Associations between depressive symptoms and 5-year subsequent work nonparticipation due to long-term sickness absence, unemployment and early retirement in a cohort of 2,413 employees in Germany.

BACKGROUND: We examined the association of depressive symptoms with subsequent events - and duration thereof - of work nonparticipation (long-term sickness absence, unemployment and early retirement). METHODS: We employed a 5-year cohort from the Study on Mental Health at Work (S-MGA), based on a random sample of employees subject to social contributions aged 31-60 years in 2012 (N = 2413). Depressive symptoms were assessed at baseline through questionnaires, while work nonparticipation was recorded in follow-up interviews. Associations of depressive symptoms with subsequent events of work nonparticipation were examined in two-part models, with events analysed by logistic regressions and their duration by generalized linear models. RESULTS: Medium to severe depressive symptoms were associated with events of work nonparticipation (males Odds Ratio [OR] = 3.22; 95% CI = 1.90-5.45; females OR = 1.92; 95% CI = 1.29-2.87), especially with events of long-term sickness absence in both genders and events of unemployment in males. Mild depressive symptoms were also associated with events of work nonparticipation (males OR = 1.59; 95% CI = 1.19-2.11; females OR = 1.42; 95% CI = 1.10-1.84). Among those experiencing one or more events, the duration of total work nonparticipation was twice as high among males [Exp(ß) = 2.06; 95% CI = 1.53-2.78] and about one third higher [Exp(ß) = 1.38; 95% CI = 1.05-1.83] among females with medium to severe depressive symptoms. CONCLUSIONS: The present study focuses on both events and duration of work nonparticipation, which are both critical for examining societal consequences of depressive symptoms. It is key to regard also mild depressive symptoms as a possible risk factor and to include different types of work nonparticipation.

Long-term associations of psychosocial working conditions with depressive symptoms and work-related emotional exhaustion: comparing effects in a 5-year prospective study of 1949 workers in Germany.

OBJECTIVE: To test the hypothesis that psychosocial working conditions are more strongly associated with subsequent work-related emotional exhaustion (core component of burnout) than with depressive symptoms at follow-up. METHODS: A 5-year cohort study (2011/2012-2017), based on a random sample of persons in employment subject to payment of social contributions aged 31-60 years (Study on Mental Health at Work; S-MGA; N = 1949), included self-reported measures of organisational demands (organisational layoffs and restructuring), task-level demands (work pace and amount of work) and job resources (influence at work, possibilities for development, control over working time, role clarity), all taken from the COPSOQ, except the organisational demands that were single-item measures. Work-related emotional exhaustion and depressive symptoms were measured with the Oldenburg Burnout Inventory and the Patient Health Questionnaire-9, respectively. RESULTS: Cochrane Q tests revealed stronger associations between psychosocial working conditions and work-related emotional exhaustion only for the amount of work (p = 0.013) and control over working time (p = 0.027). No differences were observed for the Demands and Resources Indexes, capturing overall exposure to psychosocial working conditions. The same differences were observed in a subsample including only participants who remained at the same employer from baseline to follow-up, although more psychosocial working conditions were associated with work-related emotional exhaustion than with depressive symptoms. Supplementary analyses employing dichotomous measures of work-related emotional exhaustion and depressive symptoms confirmed these results. CONCLUSIONS: Overall, the findings provide limited evidence supporting the hypothesis that psychosocial working conditions are more strongly associated with work-related emotional exhaustion than with depressive symptoms.

Physical and psychosocial working conditions as predictors of 5-year changes in work ability among 2078 employees in Germany.

OBJECTIVE: To examine 5-year prospective associations between working conditions and work ability among employees in Germany. METHODS: A cohort study (2011/2012-2017), based on a random sample of employees in employments subject to payment of social contributions aged 31-60 years (Study on Mental Health at Work; S-MGA; N = 2,078), included data on physical and quantitative demands, control (influence, possibilities for development, control over working time), relations (role clarity and leadership quality) and work ability (Work Ability Index, WAI; subscale 'subjective work ability and resources'). Data were analysed using linear regression. RESULTS: Physical demands and control were associated with small 5-year changes in work ability (ΔR2 = 1%). Among the subgroup of employees with ≥ 25 sickness days, possibilities for development, control and quality of leadership were associated with changes in work ability (ΔR2 = 8%). CONCLUSIONS: The impact of working conditions on long term changes in work ability seems to be negligible. However, in vulnerable subpopulations experiencing poor health, working conditions may be associated to a larger extent to work ability over this time span.

Working conditions as risk factors for early exit from work-in a cohort of 2351 employees in Germany.

OBJECTIVES: We would assess the possible impact of a range of physical and psychosocial working conditions on early exit from paid employment (i.e., before retirement age) in a representative employee population in Germany. METHODS: We analysed a cohort from the German Study on Mental Health at Work (S-MGA) with a baseline of 2351 employees in 2011/12, sampled randomly from the register of integrated employment biographies (IEB) at the Institute for Employment Research (IAB). Follow-up ended mid-2015. Early Exit comprised episodes of either pensioning, long-term sickness absence or unemployment ≥ 18 months. Total follow-up years were 8.422. Working conditions were partly assessed by the Copenhagen Psychosocial Questionnaire (COPSOQ). Through Cox regressions, associations of baseline working conditions with time to event of exit were estimated-adjusting for baseline age, gender, poverty, fixed-term contract and socioeconomic position. RESULTS: In multiple regressions, awkward body postures (HR = 1.24; 95% CI = 1.07-1.44), heavy lifting (1.17; 1.00-1.37) and high work pace (1.41; 1.16-1.72) were associated with exit. The estimated attributable fraction of exit for being exposed to less than optimal work environment was 25%. Regarding specific exit routes, repetitive movements (1.25; 1.03-1.53) increased the risk for the long-term sickness absence; work pace (1.86; 1.22-2.86) and role clarity (0.55; 0.31-1.00) were associated to unemployment; and control over working time (0.72; 0.56-0.95) decreased the risk of the early retirement. CONCLUSIONS: Work environment seems to be important for subsequent early exit from work. Physical and psychosocial demands seem to be associated to exit to a stronger extent than resources at work.

Workplace bullying and depressive symptoms among employees in Germany: prospective associations regarding severity and the role of the perpetrator.

OBJECTIVES: The aim of this study was to investigate the effect of self-reported workplace bullying on depressive symptoms in a prospective study among a representative sample of employees from Germany. We focused specifically on the role of the perpetrator (co-workers and superiors), which was never done before in a longitudinal design. METHODS: We used data from a nation-wide representative panel study with a 5-year follow-up (N = 2172). Data on bullying exposure were obtained separately for different perpetrators (co-workers and superiors) and degree of severity (severe bullying, i.e., at least weekly). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ). We used logistic regression analyses to examine the effect of workplace bullying at baseline on depressive symptoms at follow-up. RESULTS: After adjusting for baseline depressive symptoms, severe bullying by co-workers significantly increased the 5-year risk of depressive symptoms (OR = 2.50). Severe bullying by superiors had a nonsignificant effect. CONCLUSIONS: Workplace bullying is a risk factor for depressive symptoms among employees in Germany. The type of perpetrator seems to be an important factor to consider, as indicated by the elevated risk of depressive symptoms when bullying is perpetrated by co-workers.

Workplace bullying among employees in Germany: prevalence estimates and the role of the perpetrator.

OBJECTIVES: The aim of this study was to examine the prevalence of workplace bullying in Germany while also taking the perpetrator and severity level (measured by frequency) into account and considering the role of gender, age and socio-economic status. METHODS: We used data from a large representative sample (N = 4143) of employees in Germany subject to social security contributions. Self-reported bullying was assessed for different combinations of perpetrators (co-workers, superiors) and according to severity, i.e., being exposed at all and to severe bullying (at least weekly). RESULTS: Prevalence estimates varied from 2.9% for severe bullying by co-workers to 17.1% for overall bullying (i.e., without distinguishing by perpetrator, less severe bullying also included). Unskilled workers reported more bullying by both perpetrators than academics/managers. We also observed an age trend for severe bullying by superiors (i.e., bossing), with younger employees being more affected from bossing than elder. No gender differences were detected. CONCLUSIONS: The findings indicate that it is crucial to consider type of perpetrator and severity of the behaviors when examining the prevalence of workplace bullying. The way bullying is defined and operationalized strongly contributes to the prevalence estimates. Differences between subgroups and associations or cause-effect relationships should be analyzed with these variations in mind.

Factorial Validity of the Work Ability Index Among Employees in Germany.

Purpose The Work Ability Index (WAI) is a routinely applied instrument for the assessment of work ability. It is a single score index, based on the implicit assumption of a single factor underlying the construct of work ability. The few studies with a focus on the WAI's factor structure are mainly based on non-representative samples. The objective of this study was to examine the factor structure of the WAI within a representative sample of employees working in Germany, applying analysis procedures that consider the metric of the variables. Methods Analyses are based on a nationwide representative sample of employees aged 31-60 years from the "Study on Mental Health at Work" (German: S-MGA). Responses from n = 3968 participants were used in confirmatory factor analyses comparing competing models of the structure underlying the WAI. Results The results of the analyses suggest that the intercorrelations between the indicators of the WAI are explained better by a model with two correlated factors than by a simple one-factor structure. A model solely allowing a single loading for each indicator fits the data well and allows for an easy interpretation of the two underlying factors. Conclusions There are two correlated factors underlying the WAI: one refers to "subjective work ability and resources", the other one can be considered a "health related factor".

[Working Conditions and Mental Health Among Salaried Physicians: A Nationwide Comparison With a Representative Sample of Employees]. / Arbeitsbedingungen und psychische Gesundheit bei sozialversicherungspflichtig beschäftigten Ärzten: Ein bundesweiter Vergleich mit einer repräsentativen Beschäftigtenstichprobe.

AIM: Do the amount of workload, strain and the association between both differ between employed physician and other employees subject to social security contributions? This is investigated in this present study by comparing two representative samples. METHODS: Psycho-social working conditions were by assessed computer-assisted personal interviews and supplemented by questions about burnout and depressive symptoms. The associations were investigated by linear regression analysis including moderating effects due to differences between occupations. RESULTS: The score for depressive symptoms was lower among male and female physicians than in the comparison groups. Moreover, male physician had higher scores for burnout. Quantitative demands and job insecurity were associated with an increase of scores for burnout and depressive symptoms. Higher quality of leadership, role clarity, and decision latitude contributed to a decrease of both scores. Additional effects were found for hours worked per week (females) and number of night shifts (males). The moderating effect of occupational group was detected for quantitative demands and decision latitude. CONCLUSION: The associations of working conditions with mental health indicators are similar in the compared groups. There is a higher workload and higher level of burnout among physicians but there is no indication for more depressive symptoms.

Design and Baseline Characteristics of the HELP Study: An Extended and Long-Term Observation of Pathological Myopia in Caucasians.

PURPOSE: To assess the natural disease progression of high myopia in Caucasians considered at risk for the development of myopic choroidal neovascularization (mCNV). METHODS: Subjects were recruited in 25 clinical sites between June 2014 and June 2016. Main inclusion criteria included axial length of ≥26 mm, best-corrected visual acuity ≥0.05 decimal equivalent and presence of at least one out of five predefined morphological disease risk criteria. These were (1) subfoveal choroidal thinning < 50 µm, (2) enhanced choroidal curvature length > 6,300 µm, (3) lacquer cracks, (4) patchy atrophy > 5 mm2 and (5) preexisting mCNV in the fellow eye (German Clinical Trial Register DRKS00007761). RESULTS: A total of 150 participants (66% females) with a mean age of 57.2 (±12.7) years (range 21.9-86.2 years) were included. The disease criteria most frequently encountered were choroidal thinning (33.3%) and lacquer cracks (32.7%). Enhanced choroidal curvature length was detected in only 8 subjects and always occurred in combination with other disease criteria. Presence of patchy atrophy was found to be more common in older subjects (p = 0.0012) and also associated with a more severe disease manifestation. CONCLUSION: The baseline data of this study indicate that enhanced choroidal curvature might be less common in Caucasians than in Asian populations. Further, disease severity in patients with high myopia is relatively high in the presence of patchy atrophy.

The Study on Mental Health at Work: Design and sampling.

AIMS: The Study on Mental Health at Work (S-MGA) generates the first nationwide representative survey enabling the exploration of the relationship between working conditions, mental health and functioning. This paper describes the study design, sampling procedures and data collection, and presents a summary of the sample characteristics. METHODS: S-MGA is a representative study of German employees aged 31-60 years subject to social security contributions. The sample was drawn from the employment register based on a two-stage cluster sampling procedure. Firstly, 206 municipalities were randomly selected from a pool of 12,227 municipalities in Germany. Secondly, 13,590 addresses were drawn from the selected municipalities for the purpose of conducting 4500 face-to-face interviews. The questionnaire covers psychosocial working and employment conditions, measures of mental health, work ability and functioning. Data from personal interviews were combined with employment histories from register data. Descriptive statistics of socio-demographic characteristics and logistic regressions analyses were used for comparing population, gross sample and respondents. RESULTS: In total, 4511 face-to-face interviews were conducted. A test for sampling bias revealed that individuals in older cohorts participated more often, while individuals with an unknown educational level, residing in major cities or with a non-German ethnic background were slightly underrepresented. CONCLUSIONS: There is no indication of major deviations in characteristics between the basic population and the sample of respondents. Hence, S-MGA provides representative data for research on work and health, designed as a cohort study with plans to rerun the survey 5 years after the first assessment.

Employment status, working conditions and depressive symptoms among German employees born in 1959 and 1965.

PURPOSE: We investigated whether (1) current employment status (regular full-time, regular part-time and marginal employment) is associated with depressive symptoms and (2) whether these associations are mediated by current working conditions and previous employment history. METHODS: Two cohorts of German employees aged 46 and 52 years were selected from administrative data of the German Federal Employment Agency and answered questions about depressive symptoms (we use an applied version of BDI-V) and their current working conditions. In addition, the participants gave written consent to link register data regarding their employment histories (n = 4,207). Multiple linear regression analyses were conducted. RESULTS: Men experienced elevated depressive symptoms when working regular part-time; women experienced such symptoms when engaged in marginal employment. These associations decreased when we adjusted for job insecurity and rose slightly when we adjusted for leadership quality. Men and women who reported a low level of influence at work showed a higher risk of depressive symptoms. For women, the association between current employment position and depressive symptoms could be partly explained by low levels of influence at work. For men, the association between depressive symptoms and current regular part-time employment decreased when we adjusted for previous part-time employment. Conversely, for women, the association with depressive symptoms increased in current regular part-time and marginal employment when we adjusted for employment history. CONCLUSIONS: In both genders, the observed associations between depressive symptoms and current employment status were mediated by both current psychosocial conditions and employment history. Employees not having a regular full-time job differed from full-time employees with respect to both their current working conditions and their employment history.

A manual-based group program to improve mental health: what kind of teachers are interested and who stands to benefit from this program?

PURPOSE: In order to evaluate a manual-based group program for teachers aiming at strengthening mental health, we examined (1) whether the teachers interested in participating differ from their colleagues without interest and (2) whether there is evidence of subgroups benefiting more than others among those who participated. METHODS: Out of a basic sample of 949 schoolteachers, 337 teachers declared interest in a group program. All teachers were surveyed with the "General Health Questionnaire", the "Maslach Burnout Inventory" and the "Effort Reward Imbalance Questionnaire". In addition, participating teachers were screened with the "Symptom Checklist 27" T and χ(2)-tests were calculated to detect differences between those interested in the program and the remaining 612 teachers. Six factors were established and used for a regression analysis that identified specific parameters more or less correlating with health benefits of those who participated in the program. RESULTS: Findings showed that those declaring interest in the intervention displayed a higher degree of occupational stress according to all health parameters examined. Teachers interested in the program were significantly younger, more frequently female and single. The regression analysis showed that the baseline scores of the six health parameters were the strongest predictors for improvement. Worse scores before the beginning of the intervention correlated with a more positive effect. CONCLUSIONS: Intervention programs aiming at alleviating the mental stress of teachers find the interest of those who need it most. More importantly, the latter are the ones who--at least if our program is applied-benefit best.

Work Ability and Work Nonparticipation: A Prospective Study of 2426 Participants in Germany.

OBJECTIVE: The aim of the study is to examine the association between work ability and work nonparticipation, including long-term sickness absence (LTSA), unemployment (UE), and disability pension/early retirement (ER). METHODS: We conducted a questionnaire-based 5-year follow-up study on a representative sample of the German working population (n = 2426). We used a two-part model to examine the association of continuous Work Ability Index (WAI) scores with the probability of events of work nonparticipation and the duration thereof. RESULTS: Higher WAI scores were protective against total work nonparticipation (an index combining the three indicators), LTSA, ER and UE, the latter among males only. Higher WAI scores were protective also against duration of total work nonparticipation and LTSA, but not against duration of UE and ER among males and duration of UE among females. CONCLUSIONS: Higher WAI scores have a protective role against work nonparticipation.

Burnout and effort-reward imbalance improvement for teachers by a manual-based group program.

OBJECTIVE: We developed a manual-based psychological group program aimed at teachers and focussing on their professional relationships. The intervention comprised ten sessions over a 10-month period. The aim of the program was to strengthen teachers' health. We investigated whether the effects of our intervention, during which the MBI and ERI were applied, result in general alleviation of occupational stress experienced by teachers. METHODS: This is a randomized controlled trial. All teachers (N = 2,484) of two school types (grammar schools and secondary modern schools) in 3 districts of southwestern Germany were invited to take part in our program. All teachers declaring their interest (N = 337) in the intervention were included in the project. They were randomly assigned to either the intervention group (N = 171) or to the control group (N = 166). RESULTS: We found that teachers who participated in at least 50% of the program benefited from this short intervention. Significant improvement was achieved on the two MBI scales, Emotional Exhaustion and Personal Accomplishment, as well as on the ERI subscale Appreciation. CONCLUSION: Teachers' occupational stress level may be decreased by taking part in a short manual-based psychological group intervention that focuses on more effective handling of interpersonal problems in school. Therefore, teachers should receive support and guidance in developing the appropriate skills necessary to cope with stress appropriately.

Mental health and patterns of work-related coping behaviour in a German sample of student teachers: a cross-sectional study.

PURPOSE: The aim of this cross-sectional study was to evaluate the mental health of student teachers, to analyse the extent to which they feel prepared for their profession by the university curriculum and to investigate patterns of coping with occupational stress. METHODS: A sample of 481 German student teachers was investigated using two standardised instruments: GHQ-12 (General Health Questionnaire) and AVEM (Arbeitsbezogenes Verhaltens- und Erlebensmuster), an occupational stress and coping questionnaire describing four patterns of work-related coping behaviour. In addition, we asked how well the student teachers felt that the curriculum prepared them for their profession. RESULTS: Forty-four per cent of the student teachers report impaired mental health in the second teacher training period, indicated by a GHQ value equal to or over the cut-off of four. The AVEM responses revealed more than 40% showing risk patterns (A or B) compared to only 26.3% displaying a healthy coping style (G), while 32.8% demonstrate an unambitious style (S). These GHQ values are inversely correlated with the extent to which student teachers feel prepared for their work by the university curriculum. CONCLUSIONS: Our data indicate a problematic stress level for student teachers in the second training phase (high exposure to health risks and unfavourable coping styles). Since teaching is clearly an extremely demanding job, it is vital that teacher training systems contribute towards protecting the health of teachers by focusing on fostering healthy personal attitudes and equipping young teachers with coping styles and skills that will better prepare them for the challenges facing them in their daily work. Self-care health management should also be part of the teacher training curriculum.

Workplace Bullying and Long-Term Sickness Absence-A Five-Year Follow-Up Study of 2476 Employees Aged 31 to 60 Years in Germany.

OBJECTIVES: The aim was to investigate workplace bullying as a risk factor for five-year occurrence of long-term sickness absence (LTSA) in a representative cohort of employees in Germany. METHODS: In the German Study on Mental Health at Work (S-MGA) (n = 2476), episodes of long-term sickness absence (LTSA) between baseline and follow-up were assessed in the follow-up interview. Workplace bullying was measured in the baseline interview using a hybrid approach, which combines the behavioural experience and self-labelling methods. Through binomial regressions, the association of baseline level of workplace bullying with first-episode LTSA during follow-up was estimated, adjusting for baseline age, gender, occupational level, smoking status and physical demands at work. RESULTS: Severe bullying heightened the risk for LTSA by approximately 50% (Rate ratio-RR: 1.48, 95% Confidence interval-CI: 1.05; 2.19), while occasional bullying heightened the risk by 15% (RR: 1.15, CI: 0.85; 1.55). When excluding LTSA events occurring in the first 2 years, the associations between bullying and LTSA increased by approximately one third. CONCLUSIONS: Workplace bullying seems to be a risk factor for LTSA even when controlling for occupational level, smoking and physical demands at work and when taking possible reverse causality into account. We suggest to investigate effects of LTSA in more settings, to distinguish between occasional and severe bullying and employ longer follow-up intervals.

Precarious Work as Risk Factor for 5-Year Increase in Depressive Symptoms.

OBJECTIVES: The aim was to investigate the longitudinal relationship between precarious work and depressive symptoms in a representative cohort of employees in Germany. METHODS: In the German Study on Mental Health at Work (S-MGA) (n = 2009), depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9). Precarious work was measured through baseline (2012) self-reported job insecurity, marginal part-time, fixed-term contract, hourly wage and-during follow-ups 2012-2017-unemployment. Among employees without depressive symptoms at baseline (2012), we ran logistic regression analyses stratified by gender with depressive symptoms at follow-up in 2017 as the dependent variable, adjusting for baseline (2012) age, gender, socioeconomic position and partner status. RESULTS: Among men, job insecurity (OR: 2.47; 95% 95% CI: 1.37-4.48) and low wage (3.79; 1.64-8.72) at baseline were significantly associated with depressive symptoms at follow-up. Among women, indicators of precarious work were not associated with depressive symptoms at follow-up. Among men, a cumulative exposure index of precarious work was significantly associated with the development of depressive symptoms (one indicator: 1.84; 0.94-3.60, ≥two indicators: 7.65; 3.30-17.73). This index was not associated with depressive symptoms among women. The population attributable fraction of precarious work due to depressive symptoms among men was approximately 30%. CONCLUSIONS: Among employees in Germany, precarious work seems to be a risk factor for the subsequent development of depressive symptoms among men, but not among women. Research on precarious employment in different countries is needed.

Antecedents of Workplace Bullying among Employees in Germany: Five-Year Lagged Effects of Job Demands and Job Resources.

OBJECTIVES: The aim of the present study was to examine the long-term association of job demands and job resources with self-reported exposure to workplace bullying in a representative sample of employees in Germany. METHODS: We analysed a nation-wide representative cohort of employees working in the same workplace with a 5-year follow-up (S-MGA; N = 1637). The study contained self-reported measures of psychosocial working conditions, including work pace, amount of work, influence at work, role clarity and quality of leadership, and workplace bullying, and of organisational factors, including organisational restructuring and layoffs. RESULTS: After controlling for bullying and occupational level at baseline, higher baseline levels of organisational restructuring (OR 1.73; 95% CI 1.10-2.70), work pace (1.30; 95% CI 1.01-1.66), and amount of work (1.55; 95% CI 1.21-1.99), and lower baseline levels of influence at work (0.70; 95% CI 0.55-0.90) and quality of leadership (0.64; 95% CI 0.50-0.82), were associated with an elevated risk of workplace bullying at follow-up. In all, 90% of cases of self-reported workplace bullying could be attributed to these factors. CONCLUSIONS: The study suggests that employees reporting higher demands and lower resources, as well as organisational factors such as restructuring, are at a higher long-term risk of being targets of workplace bullying. Interventions aimed at preventing workplace bullying could benefit from a focus on psychosocial working conditions and organisational factors.

The Demand-Control Model as a Predictor of Depressive Symptoms-Interaction and Differential Subscale Effects: Prospective Analyses of 2212 German Employees.

Testing assumptions of the widely used demand-control (DC) model in occupational psychosocial epidemiology, we investigated (a) interaction, i.e., whether the combined effect of low job control and high psychological demands on depressive symptoms was stronger than the sum of their single effects (i.e., superadditivity) and (b) whether subscales of psychological demands and job control had similar associations with depressive symptoms. Logistic longitudinal regression analyses of the 5-year cohort of the German Study of Mental Health at Work (S-MGA) 2011/12-2017 of 2212 employees were conducted. The observed combined effect of low job control and high psychological demands on depressive symptoms did not indicate interaction (RERI = -0.26, 95% CI = -0.91; 0.40). When dichotomizing subscales at the median, differential effects of subscales were not found. When dividing subscales into categories based on value ranges, differential effects for job control subscales (namely, decision authority and skill discretion) were found (p = 0.04). This study does not support all assumptions of the DC model: (1) it corroborates previous studies not finding an interaction of psychological demands and job control; and (2) signs of differential subscale effects were found regarding job control. Too few prospective studies have been carried out regarding differential subscale effects.