Effort-reward imbalance and depression among private practice physicians

• Published in: International archives of occupational and environmental health 2012-02, Vol.85 (2), p.153-161
• Main Authors: Tsutsumi, Akizumi, Kawanami, Shoko, Horie, Seichi
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Biological and medical sciences; Cross-Sectional Studies; Depression; Depression - epidemiology; Depression - psychology; Earth and Environmental Science; Environment; Environmental Health; Health participants; Health services; Humans; Japan - epidemiology; Logistic Models; Medical practices; Medical sciences; Mental depression; Mood disorders; Occupational exposure; Occupational health; Occupational Medicine/Industrial Medicine; Odds Ratio; Original Article; Physicians; Physicians - psychology; Prevalence; Private Practice; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rehabilitation; Reward; Surveys and Questionnaires; Work environment; Workload - psychology
• ISSN: 0340-0131; 1432-1246
• DOI: 10.1007/s00420-011-0656-1

Purpose Current private practice physicians provide medical services in a harsh economic situation. The effort-reward imbalance (ERI) model puts its emphasis on an imbalance between high efforts spent and low rewards received in occupational life. ERI model includes three different reward factors from task to organizational levels. We examined whether ERI in terms of low organizational reward (poor prospective and job insecurity) could be the most relevant and strongly associated with depression among private practice physicians. Methods This is a cross-sectional questionnaire study of 1,103 private practice physicians who were currently working in clinical settings and completed the data of exposure and outcome. The study questionnaire was mailed to all the physicians listed as members of a local branch of the Japan Medical Association ( n  = 3,441) between November and December 2008. Outcomes were prevalence of depression as measured by the Center for Epidemiologic Studies Depression Scale and adjusted odds ratios (OR) of depression with respect to ERI. Results Fifty-seven percent of physicians were exposed to ERI, and 18% of the physicians were depressed. Logistic regression analyses revealed that ERI was significantly associated with depression (OR and 95% confidence interval = 3.57; 2.43–5.26). ERI with regard to organizational reward was most prevalent (60%) and had the strongest association with depression (5.14; 3.36–7.92). Conclusion Predominant prevalence of ERI in terms of organizational level low reward and strong associations between the ERI component and depression suggests that countermeasures from social perspective are crucial.