Exploring the effort-reward structure of university work focusing on perceived overall stress, self-reported health, and musculoskeletal disorders

  • Bence Verpeléti
    Department of Public Health, Faculty of Medicine, University of Szeged, Hungary.
  • Edina Horváth
    Department of Public Health, Faculty of Medicine, University of Szeged, Hungary.
  • Gordana Dobi-Ágoston
    Department of Public Health, Faculty of Medicine, University of Szeged, Hungary.
  • Gergely Ágoston
    Family Medicine Department, Faculty of Medicine, University of Szeged, Hungary.
  • Kitti Bérces
    Family Medicine Department, Faculty of Medicine, University of Szeged, Hungary.
  • Regina Molnár
    Department of Public Health, Faculty of Medicine, University of Szeged, Hungary.
  • Veronika Mátó
    Institute of Applied Health Sciences and Health Promotion, Juhász Gyula Faculty of Education, University of Szeged, Hungary.
  • Albert Varga
    Family Medicine Department, Faculty of Medicine, University of Szeged, Hungary.
  • Edit Paulik
    Department of Public Health, Faculty of Medicine, University of Szeged, Hungary.


Background: The effort-reward imbalance (ERI) model by Siegrist encouraged numerous scientific investigations that reported particular ties between psychosocial risks and poor self-reported health (SRH), while psychosocial work-related stress has also been linked to musculoskeletal disorders (MSDs). The aim of this study was to examine the health status and the perceived levels of occupational stress of university employees and to analyse the findings according to the employees’ effort and reward structure of work, perceived overall stress, SRH and the presence of MSDs.

Design and methods
: 398 employees – including healthcare professionals, academic personnel and workers with administrative or other jobs – employed at the University of Szeged, Faculty of Medicine were investigated with a self-administered questionnaire including the Effort-Reward Imbalance Questionnaire (ERI-Q) and Perceived Stress Scale 4 (PSS-4).

: More than half of the investigated subjects (54.8%) reported some forms of MSDs. Low self-reported health (p<0.001) and presence of MSDs (p=0.015) were significantly associated with the level of perceived stress and effort-reward imbalance (ERI), moreover increased level of perceived stress was independently associated with the likelihood of MSDs (AOR=1.13) and low self-reported health (AOR=1.30). ERI well predicted low self-reported health (AOR=2.05) as well. Increased level of perceived stress positively correlated with high work-related effort (r=0.247, p<0.001) and over-commitment (r=0.387, p<0.001) while with work-related reward (r=−0.181, p=0.011) perceived stress showed a negative connection.

: Our results suggest that addressing the burden of effort-reward imbalance and MSDs would likely lessen employees’ perceived level of overall stress and affect their self-reported overall state of health.


American Medical Association. Healthy population equals healthy economy. 2020. Accessed August 31, 2020. Available from: https://www.ama-assn.org/practice-management/economics/healthy-population-equals-healthy-economy

Mehta N, Myrskylä M. The population health benefits of a healthy lifestyle: life expectancy increased and onset of disability delayed. Health Aff (Millwood) 2017;36:1495-502. DOI: https://doi.org/10.1377/hlthaff.2016.1569

Kaspin LC, Gorman KM, Miller RM. Systematic review of employer-sponsored wellness strategies and their economic and health-related outcomes. Popul Health Manag 2013;16:14-21. DOI: https://doi.org/10.1089/pop.2012.0006

Deng J, Guo Y, Ma T, et al. How job stress influences job performance among Chinese healthcare workers: a cross-sectional study. Environ Health Prev Med 2019;24:2. DOI: https://doi.org/10.1186/s12199-018-0758-4

Parker PA, Kulik JA. Burnout, self- and supervisor-rated job performance, and absenteeism among nurses. J Behav Med 1995;18:581-99. DOI: https://doi.org/10.1007/BF01857897

Baumann A, Muijen M, Gaebel W. Mental health and well-being at the workplace – protection and inclusion in challenging times. WHO Regional Office for Europe; 2010.

Portuné R. Psychosocial risks in the workplace: An increasing challenge for German and international health protection. Arh Hig Rada Toksikol 2012;63:123-11. DOI: https://doi.org/10.2478/10004-1254-63-2012-2212

de Kok J, Vroonhof P, Snijders J, et al. Work-related MSDs: prevalence, costs and demographics in the EU. European Agency for Safety and Health at Work (EU-OSHA); 2019.

Schneider E, Irastorza X. European OSH in figures: Work-related musculoskeletal disorders in the EU — Facts and figures. European Agency for Safety and Health at Work (EU-OSHA); 2010.

Tantawy S. Work-related musculoskeletal symptoms among employees with different tasks: Ahlia University case study. Biomed Res 2019;30.

Bernal D, Campos-Serna J, Tobias A, et al. Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: A systematic review and meta-analysis. Int J Nurs Stud 2015;52:635-48. DOI: https://doi.org/10.1016/j.ijnurstu.2014.11.003

Ballester Arias AR, García AM. [Occupational exposure to psychosocial factors and presence of musculoskeletal disorders in nursing staff: A review of studies and meta-analysis].[Article in Spanish]. Rev Esp Salud Publica 2017;91:e201704028.

Siegrist J. Effort-reward imbalance at work and health. In: PL Perrewe and DC Ganster, editors. Historical and current perspectives on stress and health. Bingley: Emerald Group Publishing Ltd.; 2002. p. 261-91.

Siegrist J. Effort-reward imbalance at work – theory, measurement and evidence. Department of Medical Sociology, University Düsseldorf, Germany; 2012.

Niedhammer I, Tek M, Starke D, Siegrist J. Effort-reward imbalance model and self-reported health: cross-sectional and prospective findings from the GAZEL cohort. Soc Sci Med 2004;58:1531-41. DOI: https://doi.org/10.1016/S0277-9536(03)00346-0

Jiménez P, Bregenzer A, Kallus K, et al. Enhancing resources at the workplace with health-promoting leadership. Int J Environ Res Public Health 2017;14:1264. DOI: https://doi.org/10.3390/ijerph14101264

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96. DOI: https://doi.org/10.2307/2136404

Stauder A, Konkolÿ Thege B. Characteristics of the Hungarian version of the perceived stress scale (PSS). Mentálhigiéné és Pszichoszomatika 2006;7:203-16. DOI: https://doi.org/10.1556/Mental.7.2006.3.4

Lavoie J, Douglas K. The perceived stress scale: Evaluating configural, metric and scalar invariance across mental health status and gender. J Psychopathol Behav Assess 2012;13:34-48. DOI: https://doi.org/10.1007/s10862-011-9266-1

Salavecz G, Neculai K, Rózsa S, Kopp M. [Az Erőfeszítés-Jutalom Egyensúlytalanság Kérdőív magyar változatának megbízhatósága és érvényessége].[Article in Hungarian]. Mentálhigiéné és Pszichoszomatika 2006;7:231-46. DOI: https://doi.org/10.1556/Mental.7.2006.3.7

de Jonge J, Bosma H, Peter R, Siegrist J. Job strain, effort-reward imbalance and employee well-being: a large-scale cross-sectional study. Soc Sci Med 2000;50:1317-27. DOI: https://doi.org/10.1016/S0277-9536(99)00388-3

Yu S, Gu G, Zhou W, Wang S. Psychosocial work environment and well‐being: A cross‐sectional study at a thermal power plant in China. J Occup Health 2008;50:155-162. DOI: https://doi.org/10.1539/joh.L7098

Satoh M, Watanabe I, Asakura K. Occupational commitment and job satisfaction mediate effort-reward imbalance and the intention to continue nursing. Jpn J Nurs Sci 2017;14:49-60. DOI: https://doi.org/10.1111/jjns.12135

Siegrist J, Starke D, Chandola T, et al. The measurement of effort–reward imbalance at work: European comparisons. Soc Sci Med 2004;58:1483-99. DOI: https://doi.org/10.1016/S0277-9536(03)00351-4

Liu Q, Li C, Wanga V, Shepherd BE. Covariate-adjusted Spearman's rank correlation with probability-scale residuals. Biometrics 2018;74:595-605. DOI: https://doi.org/10.1111/biom.12812

Epstein S, Sparer E, Tran B, et al. Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists. JAMA Surg 2018;153:e174947.

James C, James D, Nie V, et al. Musculoskeletal discomfort and use of computers in the university environment. Appl Ergon 2018;69:128-35. DOI: https://doi.org/10.1016/j.apergo.2018.01.013

Milutinović D, Golubović B, Brkić N, Prokeš B. Professional stress and health among critical care nurses in Serbia. Arh Hig Rada Toksikol 2012;63:171-80. DOI: https://doi.org/10.2478/10004-1254-63-2012-2140

Central Statistics Office. [A 2014-ben végrehajtott Európai Lakossági Egészségfelmérés eredményei. Összefoglaló adatok (Results of the European Population Health Survey conducted in 2014. Summary data)].[in Hungarian]. Central Statistics Office; 2018. Available from: https://www.ksh.hu/docs/hun/xftp/idoszaki/elef/elef2014_osszefoglalo.pdf

Salavecz G, Chandola T, Pikhart H et al. Work stress and health in Western European and post-communist countries: an East-West comparison study. J Epidemiol Community Health 2009;64:57-62. DOI: https://doi.org/10.1136/jech.2008.075978

Koch P, Schablon A, Latza U, Nienhaus A. Musculoskeletal pain and effort-reward imbalance- a systematic review. BMC Public Health 2014;14:37. DOI: https://doi.org/10.1186/1471-2458-14-37

Kong L, Li W, Wang H, et al. The relationship between effort-reward imbalance and empathy among clinical nurses: A cross-sectional online survey. J Clin Nurs 2020;29:3363-72. DOI: https://doi.org/10.1111/jocn.15367

Kinman G. Effort-reward imbalance and overcommitment in UK academics: implications for mental health, satisfaction and retention. J High Educ Policy Manage 2016;38:504-18. DOI: https://doi.org/10.1080/1360080X.2016.1181884

Koner S, Chaudhuri A. A study of correlation of perceived stress and thyroid function among females in a rural population of reproductive age group. Med J Dr DY Patil Vidyapeeth 2020;13:30. DOI: https://doi.org/10.4103/mjdrdypu.mjdrdypu_219_18

Andersen LL, Fishwick D, Robinson E, et al. Job satisfaction is more than a fruit basket, health checks and free exercise: Cross-sectional study among 10,000 wage earners. Scand J Public Health 2017:45476-84.

Whitehead D. Workplace health promotion: the role and responsibility of health care managers. J Nurs Manag 2006;14:59-68. DOI: https://doi.org/10.1111/j.1365-2934.2005.00599.x

Gedif G, Sisay Y, Alebel A, Belay Y. Level of job satisfaction and associated factors among health care professionals working at University of Gondar Referral Hospital, Northwest Ethiopia: a cross-sectional study. BMC Res Notes 2018;11:824. DOI: https://doi.org/10.1186/s13104-018-3918-0

Saadat H, Kain Z. Wellness interventions for anesthesiologists. Curr Opin Anaesthesiol 2018;31:375-81. DOI: https://doi.org/10.1097/ACO.0000000000000598

Putra KR, Andayani T, Ningrum EH. Job satisfaction and caring behavior among nurses in a military hospital: A cross-sectional study. J Public Health Res 2021;10:2212. DOI: https://doi.org/10.4081/jphr.2021.2212

Motley R, Mazzaccaro R, Burmeister D, et al. Using focus groups to identify characteristics of an ideal work environment for advanced practice clinicians. Healthcare 2016;4:151-4. DOI: https://doi.org/10.1016/j.hjdsi.2015.10.007

McNamee R. Regression modelling and other methods to control confounding. Occup Environ Med 2005;62:500-6. DOI: https://doi.org/10.1136/oem.2002.001115

Lee E-H. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci) 2012;6:121-7.