Chronic psychosocial stress at work and risk of depression: evidence from prospective studies

  • Johannes Siegrist


Due to their high prevalence and severe consequences depressive disorders provide a primary challenge to medicine and public health. Improving our understanding of modifiable risk factors may help to advance preventive efforts. Chronic psychosocial stress at work, as defined by two theoretical models, demand-control and effort-reward imbalance, is one such modifiable risk factor. This paper reviews and discusses current evidence of associations between work-related psychosocial stress and depression based on a systematic review of prospective cohort studies of these two models, published within the last 10 years. Findings from 12 reports indicate a rather consistently elevated odds ratio of about 1.8 of depression among men and women who were exposed to high demand and low control at work or who spent high efforts in combination with low rewards received in turn. Findings are substantiated by results from experimental investigations that explored psychobiological mechanisms underlying this association. In conclusion, there is solid evidence of a prospectively established moderate association of chronic psychosocial stress at work, as defined by theoretical models, with depression. Despite open research questions the implications of these findings for prevention should be addressed.


work stress depression demand-control effort-reward imbalance 


Conflict of interest statement

I hereby declare that I don’t have any financial relationship with sponsoring organisations or interests that organisations represent.


  1. 1.
    Ahola K, Hakanen J (2007) Job strain, burnout, and depressive symptoms: a prospective study among dentists. J Affect Disord 104:103–110PubMedCrossRefGoogle Scholar
  2. 2.
    Berwick DM, Murphy JM, Goldman PA et al (1991) Performance of a five-item mental health screening test. Med Care 29:169–176PubMedCrossRefGoogle Scholar
  3. 3.
    Brunner E, Davey Smith G, Marmot M, Canner R, Beksinska M, O’Brien J (1996) Childhood social circumstances and psychosocial and behavioral factors as determinants of plasma fibrogen. Lancet 347:1008–1013PubMedCrossRefGoogle Scholar
  4. 4.
    Caspi A, Moffitt T (2006) Gene-environment interactions in psychiatry: joining forces with neuroscience. Nat Rev Neurosci 7:583–590PubMedCrossRefGoogle Scholar
  5. 5.
    Derogatis L (1977) Administration, scoring and procedures manual -I for the R(evised) version. John Hopkins University School of Medicine, BaltimoreGoogle Scholar
  6. 6.
    Dragano N, He Y, Moebus S, Jöckel KH, Erbel R, Siegrist J (2008) Two models of job stress and depressive symptoms. Results from a population-based study. Soc Psychiatry Psychiatr Epidemiol 43:72–78PubMedCrossRefGoogle Scholar
  7. 7.
    Godin I, Kittel F, Coppieters Y, Siegrist J (2005) A prospective study of cumulative job stress in relation to mental health. BMC Public Health 15:67CrossRefGoogle Scholar
  8. 8.
    Goldberg DP (1972) Detecting psychiatric illness by questionnaire. Maudsley monograph no. 21. Oxford University Press, LondonGoogle Scholar
  9. 9.
    Griffin JM, Fuhrer R, Stansfeld SA, Marmot M (2005) The importance of low control at work and home on depression and anxiety: do these effects vary by gender and social class? Soc Sci Med 54:783–798CrossRefGoogle Scholar
  10. 10.
    Hamer M, Williams E, Vuonovirta E (2006) The effects of effort-reward imbalance on inflammatory and cardiovascular responses to mental stress. Psychosom Med 68:408–413PubMedCrossRefGoogle Scholar
  11. 11.
    Hurwitz Eller N, Netterstrom B, Hansen AM (2006) Psychosocial factors at home and at work and levels of salivary cortisol. Biol Psychol 73:280–297CrossRefGoogle Scholar
  12. 12.
    Johnson JV, Hall EM (1988) Job strain, work place social support, and cardiovascular disease: a cross-sectional study of a random sample of the Swedish working population. Am J Public Health 78:1336–42PubMedGoogle Scholar
  13. 13.
    Karasek RA, Brisson C, Kawakami N et al (1998) The job content questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 3:322–355PubMedCrossRefGoogle Scholar
  14. 14.
    Karasek RA, Theorell T (1990) Healthy work. Stress, productivity and the reconstruction of working life. Basic Books, New YorkGoogle Scholar
  15. 15.
    Kessler RC, Andrews G, Mroczek D, Ustun TB, Wittchen HU (1998) The world health organization composite international diagnostic interview short-form (CIDI-SF). Int J Methods Psychiatr Res 7:171–185CrossRefGoogle Scholar
  16. 16.
    Kivimäki M, Vahtera J, Elovainio M, Virtanen M, Siegrist J (2007) Effort-reward imbalance, procedural injustice and relational injustice as psychosocial predictors of health: complementary or redundant models? Occup Environ Med 64:659–665PubMedCrossRefGoogle Scholar
  17. 17.
    de Lange AH, Taris TW, Kompier MA, Houtman IL, Bongers PM (2005) Different mechanisms to explain the reversed effects of mental health on work characteristics. Scand J Work Environ Health 31:3–14PubMedGoogle Scholar
  18. 18.
    Marchand A, Demers A, Durand P (2005) Does work really cause distress? The contribution of occupational structure and work organization to the experience of psychological distress. Soc Sci Med 61:1–14PubMedCrossRefGoogle Scholar
  19. 19.
    Mathers CD, Lopez AD, Murray CJL (2006) The burden of disease and mortality by condition: data, methods, and results for 2001. In: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (eds) Global burden of disease and risk factors, pp 45–234. Available online at
  20. 20.
    Mausner-Dorsch H, Eaton WW (2000) Psychosocial work environment and depression: epidemiologic assessment of the demand-control model. Am J Public Health 90:1765–1770PubMedCrossRefGoogle Scholar
  21. 21.
    McEwen B (1998) Protective and damaging effects of stress mediators. N Engl J Med 338:S171–S179CrossRefGoogle Scholar
  22. 22.
    Niedhammer I, Goldberg M, Leclerc A et al (1998) Psychosocial factors at work and subsequent depressive symptoms in the Gazel cohort. Scand J Work Environ Health 24:197–205PubMedGoogle Scholar
  23. 23.
    Niedhammer I, Chastang JF, David S, Barouhiel L, Barrandon G (2006) Psychosocial work environment and mental health: jobstrain and effort-reward imbalance models in a context of major organizational changes. Int J Occup Environ Health 12:111–119PubMedGoogle Scholar
  24. 24.
    Paterniti S, Niedhammer I, Lang T, Consoli SM (2002) Psychosocial factors at work, personality traits and depressive symptoms. Longitudinal results from the GAZEL Study. Br J Psychiatry 181:111–117PubMedCrossRefGoogle Scholar
  25. 25.
    Pikhart H, Bobak M, Pajak A et al (2004) Psychosocial factors at work and depression in three countries of Central and Eastern Europe. Soc Sci Med 58:1475–1482PubMedCrossRefGoogle Scholar
  26. 26.
    Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measure 1:385–401CrossRefGoogle Scholar
  27. 27.
    Rugulies R, Bültmann U, Aust B, Burr H (2006) Psychosocial work environment and incidence of severe depressive symptoms: prospective findings from a 5-year follow-up of the Danish work environment cohort study. Am J Epidemiol 163:877–887PubMedCrossRefGoogle Scholar
  28. 28.
    Sanderson K, Andrews G (2006) Common mental disorders in the workforce: recent findings from descriptive and social epidemiology. Can J Psychiatry 51:63–75PubMedGoogle Scholar
  29. 29.
    Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1:27–41PubMedCrossRefGoogle Scholar
  30. 30.
    Siegrist J, Starke D, Chandola T et al (2004) The measurement of effort-reward imbalance at work: European comparisons. Soc Sci Med 58:1483–1499PubMedCrossRefGoogle Scholar
  31. 31.
    Shields M (1999) Long working hours and health. Health Rep 11:33–48PubMedGoogle Scholar
  32. 32.
    Spector PE, Chen PY, O’Connell BJ (2000) A longitudinal study of relations between job stressors and job strains while controlling for prior negative affectivity and strains. J Appl Psychol 85:211–8PubMedCrossRefGoogle Scholar
  33. 33.
    Stansfeld SA, Fuhrer R, Shipley MJ, Marmot M (1999) Work characteristics predict psychiatric disorder: prospective results from the Whitehall II study. Occup Environ Med 56:302–307PubMedGoogle Scholar
  34. 34.
    Stansfeld S, Candy B (2006) Psychosocial work environment and mental health—a meta-analytic review. Scand J Work Environ Health 32:443–62PubMedGoogle Scholar
  35. 35.
    Steptoe A, Siegrist J, Kirschbaum C, Marmot M (2004) Effort-reward imbalance, overcommitment, and measures of cortisol and blood pressure over the working day. Psychosom Med 66:323–329PubMedCrossRefGoogle Scholar
  36. 36.
    Tsutsumi A, Kayaba K, Theorell T, Siegrist J (2001) Association between job stress and depression among Japanese employees threatened by job loss in a comparison between two complementary job-stress models. Scand J Work Environ Health 27:146–153PubMedGoogle Scholar
  37. 37.
    Wahrendorf M, von dem Knesebeck O, Siegrist J (2006) Social productivity and well-being of older people: baseline results from the SHARE study. Eur J Ageing 3:67–73CrossRefGoogle Scholar
  38. 38.
    Wang JL, Pattern SB (2004) Perceived work stress and major depressive episodes in a population of employed Canadians over 18 years old. J Nerv Ment Dis 192:160–163PubMedCrossRefGoogle Scholar
  39. 39.
    Wang JL (2006) Perceived work stress, imbalance between work and family/personal lives, and mental disorders. Soc Psychiatry Psychiatr Epidemiol 41:541–548PubMedCrossRefGoogle Scholar
  40. 40.
    Wege N, Dragano N, Erbel R et al (2008) When does work stress hurt? Testing the interaction with socioeconomic position in the Heinz Nixdorf recall study. J Epidemiol Community Health 62:338–341PubMedCrossRefGoogle Scholar
  41. 41.
    Ylipaavalniemi J, Kivimäki M, Elovainio M et al (2005) Psychosocial work characteristics and incidence of newly diagnosed depression: a prospective cohort study of three different models. Soc Sci Med 61:111–122PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.Dept. of Medical Sociology, Faculty of MedicineHeinrich-Heine-University of DuesseldorfDüsseldorfGermany

Personalised recommendations