecting the most fragile subjects, such as the elderly. Therefore, it is essential to implement containment strategies before the occurrence of potentially out-of-control situations, resulting in congestion in hospitals and health services.

Digital literacy and online political behavior

AbstractDigital literacy is receiving increased scholarly attention as a potential explanatory factor in the spread of misinformation and other online pathologies. As a concept, however, it remains surprisingly elusive, with little consensus on definitions or measures. We provide a digital literacy framework for political scientists and test survey items to measure it with an application to online information retrieval tasks. There exists substantial variation in levels of digital literacy in the population, which we show is correlated with age and could confound observed relationships. However, this is obscured by researchers’ reliance on online convenience samples that select for people with computer and internet skills. We discuss the implications of these measurement and sample selection considerations for effect heterogeneity in studies of online political behavior. We argue that there is no universally applicable formula for selecting a given non-probability sample or operationalization of the concept of digital literacy; instead, we conclude, researchers should make theoretically informed arguments about how they select both sample and measure.

Misdemeanor Crime Rates in the First Year of the COVID-19 Pandemic

Declared a national emergency on March 1, 2020, the Coronavirus Disease (COVID-19) has caused a major change in everyday life and crime statistics across the United States (U.S.). The research in this study aims to assess changes in reported misdemeanor crimes in Alachua County, Florida in the first year of the COVID-19 pandemic, as well as changes in the rate of misdemeanor crimes committed by certain genders and race demographics. Data was collected from the Alachua County Clerk of Circuit Court’s On-Line Court Records and Document Images Access Page from January 2019 to December 2020. The results of this study were consistent with the researcher’s hypothesis that the number of overall misdemeanor cases filed would substantially increase regardless of race or gender, likely as a result of social disorganization and community unrest. However, the original hypotheses that women and Black people would be seen committing higher rates of misdemeanor crimes in 2020 due to gender inequality and racial biases were rejected, with the data showing no statistical significance in the change in the number of cases filed for these populations. A potential explanatory factor for these findings is an overcommitment of responsibilities put upon women and girls, and a fear of racial prejudice and lack of social unity amongst Black people. These findings are important to highlight latent functions of state ordinances enacted to mitigate the spread of COVID-19, and to spotlight necessary crime control and reduction techniques that must be implemented simultaneously to adapt to the “new normal.”

The Political Consequences of Be(com)ing Mindful. How Mindfulness Might Affect Political Attitudes

Though research provides ample evidence that mindfulness shapes psychological processes and states that are linked to political attitudes and behavior, political science has so far largely ignored mindfulness as a potential explanatory factor shaping political attitudes and actions. This literature review aims to provide a comprehensive overview of the concept of mindfulness and outlines potential linkages between mindfulness and outlines political attitudes. I begin by identifying gaps in the literature on political attitude formation and change as well as its linkage to political behavior. I then introduce mindfulness as a multifaceted concept, discussing its definitional features and unravelling the mechanisms of mindfulness affecting cognitive and emotional abilities. Building on this foundation, I review research on correlates and effects of mindfulness on attitudes and behaviors related to the political domain, such as pro-environmentalism and pro-social behavior. Critically reflecting on extant research on mindfulness, I propose possible research avenues for political science that enhance its dialogue with neuroscience and social psychology.

Advances in Understanding Early-Onset Colorectal Cancer.

Since the 1990s, the incidence of early-onset colorectal cancer (at <50 years of age) in the US has increased by more than 50%; similar increases have also been observed internationally. These increases are found particularly among individuals born during and after the 1960s, raising the possibility that the increased rates of early-onset colorectal cancer are attributable to changes in risk-factor patterns throughout successive generations. The reasons for these alarming epidemiologic patterns for early-onset colorectal cancer worldwide are only recently being investigated and major gaps in our knowledge remain. In the current issue of this journal, Arif and colleagues differentiated characteristics and outcomes of early-onset colorectal cancer in patients with the predisposing conditions of inflammatory bowel disease or hereditary genetic syndromes, compared with patients who have sporadic disease. Also, in this issue, Schumacher and colleagues investigated risk factors for early-onset colorectal adenocarcinoma in a nested case-control study among Kaiser Permanente Southern California (KPSC) health plan members. The research presented on characteristics and outcomes points to the importance of sporadic disease in the rise of early-onset colorectal cancer, while the research presented on risk factors points to the importance of obesity as a potential explanatory factor for this rise.See related articles by Arif et al., p. 1785 and by Schumacher et al., p. 1792.

Lockdowns, lethality, and laissez-faire politics. Public discourses on political authorities in high-trust countries during the COVID-19 pandemic.

This study looks at population response to government containment strategies during initial stages of the COVID-19 pandemic in four high-trust Northern European countries-Denmark, Germany, the Netherlands, and Sweden-with special emphasis on expressions of governmental trust. Sentiment analysis and topic modeling analysis were performed using Twitter data from three phases during the initial European lockdown, and results were compared over time and between countries. Findings show that, in line with existing theory, assertive crisis responses and proactive communication were generally well-received, whereas tentative crisis responses or indications by the authorities that the crisis was manageable were generally met with suspicion. In addition, while government support was high in all countries during the height of the crisis, messages critical of the government as well as conspiracy theories were nevertheless widely circulated. Importantly, countries with the least assertive strategies, rather than clear negative responses, saw heightened polarization of sentiment in the population. Furthermore, in the case of Sweden, a laissez-faire strategy was generally accepted by the population, despite strong criticism from other countries, until mortality rates started to rise. Possible explanations for these findings are discussed with an emphasis of prior trust as a potential explanatory factor. Future research should seek to replicate these findings in other countries with different levels of prior governmental trust or with a different severity of the COVID-19 outbreak than the countries in this study as well as triangulate the findings of this study using alternative methods.

Intense Sweeteners, Taste Receptors and the Gut Microbiome: A Metabolic Health Perspective.

Intense sweeteners (IS) are often marketed as a healthier alternative to sugars, with the potential to aid in combating the worldwide rise of diabetes and obesity. However, their use has been counterintuitively associated with impaired glucose homeostasis, weight gain and altered gut microbiota. The nature of these associations, and the mechanisms responsible, are yet to be fully elucidated. Differences in their interaction with taste receptors may be a potential explanatory factor. Like sugars, IS stimulate sweet taste receptors, but due to their diverse structures, some are also able to stimulate bitter taste receptors. These receptors are expressed in the oral cavity and extra-orally, including throughout the gastrointestinal tract. They are involved in the modulation of appetite, glucose homeostasis and gut motility. Therefore, taste genotypes resulting in functional receptor changes and altered receptor expression levels may be associated with metabolic conditions. IS and taste receptors may both interact with the gastrointestinal microbiome, and their interactions may potentially explain the relationship between IS use, obesity and metabolic outcomes. While these elements are often studied in isolation, the potential interactions remain unexplored. Here, the current evidence of the relationship between IS use, obesity and metabolic outcomes is presented, and the potential roles for interactions with taste receptors and the gastrointestinal microbiota in modulating these relationships are explored.

The Neglected Role of Inequality in Explanations of the Collapse of Ancient States

Author(s): Levitt, Malcolm Stanley | Abstract: Despite recent and past research into the collapse of ancient states and into ancient inequality, the possible role of inequality in collapse has been ignored. Inequality as a potential explanatory factor in civil war and collapse in modern states has been the subject of around 150 flawed regression analyses, from which no consensus has emerged. Data for ancient states is insufficient to enable such quantitative modelling. But case studies of the Egyptian Old Kingdom, the Western Roman Empire and the Classic Maya suggest some role for inequality, although the data is sparse and contentious. Paucity of data probably reflects lack of interest and a recent study (Kohler and Ellyson 2018) shows what can be achieved.

Effect of essential amino acid supplementation and aerobic exercise on insulin sensitivity in healthy older adults: A randomized clinical trial

The combination of prolonged essential amino acid (EAA) supplementation and aerobic exercise training (Ex) improves muscle protein metabolism, strength and function in healthy older adults. However, excess EAA intake may worsen insulin sensitivity. Here we report the effects of EAA supplementation (EAA, n=11), placebo (PLA, n=10), aerobic exercise with placebo (Ex+PLA, n=11) or Ex with EAA supplementation (Ex+EAA, n=10) for 22 weeks on insulin sensitivity in non-diabetic older adults. A 2×2 design with block randomization and double blinding for supplement or placebo was used. Subjects ingested EAA (15g) or placebo daily. Exercising subjects participated in supervised progressive vigorous treadmill walking 3 times weekly. Measures of insulin sensitivity by oral glucose tolerance testing were collected at baseline and 22 weeks. Dietary intakes of protein and specific amino acids were determined in a subset of subjects. Overall, exercise improved insulin sensitivity, while EAA supplementation had no effect. In the dietary subset, post-intervention insulin sensitivity did not correlate significantly with the total intake of EAA, anti-angiogenic amino acids (cysteine, methionine), or branched-chain amino acids (isoleucine, leucine, valine). Overall, we conclude that in healthy older adults with moderate protein intake, EAA supplementation is metabolically safe as it does not decrease insulin sensitivity regardless of its combination with aerobic exercise. Thus, daily protein intake should be controlled for when modeling insulin sensitivity. Future studies should explore the role of increased blood flow as a potential explanatory factor for the observed interaction between aerobic exercise and supplementation. NCT00872911.

Does freshwater connectivity influence phosphorus retention in lakes?

AbstractLake water residence time and depth are known to be strong predictors of phosphorus (P) retention. However, there is substantial variation in P retention among lakes with the same depth and residence time. One potential explanatory factor for this variation is differences in freshwater connectivity of lakes (i.e., the type and amount of freshwater connections to a lake), which can influence watershed P trapping or the particulate load fraction of P delivered to lakes via stream connections. To examine the relationship between P retention and connectivity, we quantified several different measures of connectivity including those that reflect downstream transport of material (sediment, water, and nutrients) within lake‐stream networks (lake‐stream‐based metrics) as well as those that reflect transport of material from hillslope and riparian areas adjacent to watershed stream networks (stream‐based metrics). Because it is not always clear what spatial extent is appropriate for determining functional differences in connectivity among lakes, we compared connectivity metrics at two important spatial extents: the lake subwatershed extent and the lake watershed extent. We found that variation in P retention among lakes was more strongly associated with connectivity metrics measured at the broader lake watershed extent rather than metrics measured at the finer lake subwatershed extent. Our results suggest that both connectivity between lakes and streams as well as connectivity of lakes and their terrestrial watersheds influence P retention.

Management in the early days of the Irish Free State: Bennetts of Ballinacurra

Abstract This study details the management practices of a malting business called Bennetts of Ballinacurra (Bennetts), from approximately 1920s to the mid-1930s, a period when the Irish Free State was in its infancy. There is little extant literature on the management practices of Irish businesses of the time. Archival records, containing the company’s books, records and correspondence, were our primary source. Our findings revealed a relatively sophisticated management information system for which its merchant background and close connections to Arthur Guinness &amp; Sons Ltd. (Guinness) were a potential explanatory factor. In addition, despite the business being small, the study revealed how management coped with issues such as business structure and industrial relations in a time of great political and economic change. There is scope for future research to utilise the archives of Bennetts, as well as other archives identified in our study.

An international comparison of risk factors between two regions with distinct differences in asthma prevalence

Background and purposeInvestigation of the geographic variation in asthma prevalence can improve our understanding of asthma etiology and management. The purpose of our investigation was to compare the prevalence of asthma and wheeze among adolescents living in two distinct international regions and to investigate reasons for observed differences. MethodsA cross-sectional survey of 13–14 year olds was completed in Saskatoon, Canada (n=1200) and Skopje, Republic of Macedonia (n=3026), as part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3 study. Surveys were self-completed by students following the ISAAC protocol. Multiple logistic regression models were used to investigate associations with reports of asthma and current wheeze. A mediation analysis was then completed. ResultsAsthma prevalence was much higher in Saskatoon than Skopje (21.3% vs. 1.7%) as was the prevalence of current wheeze (28.2% vs. 8.8%). Higher paracetamol (acetaminophen) use was a consistent risk factor for asthma and wheeze in both locations and showed dose-response relationships. In both countries, paracetamol use and physical activity mediated some of the association for both asthma and wheeze. In Saskatoon, among those with current wheeze, 42.6% reported ever having a diagnosis of asthma compared to 10.2% among Skopje adolescents. ConclusionsThe results suggest that the variation in risk factors between the two locations may explain some of the differences in the prevalence of asthma and wheeze between these two study sites. However, diagnostic labeling patterns should not be ruled out as another potential explanatory factor.

The role of domestication and experience in \u2018looking back\u2019 towards humans in an unsolvable task

A key element thought to have changed during domestication is dogs’ propensity to communicate with humans, particularly their inclination to gaze at them. A classic test to measure this is the ‘unsolvable task’, where after repeated successes in obtaining a reward by object-manipulation, the animal is confronted with an unsolvable version of the task. ‘Looking back’ at humans has been considered an expression of dogs seeking help. While it occurs more in dogs than in socialized wolves, the level of exposure to human communication also appears to play a role. We tested similarly raised adult wolves and mixed breed dogs, pet dogs and free-ranging dogs. Unlike previous studies, as well as species and levels of socialization, we included ‘persistence’ in trying to solve the task as a potential explanatory factor. Wolves were more persistent than all dog groups. Regardless of socialization or species, less persistent animals looked back sooner and longer. Free-ranging dogs, despite little exposure to dog-human communication, behaved similarly to other dogs. Together, results suggest that basic wolf-dog differences in motivation and exploration may override differences in human-directed behaviour when animals are equally socialized, and that once the human is considered a social partner, looking behaviour occurs easily.

Emotion dysregulation explains associations between anxiety sensitivity and hazardous drinking and drinking motives among adult treatment-seeking smokers.

Smoking and drinking frequently co-occur. For example, alcohol use is associated with smoking lapses during quit attempts. However, little is known regarding psychological factors explaining drinking among smokers. Anxiety sensitivity is a risk factor associated with hazardous drinking and drinking to cope and/or conform, although little is known about mechanisms underlying such associations. One potential explanatory factor is emotion dysregulation. The current study examined emotion dysregulation as an explanatory factor underlying Anxiety Sensitivity and 5 alcohol-related outcomes: hazardous drinking, alcohol consumption, alcohol problems, coping-oriented drinking, and drinking to conform. Participants for this study were 467 treatment-seeking adult, daily smokers (48.2% women; Mage = 36.7 years, SD = 13.6) who reported smoking an average of 16.5 cigarettes per day. Results indicate significant indirect effects of Anxiety Sensitivity on hazardous drinking via emotion dysregulation, alcohol consumption, alcohol problems, drinking to cope, and drinking to conform. Effects were medium in size. Alternative models testing indirect effects of emotion dysregulation through Anxiety Sensitivity on outcomes, and Anxiety Sensitivity through outcomes on emotion dysregulation were nonsignificant and all had small effect sizes. Follow-up tests examined the path of effects from Anxiety Sensitivity through specific emotion-dysregulation subfactors. Thus, among treatment-seeking smokers, emotion dysregulation may explain the associations of Anxiety Sensitivity with alcohol-related outcomes. This pattern of findings highlights the potential importance of interventions targeting emotion dysregulation among hazardous-drinking smokers. (PsycINFO Database Record

Borderline personality disorder associates with violent criminality in women: A population based follow-up study of adolescent psychiatric inpatients in Northern Finland

Various psychiatric problems in adolescence and early adulthood have been shown to associate with criminal behaviour. In this study the association of personality disorders (PDs) with criminal behaviour was examined in adolescents treated in psychiatric hospitals.The study sample consisted of 508 adolescents (age 13–17) admitted to acute psychiatric impatient care between April 2001 and March 2006. Crime data was obtained from the Finnish Legal Register Centre on September 2013. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) was used to assess psychiatric diagnoses in adolescence. The information on PDs in early adulthood was based on follow-up information on psychiatric treatments in either out- or inpatient settings until the end of 2012, and was extracted from the National Care Register for Health Care provided by the Finnish National Institute for Health and Welfare.A total of 22 (39%) of the 57 subjects with PD had committed a crime. In women, the likelihood for violent criminality was significantly increased in those with Borderline PD (OR 6.09, CI 1.24–29.84, p=0.009) and was also associated with conduct disorder (OR 4.26, CI 1.38–13.19, p=0.012), child welfare placement (OR 11.82, CI 3.61–38.76, p<0.001) and parent's substance use disorder (OR 7.74, CI 2.30–26.10, p=0.001). In men, no association was observed between PD and any kind of criminal behaviour. Significant predictors for violent criminality in males were conduct disorder (OR 4.05, CI 1.75–9.38, p=0.001), substance use disorder (OR 2.51, CI 1.22–5.17, p=0.012) and special services at school (OR 2.58, CI 1.16–5.76, p=0.021).Females with Borderline PD showed an increased risk for violent offending. This suggests Borderline PD as a potential explanatory factor for violent assaults by females and highlights the importance of recognizing the risk for violence in young women with a Borderline PD.

Effort-reward imbalance and perceived quality of patient care: a cross-sectional study among physicians in Germany.

BackgroundWork stress may impair physicians’ ability to provide high quality patient care. Prior research remains however sparse and has insufficiently explored explanations for this relationship. It has been suggested that physicians’ poor mental health is one potential explanatory factor. We drew on a well-established model to measure work stress (the effort-reward imbalance [ERI] model) in order to test this hypothesis. Further, to address another research gap and to potentially inform the development of better-targeted interventions, we aimed to examine associations of individual ERI constructs with the quality of care.MethodsWe used cross-sectional data, which had been collected in 2014 among 416 physicians in Germany. ERI constructs (i.e. effort, reward, the ERI ratio, and overcommitment) were measured by the established 23-item questionnaire. Physicians’ perceptions of quality of care were assessed by a six-item instrument inquiring after poor care practices or attitudes. Physicians’ mental health was operationalized by the state scale of the Spielberger's State-Trait Depression Scales. We used both continuous and categorized dependent and independent variables in multivariable linear and logistic regression analyses.ResultsBoth an increasing ERI ratio and increasing effort were associated with poorer quality of care while increasing rewards were related to better care. Physicians’ depressive symptoms did not affect these associations substantially. Associations with overcommitment were weak and attenuated to non-significant levels by correction for depressive symptoms. The level of overcommitment did not modify associations between the ERI ratio and quality of care.ConclusionsOur study suggests that high work-related efforts and low rewards are associated with reports of poorer patient care among physicians, irrespectively of physicians’ depressive symptoms. Quality of patient care may thus be improved by concurrently reducing effort and increasing rewards among physicians.