Can high psychological job demands, low decision latitude, and high job strain predict disability pensions? A 12-year follow-up of middle-aged Swedish workers

  • Catarina CanivetEmail author
  • BongKyoo Choi
  • Robert Karasek
  • Mahnaz Moghaddassi
  • Carin Staland-Nyman
  • Per-Olof Östergren
Original Article



The aim of this study was to investigate whether job strain, psychological demands, and decision latitude are independent determinants of disability pension rates over a 12-year follow-up period.


We studied 3,181 men and 3,359 women, all middle-aged and working at least 30 h per week, recruited from the general population of Malmö, Sweden, in 1992. The participation rate was 41 %. Baseline data include sociodemographics, the Job Content Questionnaire, lifestyle, and health-related variables. Disability pension information was obtained through record linkage from the National Health Insurance Register.


Nearly 20 % of the women and 15 % of the men were granted a disability pension during the follow-up period. The highest quartile of psychological job demands and the lowest quartile of decision latitude were associated with disability pensions when controlling for age, socioeconomic position, and health risk behaviours. In the final model, with adjustment also for health indicators and stress from outside the workplace, the hazard ratios for high strain jobs (i.e. high psychological demands in combination with low decision latitude) were 1.5 in men (95 % CI, 1.04–2.0) and 1.7 in women (95 % CI, 1.3–2.2). Stratifying for health at baseline showed that high strain tended to affect healthy but not unhealthy men, while this pattern was reversed in women.


High psychological demands, low decision latitude, and job strain were all confirmed as independent risk factors for subsequent disability pensions. In order to increase chances of individuals remaining in the work force, interventions against these adverse psychosocial factors appear worthwhile.


Disability leave Stress, physiological Stress, psychological Gender Longitudinal studies 



This study was supported by grants from the Swedish Medical Research Council, the Swedish Council for Social Research, the Medical Faculty at Lund University, the National Institute of Public Health, and the Swedish Work Environment Fund.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Catarina Canivet
    • 1
    Email author
  • BongKyoo Choi
    • 2
  • Robert Karasek
    • 3
  • Mahnaz Moghaddassi
    • 1
  • Carin Staland-Nyman
    • 4
  • Per-Olof Östergren
    • 1
  1. 1.Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Malmö University HospitalLund UniversityMalmöSweden
  2. 2.Center for Occupational and Environment HealthUniversity of CaliforniaIrvineUSA
  3. 3.Department of Work EnvironmentUniversity of MassachusettsLowellUSA
  4. 4.Unit of Social Medicine, Department of Public Health and Community MedicineUniversity of GothenburgGothenburgSweden

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