Psychosocial stress at work is increasingly recognized
as a health risk in modern working
life. To assess such risks in a reliable way, quality-
assured methods with a good theoretical
basis are needed. One such approach is the
model of effort-reward imbalance at work
described in the present paper. This model is
based on the claim that violation of the basic
principle of fair exchange, the reciprocity of
efforts spent and rewards received at work,
elicits marked stress reactions in affected employees
which, if sustained, increase the risk
of stress-related disorders. Rewards include
money, promotion prospects, job security
and the non-material rewards of esteem and
appreciation. Efforts reflect the external demands
of the job, but are modified by personal
motivation (e.g. coping patterns, overcommitment).
Testing the model with data from prospective
epidemiological studies revealed
an overall doubling of the risk of developing
an incident depressive disorder over a 5-year
period for those exposed to effort-reward
imbalance at work relative to that for non-exposed
employees. Finally, some theoretically
based policy measures at the individual, interpersonal
and organisational level are proposed;
they aim to promote good quality of
work and working conditions which enhance
the health of the majority of employees.
