Article Text

Download PDFPDF
Original article
Effort–reward imbalance and medically certified absence for mental health problems: a prospective study of white-collar workers
  1. R Ndjaboué1,2,
  2. C Brisson1,2,3,
  3. M Vézina1,3,4,
  4. C Blanchette2,
  5. R Bourbonnais1,5,6
  1. 1Groupe interdisciplinaire de recherche sur l'organisation et la santé au travail (GIROST), Québec, Québec, Canada
  2. 2Centre de recherche du CHU de Québec, URESPHSS, Québec, Canada, affilié à l'Université Laval
  3. 3Social and Preventive Medicine Department, Pavillon Ferdinand-Vandry, Laval University, Quebec, Quebec, Canada
  4. 4National Public Health Institute, Quebec, Quebec, Canada
  5. 5Rehabilitation Department, Faculty of Medicine, Pavillon Ferdinand-Vandry, Laval University, Québec, Québec, Canada
  6. 6Centre de santé et de services sociaux de la Vieille-Capitale (CSSSVC-RIPOST), Quebec, Quebec, Canada
  1. Correspondence to Ruth Ndjaboue, Centre de recherche du CHU de Québec, Unité de recherche en santé des populations, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, Québec, Canada, G1S 4L8, affilié à l'niversité Laval; ruth-sandra.ndjaboue-njike.1{at}


Objective Little is known about the effects of psychosocial work factors on objectively assessed mental health problems leading to medically certified absence. Only one study has evaluated the prospective effects of effort–reward imbalance (ERI) at work with regards to this outcome. The present study aimed to evaluate the effects of ERI on the incidence of medically certified absence for mental health problems.

Methods The study included 2086 white-collar workers (63.3% women) employed in public organisations in Quebec city. Participants were followed over a 9-year period. Medical absences from work were collected from employers’ files and psychosocial factors were measured using the ERI questionnaire. Cox regression models were used to estimate the incidence of certified sickness absence due to mental health problems that lasted 5 workdays or more, while controlling for confounders.

Results Workers exposed to ERI had a higher risk of a first spell of medically certified absence for mental health problems (HR=1.38, 95% CI 1.08 to 1.76) compared with unexposed workers. Low reward was significantly associated with a high risk among men (HR=2.80, 95% CI 1.34 to 5.89) but not in women. (HR=1.24, 95% CI 0.90 to 1.73). Effort at work had no effect on certified absence. All these effects were adjusted for potential confounders.

Conclusions ERI and low reward at work were prospectively associated with medically certified absence for mental health problems. These effects seem to differ by gender. Primary prevention that is aimed at reducing these stressors should be considered to help reduce the incidence of such severe mental health problems.

Statistics from

Request Permissions

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.