A longitudinal study comparing the effort-reward imbalance and demand-control models using objective measures of physician utilization

Background: The objectives of this study were to compare the predictive validity of the demand-control and effort-reward imbalance models using objective measures of physician utilization. Methods: Self-reports for psychosocial work conditions were obtained in interviews with 1,028 workers using the demand-control and effort-reward imbalance models. Physician utilization outcomes were obtained through linkage to the British Columbia Linked Health Database. Outcomes were any visit to a physician for mental health reasons and 30 or more physician visits for any reason. The predictive validity of both models was compared in a longitudinal study using logistic regression. Results: Neither job strain nor effort-reward imbalance predicted either outcome. However, low esteem reward and low status control increased the risk for 30 or more physician visits by, respectively, approximately 60% and 30%. Conclusions: In a sample of middle-aged blue-collar current and ex-sawmill workers in Western Canada, followed prospectively, after controlling for sociodemographic and workplace confounders, and reducing the potential for adverse health selection into high-stress jobs, low esteem reward and low status control were associated with a significantly greater risk for 30 or more physician visits for any reason.