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Original Article
The combined effects of job demand and control, effort-reward imbalance and work-family conflicts on the risk of major depressive episode: a 4-year longitudinal study
  1. Yeshambel T Nigatu1,2,
  2. JianLi Wang1,2,3
  1. 1 Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
  2. 2 Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Canada
  3. 3 School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
  1. Correspondence to Dr Yeshambel T Nigatu, University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; yeshambel.nigatu{at}


Purpose Work-related psychosocial factors may precipitate the onset of depression. In occupational mental health research, there are three widely used theoretical models, namely, job demand and control (JD-C), effort-reward imbalance (ERI) and work-family conflicts (WFC). However, the interaction between these models and their combined effect on the risk of major depression in the workplace is largely unknown. The aim of this study is to examine the longitudinal combined effects of JD-C, ERI and WFC on the risk of major depression in the working population.

Methods Longitudinal data (2008-2013) were collected on randomly selected participants (n=4200) from the working population of the province of Alberta, Canada, at baseline and 1-, 2-, 3- and 4-year follow-up. Data about JD-C, ERI, WFC and major depression were collected by trained interviewers using a computer-assisted telephone interviewing method. Generalised estimating equations for longitudinal modelling were used.

Results There was an independent association between high ERI and high WFC at tx and major depression at tx+1 (OR 1.56, 95% CI 1.25 to 1.96; OR 1.33, 95% CI 1.16 to 1.52), respectively. The combined effects of JD-C and ERI, ERI and WFC, and WFC and JD-C on the risk of major depression were as follows: OR 1.71, 95% CI 1.22 to 2.42, OR 2.47, 95% CI 1.99 to 3.49 and OR 2.21, 95% CI 1.48 to 3.30, respectively. The relative excess risks attributable to the interactions were statistically non-significant.

Conclusions Work-related psychosocial factors are associated with increased risk of major depression over time, but their combined effect is not synergistic. The effects of the factors depicted in the three occupational health models on the risk of major depression appear to be additive.

  • mental health
  • occupational health practice
  • psychiatry
  • disability
  • longitudinal studies

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  • Contributors YTN and JW conceived and designed the study. YTN performed statistical analyses and drafted the manuscript. JW critically reviewed the article for important intellectual content. All authors have approved the final article and accept full responsibility for the design and the conduct of the study, and all approved the decision to publish.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Conjoint Health Research Ethics Board of the University of Calgary.

  • Provenance and peer review Not commissioned; externally peer reviewed.