Effort-reward imbalance was measured using the German version of the Effort-Reward Imbalance questionnaire (ERI-S 10; [16, 54]) with two sub-scales (i) effort (consisting of three items, e.g. ‘I have constant time pressure due to a heavy workload’, ‘I have many interruptions and disturbances while performing my job’) and (ii) reward (consisting of seven items, e.g. ‘Considering all my efforts and achievements, I receive the respect and prestige I deserve at work’, ‘My job promotion prospects are poor’). Participants responded on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). Both scales show high internal consistency, with Cronbach’s alpha coefficients of α = 0.80 for effort and α = 0.84 for reward [55]. An effort-reward ratio = 1 (see Siegrist and colleagues [17]) indicates a balance between reported effort and reward. If individuals report less effort for each reward, the effort-reward ratio is < 1. In contrast, a ratio > 1 indicates that more effort is expended than reward received, indicating an imbalance.
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