Authors of summary: Teresa Brinkel and Christine Fekete (Swiss Paraplegic Research)
Original article: Fekete C, Wahrendorf M, Reinhardt JD, Post MW, Siegrist J. Work stress and quality of life in persons with disabilities from four European countries: the case of spinal cord injury. Quality of Life Research. 2014;23(5):1661-71.

Chronic work-related stress and little influence on the working process also minimize the quality of life in persons with spinal cord injury (SCI). According to this study, the severity of the impact of work-related stress does not depend on education or the financial situation of an employee with SCI.

What was the aim of this study?

Continuing pressure from deadlines, excessive demands or mobbing at the workplace can trigger stress and lead to extensive mental and physical limitations. Depression, tenseness, sleep disorders and high blood pressure are examples for possible reactions of the body due to continuing stress. Numerous studies confirm that stress-causing working conditions can contribute to decreasing the quality of life and health.

It has also been scientifically proven that stress decreases the quality of life especially in persons who are socially and financially less well established. Socioeconomic factors such as education, profession or income therefore play an important role with respect to the impacts of stress on the individual.

While there is evidence in this context for the general population, there are hardly any comparable studies about persons with disabilities. This study therefore focused on the following two questions:

  1. Is there a connection between work-related stress and quality of life in persons with SCI?
  2. Does work-related stress in persons with SCI have a higher impact on the quality of life in socioeconomically disadvantaged populations than in privileged populations?

How did the researchers proceed?

The data used came from the SwiSCI survey as well as from ILIAS, an international research project on the labor market integration of persons with spinal cord injury ( The researchers evaluated data that was collected from 386 employees with SCI from Switzerland, the Netherlands, Norway, and Denmark. These persons were working at least 18 hours per week when the study was performed.

In order to be able to assess "work-related stress", the "quality of life" and the "socioeconomic status" of the persons with SCI, the researchers matched each of these three abstract terms with concrete indicators which could be measured on the basis of the collected data:

  • Work-related stress was therefore measured using the imbalance between commitment (e.g. work performed, experienced time pressure, high expectations) and reward (e.g. appreciation, adequate compensation). A discrepancy between these factors can lead to work-related stress reactions. The participants were also asked how much influence they had as employees on the working processes since it is known that less control on the job can also contribute to the perception of stress.
  • In order to assess the quality of life of the participants they were required to indicate how satisfied they were with their health, their social relations, the performance of daily activities and their housing situation.
  • The socioeconomic status of the participants was determined according to their education and financial situation.

What did the researchers discover?

The data analysis showed that the quality of life of employees with SCI varies, namely with respect to dependence on the degree of work-related stress. Persons who experienced an imbalance between their work commitment and their compensation underlie an increased risk for a lower quality of life (see figure 1): They are less satisfied with their health (see figure 2), with their social relations, with their daily activities and their housing situation.

Figure 1: relation between work-related stress and quality of life

Figure 2: relation between work-related stress and satisfaction with one’s own health

The researchers were able to also detect similar connections in persons with little influence on the work organization, the pace of work or work-related decisions. These persons generally reported a lower quality of life than persons with more abilities to exert influence (see figures 3 and 4).

Figure 3: relation between job control and quality of life

Figure 4: relation between job control and satisfaction with one's own health

What this study did not confirm is a decrease of quality of life due to stress-causing work especially in socioeconomically disadvantaged populations. The data did not show that persons with SCI with basic vocational training and financial problems suffer more from the consequences of burdensome working conditions than more privileged persons.

What do these findings mean?

In contrast to the general population this study about persons with SCI did not find a connection between socioeconomic factors and the impact of burdensome working conditions. One possible reason is that the survey was conducted in countries that have a well-established social and health system. The scientists assume that the favorable social framework in these countries (e.g. social insurances, measures of occupational safety or financial support) absorb the negative effects of work-related stress on the quality of life in less privileged populations. It would therefore be interesting to conduct such a study in countries with a less well developed social system.

Who conducted and financed the study?

The SwiSCI-survey, on the data of which the current study is based, is conducted by various collaboration partners within Switzerland (see article on the SwiSCI study design). The ILIAS-project is financed by Swiss Paraplegic Research in Nottwil (Switzerland), the Revalidatiefonds in Odijk and the Dwarslaesiefonds in Amsterdam (both in the Netherlands) as well as the Central Norwegian Regional Health Authority in Stjørdal (Norway). The evaluation of the data for this study on work-related stress was carried out at Swiss Paraplegic Research.

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