Rugulies Reiner, Aust Birgit, Madsen Ida Eh
National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen.
Scand J Work Environ Health. 2017 Jul 1;43(4):294-306. doi: 10.5271/sjweh.3632. Epub 2017 Mar 17.
Objective The aim of this review was to determine whether employees exposed to effort-reward imbalance (ERI) at work have a higher risk of depressive disorders than non-exposed employees. Methods We conducted a systematic review and meta-analysis of published prospective cohort studies examining the association of ERI at baseline with onset of depressive disorders at follow-up. The work was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and a detailed study protocol was registered before literature search commenced (Registration number: CRD42016047581). We obtained a summary estimate for the association of ERI with risk of depressive disorders by pooling the study-specific estimates in a meta-analysis. We further conducted pre-defined sensitivity analyses. Results We identified eight eligible cohort studies, encompassing 84 963 employees and 2897 (3.4%) new cases of depressive disorders. Seven of the eight studies suggested an increased risk of depressive disorders among employees exposed to ERI. The pooled random-effects estimate was 1.49 [95% confidence interval (95% CI) 1.23-1.80, P<0.001], indicating that ERI predicts risk of depressive disorders. The estimate was robust in sensitivity analyses stratified by study quality, type of ERI ascertainment and type depressive disorder ascertainment, respectively. Conclusions Employees exposed to ERI were at increased risk of depressive disorder. Future studies on ERI and depressive disorders should examine if this association is stronger or weaker when ERI is measured repeatedly during follow-up and with other methods than self-report or when depressive disorders are ascertained with clinical diagnostic interviews.
目的 本综述的目的是确定工作中面临付出-回报失衡（ERI）的员工患抑郁症的风险是否高于未暴露的员工。方法 我们对已发表的前瞻性队列研究进行了系统评价和荟萃分析，这些研究考察了基线时的ERI与随访时抑郁症发病之间的关联。该研究按照系统评价和荟萃分析的首选报告项目（PRISMA）声明进行，在开始文献检索前已注册详细的研究方案（注册号：CRD42016047581）。我们通过荟萃分析汇总各研究的具体估计值，得出ERI与抑郁症风险关联的汇总估计值。我们还进一步进行了预定义的敏感性分析。结果 我们确定了8项符合条件的队列研究，涵盖84963名员工和2897例（3.4%）新发抑郁症病例。8项研究中的7项表明，暴露于ERI的员工患抑郁症的风险增加。汇总的随机效应估计值为1.49[95%置信区间（95%CI）1.23 - 1.80，P<0.001]，表明ERI可预测抑郁症风险。在分别按研究质量、ERI确定类型和抑郁症确定类型分层的敏感性分析中，该估计值具有稳健性。结论 暴露于ERI的员工患抑郁症的风险增加。未来关于ERI与抑郁症的研究应考察在随访期间多次测量ERI且采用自我报告以外的其他方法，或通过临床诊断访谈确定抑郁症时，这种关联是更强还是更弱。
