Effort-Reward Imbalance, related risk factors and the association with depression and suicidal ideation in German dentists- BMC Psychology

Abstract

Abstract Background Dentistry involves substantial physical, psychological, and organizational demands. Increasing administrative tasks and structural changes in dental health care may exacerbate imbalances between professional effort and rewards. According to the Effort-Reward Imbalance (ERI) model, such imbalances are linked to adverse mental health outcomes. This study investigates determinants of ERI among German dentists and its association with depressive symptoms and suicidal ideation. Methods A nationwide cross-sectional online survey was conducted in Germany from July 2021 to February 2022, with 589 practicing dentists participating. ERI was assessed using a validated self-report questionnaire. Depressive symptoms were measured with the Patient Health Questionnaire-2, and suicidal ideation with item 9 from the Patient Health Questionnaire-9. Sociodemographic and occupational variables were collected via self-report. Differences between male and female participants were analyzed using chi-square tests and t-tests. Linear regression analyses was used to identify predictors of ERI, and Spearman correlations examined associations with mental health outcomes. Results The mean ERI ratio was 1.1, with 53.1% of participants showing an unfavorable imbalance. Depressive symptoms were identified in 21.1% of respondents, and 11.8% reported suicidal ideation in the last two weeks. Higher imbalance was significantly associated with increased depressive symptoms and suicidal ideation. Bureaucratic burden was the strongest predictor of imbalance, followed by age and taking care of children. No significant gender differences were observed. Conclusions ERI is prevalent among German dentists and closely linked to impaired mental health. Administrative burdens represent an important modifiable stressor. Reducing bureaucratic workload and improving structural working conditions may help restore balance and support mental well-being in this population.