Social Science & Medicine 58 (2004) 1475–1482 Psychosocial factors at work and depression in three countries of Central and Eastern Europe Hynek Pikhart a, *, Martin Bobak a , Andrzej Pajak b , Sofia Malyutina c , Ruzena Kubinova d , Roman Topor b , Helena Sebakova e , Yuri Nikitin c , Michael Marmot a a Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK b Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland c Institute of Internal Medicine, Russian Academy of Sciences, Novosibirsk, Russia d National Institute of Public Health, Prague, Czech Republic e District Institute of Public Health, Karvina, Czech Republic Abstract Psychosocial factors at work have been found to predict a range of health outcomes but their effect on mental health outcomes has not been extensively studied. This paper explores the relationship between psychosocial factors at work and depression in three countries of Central and Eastern Europe. The data come from a cross-sectional study of working men (n ¼ 645) and women (n ¼ 523) aged 45–64 years, randomly selected from population registers in Novosibirsk (Russia), Krakow (Poland) and Karvina-Havirov (Czech Republic). The questionnaire included questions on the effort and reward at work, job control, the full CES-D scale of depression, and a range of other characteristics. Linear regression was used to estimate the association between depression score and work characteristics: the logarithm of the effort–reward ratio, and continuous job control score. The means of the depression score were 10.5 for men and 14.2 for women. After controlling for age, sex and country, effort-reward ratio (logarithmically transformed) was strongly related to depression score; a 1 SD increase in the log transformed effort-reward ratio was associated with an increase in the depression of 2.0 points (95% CI 1.5; 2.4), and further adjustment did not materially change the effect. Job control was inversely associated with depression score in Poland and the Czech Republic (not in Russia) but the association was largely eliminated by controlling for socioeconomic characteristics. This study suggests that the effort– reward imbalance at work is related to prevalence of depression in these central and eastern European populations. r 2003 Elsevier Ltd. All rights reserved. Keywords: Depression; Job stress; Effort–reward model; Job control; Psychosocial factors; Eastern Europe Introduction The influence of psychosocial factors at work on health has been studied extensively over the last two decades (Karasek & Theorell, 1990; Siegrist, 1996; Marmot, Siegrist, Theorell, & Feeney, 1999; Cooper, 1998). Most studies have focused on the relation with cardiovascular disease (Siegrist, Peter, Junge, Cremer, & Seidel, 1990; Karasek et al., 1988; Johnson, Stewart, Hall, Fredlund, & Theorell, 1996; Bosma, Peter, Siegrist, & Marmot, 1998) but several other health outcomes have also been examined, including self-rated health, sickness absence, neck and low back pain, psychiatric disorder and depression (North, Syme, Feeney, Shipley, & Marmot, 1996; Isacsson, Hanson, Ranstam, Rastam, & Isacsson, 1995; Tsutsumi, Kayaba, Theorell, & Siegrist, 2001; Stansfeld, Fuhrer, Shipley, & Marmot, 1999; Pikhart et al., 2001; Peter & Siegrist, 1997). This paper examines whether psychosocial work environment is associated with depression. Depression is related to several cardiovascular risk factors and, possibly, to the ARTICLE IN PRESS *Corresponding author. Tel.: +44-20-76791906; fax: +44- 20-78130280. E-mail address: hynek@public-health.ucl.ac.uk (H. Pikhart). 0277-9536/$-see front matter r 2003 Elsevier Ltd. All rights reserved. doi:10.1016/S0277-9536(03)00350-2