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

Background: 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). Methods: 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. Results: 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