Quality of Life Research

, Volume 23, Issue 5, pp 1661–1671 | Cite as

Work stress and quality of life in persons with disabilities from four European countries: the case of spinal cord injury

  • Christine Fekete
  • Morten Wahrendorf
  • Jan D. Reinhardt
  • Marcel W. M. Post
  • Johannes Siegrist



Evidence on the adverse effects of work stress on quality of life (QoL) is largely derived from general populations, while respective information is lacking for people with disabilities. We investigated associations between work stress and QoL and the potentially moderating role of socioeconomic circumstances in employed persons with spinal cord injury (SCI).


Cross-sectional data from 386 employed men and women with SCI (≥18 work h/week) from the Netherlands, Switzerland, Denmark, and Norway were analyzed. Work stress was assessed with the ‘effort–reward imbalance’ (ERI) model and the control component of the ‘demand/control’ model. QoL was operationalized with five WHOQoL BREF items. Socioeconomic circumstances were measured by years of formal education and perception of financial hardship. We applied ordinal and linear regressions to predict QoL and introduced interaction terms to assess a potential moderation of socioeconomic circumstances.


Multivariate analyses showed consistent associations between increased ERI and decreased overall QoL (coefficient −1.55, p < 0.001), domain-specific life satisfaction (health −1.32, p < 0.001; activities of daily living −1.28, p < 0.001; relationships −0.84, p = 0.004; living conditions −1.05, p < 0.001), and the QoL sum score (−2.40, p < 0.001). Low job control was linked to decreased general QoL (0.13, p = 0.015), satisfaction with relationships (0.15, p = 0.004), and QoL sum score (0.15, p = 0.029). None of the tested interaction terms were significant.


ERI was consistently related to all indicators of QoL, while associations with job control were less consistent. Our results do not support the notion that unfavorable socioeconomic circumstances moderate the association between work stress and QoL among persons with SCI.


Effort–reward imbalance Job control Spinal cord injury Socioeconomic position 



The authors would like to thank the staff of the SwiSCI Study Center and the ILIAS members for their efforts in realizing this study. Special thanks go to the ILIAS Steering Committee members Jane Horsewell (Denmark), Annelie Leiulfsrud (Norway), Dr. Fin Biering-Soerensen (Denmark), and Dr. Hakon Leiulfsrud (Norway). We are grateful to all the participants of the SwiSCI, and the ILIAS survey for their time and effort spent in responding to our questions. Also, we would like to thank the associations for persons with SCI in Switzerland (SPV), the Netherlands (DON), Denmark (RYK), and Norway (LARS), as well as the European Spinal Cord Injury Federation (ESCIF) for their efforts during recruitment. This study has been financed in the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), supported by the Swiss Paraplegic Foundation. The Dutch part of this study has been financially supported by the Revalidatiefonds, the Dwarslaesiefonds, and Swiss Paraplegic Research. The Norwegian part of the study was funded by the Central Norwegian Regional Health Authority (Grant Number: 46056402). JS was additionally supported by the grant agreement HEALTH-F3-2011-278350 (DRIVERS) of the European Commission. The members of the SwiSCI Steering Committee are: Abdul Al-Khodairy, Olivier Deriaz (Clinique Romande de Réadaptation, Sion); Michael Baumberger, Hans Peter Gmünder (Swiss Paraplegic Center, Nottwil); Armin Curt, Martin Schubert (University Clinic Balgrist, Zürich); Hansjörg Lüthi, Margret Hund-Georgiadis (REHAB Basel, Basel); Thomas Troger, Urs Styger (Swiss Paraplegic Association, Nottwil); Max Moor (Parahelp, Nottwil); Hardy Landolt (Representative for persons with SCI, Glarus); Rita Schaumann-Von Stosch (SUVA, Luzern); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Martin Brinkhof, Christine Thyrian (SwiSCI Study Center at Swiss Paraplegic Research, Nottwil).

Conflict of interest

The authors declare no competing interests.


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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Christine Fekete
    • 1
  • Morten Wahrendorf
    • 2
  • Jan D. Reinhardt
    • 1
    • 3
    • 4
    • 5
  • Marcel W. M. Post
    • 6
  • Johannes Siegrist
    • 7
    • 8
  1. 1.Swiss Paraplegic ResearchNottwilSwitzerland
  2. 2.Faculty of MedicineInstitute of Medical Sociology, Heinrich-Heine-UniversityDuesseldorfGermany
  3. 3.University of LucerneLucerneSwitzerland
  4. 4.Institute for Disaster Management and ReconstructionSichuan UniversityChengduChina
  5. 5.Hong Kong Polytechnic UniversityHong KongChina
  6. 6.Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation MedicineUniversity Medical Center Utrecht and De HoogstraatUtrechtThe Netherlands
  7. 7.Faculty of MedicineHeinrich-Heine-UniversityDuesseldorfGermany
  8. 8.Life-Science CenterDuesseldorfGermany

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