Organisational downsizing and work stress: testing synergistic health effects in employed men and women

Study objective: To systematically study the separate and combined effects of organisational downsizing and work related stress on a measure of health in "survivors of layoffs''. Design: Using Rothman's approach, separate and combined effects of the two exposures in estimating the risk of poor self rated health (work related symptoms) are analysed in a large sample of male and female employees. Setting: 0.1% cross sectional sample of the German working population. Participants: 12 240 men and 10 319 women, aged 16 to 59 years, surveyed in 1998-1999. Main results: Compared with the reference group, the group of participants who were simultaneously exposed to downsizing and work related stress (effort-reward imbalance) exhibited odds ratios (OR) of three or more work related symptoms that were by far higher (OR 4.41 in men and OR 5.37 in women) than those associated with single exposures. Altogether 21% (men) and 31% (women) of the effect size of the combined exposure was attributable to synergistic interaction. Conclusion: Although reduced health associated with organisational downsizing is partly attributable to an increase in work related stress these findings show an additional synergy effect produced by the combined exposure to both conditions.