Emotional demands and exhaustion: cross-sectional and longitudinal associations in a cohort of Danish public sector employees

  • Marianne Agergaard Vammen
  • Sigurd Mikkelsen
  • Julie Lyng Forman
  • Åse Marie Hansen
  • Jens Peter Bonde
  • Matias Brødsgaard Grynderup
  • Henrik Kolstad
  • Linda Kaerlev
  • Reiner Rugulies
  • Jane Frølund ThomsenEmail author
Original Article



To examine cross-sectional and longitudinal associations between content-related emotional demands at work and exhaustion, and to investigate if these associations were modified by other psychosocial work characteristics.


In 2007, 4489 Danish public service employees participated in the PRISME study by completing postal questionnaires, and 3224 participated in the follow-up in 2009. Content-related emotional demands were measured by a scale (scored 1 to 5) based on five work-content-related items, and exhaustion was measured with the general exhaustion scale from the Copenhagen Burnout Inventory (CBI) (scored 1 to 5). The cross-sectional and longitudinal associations with exhaustion were analysed in the same model and adjusted for effects of potential confounders. Effect modifications were examined separately for self-reported emotional enrichment, meaningful work, job control, social support at work and quantitative demands.


Exhaustion increased with increasing emotional demands, both cross-sectionally and longitudinally. However, although statistically significant, the effect was small. In the longitudinal analysis, a one unit increase in emotional demands was associated with a 0.03 unit (95% CI: 0.01–0.06) increase in exhaustion. We found statistically significant effect modification for three of six potentially modifying work characteristics. The effect of emotional demands on exhaustion was lower for participants with high levels of emotional enrichment (cross-sectionally and longitudinally), high levels of meaningful work (longitudinally), and higher for high levels of quantitative demands (cross-sectionally).


Increasing content-related emotional demands were associated with increasing levels of exhaustion, cross-sectionally and longitudinally. This effect was reduced if the work was experienced as emotionally enriching and meaningful.


Work demands Mental health Psychosocial work factors Effect modification Cohort study 



The PRISME study was supported by an unrestricted research grant from the Danish Working Environment Research Fund and Lundbeck A/S.

Compliance with ethical standards

Conflict of interest

Marianne Agergaard Vammen was funded by Lundbeck A/S. Lundbeck A/S was not involved in any parts of the study or the preparation of the article. Jane Frølund Thomsen is appointed by the Danish National Board of Health to the Committee of Occupational Diseases, an advisory committee for the Danish National Board of Industrial Injuries.

Ethical standards

The study protocol was approved by the local Scientific Ethical Committee (RRS 2006-1028) and the Danish Protection Agency (2009-41-3215). Informed consent was obtained from all individual participants included in the study. All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

420_2018_1398_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Marianne Agergaard Vammen
    • 1
  • Sigurd Mikkelsen
    • 1
  • Julie Lyng Forman
    • 2
  • Åse Marie Hansen
    • 2
  • Jens Peter Bonde
    • 1
  • Matias Brødsgaard Grynderup
    • 2
  • Henrik Kolstad
    • 3
  • Linda Kaerlev
    • 4
    • 5
  • Reiner Rugulies
    • 6
    • 7
    • 8
  • Jane Frølund Thomsen
    • 1
    Email author
  1. 1.Department of Occupational and Environmental MedicineBispebjerg University HospitalCopenhagen NVDenmark
  2. 2.Department of Public HealthUniversity of CopenhagenCopenhagen KDenmark
  3. 3.Department of Clinical Medicine, Occupational Medicine, Danish Ramazzini CentreAarhus University HospitalAarhus CDenmark
  4. 4.Research Unit of Clinical Epidemiology, Institute of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
  5. 5.Center for Clinical EpidemiologyOdense University HospitalOdense MDenmark
  6. 6.Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
  7. 7.National Research Centre for the Working EnvironmentCopenhagen ODenmark
  8. 8.Department of PsychologyUniversity of CopenhagenCopenhagenDenmark

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