title: Effort-Reward Imbalance and Post-Traumatic Stress After a Workplace Terror Attack.
abstract: OBJECTIVE
  Following adverse work conditions, health consequences can be explained by an imbalance between the effort made and the reward received. We investigated the association between extra effort, perceived reward, and post-traumatic stress disorder (PTSD). The Effort-Reward Imbalance Model was used to examine whether extra effort at work in the aftermath of a workplace-related terrorist attack affected the risk of PTSD and the effects of reward for extra effort from a leader or colleagues.
  
  
  METHODS
  Cross-sectional data were collected 10 months after a terrorist attack in Norway in 2011. Out of 3520 Ministry employees invited, 1927 agreed to participate. Employees reported any extra effort performed as a result of the bomb explosion and any reward received from a leader or colleagues. PTSD was assessed with the PTSD Checklist.
  
  
  RESULTS
  Employees who reported extra effort displayed increased risk for PTSD (odds ratio [OR]=1.71, 95% confidence interval [CI]: 1.15-2.55, P=0.008). Perceived reward for extra effort from a leader was associated with lower risk for PTSD (OR=0.39, 95% CI: 0.23-0.64, P<0.001) but not perceived reward from colleagues.
  
  
  CONCLUSIONS
  Extra effort may increase the risk of PTSD, but reward from a leader may mitigate this effect. The Effort-Reward Imbalance Model appears to be an appropriate approach that may contribute to understanding of the etiology of work-related PTSD.
authors.affiliation: 1Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway.
authors.forename: Camilla
authors.initials: C
authors.lastname: Hem
authors.affiliation: 2National Institute of Occupational Health and Department of Psychosocial Science,University of Bergen,Bergen,Norway.
authors.forename: Morten Birkeland
authors.initials: MB
authors.lastname: Nielsen
authors.affiliation: 1Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway.
authors.forename: Marianne Bang
authors.initials: MB
authors.lastname: Hansen
authors.affiliation: 1Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway.
authors.forename: Trond
authors.initials: T
authors.lastname: Heir
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004651:Employment / Q000523:psychology / Q000592:standards; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009664:Norway; D012201:Reward; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000453:epidemiology / Q000209:etiology*; D013315:Stress, Psychological / Q000150:complications / Q000209:etiology; D011795:Surveys and Questionnaires; D023481:Terrorism / Q000523:psychology* / Q000706:statistics & numerical data; D017132:Workplace / Q000523:psychology*
keywords: Effort-Reward Imbalance (ERI) Model; job-stress; leadership; post-traumatic; social support; stress disorders