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Effort-reward imbalance among students at German universities: associations with self-rated health and mental health

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Abstract

Purpose

Although psychosocial stress has been associated with adverse health parameters, little is known about this topic among the variety of university students. We thus examined associations of psychosocial stress due to academic education with self-rated health, and symptoms of depression and anxiety among students from various study disciplines.

Methods

We used data from the Nutrition and Physical Activity (NuPhA) Study, a cross-sectional online survey among students enrolled across German universities (n = 698). Academic stress was assessed by a newly developed and validated student version of the Effort–Reward Imbalance (ERI-Student) Questionnaire. Depressive and anxiety symptoms were measured by applying the Patient Health Questionnaire-4 (PHQ-4) and using validated cut-offs.

Results

Separate multivariate logistic regression analyses run for the different ERI components, the ERI-ratio revealed that high effort, low reward, high over-commitment, and a high ERI-ratio were associated with poor self-rated health, and depressive and anxiety symptoms (odds ratios ≥ 2.43). Separate analyses for medical students and non-medical students largely confirmed these findings for both groups. Associations between all ERI components, the ERI ratio, and both mental health measures were, however, more pronounced among medical students.

Conclusions

We were able to show consistent associations between the ERI-Student Questionnaire and self-rated health and mental health across students from different study disciplines. Further research on associations between academic stress and health parameters is necessary to develop effective strategies that prevent students from adverse health outcomes during their academic education.

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References

  • Barbosa P, Raymond G, Zlotnick C, Wilk J, Toomey R 3rd, Mitchell J 3rd (2013) Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students. Educ Health (Abingdon) 26(1):9–14

    Google Scholar 

  • Beiter R et al (2015) The prevalence and correlates of depression, anxiety, and stress in a sample of college students. J Affect Disorders 173:90–96

    CAS  Google Scholar 

  • Brenneisen Mayer F et al (2016) Factors associated to depression and anxiety in medical students: a multicenter study. Bmc Med Educ 16(1):282

    Google Scholar 

  • Dahlin M, Joneborg N, Runeson B (2005) Stress and depression among medical students: a cross-sectional study. Med Educ 39(6):594–604

    Google Scholar 

  • Darboe A, Lin IF, Kuo HW (2016) Effort-reward imbalance and self-rated health among Gambian healthcare professionals. Bmc Health Serv Res. https://doi.org/10.1186/s12913-016-1347-0

    Article  Google Scholar 

  • Dyrbye LN, Thomas MR, Shanafelt TD (2006) Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Acad Med 81(4):354–373

    Google Scholar 

  • El Ansari W, Oskrochi R, Haghgoo G (2014) Are students’ symptoms and health complaints associated with perceived stress at university? Perspectives from the United Kingdom and Egypt. Int J Environ Res Public Health 11(10):9981–10002

    Google Scholar 

  • Guo HX, Yang WJ, Cao Y, Li J, Siegrist J (2014) Effort-reward imbalance at school and depressive symptoms in chinese adolescents: the role of family socioeconomic status. Int J Env Res Pub He 11(6):6085–6098

    Google Scholar 

  • Hahn H, Kropp P, Kirschstein T, Rucker G, Muller-Hilke B (2017) Test anxiety in medical school is unrelated to academic performance but correlates with an effort/reward imbalance. Plos One 12(2)

    Google Scholar 

  • Haldorsen H, Bak NH, Dissing A, Petersson B (2014) Stress and symptoms of depression among medical students at the University of Copenhagen. Scand J Public Healt 42(1):89–95

    Google Scholar 

  • Hapke U, Maske UE, Scheidt-Nave C, Bode L, Schlack R, Busch MA (2013) Chronic stress among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5–6):749–754

    CAS  Google Scholar 

  • Heinen I, Bullinger M, Kocalevent RD (2017) Perceived stress in first year medical students—associations with personal resources and emotional distress. Bmc Med Educ 17:4

    Google Scholar 

  • Herrera R et al (2017) Chronic stress in young german adults: who is affected? A prospective cohort study. Int J Environ Res Public Health 14(11):1325

    Google Scholar 

  • Jurkat HB et al (2011) Depressivität und Stressbewältigung bei Medizinstudierenden. Der Nervenarzt 82(5):646–652

    CAS  Google Scholar 

  • Kroenke K, Spitzer RL, Williams JBW (2003) The Patient Health Questionnaire-2—Validity of a two-item depression screener. Med Care 41(11):1284–1292

    Google Scholar 

  • Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B (2007) Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 146(5):317–325

    Google Scholar 

  • Kroenke K, Spitzer RL, Williams JBW, Lowe B (2009) An Ultra-Brief Screening Scale for anxiety and depression: the PHQ-4. Psychosomatics 50(6):613–621

    Google Scholar 

  • Laftman SB, Modin B, Ostberg V, Hoven H, Plenty S (2015) Effort-reward imbalance in the school setting: associations with somatic pain and self-rated health. Scand J Public Health 43(2):123–129

    Google Scholar 

  • Li J, Shang L, Wang T, Siegrist J (2010) Measuring effort-reward imbalance in school settings: a novel approach and its association with self-rated health. J Epidemiol 20(2):111–118

    CAS  Google Scholar 

  • Loerbroks A et al (2015) The association of effort-reward imbalance and asthma: findings from two cross-sectional studies. Int Arch Occup Environ Health 88(3):351–358

    Google Scholar 

  • Lowe B, Kroenke K, Grafe K (2005) Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res 58(2):163–171

    Google Scholar 

  • Lowe B et al (2010) A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disorders 122(1–2):86–95

    Google Scholar 

  • Mackenzie S et al (2011) Depression and suicide ideation among students accessing campus health care. Am J Orthopsychiatry 81(1):101–107

    Google Scholar 

  • Ohlander J, Weigl M, Petru R, Angerer P, Radon K (2015) Working conditions and effort-reward imbalance of German physicians in Sweden respective Germany: a comparative study. Int Arch Occup Environ Health 88(4):511–519

    Google Scholar 

  • Opoku-Acheampong A et al (2017) Perceived stress and quality of life of pharmacy students in University of Ghana. BMC Res Notes 10(1):115

    Google Scholar 

  • Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP (2003) Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol 88(5):879–903

    Google Scholar 

  • Proeschold-Bell RJ, Miles A, Toth M, Adams C, Smith BW, Toole D (2013) Using effort-reward imbalance theory to understand high rates of depression and anxiety among clergy. J Prim Prev 34(6):439–453

    Google Scholar 

  • Racic M, Todorovic R, Ivkovic N, Masic S, Joksimovic B, Kulic M (2017) Self- perceived stress in relation to anxiety, depression and health-related quality of life among health professions students: a cross-sectional study from Bosnia and Herzegovina. Zdr Varst 56(4):251–259

    Google Scholar 

  • Reed DA et al (2011) Relationship of pass/fail grading and curriculum structure with well-being among preclinical medical students: a multi-institutional study. Acad Med 86(11):1367–1373

    Google Scholar 

  • Saipanish R (2003) Stress among medical students in a Thai medical school. Med Teach 25(5):502–506

    Google Scholar 

  • Shapiro SL, Schwartz GE, Bonner G (1998) Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med 21(6):581–599

    CAS  Google Scholar 

  • Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1(1):27–41

    CAS  Google Scholar 

  • Siegrist J (1998) Reciprocity in basic social exchange and health: can we reconcile person-based with population-based psychosomatic research? J Psychosom Res 45(2):99–105

    CAS  Google Scholar 

  • Siegrist J et al (2004) The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med 58(8):1483–1499

    Google Scholar 

  • Siegrist J, Wege N, Puhlhofer F, Wahrendorf M (2009) A short generic measure of work stress in the era of globalization: effort-reward imbalance. Int Arch Occup Environ Heaith 82(8):1005–1013

    Google Scholar 

  • Slavin SJ, Schindler DL, Chibnall JT (2014) Medical student mental health 3.0: improving student wellness through curricular changes. Acad Med 89(4):573–577

    Google Scholar 

  • Song Y, Lindquist R (2015) Effects of mindfulness-based stress reduction on depression, anxiety, stress and mindfulness in Korean nursing students. Nurse Educ Today 35(1):86–90

    Google Scholar 

  • Sperlich S, Peter R, Geyer S (2012) Applying the effort-reward imbalance model to household and family work: a population-based study of German mothers. Bmc Public Health 12:12

    Google Scholar 

  • Sperlich S, Arnhold-Kerri S, Siegrist J, Geyer S (2013) The mismatch between high effort and low reward in household and family work predicts impaired health among mothers. Eur J Public Health 23(5):893–898

    Google Scholar 

  • Sperlich S, Barre F, Otto F (2016) Effort-reward imbalance in household and family work—analysing the psychometric properties among fathers of underage children. Psychother Psychosom Med Psychol 66(2):57–66

    Google Scholar 

  • Statistisches Bundesamt (2018) [Students at German universities] Fachserie 11 Reihe 4,1 Sommersemester 2017

  • Stewart SM, Betson C, Lam TH, Marshall IB, Lee PW, Wong CM (1997) Predicting stress in first year medical students: a longitudinal study. Med Educ 31(3):163–168

    CAS  Google Scholar 

  • Subramanian SV, Huijts T, Avendano M (2010) Self-reported health assessments in the 2002 World Health Survey: how do they correlate with education? Bull World Health Organ 88(2):131–138

    CAS  Google Scholar 

  • van Vegchel N, de Jonge J, Bosma H, Schaufeli W (2005a) Reviewing the effort-reward imbalance model: drawing up the balance of 45 empirical studies. Soc Sci Med 60(5):1117–1131

    Google Scholar 

  • van Vegchel N, de Jonge J, Landsbergis PA (2005b) Occupational stress in (inter)action: the interplay between job demands and job resources. J Organ Behav 26(5):535–560

    Google Scholar 

  • Vitaliano PP, Maiuro RD, Mitchell E, Russo J (1989) Perceived stress in medical school: resistors, persistors, adaptors and maladaptors. Soc Sci Med 28(12):1321–1329

    CAS  Google Scholar 

  • Wege N, Muth T, Li J, Angerer P (2016) Mental health among currently enrolled medical students in Germany. Public Health 132:92–100. https://doi.org/10.1016/j.puhe.2015.12.014

    Article  CAS  Google Scholar 

  • Wege N, Li J, Muth T, Angerer P, Siegrist J (2017) Student ERI: Psychometric properties of a new brief measure of effort-reward imbalance among university students. J Psychosom Res 94:64–67

    Google Scholar 

  • Wege N, Li J, Siegrist J (2018) Are there gender differences in associations of effort-reward imbalance at work with self-reported doctor-diagnosed depression? Prospective evidence from the German Socio-Economic Panel. Int Arch Occup Environ Health 91(4):435–443

    Google Scholar 

  • Weyers S, Peter R, Boggild H, Jeppesen HJ, Siegrist J (2006) Psychosocial work stress is associated with poor self-rated health in Danish nurses: a test of the effort-reward imbalance model. Scand J Caring Sci 20(1):26–34

    Google Scholar 

  • Wild K, Scholz M, Ropohl A, Brauer L, Paulsen F, Burger PH (2014) Strategies against burnout and anxiety in medical education—implementation and evaluation of a new course on relaxation techniques (Relacs) for medical students. Plos One 9(12):e114967

    Google Scholar 

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Acknowledgements

The authors thank all students that participated in the quantitative part of the NuPhA Study. Further, we are indebted to Prof. Johannes Siegrist and Dr. Natalia Wege, both from the University of Düsseldorf, for granting us permission to use the ERI-Student Questionnaire.

Funding

The quantitative part of the NuPhA Study was partially funded by the non-profit organisation “Institute Danone Ernährung für Gesundheit e.V., Haar, Germany” (project number: 2014/01). The funding organisation had no influence on designing, analysing, or interpreting the data. In addition, they had no role in writing or in publishing of this manuscript.

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Authors and Affiliations

  1. Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Straße 7-11, 68167, Mannheim, Germany

    Jennifer Hilger-Kolb, Katharina Diehl & Raphael Herr

  2. Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany

    Jennifer Hilger-Kolb & Adrian Loerbroks

Authors
  1. Jennifer Hilger-Kolb
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  2. Katharina Diehl
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  3. Raphael Herr
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  4. Adrian Loerbroks
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Contributions

JH-K and AL designed the scope of the manuscript and have final responsibility for the content of the manuscript. KD and JH-K designed the NuPhA Study and collected all data. RH conducted the statistical analysis. RH and KD carefully reviewed the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Jennifer Hilger-Kolb.

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Conflict of interest

The authors have no competing interest to report.

Ethical approval

The NuPhA Study received ethical approval by the Ethics Committee of the Medical Faculty Mannheim, Heidelberg University (2013-634-N-MA).

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Hilger-Kolb, J., Diehl, K., Herr, R. et al. Effort-reward imbalance among students at German universities: associations with self-rated health and mental health. Int Arch Occup Environ Health 91, 1011–1020 (2018). https://doi.org/10.1007/s00420-018-1342-3

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  • DOI: https://doi.org/10.1007/s00420-018-1342-3

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