Article Text

other Versions

Effort-reward imbalance, procedural injustice and relational injustice as psychosocial predictors of health: Complementary or redundant models?
  1. Mika Kivimäki (mika.kivimaki{at}
  1. University College London, UK, and Finnish Institute of Occupational Health, United Kingdom
    1. Jussi Vahtera
    1. Finnish Institute of Occupational Health, Finland
      1. Marko Elovainio
      1. National Research and Development Centre for Health and Welfare, Gabon
        1. Marianna Virtanen
        1. Finnish Institute of Occupational Health, Finland
          1. Johannes Siegrist
          1. University of Duesseldorf, Germany


            Objective Effort-reward imbalance at work (ERI) is an established psychosocial risk factor but there are also newer conceptualisations, such as procedural injustice (decisions at work lack consistency, openness and input from all affected parties) or relational injustice (problems in considerate and fair treatment of employees by supervisors). We examined whether procedural injustice and relational injustice are associated with employee health in addition to, and in combination with ERI.

            Methods Prospective survey data from two cohorts related to public-sector employees [n=18,066 (78% women, age range 19-62) in the 10-Town study and 4833 (89% women, age range 20-60) in the Finnish Hospital Personnel study]. Self-rated poor health, minor psychiatric morbidity and doctor-diagnosed depression were assessed at baseline (2000-2002) and at follow-up (2004). To determine incident morbidity, we excluded baseline cases.

            Results In multivariate models including age, sex, occupational status and all three psychosocial factors as predictors, high ERI and either high procedural injustice or high relational injustice were associated with increased morbidity at follow-up in both cohorts. After combining procedural and relational injustice into a single measure of organizational injustice, high ERI and high injustice were both independently associated with health. For all outcome measures, a combination of high ERI and high organizational injustice was related to a greater health risk than high ERI or injustice alone.

            Conclusion Evidence from two independent employee cohorts suggests that procedural and relational components of injustice, as a combined index, and ERI are complementary risk factors.

            • health status
            • mental health
            • occupational stress
            • psychosocial factors

            Statistics from

            If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.