Unrewarding work and major depressive episode

By Scott Cunningham, MD, PhD
Published November 18, 2022

Key Takeaways

  • Unrewarding work is a significant risk factor for a major depressive episode.

Putting It Into Practice

While effort-reward imbalance is associated with decreased self-rated health, increased work engagement and job satisfaction have a positive impact on self-rated health.

To improve work engagement and job satisfaction, employers should have an awareness of the effort-to-reward relationship in the workplace, provide opportunities for career development, and incentivize worker effort.

Why this study matters

It has been shown that an imbalance between effort and reward in the workplace leads to active distress. Moreover, active distress is exacerbated by workers who are committed to their work compared to non-committed workers. Together, these factors are associated with adverse health outcomes, and as shown in the current study, major depression.

Study design

Data were obtained for this prospective study with a 9-y follow-up from the Mid-life in the US Study (MIDUS).

The 1591 participants were assessed for effort-reward imbalance at baseline using a validated 17-item scale. A major depressive episode in the past 12 months was assessed at baseline and follow-up using the Composite International Diagnostic Interview Short Form.

Results and conclusion

Participants in the cross-sectional and prospective groups within the highest quartile of effort-reward imbalance were at highest risk for a major depressive episode (OR = 1.47 and RR = 1.29, respectively).

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