Associations between overcommitment, effort-reward imbalance and mental health: findings from a longitudinal study.

PURPOSE: The effort-reward imbalance (ERI) model includes extrinsic and intrinsic aspects of work stress. The single components, ERI and overcommitment (OC), are known to be associated with mental health. The aim of this study was to test whether OC is a mediator of the association between ERI and mental health. METHODS: Longitudinal analyses were conducted using data from the Third German Sociomedical Panel of Employees on German employees aged 40-54 years. The short version of the ERI questionnaire was used to measure ERI and OC at baseline (2013). Outcomes were mental health problems and self-rated mental health (5-Item Mental Health Inventory) in 2015. Multivariate regressions were conducted controlling for sociodemographics, health-related behaviour, job-related aspects, and mental health at baseline. RESULTS: A total of 912 men and 1148 women were included in the final analysis. Baseline OC was positively associated with follow-up mental health problems and negatively with self-rated follow-up mental health. While there was no direct effect of ERI on mental health, ERI affected mental health problems (b = 0.14; 95% CI 0.03 to 0.25) and self-rated mental health (b = - 1.15; 95% CI - 1.79 to - 0.57) indirectly through OC. CONCLUSIONS: OC was associated with reduced mental health. There was no association between ERI and mental health that was independent of OC. OC could therefore be interpreted as a mediator between ERI and mental health. Future studies are needed to test the causality of this association.

Influence of social support among employees on mental health and work ability-a prospective cohort study in 2013-15.

Background: The study examined the association of social support with mental health, subjective work ability and psychological consultation. Methods: The cohort study included 1886 German employees (40-54 years) with sickness absence exceeding six weeks in 2012. Postal surveys were carried out in 2013 and 2015. Results: After adjustment for socio-demographic data, work-related characteristics and personality factors, persons with low social support compared to high social support had poorer mental health (b=-4.96; 95% CI: -7.11 to -2.81) and a lower work ability index (b=-1.10; 95% CI -2.00 to -0.21). Low social support was not associated with increased odds of consulting a psychologist (OR =1.30; 95% CI: 0.86-1.96). Conclusions: Low social support is an independent predictor of poorer mental health and lower work ability. This study highlights the importance of identifying people who have limited access to social support.

Injustice at work affects work ability and role functioning: findings of a cohort study.

OBJECTIVES: The aim was to analyze the longitudinal effects of organizational injustice (OIJ) and effort-reward imbalance (ERI) on work ability, emotional role functioning and physical role functioning. METHODS: Longitudinal data with a two-year follow-up of people previously receiving sickness absence benefits were used for analyses. OIJ and ERI were included separately and mutually in logistic regression models. Effects were tested for additivity. All analyses were additionally performed stratified by sex. All models were adjusted for sociodemographics and neuroticism. RESULTS: 1886 participants (44.5% men, mean age: 48 years) were included. When mutually adjusted, OIJ and ERI affected work ability, and OIJ affected emotional role functioning. In stratified analyses, OIJ affected all outcomes in women, and ERI affected work ability in men. Additive effects of OIJ and ERI were not identified. CONCLUSIONS: OIJ and ERI are important risk factors of limited participation. People with experiences of health-related and work-related impairments are in need of reliable structures and just working conditions.

Associations between organizational injustice and work ability, self-reported disability days, and medical consultations: cross-sectional findings from employees with prior sickness absence payments.

PURPOSE: The aim of the study was to identify associations between organizational injustice and work ability, disability days, and consultations with general practitioners. METHODS: Cross-sectional data of persons previously receiving sickness absence benefits were used for analyses. Organizational injustice was assessed using a German version of the "organizational justice questionnaire". Dependent variables were the Work Ability Index, self-reported disability days, and consultations with general practitioners. Associations were adjusted for sociodemographic characteristics, behavioral health risks, neuroticism, effort-reward imbalance, and overcommitment. RESULTS: The analysis included 2983 employed persons (54.1% women, mean age: 47.9 years). High organizational injustice was associated with poor work ability (OR = 2.04, 95% CI 1.55-2.69). There were also slight associations with frequent self-reported disability days (OR = 1.34, 95% CI 1.06-1.68). The dependent variables were also associated with the effort-reward ratio and overcommitment. CONCLUSION: Organizational injustice is associated with work ability, self-reported disability days, and health-care utilization. Results support the notion of a complementary role of the models of organizational justice and effort-reward imbalance.

Self-Reported Poor Work Ability--An Indicator of Need for Rehabilitation? A Cross-Sectional Study of a Sample of German Employees.

OBJECTIVE: The purpose of this study was to assess associations of self-reported work ability as measured by the Work Ability Index (WAI) with modifiable behavioral and occupational health risks, health service utilization, and intended rehabilitation and pension requests. DESIGN: This is a cross-sectional study of a random sample of German employees aged 40-54 yrs on sickness benefits in 2012 (trial registration: DRKS00004824). RESULTS: In total, 1312 male and 1502 female employees were included in the analyses. Low WAI scores (i.e., <37 points) were associated with a higher prevalence of occupational and behavioral health risks; a higher likelihood of frequent visits to general, somatic, and psychologic specialists as well as hospital stays; and four to six times higher risks of intended rehabilitation and pension requests. A two-item version of the WAI was as strongly associated with intended rehabilitation and pension requests as the total score. CONCLUSIONS: This study indicates that the WAI is a sensitive screening tool to identify workers on sick leave with a probable need for rehabilitation. The WAI could support the assessment of need for rehabilitation by occupational health services in return-to-work strategies, which include the opportunity to access multiprofessional rehabilitation.

The Work Ability Index as a screening tool to identify the need for rehabilitation: longitudinal findings from the Second German Sociomedical Panel of Employees.

OBJECTIVE: To evaluate the predictive value of the Work Ability Index (WAI) for different indicators of the need for rehabilitation at 1-year follow-up. DESIGN: Cohort study. METHODS: Data were obtained from the Second German Sociomedical Panel of Employees, a large-scale cohort study with postal surveys in 2009 and 2010. RESULTS: A total of 457 women and 579 men were included. Confirmatory factor analysis confirmed the one-dimensionality of the WAI. Regression analyses showed that poor and moderate baseline WAI scores were associated with lower health-related quality of life and more frequent use of primary healthcare 1 year later. Subjects with poor baseline work ability had 4.6 times higher odds of unemployment and 12.2 times higher odds of prolonged sick leave than the reference group with good or excellent baseline work ability. Moreover, the odds of subjectively perceived need for rehabilitation, intention to request rehabilitation and actual use of rehabilitation services were 9.7, 5.7 and 3 times higher in the poor baseline WAI group and 5.5, 4 and 1.8 times higher in the moderate baseline WAI group, respectively. A WAI score ≤ 37 was identified as the optimal cut-off to predict the need for rehabilitation. CONCLUSION: The WAI is a valid screening tool for identifying the need for rehabilitation.

Effort-reward imbalance and work ability: cross-sectional and longitudinal findings from the Second German Sociomedical Panel of Employees.

BACKGROUND: Although data from longitudinal studies are sparse, effort-reward imbalance (ERI) seems to affect work ability. However, the potential pathway from restricted work ability to ERI must also be considered. Therefore, the aim of our study was to analyse cross-sectional and longitudinal associations between ERI and work ability and vice versa. METHODS: Data come from the Second German Sociomedical Panel of Employees. Logistic regression models were estimated to determine cross-sectional and longitudinal associations. The sample used to predict new cases of poor or moderate work ability was restricted to cases with good or excellent work ability at baseline. The sample used to predict new cases of ERI was restricted to persons without ERI at baseline. RESULTS: The cross-sectional analysis included 1501 full-time employed persons. The longitudinal analyses considered 600 participants with good or excellent baseline work ability and 666 participants without baseline ERI, respectively. After adjustment for socio-demographic variables, health-related behaviour and factors of the work environment, ERI was cross-sectionally associated with poor or moderate work ability (OR = 1.980; 95% CI: 1.428 to 2.747). Longitudinally, persons with ERI had 2.1 times higher odds of poor or moderate work ability after one year (OR = 2.093; 95% CI: 1.047 to 4.183). Conversely, persons with poor or moderate work ability had 2.6 times higher odds of an ERI after one year (OR = 2.573; 95% CI: 1.314 to 5.041). CONCLUSIONS: Interventions that enable workers to cope with ERI or address indicators of ERI directly could promote the maintenance of work ability. Integration management programmes for persons with poor work ability should also consider their psychosocial demands.

Adverse effects of effort-reward imbalance on work ability: longitudinal findings from the German Sociomedical Panel of Employees.

OBJECTIVE: The aim of this paper was to analyse the longitudinal effects of effort-reward imbalance (ERI) on work ability, mental health and physical functioning. METHODS: A total of 603 men and women aged 30-59 years participating in the first two waves of the German Sociomedical Panel of Employees were included in the analyses. Work ability was assessed using the Work Ability Index. Mental health and physical functioning were assessed using scales of the Medical Outcomes Study 36-item Short-Form Health Survey. RESULTS: Our longitudinal analysis showed that high ERI-related work stress exposure at baseline was associated with a decrease in work ability, mental health and physical functioning over time. In case of work ability (b=-0.512; 95% CI -1.018 to -0.006) and mental health (b=-2.026; 95% CI -3.483 to -0.568), this also held true after adjusting for other factors of the work environment (physical demands, job control and psychological job demands). CONCLUSIONS: Work stress by ERI has an impact on work ability independent of and above that of other known explanatory variables.

Work stress and work ability: cross-sectional findings from the German sociomedical panel of employees.

PURPOSE: Maintenance of work ability and restoration of reduced work ability by prevention and rehabilitation are major aims of disability management. To achieve these aims, decision-makers and health care providers need evidence of the determinants of restricted work ability. The aim of this article was to analyse the cross-sectional association between work stress and work ability in a population drawn from a random sample of employees. METHODS: A total of 1463 working men and women aged 30-59 years from the baseline survey of the German SPE were included in the analyses. Work stress was defined in terms of the demand-control model and the effort-reward (ER) imbalance model. Work ability was assessed by the Work Ability Index (WAI). We used multiple imputations to account for missing data and calculated logistic regression models to estimate associations between the two work stress models and restrictions of work ability. RESULTS: Approximately one third (32.0%) of the respondents reported restrictions of work ability (WAI <37) indicating a need of interventions to improve and to restore work ability. High job strain was experienced by about one third (34.2%) of the participants and 12.7% of the respondents reported an ER ratio > 1 indicating an ER imbalance. Restrictions of work ability were explained independently by high job strain due to high demand and low control (OR = 4.66; 95% CI = [2.93, 7.42]) and by effort-reward imbalance (OR = 2.88; 95% CI = [1.95, 4.25]). CONCLUSION: Work stress is associated with restrictions of work ability, but longitudinal analyses are required to confirm a causal relation.