Open Access Research article

A comparison between the effort-reward imbalance and demand control models

Aleck S Ostry1*, Shona Kelly1, Paul A Demers1, Cameron Mustard2 and Clyde Hertzman1

Author Affiliations

1 Department of Health Care and Epidemiology, University of British Columbia, Canada

2 Institute of Work and Health (Toronto), Canada

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BMC Public Health 2003, 3:10  doi:10.1186/1471-2458-3-10

Published: 27 February 2003



To compare the predictive validity of the demand/control and reward/imbalance models, alone and in combination with each other, for self-reported health status and the self-reported presence of any chronic disease condition.


Self-reports for psychosocial work conditions were obtained in a sample of sawmill workers using the demand/control and effort/reward imbalance models. The relative predictive validity of task-level control was compared with effort/reward imbalance. As well, the predictive validity of a model developed by combining task-level control with effort/reward imbalance was determined. Logistic regression was utilized for all models.


The demand/control and effort/reward imbalance models independently predicted poor self-reported health status. The effort-reward imbalance model predicted the presence of a chronic disease while the demand/control model did not. A model combining effort-reward imbalance and task-level control was a better predictor of self-reported health status and any chronic condition than either model alone. Effort reward imbalance modeled with intrinsic effort had marginally better predictive validity than when modeled with extrinsic effort only.


Future work should explore the combined effects of these two models of psychosocial stress at work on health more thoroughly.