title: Work stress and quality of life in persons with disabilities from four European countries: the case of spinal cord injury.
abstract: BACKGROUND
  Evidence on the adverse effects of work stress on quality of life (QoL) is largely derived from general populations, while respective information is lacking for people with disabilities. We investigated associations between work stress and QoL and the potentially moderating role of socioeconomic circumstances in employed persons with spinal cord injury (SCI).
  
  
  METHODS
  Cross-sectional data from 386 employed men and women with SCI (≥18 work h/week) from the Netherlands, Switzerland, Denmark, and Norway were analyzed. Work stress was assessed with the 'effort-reward imbalance' (ERI) model and the control component of the 'demand/control' model. QoL was operationalized with five WHOQoL BREF items. Socioeconomic circumstances were measured by years of formal education and perception of financial hardship. We applied ordinal and linear regressions to predict QoL and introduced interaction terms to assess a potential moderation of socioeconomic circumstances.
  
  
  RESULTS
  Multivariate analyses showed consistent associations between increased ERI and decreased overall QoL (coefficient -1.55, p < 0.001), domain-specific life satisfaction (health -1.32, p < 0.001; activities of daily living -1.28, p < 0.001; relationships -0.84, p = 0.004; living conditions -1.05, p < 0.001), and the QoL sum score (-2.40, p < 0.001). Low job control was linked to decreased general QoL (0.13, p = 0.015), satisfaction with relationships (0.15, p = 0.004), and QoL sum score (0.15, p = 0.029). None of the tested interaction terms were significant.
  
  
  CONCLUSIONS
  ERI was consistently related to all indicators of QoL, while associations with job control were less consistent. Our results do not support the notion that unfavorable socioeconomic circumstances moderate the association between work stress and QoL among persons with SCI.
authors.affiliation: Swiss Paraplegic Research, 6207, Nottwil, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Fekete
authors.forename: Morten
authors.initials: M
authors.lastname: Wahrendorf
authors.forename: Jan D
authors.initials: JD
authors.lastname: Reinhardt
authors.forename: Marcel W M
authors.initials: MW
authors.lastname: Post
authors.forename: Johannes
authors.initials: J
authors.lastname: Siegrist
mesh_terms: D000203:Activities of Daily Living; D003430:Cross-Sectional Studies; D003718:Denmark; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007398:Interpersonal Relations; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D010549:Personal Satisfaction; D011788:Quality of Life; D012927:Social Control, Informal; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D013557:Switzerland; D014937:Work / Q000523:psychology*