Effort–reward imbalance in police work: associations with the cortisol awakening response

  • John M. Violanti
  • Desta Fekedulegn
  • Ja Kook Gu
  • Penelope Allison
  • Anna Mnatsakanova
  • Cathy Tinney-Zara
  • Michael E. Andrew
Original Article



We hypothesized that effort–reward imbalance (ERI) is associated with an atypical cortisol response. ERI has been associated with higher job stress. Stress triggers cortisol secretion via the hypothalamic–pituitary–adrenal (HPA) axis, and significant deviation from a typical cortisol pattern can indicate HPA axis dysfunction.


176 police officers participated from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. ERI was the exposure variable. Outcome variables were saliva-based peak and mean cortisol values, total area under the curve ground (AUCG) and baseline (AUCI); linear regression line fitted to log-transformed cortisol. Regression analyses were used to examine linear trend between ERI and cortisol parameters. Repeated measures analysis examined whether the pattern of cortisol over time differed between low ERI (< median) and high ERI (≥ median).


Mean age was 46 years (SD = 6.6). After adjustment for potential confounders, there was a significant inverse association between ERI and peak cortisol (β = − 0.20, p = 0.009), average cortisol (β = − 0.23, p = 0.003), and total area under the curve (β = − 0.21, p = 0.009). ERI was not significantly associated with AUCI (β = − 0.11, p = 0.214); slope of the regression line fitted to the cortisol profile (β = − 0.009, p = 0.908). Repeated measures analyses showed that the cortisol pattern did not vary significantly between high and low ERI using the median as a cut point (interaction p value = 0.790).


ERI was inversely associated with the magnitude of awakening cortisol over time, indicating HPA axis dysregulation and potential future health outcomes.


Police Stress Effort reward imbalance Awakening cortisol HPA axis dysregulation 



This study was funded by the National Institute for Occupational Safety and Health, Contract #200-2003-01580. The funders had no involvement in the design, data collection, analysis, interpretation, or writing the manuscript or decision to publish.

Compliance with ethical standards

Conflict of interest

This research was conducted at The State University of New York at Buffalo, Buffalo, NY, USA, and was funded by the National Institute for Occupational Safety and Health (NIOSH), Contract no. 200-2003-01580. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the University at Buffalo, State University of New York Internal Review Board, and duly approved by the review board.

Informed consent

Informed consent was obtained from all participants included in the study.


  1. Allisey A, Rodwell J, Noblet A (2016) An application of an extended effort–reward imbalance model to police absenteeism behavior. Pers Rev 45:663–668CrossRefGoogle Scholar
  2. Basińska B, Wiciak I (2013) Evaluation of professional demands and financial reward through the perception of police managers. Intern Secur 5:171–184Google Scholar
  3. Bellingrath S, Weigl T, Kudielka B (2008) Cortisol dysregulation in school teachers in relation to burnout, vital exhaustion, and effort–reward imbalance. Biol Psychol 78:104–113. CrossRefGoogle Scholar
  4. Berg A, Hem E, Lau B, Ekeberg O (2006) An exploration of job stress and health in the Norwegian police service: a cross sectional study. J Occup Med Toxicol 26:1–9. CrossRefGoogle Scholar
  5. Burke R (2017) Stress in policing: an overview. In: Burke RJ (ed) Stress in policing: sources, consequences, and interventions. Routledge, London, pp 3–28Google Scholar
  6. Carter RT, Forsyth J (2010) Reactions to racial discrimination: emotional stress and help-seeking behaviors. Psychol Trauma 2(3):183–191CrossRefGoogle Scholar
  7. Charles L, Violanti J, Gu J, Fekedulegn D, Andrew M, Burchfiel C (2011) Sleep duration and biomarkers of metabolic function among police officers. J Occup Environ Med 53:831–837CrossRefGoogle Scholar
  8. Chida Y, Steptoe A (2009) Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol 80:265–278CrossRefGoogle Scholar
  9. Community Oriented Police Services (COPS) Newsletter (2013) That’s not fair! Policing and perceptions of fairness, vol 6, pp 5–6Google Scholar
  10. de Jonge J, Bosma H, Peter R, Siegrist J (2000) Job strain, effort–reward imbalance and employee well-being: a large-scale cross-sectional study. Soc Sci Med 50:1317–1327. CrossRefGoogle Scholar
  11. Dragano N, Siegrist J, Nyberg ST et al (2017) Effort–reward imbalance at work and incident coronary heart disease: a multicohort study of 90,164 individuals. Epidemiology 28(4):619–626CrossRefGoogle Scholar
  12. Eddy P, Wertheim EH, Hale MW, Wright BJ (2018) A systematic review and meta-analysis of the effort–reward imbalance model of workplace stress and hypothalamic-pituitary-adrenal axis measures of stress. Psychosom Med 80(1):103–113Google Scholar
  13. Eller NH, Netterstrom B, Allerup P (2005) Progression in intima media thickness—the significance of hormonal biomarkers of chronic stress. Psychoneuroendocrinology 30:715–723CrossRefGoogle Scholar
  14. Eller NH, Kritiansen J, Hansen AM (2011) Long-term effects of psychosocial factors of home and work on biomarkers of stress. Int J Psychophysiol 79:195–202CrossRefGoogle Scholar
  15. Eller NH, Nielsen SF, Blond M, Nielsen ML, Hamsen AM, Nettterstrom B (2012) Effort reward imbalance, and salivary cortisol in the morning. Biol Psychol 89:342–348CrossRefGoogle Scholar
  16. Feuer E, Rosenman K (1986) Mortality in police and firefighters in New Jersey. Am J Ind Med 9:517–27CrossRefGoogle Scholar
  17. Forastiere F, Perucci CA, Miceli M, Rapiti E, Bargagli A, Borgia P (1994) Mortality among urban policemen in Rome. Am J Ind Med 26:785–98CrossRefGoogle Scholar
  18. Franke W,D, Anderson DF (1994) Relationship between physical activity and risk factors for cardiovascular disease among law enforcement officers. J Occup Med 36:1127–1132CrossRefGoogle Scholar
  19. Fries E, Dettenborn L, Kirschbaum C (2009) The cortisol awakening response (CAR): facts and future directions. Int J Psychophysiol 72:67–73CrossRefGoogle Scholar
  20. Garbarino S, Cuomo G, Chiorri C, Magnavita N (2013) Association of work-related stress with mental health problems in a special police force unit. BMJ Open 3:e002791. CrossRefGoogle Scholar
  21. Gidron Y, Ronson A (2008) Psychosocial factors, biological mediators, and cancer prognosis: a new look at an old story. Curr Opin Oncol 20:386–392CrossRefGoogle Scholar
  22. Godin I, Kittel F, Coppieters Y, Seigrist J (2005) A prospective study of cumulative job stress in relation to mental health. BMC Public Health 5:67–77CrossRefGoogle Scholar
  23. Hanson EKS, Maaas CJM, Meijman TF, Godaert GLR (2000) Cortisol secretion throughout the day, perceptions of the work environment, and negative affect. Ann Behav Med 22:316–324CrossRefGoogle Scholar
  24. Harris A, Ursin H, Murison R, Eriksen HR (2007) Coffee, stress and cortisol in nursing staff. Psychoneuroendocrinology 32:322–330CrossRefGoogle Scholar
  25. Hellhammer DH, Wust S, Kudielka BM (2009) Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology 34:163–171CrossRefGoogle Scholar
  26. Huber T,J, Issa K, Schik G, Wolf OT (2006) The cortisol awakening response is blunted in psychotherapy inpatients suffering from depression. Psychoneuroendocrinology 31:900–904CrossRefGoogle Scholar
  27. Izawa S, Tsutsumi A, Ogawa N (2016) Effort–reward imbalance, cortisol secretion, and inflammatory activity in police officers with 24‑h work shifts. Int Arch Occup Environ Health 89:1147–1154. CrossRefGoogle Scholar
  28. Janzen B, Muhajarine N, Zhu T (2007) Effort–reward imbalance, over-commitment, and psychological distress in Canadian police officers. Psychol Rep 100:525–530CrossRefGoogle Scholar
  29. Karlson B, Lindfors P, Riva R, Mellner C, Theorell T (2012) Psychosocial work stressors and salivary cortisol. In: Kristenson M, Garvin P, Lundberg U (eds) The role of saliva cortisol measurement in health and disease. Bentham Science Publishers, Bussum, pp 43–66Google Scholar
  30. Kikuchi Y, Nakaya M, Ikeda M, Narita K, Takeda M, Nishi M (2010) Effort–reward imbalance and depressive state in nurses. Occup Med 60:231–233CrossRefGoogle Scholar
  31. Kivimaki M, Vahtera J, Elovainio M, Virtanen M, Siegrist J (2007) Effort–reward imbalance, procedural injustice and relational injustice as psychosocial predictors of health: complementary or redundant models? Occup Environ Med 64:659–665. CrossRefGoogle Scholar
  32. Kuper H, Sigh-Manoux A, Marmot M (2002) When reciprocity fails: effort–reward imbalance in relation to coronary heart disease and health functioning within the Whitehall II study. Occup Environ Med 59:777–784CrossRefGoogle Scholar
  33. Lee J (2000) The salience of race in everyday life: black customers’shopping experiences in black and white neighborhoods. Work Occup 27:353–376CrossRefGoogle Scholar
  34. Lehr D, Hillbert A, Keller S (2009) What can balance the effort? Associations between effort–reward imbalance, over-commitment and affective disorders in German teachers. Int J Occup Environ Health 15:374–384CrossRefGoogle Scholar
  35. Maina G, Palmas A, Bovenzi M, Filon FL (2009) Salivary cortisol and psychosocial hazards at work. Am J Ind Med 52:251–260CrossRefGoogle Scholar
  36. Marchand A, Juster R,P, Durand P, Lupien S,J (2016) Work stress models and diurnal cortisol variations: the SALVEO study. J Occup Health Psychol 21:182–193. CrossRefGoogle Scholar
  37. McEwen (2008) Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol 583:174–185. CrossRefGoogle Scholar
  38. McEwen BS, Wingfield JC (2003) The concept of allostasis in biology and biomedicine. Horm Behav 43:2–15CrossRefGoogle Scholar
  39. Motzer SA, Hertig V (2004) Stress, stress response, and health. Nurs Clin North Am 39:1–17CrossRefGoogle Scholar
  40. Neylan TC, Brunet A, Pole N, Best SR, Metzler TJ, Yehuda R, Marmar CR (2005) PTSD symptoms predict waking salivary cortisol levels in police officers. Psychoneuroendocrinology 30:373–381CrossRefGoogle Scholar
  41. Ota A, Mase J, Howteerakul N, Rajatanun T, Suwannapong N, Yatsuya H (2014) The effort–reward imbalance work-stress model and daytime salivary cortisol and dehydroepiandrosterone (DHEA) among Japanese women. Sci Rep 4:6402. CrossRefGoogle Scholar
  42. Prati G, Pietrantoni L (2010) Risk and resilience factors among Italian municipal police officers exposed to critical incidents. J Police Crim Psychol 25:27–33. CrossRefGoogle Scholar
  43. President’s Task Force on 21st Century Policing (2015) Final report of the President’s Task Force on 21st Century Policing. Office of Community Oriented Policing Services, Washington, DCGoogle Scholar
  44. Sallis JF, Haskell WL, Wood PD, Fortmann SP, Rogers T, Blair SN, Paffenbarger RS Jr (1985) Physical activity assessment methodology in the Five-City Project. Am J Epidemiol 121:91–106CrossRefGoogle Scholar
  45. Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1:27–41CrossRefGoogle Scholar
  46. Siegrist J (1998) Adverse health effects of effort–reward imbalance at work:theory, empirical support, and implications for prevention. In: Cooper CL (ed) Theories of organizational stress. Oxford University Press, Oxford, pp 190–204Google Scholar
  47. Siegrist J (2002) Effort–reward imbalance at work and health. In: Perrewe´ PL, Ganster DC (eds) Historical and current perspectives on stress and health. JAI Elsevier, Amsterdam, pp 261–291CrossRefGoogle Scholar
  48. Spielberger C, Westberry L, Grier K, Greenfield G (1981) The police stress survey: sources of stress in law enforcement, Human Resources Institute Monograph Series Three, No. 6. University of South Florida, College of Social and Behavioral Sciences, Tampa, FLGoogle Scholar
  49. Stalder T, Kirshbuam C, Kudielka BM, Adam EK, Pruessner JC, Wust C, Evans P et al (2015). Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology. CrossRefGoogle Scholar
  50. Steptoe A, Siegrist J, Kisrchbaum C, Marmot M (2004) Effort-reward imbalance, overcommitment, and measures of cortisol and blood pressure over the working day. Psychosom Med 66:323–329. CrossRefGoogle Scholar
  51. Van Vegchel N, de Jonge J, Bosma H, Schaufeli W (2005) Reviewing the effort–reward imbalance model: drawing up the balance of 45 empirical studies. Soc Sci Med 60:1117–1131CrossRefGoogle Scholar
  52. Vena JE, Violanti JM, Marshall J, Fiedler RC (1986) Mortality of a municipal worker cohort: III. Police officers. Am J Ind Med 10:383–397CrossRefGoogle Scholar
  53. Vena JE, Charles LE, Gu JK, Burchfiel CM, Andrew ME, Fekedulegn D, Violanti JM (2014) Mortality of a police cohort: 1950–2005. J Law Enforc Leadersh Ethics 1:7–30Google Scholar
  54. Violanti JM, Burchfiel CM, Miller DB, Andrew ME, Dorn J, Wactawski-Wende J, Beighley CM, Pierino K, Joseph PN, Vena JE, Sharp DS, Trevisan M (2006) The buffalo cardio-metabolic occupational police stress (BCOPS) pilot study: methods and participant characteristics. Ann Epidemiol 16(2):148–56CrossRefGoogle Scholar
  55. Violanti JM, Fekedulegn D, Hartley TA, Charles LE, Miller DB, Burchfiel CM (2017) The impact of perceived intensity and frequency of police work occupational stressors on the cortisol awakening response (CAR): the BCOPS study. Psychoneuroendocrinology 75:124–131CrossRefGoogle Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • John M. Violanti
    • 1
  • Desta Fekedulegn
    • 2
  • Ja Kook Gu
    • 2
  • Penelope Allison
    • 2
  • Anna Mnatsakanova
    • 2
  • Cathy Tinney-Zara
    • 1
  • Michael E. Andrew
    • 2
  1. 1.Department of Epidemiology and Environmental Health, School of Public Health and Health ProfessionsThe State University of New York at BuffaloBuffaloUSA
  2. 2.Health Effects Laboratory Division, Biostatistics and Epidemiology Branch, Centers for Disease Control and PreventionNational Institute for Occupational Safety and HealthMorgantownUSA

Personalised recommendations