Job insecurity and effort-reward imbalance affect health and well-being

A Danish research project has examined whether work-related psycho-social factors affect an employee’s mental health and well-being. It reveals that factors such as job insecurity and effort-reward imbalance do have a negative effect on the health and wellbeing of employees, affecting how they perceive their health and how they sleep. The effects are more pronounced for those who have also had experience of unemployment and have fewer labour market opportunities.


The National Research Centre for the Working Environment (NFA) recently published the results from a substantial research project entitled ‘Psycho-social work environment, mental health and working capacity (in Danish)’, carried out between 2007 and 2010. The study reveals that work-related psycho-social factors such as job insecurity and effort-reward imbalance negatively affect the health, sleep and mental wellbeing of employees.

The research project is based on a combination of data sources including a representative sample survey of approximately 8,000 Danish employees (NAK), a random sample survey of approximately 7,000 Danish inhabitants carried out by the Department of Public Health at Copenhagen University (I FSV) and different data on sickness absence, medicine and so on.

Effort-reward imbalance affects self-rated health and sleep

According to the research project, an imbalance in effort and reward is associated with a decline in health and increased sleep difficulties, as assessed by the subjects themselves. The study’s definition of reward follows the international ERI model and therefore includes financial and status reward, esteem reward and job security. Effort was measured by the following four items; uneven distribution of work so that it piles up, time to complete all work tasks, overtime work and speed of work.

The study’s main results on the issue of effort-reward imbalance are as follows:

  • Danish employees overall experience a good balance between effort and reward in their job;
  • there is a connection between effort-reward imbalance and poorer self-rated health as well as sleep difficulties;
  • the employees answered that they experienced a high level of effort-reward imbalance in the first study had a higher risk of assessing their health as poor five years later;
  • executives in the public sector, social workers, managing clerks in the public sector and medical secretaries experience the greatest effort-reward imbalance;
  • nursery assistants and childminders experience the best balance between effort and reward;
  • people in higher occupational grades experience a higher effort-reward imbalance than those in lower occupational grade.

The results still apply when they are controlled for age, gender, occupational grade, children, smoking, alcohol consumption, depressive symptoms, leisure time physical activity, cohabitation and socioeconomic status. In regards to sleeping difficulties, the results were also controlled for working hours and sickness absence.

Job insecurity affects health

Examining job insecurity, the research project shows that people who are concerned about losing their job, and who believe it will be hard to find a new job, are more likely to assess their health as poor compared to people who are not facing job insecurity.

The more specific results from the study about job insecurity are as follows:

  • women facing job insecurity have an increased risk of a decline in health, while the study showed no such effect caused by job insecurity among men;
  • the analyses further showed that job insecurity, among both women and men, had a stronger effect on self-rated health when it was combined with poor chances in the labour market;
  • job insecurity has the strongest effect on self-rated health in cases where employees have previously experienced long term unemployment;
  • the connection between job insecurity and the perception of poor health is stronger for employees who are under fifty compared to those over fifty years old.

The incidence of taking antidepressant medication increases if employees have previously experienced long-term unemployment and, at the same time, are experiencing job insecurity in their present job. The results still apply when being controlled for age, occupational grade, children, smoking, Body Mass Index (BMI), cohabitation and socioeconomic status.


The overall results of this study show that concerns about losing one’s job can have severe consequences on the health of employees, particularly where they are linked to poor labour market opportunities and previous experience of unemployment. Furthermore, the experts behind the study point to the fact that a greater balance between effort and reward in Danish workplaces would contribute to a reduction in the number of employees assessing their health as poor.

Stine Milling and Helle Ourø Nielsen, Oxford Research

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