The Question

Job strain, the combination of high demands and low control at work, and effort-reward imbalance, where the effort a job requires is not matched by adequate recognition, pay, or security, are two of the most studied psychosocial stressors in occupational health research. Both have been associated individually with increased risk of coronary heart disease. Lavigne-Robichaud and colleagues (2023) examined what happens when workers are exposed to both simultaneously, tracking outcomes over 18 years.

The Study

The prospective cohort study followed 6,465 white-collar workers in Quebec, Canada from 2000 to 2018, measuring both job strain and effort-reward imbalance at baseline and tracking coronary heart disease events through medico-administrative databases (Lavigne-Robichaud et al., 2023). The 18-year follow-up period and the use of objective health records rather than self-reported outcomes are significant methodological strengths.

What They Found

Among men, exposure to either job strain or effort-reward imbalance alone was associated with a 49 percent increase in coronary heart disease risk. Combined exposure to both stressors was associated with a 103 percent increase: more than double the risk compared to workers exposed to neither (Lavigne-Robichaud et al., 2023). The combination is not merely additive; it appears to be substantially amplifying.

Among women, the findings were inconclusive, with no statistically significant associations observed for any of the stressor conditions (Lavigne-Robichaud et al., 2023). The authors note this warrants further investigation, as the pattern may reflect genuine sex differences in how psychosocial stressors translate into cardiovascular risk, or it may reflect differences in the sample or in how these stressors manifest in women’s working conditions.

Why It Matters

A doubling of coronary heart disease risk is a large effect, and one with direct implications for how organisations should think about job design, workload management, and recognition systems. The finding that the combination of stressors produces effects substantially greater than either alone suggests that addressing only one while leaving the other in place may provide limited protection (Lavigne-Robichaud et al., 2023). Organisations serious about employee health need to consider both the demands they place on workers and the adequacy of what they offer in return.

Reference

Lavigne-Robichaud, M., Trudel, X., Talbot, D., Milot, A., Gilbert-Ouimet, M., Vézina, M., Laurin, D., Dionne, C. E., Pearce, N., Dagenais, G. R., & Brisson, C. (2023). Psychosocial stressors at work and coronary heart disease risk in men and women: 18-year prospective cohort study of combined exposures. Circulation: Cardiovascular Quality and Outcomes. Advance online publication. https://doi.org/10.1161/CIRCOUTCOMES.122.009700