Department of Environmental Health Sciences, Fielding School of Public Health; School of Nursing, University of California Los Angeles, Los Angeles, California (Dr Li); Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany (Dr Li); Stress Research Institute, Stockholm University, Stockholm, Sweden (Dr Leineweber and Dr Nyberg); Work Stress Research, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany (Dr Siegrist).
The aim of this study was to test nonsymmetric effects of cost/gain imbalance at work on depression, based on the effort-reward imbalance (ERI) model.
Study participants were derived from two large national studies from Germany and Sweden. Associations between the ERI scales, including the effort-reward (E-R) ratio in 2016 and depression (in 2016 for German sample, and in 2018 for Swedish sample) were examined by multivariable logistic regression.
In both samples, high cost/low gain, but not low cost/high gain, is associated with depression, with a 3- to 5-fold elevated risk in the highest decile of the E-R ratio.
The short version of the ERI questionnaire is a psychometrically useful tool for epidemiological research. The finding demonstrating nonsymmetric effects of cost/gain imbalance contributes to a theoretical clarification of this stress-theoretical model.