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The Organizational Work Factors' Effect on Mental Health Among Hospital Workers Is Mediated by Perceived Effort–Reward Imbalance: Result of a Longitudinal Study

Lamy, Sébastien MPH; De Gaudemaris, Régis MD, PhD; Lepage, Benoit MD; Sobaszek, Annie MD, PhD; Caroly, Sandrine PhD; Kelly-Irving, Michelle PhD; Lang, Thierry MD, PhD

Journal of Occupational and Environmental Medicine: July 2013 - Volume 55 - Issue 7 - p 809–816
doi: 10.1097/JOM.0b013e31828acb19
Original Articles

Objectives: This longitudinal study aimed to test the hypothesis that organizational work factors (OWFs) may be related to depressive symptoms through an increased effort–reward imbalance (ERI) ratio among registered nurses (RNs) and nursing assistants working in hospitals.

Methods: We studied 2117 female RNs and nursing assistants who stayed in the same work unit and position during the follow-up from the ORSOSA (ORganisation des SOins–SAnté) longitudinal study. The work characteristics and workers' health were assessed in 2006 and 2008.

Results: We confirmed our hypothesis of both direct and mediated effects of OWFs on workers' health. We showed that issues about patient-related information exchanges increased RNs' depressive disorders by increasing first a perceived ERI.

Conclusions: Our results advocate integrating both the work organizational level and the individual level into preventive actions to improve workers' mental health.

From the French Institute of Health and Medical Research (Mr Lamy and Drs Lepage and Kelly-Irving, and Prof Lang) and Université Toulouse III (Mr Lamy and Drs Lepage and Kelly-Irving, and Prof Lang), Toulouse, France; Laboratoire TIMC-IMAG (Techniques for Biomedical Engineering and Complexity Management - Informatics, Mathematics and Applications - Grenoble) (Prof De Gaudemaris) and Laboratoire PACTE (Politiques Publiques, Action Publique, Territoires) (Dr Caroly), The French National Center for Scientific Research, and Université Joseph Fourier (Prof De Gaudemaris and Dr Caroly), Grenoble, France; and Lille Centre Hospitalier Régional Universitaire (Prof Sobaszek), Clinique de Santé Publique, Médecine du Travail et Pathologies Professionnelles, and Université Lille 2 (Prof Sobaszek), Lille, France.

Address correspondence to: Sébastien Lamy, MPH, INSERM, UMR 1027, Faculté de Médecine, 37 allées Jules Guesde, 31062 Toulouse Cedex, France (

This research was supported by the CNRACL (Caisse Nationale de Retraites des Agents des Collectivités Locales). The CNRACL was not involved in the study design, in the collection, analyses, and interpretation of the data, in the writing of the report, or in the decision to submit this article for publication.

No conflicts of interest were declared.

Copyright © 2013 by the American College of Occupational and Environmental Medicine