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Psychosocial work environment and myocardial infarction: improving risk estimation by combining two complementary job stress models in the SHEEP Study
  1. R Peter1,
  2. J Siegrist2,
  3. J Hallqvist3,
  4. C Reuterwall4,
  5. T Theorell5,
  6. The SHEEP Study Group6
  1. 1Department of Medical Sociology, University of Ulm, Germany
  2. 2Department of Medical Sociology, University of Duesseldorf, Germany
  3. 3Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden
  4. 4Department of Epidemiology/NSVO, Karolinska Hospital, Norrbacka-KS, Sweden
  5. 5National Institute for Psychosocial Factors and Health, Stockholm, Sweden
  6. 6Karolinska Institute: Institute of Environmental Medicine, Department of Public Health Sciences, Units of Social Medicine and Occupational Health, and Department of Medical Epidemiology; National Institute for Working Life, Department of Occupational Health; National Institute for Psychosocial Factors and Health; Stockholm County Council: Departments of Environmental Medicine, Epidemiology, Occupational Health, and Social Medicine; the Departments of Medicine at Danderyd, Huddinge, Löwenströmska, Nacka, Norrtälje, Sabbatsberg, St Görans, Södersjukhuset, and Södertälje Hospital, and the Departments of Cardiovascular Medicine and Clinical Chemistry, Karolinska Hospital (all at hospitals in the County of Stockholm, Sweden).
  1. Correspondence to:
 Dr R Peter, Department of Medical Sociology, University of Ulm, Am Hochstraess 8, D-89081 Ulm, Germany;


Objectives: Associations between two alternative formulations of job stress derived from the effort-reward imbalance and the job strain model and first non-fatal acute myocardial infarction were studied. Whereas the job strain model concentrates on situational (extrinsic) characteristics the effort-reward imbalance model analyses distinct person (intrinsic) characteristics in addition to situational ones. In view of these conceptual differences the hypothesis was tested that combining information from the two models improves the risk estimation of acute myocardial infarction.

Methods: 951 male and female myocardial infarction cases and 1147 referents aged 45–64 years of The Stockholm Heart Epidemiology (SHEEP) case-control study underwent a clinical examination. Information on job stress and health adverse behaviours was derived from standardised questionnaires.

Results: Multivariate analysis showed moderately increased odds ratios for either model. Yet, with respect to the effort-reward imbalance model gender specific effects were found: in men the extrinsic component contributed to risk estimation, whereas this was the case with the intrinsic component in women. Controlling each job stress model for the other in order to test the independent effect of either approach did not show systematically increased odds ratios. An improved estimation of acute myocardial infarction risk resulted from combining information from the two models by defining groups characterised by simultaneous exposure to effort-reward imbalance and job strain (men: odds ratio 2.02 (95% confidence intervals (CI) 1.34 to 3.07); women odds ratio 2.19 (95% CI 1.11 to 4.28)).

Conclusions: Findings show an improved risk estimation of acute myocardial infarction by combining information from the two job stress models under study. Moreover, gender specific effects of the two components of the effort-reward imbalance model were observed.

  • job stress, effort-reward imbalance
  • job strain
  • myocardial infarction

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