Effort-reward imbalance among students at German universities: associations with self-rated health and mental health

  • Jennifer Hilger-KolbEmail author
  • Katharina Diehl
  • Raphael Herr
  • Adrian Loerbroks
Original Article



Although psychosocial stress has been associated with adverse health parameters, little is known about this topic among the variety of university students. We thus examined associations of psychosocial stress due to academic education with self-rated health, and symptoms of depression and anxiety among students from various study disciplines.


We used data from the Nutrition and Physical Activity (NuPhA) Study, a cross-sectional online survey among students enrolled across German universities (n = 698). Academic stress was assessed by a newly developed and validated student version of the Effort–Reward Imbalance (ERI-Student) Questionnaire. Depressive and anxiety symptoms were measured by applying the Patient Health Questionnaire-4 (PHQ-4) and using validated cut-offs.


Separate multivariate logistic regression analyses run for the different ERI components, the ERI-ratio revealed that high effort, low reward, high over-commitment, and a high ERI-ratio were associated with poor self-rated health, and depressive and anxiety symptoms (odds ratios ≥ 2.43). Separate analyses for medical students and non-medical students largely confirmed these findings for both groups. Associations between all ERI components, the ERI ratio, and both mental health measures were, however, more pronounced among medical students.


We were able to show consistent associations between the ERI-Student Questionnaire and self-rated health and mental health across students from different study disciplines. Further research on associations between academic stress and health parameters is necessary to develop effective strategies that prevent students from adverse health outcomes during their academic education.


Effort-reward imbalance Mental health Psychosocial stress Self-rated health University students 



The authors thank all students that participated in the quantitative part of the NuPhA Study. Further, we are indebted to Prof. Johannes Siegrist and Dr. Natalia Wege, both from the University of Düsseldorf, for granting us permission to use the ERI-Student Questionnaire.

Author contributions

JH-K and AL designed the scope of the manuscript and have final responsibility for the content of the manuscript. KD and JH-K designed the NuPhA Study and collected all data. RH conducted the statistical analysis. RH and KD carefully reviewed the manuscript. All authors read and approved the final version of the manuscript.


The quantitative part of the NuPhA Study was partially funded by the non-profit organisation “Institute Danone Ernährung für Gesundheit e.V., Haar, Germany” (project number: 2014/01). The funding organisation had no influence on designing, analysing, or interpreting the data. In addition, they had no role in writing or in publishing of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no competing interest to report.

Ethical approval

The NuPhA Study received ethical approval by the Ethics Committee of the Medical Faculty Mannheim, Heidelberg University (2013-634-N-MA).

Supplementary material

420_2018_1342_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
  2. 2.Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of MedicineUniversity of DüsseldorfDüsseldorfGermany

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