Effort-reward-imbalance, burnout, and physical pain mediate the relationship between overcommitment and depression in German Emergency Medical Technicians

Effort-reward-imbalance, burnout, and physical pain mediate the relationship between overcommitment and depression in German Emergency Medical Technicians | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effort-reward-imbalance, burnout, and physical pain mediate the relationship between overcommitment and depression in German Emergency Medical Technicians Laura Manns, Claus Vögele, Pascal Stammet, André Schulz This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5825856/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 May, 2025 Read the published version in Journal of Occupational Medicine and Toxicology → Version 1 posted 9 You are reading this latest preprint version Abstract Background: Overcommitment (OC) is highly prevalent in health care employees, and may predict depression symptoms. The literature suggests that the relationship between OC and depression is mediated by Effort-Reward-Imbalance (ERI), burnout and physical pain. This study tested a two-step mediation effect between OC and depression by ERI in a first, and burnout and physical pain in a second step using a cohort of German Emergency Medical Technicians (EMTs). Methods: A cross-sectional study was carried out on a volunteer sample of 303 EMTs in Germany. OC and ERI were assessed using the ERI questionnaire, burnout with the Maslach Burnout Inventory, physical pain with the Short Form 36, and depression with the BDI-II. The relationship between these variables was tested using a mediation analysis. Results: We found a partial mediation effect between OC and depression via ERI, burnout (emotional exhaustion, personal accomplishment) and physical pain. The mediation effect of emotional exhaustion is significantly higher than those of depersonalization and physical pain. Conclusions: The partial mediation effect suggests the validity of our model assumptions, but also indicates direct relationships between variables (i.e. OC, ERI and depression). The identification of emotional exhaustion as key mediator implies that prevention and intervention approaches in EMTs should be based on this indicator. Burnout depression effort-reward imbalance overcommitment paramedic physical pain Figures Figure 1 1. Introduction The rising prevalence of depression in German health-care employees in recent years, especially in Emergency Medical Technicians (EMT), and the resulting inability to work, constitutes an important public concern (1). The increasing number of emergency calls- and responses has led to escalating workloads for EMTs (2), and those who are overcommitted to their work may be at particular risk. Previous studies found a strong link between overcommitted behavior and the occurrence of depression symptoms (3). Little is known, however, about the interaction and mediating factors between overcommitment (OC) and depression symptoms. OC as a personality trait can contribute to occupational stress (4). The Effort-Reward Imbalance (ERI) model is a well-established theoretical framework in occupational health. The model was developed and introduced by (5), positing that occupational stress arises from an imbalance between efforts at work and rewards received. It comprises the three main components effort, reward and OC . Effort refers to demands or pressure at work, whereas rewards include salary, esteem and career opportunities. OC describes a personality trait, contributing to high work-related commitment (6). Stress results from an imbalance between perceived efforts and perceived rewards. Overcommitted behavior could, therefore, lead to an imbalance by expanding work-related efforts but not increasing rewards. Previous studies showed that especially occupational groups working in health care are prone to experiencing OC and ERI (7,8). In their review (9) conclude that OC in health care employees occurs due to feelings of responsibility for their patients’ care. With increasing numbers of emergency calls and -responses, which is not accompanied by a concomitant rise in the number of employees, overcommitted EMTs may be at increased risk for experiencing ERI, resulting in work-related stress. (10) found that depression among Emergency medical service (EMS) employees mainly occurs due to work-life characteristics, such as OC and ERI. Recent studies explored the direct link between OC and depression, assuming that OC directly affects the occurrence of depression symptoms (11,12). Some findings, however, suggest that the relationship between OC and depression is complex and multifaceted, in that the effect of OC on depression is due to ERI and prolonged experiences of work-related stress (13,14). The question arises whether the relationship between OC and depression symptoms is mediated by ERI. Hence, in the current study we aimed at testing for this partial mediation effect (i.e. direct and indirect effect of OC on depression). Prolonged exposure to job-related stress may result in burnout (15) with the main dimensions emotional exhaustion, depersonalization and reduced personal accomplishment. Several studies investigating the link between OC, ERI, and burnout, as well as between burnout and depression symptoms, found that ERI and OC are determinants of burnout (16), which in turn predicts depression (17). A model explaining the link between OC, ERI, burnout and depression symptoms is the Job Demands-Resources (JD-R) model (18), stating that high job demands but low job resources lead to a state of cynicism and emotional exhaustion. If this state persists, it may result in an inability to effectively cope with job demands, leading to chronic stress and, therefore, increasing depression symptoms (19). (20) pointed out that increasing numbers of emergency calls and -responses and decreasing recovery or relaxation periods are amongst the main factors leading to burnout in EMS-employees. Moreover, it was found that high levels in ERI and symptoms of burnout in EMTs lead to lower quality of perceived patient care (21,22), suggesting a significant negative effect for the patients concerned. Due to their relationship with OC, ERI, and depression, we included burnout dimensions as additional factors in our mediation model. In addition to mental health impairments the prolonged exposure to job-related stress has been associated with musculoskeletal pain and other physical health issues. A review by (23) found that mainly ERI, but not OC, was directly related to musculoskeletal pain, in that employees who showed high levels of ERI reported musculoskeletal pain more frequently than employees reporting low levels of ERI. Other studies report similar findings, indicating that ERI is associated with neck-shoulder pain (24), and low back and hip pain (25), especially in high-stress professions, such as EMS or police work. Furthermore, previous studies suggest that physical pain has an impact on the occurrence of depression symptoms (26). A review by (27) not only showed a relationship between pain and depression, but also that the coexistence of depression and pain leads to the prolonged presence of symptoms. Given that physical pain is correlated with ERI, but not with OC (Koch et al., 2014), it appears plausible that physical pain also mediates the relationship between ERI and depression. Given the complexity of the associations between OC, ERI, burnout, pain, and depression, particularly in the high-stress context of EMS work, the aim of the current study was to examine a two-step mediation model to explain their inter-relationship. A better understanding of the mechanisms underlying work stress and health in EMTs may contribute to the development of more effective prevention and intervention approaches. We expected to find a direct effect of OC on depression symptoms. First, we hypothesized that OC increases ERI. Second, we expected the relationship between ERI and depression symptoms to be mediated by burnout and physical pain. To test these assumptions, we collected data using an online questionnaire, addressing German EMTs. To examine the relationship between the variables, a mediation analysis was conducted using Hayes’ model 81 in the PROCESS Macro (28). We hypothesized that OC directly predicts depression symptoms. We also hypothesized that OC has an indirect effect on depression symptoms, first, through ERI, and second, through ERI, as well as burnout and physical pain as chain mediator variables. 2. Materials and Methods 2.1 Participants and Procedure In this cross-sectional study 325 volunteers all over Germany participated. The sample size after exclusion of participants, who did not meet the inclusion criteria was N = 303 participants. Inclusion criteria were the job qualifications EMT-P and EMT-I, based in Germany as well as employment more than 10%. Two-hundred-twenty participants were EMT-Paramedic (EMT-P) and 93 EMT-Intermediate (EMT-I), based in Germany. The sample consisted of 197 men, 112 women and one non-binary participant. Two-hundred-twenty participants worked twelve-hour shifts, 25 worked eight-hours, 47 worked 24-hours shifts, seven worked ten-hours, three eleven-hours and one participant worked six-hours shifts. The mean age was 33.1 years (SD = 10.27 years). The mean for years in job was 10.7 years ( SD = 9.01). The average weekly working hours were 93.85% for a full-time position ( SD = 17.09). Exclusion criteria were part-time employment less than 10% and a job qualification as a Medical Doctor. The recruitment took place from 10/11/2023 to 12/15/2023 via social media, EMS-Platforms (e.g. QM-Platform) or invitations via E-Mail, including the link to the online survey. The survey was designed as self-assessment. All questionnaires were approved for self-assessment and online suitable. Since there was no compensation offered, it is likely only EMTs took part in the survey. Participants provided informed consent and were informed of their right to discontinue their participation at any time. Ethics approval was obtained according to the ethics regulations of the psychology study programs of the University of Luxembourg. 2.2 Measures 2.2.1 Socio-demographics Socio-demographic data was collected including age, gender, and long-term medication intake (yes or no). Job-related data was collected including qualification (EMT-P, EMT-I), employment status (in percent) and years employed as EMT. These items were used as descriptive and confounding variables. 2.2.2 Depression symptoms Depression symptoms were assessed with the 21-items Beck Depression Inventory-II (BDI-II) (29). Responses were rated on a four-point scale (0-3). Items are summed up to create a scale score ranging from 0-36. Scores ranging from 14-19 indicate a mild level of depression, scores ranging from 20-28 indicate a moderate level of depression and scores ranging from 29-63 indicate a severe level of depression. Cronbach’s α coefficient for the BDI-II in this study was .93. 2.2.3 OC and ERI OC and ERI were measured with the 22-items version of the ERI Questionnaire (30), consisting of the three scales Effort, Reward and OC. Responses are provided on a four-point Likert scale assessing the level of agreement ranging from Strongly disagree (1) to Strongly agree (4). Scale scores are summed up. OC was measured by six items, with scores ranging from 6-24. Effort was measured by six items with scores ranging from 6-24, and Reward was measured by ten items with scores ranging from 10-40. Higher scores indicate higher levels for the respective scale. The recommended analysis procedure for the ERI involves computing the ER-Ratio, with a cut-off point of one. Scores above one indicate a high ERI.In this study, Cronbach’s α coefficients in this study were .68 for OC, .67 for Effort and .82 for Reward. 2.2.4 Burnout We assessed burnout with the 22-items version of Maslach Burnout Inventory-Human Services Survey (MBI-HSS) (15). The MBI-HSS measures Burnout in three dimensions: Emotional Exhaustion (MBI EE) with nine items, Depersonalization (MBI DP) with five items, and Personal Accomplishment (MBI PA) with eight items. Responses are given on a seven-point Likert scale ranging from never (1) to every day (7). Item scores of the respective scales are summed up to create scale scores. For MBI EE, a score less than 17 indicates a low level of MBI EE, a score ranging from 18-29 indicates a moderate level and a score above 30 a high level. For MBI DP a score less than 5 indicates a low level, a score ranging from six to eleven indicates a moderate level and a score above twelve a high level. For MBI PA, a score less than 33 indicates a low level, a score ranging from 34-39 indicates a moderate level and a score above 40 a high level. High levels for MBI EE and MBI DP, as well as a low level for MBI PA indicate a severe Burnout level. In this study, Cronbach’s α coefficients were .91for Emotional Exhaustion, .73 for Depersonalization and .74 for Personal Accomplishment. 2.2.5 Physical pain Physical pain (SF-36 BP) was assessed with the subscale bodily pain of the SF-36 health survey questionnaire (31). The subscale consists of two items. The first item “How much bodily pain have you had over the past 4 weeks?” is measured with a six-point scale from None (1) to Very severe (6). The second item, “During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?” is assessed with a five-point scale from Not at all (1) to Extremely (5). Item scales are summed up to a total score ranging from two to eleven. The higher the score the higher the level of pain indicated for the past four weeks. In this study, Cronbach’s α coefficient for Bodily Pain was .85. 2.3 Statistical analysis We calculated Pearson correlations to examine the zero-order relationships between the dependent, independent and mediator variables. The mediation analysis was computed using IBM SPSS Statistics 29.0 and Hayes’ model 81 in the PROCESS Macro (28). For the mediation analysis, the dependent (depression symptoms), independent (OC) and mediator variables (ERI, burnout and physical pain), as well as confounds (age, qualification, long-term medication intake, years employed as EMT and time type) were added. The mediation model is shown in Fig. 1. Assumptions for mediation analysis were tested. Due to heteroscedasticity, the HC3 method was used. The number of bootstrap samples was 5000. The estimation of confidence intervals (CI) was 95%. If zero was included in CI, no mediating effect can be assumed. 3. Results 3.1 Descriptives and correlations The mean scores of OC in this sample was 15.08 ( SD = 2.62), for ERI 1.43 ( SD = 0.49), for MBI EE 29.79 ( SD = 11.14), for MBI DP 15.40 ( SD = 6.29), for MBI PA 34.85 ( SD = 7.87), for SF-36 BP 4.36 ( SD = 2.3) and for BDI-II 15.41 ( SD = 10.48). The dependent (depression/BDI-II), independent (OC) and mediator variables (ERI, emotional exhaustion, depersonalization, personal accomplishment) are all positively inter-correlated (see Table 1), except for personal accomplishment, which showed a negative correlation with all other variables. Table 1: Pearson correlations of dependent (DV), independent (IV) and mediator variables (MV). 1. 2. 3. 4. 5. 6. 7. 1. OC (IV) 1 2. ERI (MV) .461 ** 1 3. MBI EE (MV) .485 ** .662 ** 1 4. MBI DP (MV) .347 ** .471 ** .692 ** 1 5. MBI PA (MV) -.341 ** -.379 ** -.253 ** -.253 ** 1 6. SF-36 BP (MV) .247 ** .382 ** .369 ** .282 ** -.346 ** 1 7. BDI II (DV) .474 ** .581 ** .697 ** .496 ** -.472 ** .471 ** 1 N = 303 ** p < 0.01 3.2 Mediation analysis The results for each path of the mediation analysis are displayed in Table 2 and results for indirect effects are displayed in Table 3. The analysis showed a significant positive direct effect for OC on BDI-II, and a positive significant indirect effect on BDI-II, indicating a partial mediation effect. OC predicted ERI, and ERI positively predicted BDI-II scores. In addition, ERI positively predicted the burnout dimensions MBI EE and MBI DP, as well as SF-36 BP. There was a significant negative association between ERI and the burnout dimension MBI PA. MBI EE and SF-36 BP positively predicted BDI-II scores, whereas MBI PA negatively predicted BDI-II scores. MBI DP and BDI-II scores were unrelated. For the parallel mediators, a contrast in indirect effects was observed for MBI EE and SF-36 BP, b = .313, BCa 95% CI [.135, .514], indicating a larger effect for MBI EE. Table 2: Results of the serial and parallel mediation analysis for each mediation model n = 303; B = regression coefficient; SE = standard error; t = t-test value; LCI = lower limit of the 95 % confidence interval; UCI = upper limit of the 95 % confidence interval Model 1: OC → ERI; Model 2: OC → ERI → MBI EE; Model 3: OC → ERI → MBI DP; Model 4: OC → ERI → MBI PA; Model 5: OC → ERI → SF-36 BP; Model 6: OC → ERI → MBI EE, MBI DP, MBI PA, SF-36 BP → BDI-II *** p < 0.001; ** p < 0.01; * p < 0.05 Table 3: Effects and indirect effects of the mediation analysis of OC on depression via ERI, burnout and physical pain, shown for the different paths B SE Bootstrap LCI Bootstrap UCI t Total effect OC on BDI-II 1.935 *** .221 1.499 2.369 8.753 Direct effect OC on BDI-II .494 ** .177 .147 .843 2.799 Total indirect effect OC on BDI-II 1.439 .192 1.084 1.832 Indirect effect via ERI .25 .106 .055 .473 Indirect effect via ERI and MBI EE .41 .094 .243 .612 Indirect effect via ERI and MBI DP .029 .035 -.036 .101 Indirect effect via ERI and MBI PA .061 .027 .015 .121 Indirect effect via ERI and SF-36 BP .097 .038 .038 .183 n = 303; B = regression coefficient; SE = standard error; t = t-test value; LCI = lower limit of the 95 % confidence interval; UCI = upper limit of the 95 % confidence interval *** p < 0.001; ** p < 0.01; * p < 0.05 4. Discussion To the best of our knowledge this is the first study to investigate the relationship betweenOC and depression, and the mediating role of ERI, burnout and physical pain in German EMTs. We hypothesized that OC directly and indirectly predicts depression. Furthermore, it was hypothesized that the relationship is mediated by ERI in a first step, and by burnout and physical pain in a second step. Our findings support both hypotheses, as a partial mediation effect was observed, although limited to the burnout facets of emotional exhaustion and personal accomplishment, as well as to physical pain. In this study we found that OC has both a direct and an indirect effect on depression in EMTs. This finding demonstrates that EMTs who are overcommitted to their work, such as to be expected increasing emergency calls and -responses, are more at risk to experience higher levels of depression. (32) reported that individuals who are overcommitted might struggle to detach from their work, leading to difficulties in relaxation. An inadequate detachment from work can result in insufficient recovery periods, thereby leading to elevated levels of stress and facilitating depression symptoms. Our results are also in line with previous studies examining the relation between OC and reduced overall mental health (Jung et al., 2023; Preckel et al., 2005). For example, OC has been directly linked to increased anxiety (11), higher job stress levels (35), sleep disturbances, and cardiovascular disorders that are linked to stress (36). Our findings support the key role of OC for mental health in EMTs, suggesting that prevention and intervention programs should target EMTs with high OC. The results further support our hypothesis that ERI mediates the association of OC and depression. EMTs who are overcommitted might experience higher levels of ERI, which might contribute to increasing depression symptoms. The ERI-Model (5) suggests that stress at work can be caused by the mismatch in perceived effort compared to perceived reward. Employees who show overcommitted behavior tend to work beyond their capacities, thus exerting excessive effort (37), which contributes to the mismatch in perceived effort compared to perceived reward. Other studies (38,39) also found evidence that OC as a personality trait is a risk factor for experiencing ERI and work-related stress. Further contributing to our findings, Rugulies et al. (2017) reported in their meta-analysis ERI to be a significant risk factor for depression symptoms. There is no consistent evidence, however, for ERI mediating between OC and depression. (41) found that OC alone was not directly predictive for affective disorders in schoolteachers. Moreover, they found a strong link between ERI and depression symptoms, which was even stronger when introducing OC as a moderating variable. Another study examining the relationship between OC, ERI and mental health (37) found that ERI had no direct effect on mental health, unless OC was introduced as a mediator variable, stating OC to be a mediator between ERI and mental health. These findings are in contrast to our finding, that ERI mediates the association between OC and depression. An explanation for these inconsistencies might be that previous studies conceptualized OC as a coping mechanism rather than a personality trait as in the present study. If OC is conceived as a personality trait leading to an increase in job effort without concomitant increases in reward, this might result in ERI. In partial disagreement with our hypothesis for burnout as a chain mediator between OC, ERI and depression, not all burnout dimensions turned out to be significant mediators, in that MBI DP did not show a significant mediating effect in our model. This suggests that overcommitted EMTs are more likely to experience higher levels in ERI, leading to higher levels in emotional exhaustion and lower levels in personal accomplishment, in turn leading to elevated levels in depression. The inconsistent mediation effect of the burnout scales differs from previous studies (12,42), who found burnout to mediate between work-related stress and depression symptoms. In Violanti et al. (2018) people with higher scores in ERI and OC showed higher scores in depersonalization and emotional exhaustion, whereas in Martin et al. (1997) higher scores in depersonalization and emotional exhaustion strongly predicted the severity of depression symptoms. Our findings of emotional exhaustion as the strongest chain mediator between ERI and depression imply that future prevention and intervention programs in EMTs should particularly focus on the reduction of emotional exhaustion. An explanation for this contradicting finding might be that due to high correlations between emotional exhaustion and depersonalization, it is possible that both dimensions affect depression levels, resulting in a non-mediating effect of depersonalization (45). This assumption is supported by our finding that, concerning the parallel mediators, the burnout dimension of emotional exhaustion seems to have the strongest mediating effect. An alternative explanation is that the role of emotional exhaustion as a chain mediator of OC, ERI and depression may be a specific characteristic of EMTs. Future studies should compare EMTs with comparable social services with regard to OC, ERI, burnout and depression to test the specificity of this pattern. Our findings further demonstrate a mediating effect through physical pain as a chain mediator between OC, ERI and depression. There is evidence (Herr et al., 2015) suggesting that work-related stress enhances the probability of musculoskeletal pain. Due to higher work-related stress experiences, muscle tensions can be enhanced, hence causing physical pain, which may contribute to depression symptoms (47,48). Our findings not only suggest that burnout, but also physical symptoms may be affected by OC/ERI, finally contributing to mental health in EMTs. Hence, the modification of the antecedents of OC and ERI, such as a reduction of workload, an increase of monetary compensation or an extension of relaxation periods, have the potential to positively affect both physical and mental health in EMTs. Our findings have theoretical implications for the mechanisms linking occupational stress and mental health, by contributing to a better understanding of the interaction between OC and depression in EMTs. The complexity of the mediation model suggests that simple linear models might not be sufficient to understand the relationship between occupational stress and mental health outcomes. Moreover, our findings emphasize the importance of integrating indicators of physical and mental health. Furthermore, the differences between the burnout dimensions in mediating effects demonstrate the necessity to integrate emotional exhaustion, depersonalization and personal accomplishment as separate variables to predict mental health in EMTs. These results have important practical implications in the field of EMS, in that they demonstrate the need to support mental health and decrease the number of EMTs experiencing depression symptoms by managing OC effectively. Especially EMTs who are highly overcommitted, and those with high levels of emotional exhaustion are at risk of experiencing physical and mental health impairments. Therefore, EMS organizations should consider implementing stress management programs and trainings on effective coping strategies to handle work related stress and OC. EMS organizations should also consider organizational changes, reducing excessive job demands and improving rewards, thereby reducing perceived ERI. Considering the increase in emergency calls and -responses over the last years, and the associated strain (= effort ), our findings highlight the importance to increase rewards , thereby protecting EMTs from occupational stress. Limitations First, the current study used a cross-sectional design. As the mediation model was based on theoretical assumptions, it might well be that statistical effects show equal significance levels when re-arranging them, although with a lower conceptual validity of the model. To draw conclusions on causalities between these variables a longitudinal design is needed. Furthermore, a longitudinal design would provide insights into the evolvement of the relationship between OC and depression, as well as their mediation over time. Notwithstanding, the current results suggest a complex relationship between OC and depression, as well as their mediation by ERI, burnout and physical pain. Second, the sample in this study was relatively young with a mean age of 33.1 years (SD = 10.27 years) and this may, therefore, limit the results’ generalizability to EMTs in general. As age was unrelated to all other variables in our mediation models, however, this assumption seems not to be supported by our data. Third, this study included only EMS employees in Germany, limiting the applicability of the results to EMTs in general. Future studies should examine the mediation model in other professions as well. The data in this study relies on self-reported data, introducing biases such as social desirability. However, the data was anonymously collected via online platforms, keeping biases like social desirability at a minimum. Conclusions This study demonstrates that the relationship between OC and depression is partially mediated by ERI (first step), as well as burnout (emotional exhaustion, personal accomplishment) and physical pain (second step) in German EMTs. Emotional exhaustion was identified as strongest chain mediator of the second step. Furthermore, OC still has a direct positive effect on depression symptoms. Our findings demonstrate the need for prevention and intervention programs to target OC/ERI and burnout (e.g., effective stress management strategies and organizational changes in EMS) to reduce risk factors for mental- and physical health impairments. Abbreviations BDI-II Beck Depression Inventory-II CI confidence interval DV dependent variable ERI Effort-Reward Imbalance EMS emergency medical service EMT emergency medical technicians EMT-P EMT-Paramedic EMT-S EMT-Intermediate OC overcommitment IV independent variable JD-R model Job Demands-Resources model LCI lower limit of the 95 % confidence interval MBI DP Maslach Burnout Inventory, scale ‘Depersonalization’ MBI EE Maslach Burnout Inventory, scale ‘Emotional Exhaustion’ MBI HSS Maslach Burnout Inventory-Human Services Survey MBI PA Maslach Burnout Inventory, scale ‘Personal Accomplishment’ MV mediator variable SD standard deviation SE standard error SF-36 PP Short Form 36, scale ‘Phyiscal Pain’ UCI upper limit of the 95 % confidence interval Declarations Funding This research did not receive external funding. Ethics statement The present study adhered to the guidelines of the Helsinki Declaration for the experimental investigation with human participants required by the University of Luxembourg. Ethics approval was obtained according to the ethics regulations of the psychology study programs of the University of Luxembourg. All participants provided informed consent before data collection. Conflict of interest disclosure The authors have no conflicts of interest to report. Acknowledgment We thank Moritz Igelmund for his help in data acquisition Data availability The data reported in this article are available on reasonable request. The data are not publicly available because the informed consent did not cover publication of raw or processed data. Author contribution Concecptualization: LM, AS. Study design: LM, CV, PS, AS. Data collection: LM. Data curation: LM. Data analysis: LM, CV, PS, AS. Manuscript writing/first draft: LM, AS. Manuscript writing/review and editing: LM, CV, PS, AS. References May T, Arnold C, Klas T, Möckel C, Maaß L, Hofmann T, u. a. Arbeitsunfähigkeit bei präklinischen Rettungskräften in Deutschland: Ergebnisse der EMS-Health-Studie. Zentralblatt Für Arbeitsmedizin Arbeitsschutz Ergon. Mai 2023;73(3):120–8. Herr D, Bhatia S, Breuer F, Poloczek S, Pommerenke C, Dahmen J. Increasing emergency number utilisation is not driven by low-acuity calls: an observational study of 1.5 million emergency calls (2018–2021) from Berlin. BMC Med. 16. Mai 2023;21(1):184. Wirtz PH, Siegrist J, Rimmele U, Ehlert U. Higher overcommitment to work is associated with lower norepinephrine secretion before and after acute psychosocial stress in men. Psychoneuroendocrinology. Januar 2008;33(1):92–9. Chen SW, Pikhart H, Peasey A, Pajak A, Kubinova R, Malyutina S, u. a. Work stress, overcommitment personality and alcohol consumption based on the Effort–Reward Imbalance model: A population–based cohort study. SSM - Popul Health. März 2023;21:101320. Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996;1(1):27–41. Siegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, u. a. The measurement of effort–reward imbalance at work: European comparisons. Soc Sci Med. April 2004;58(8):1483–99. Jasper S, Stephan M, Al-Khalaf H, Rennekampff HO, Vogt PM, Mirastschijski U. Too little appreciation for great expenditure? Workload and resources in ICUs. Int Arch Occup Environ Health. Oktober 2012;85(7):753–61. Li J, Galatsch M, Siegrist J, Müller BH, Hasselhorn HM. Reward frustration at work and intention to leave the nursing profession—Prospective results from the European longitudinal NEXT study. Int J Nurs Stud. Mai 2011;48(5):628–35. Van Vegchel N, De Jonge J, Bosma H, Schaufeli W. Reviewing the effort–reward imbalance model: drawing up the balance of 45 empirical studies. Soc Sci Med. März 2005;60(5):1117–31. Bentley MA, Crawford JM, Wilkins JR, Fernandez AR, Studnek JR. An Assessment of Depression, Anxiety, and Stress Among Nationally Certified EMS Professionals. Prehosp Emerg Care. Juli 2013;17(3):330–8. Bergin AJ, Jimmieson NL. Explaining psychological distress in the legal profession: The role of overcommitment. Int J Stress Manag. Mai 2013;20(2):134–61. Zhong J, You J, Gan Y, Zhang Y, Lu C, Wang H. Job Stress, Burnout, Depression Symptoms, and Physical Health among Chinese University Teachers. Psychol Rep. Dezember 2009;105(3_suppl):1248–54. Kinman G, Jones F. Effort‐reward imbalance, over‐commitment and work‐life conflict: testing an expanded model. Heraty N, Herausgeber. J Manag Psychol. 28. März 2008;23(3):236–51. Preckel D, Meinel M, Kudielka BM, Haug H, Fischer JE. Effort‐reward‐imbalance, overcommitment and self‐reported health: Is it the interaction that matters? J Occup Organ Psychol. März 2007;80(1):91–107. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory: Third edition. In: Evaluating stress: A book of resources. Lanham, MD, US: Scarecrow Education; 1997. S. 191–218. Szigeti R, Balázs N, Bikfalvi R, Urbán R. Burnout and depressive symptoms in teachers: Factor structure and construct validity of the Maslach Burnout inventory‐educators survey among elementary and secondary school teachers in Hungary. Stress Health. Dezember 2017;33(5):530–9. Ahola K, Honkonen T, Isometsä E, Kalimo R, Nykyri E, Aromaa A, u. a. The relationship between job-related burnout and depressive disorders—results from the Finnish Health 2000 Study. J Affect Disord. September 2005;88(1):55–62. Bakker AB, Demerouti E. The Job Demands‐Resources model: state of the art. J Manag Psychol. 3. April 2007;22(3):309–28. Naylor R. Key factors influencing psychological distress in university students: the effects of tertiary entrance scores. Stud High Educ. 4. März 2022;47(3):630–42. Hering T, Beerlage I. Arbeitsbedingungen, Belastungen und Burnout im Rettungsdienst. Notf Rettungsmedizin. Oktober 2004;7(6):415–24. Baier N, Roth K, Felgner S, Henschke C. Burnout and safety outcomes - a cross-sectional nationwide survey of EMS-workers in Germany. BMC Emerg Med. Dezember 2018;18(1):24. Loerbroks A, Weigl M, Li J, Angerer P. Effort-reward imbalance and perceived quality of patient care: a cross-sectional study among physicians in Germany. BMC Public Health. Dezember 2016;16(1):342. Koch P, Schablon A, Latza U, Nienhaus A. Musculoskeletal pain and effort-reward imbalance- a systematic review. BMC Public Health. Dezember 2014;14(1):37. Halonen JI, Virtanen M, Leineweber C, Rod NH, Westerlund H, Magnusson Hanson LL. Associations between onset of effort-reward imbalance at work and onset of musculoskeletal pain: analyzing observational longitudinal data as pseudo-trials. Pain. August 2018;159(8):1477–83. Rugulies R, Krause N. Effort-reward imbalance and incidence of low back and neck injuries in San Francisco transit operators. Occup Environ Med. 21. November 2007;65(8):525–33. Ohayon MM, Schatzberg AF. Chronic pain and major depressive disorder in the general population. J Psychiatr Res. Mai 2010;44(7):454–61. IsHak WW, Wen RY, Naghdechi L, Vanle B, Dang J, Knosp M, u. a. Pain and Depression: A Systematic Review. Harv Rev Psychiatry. November 2018;26(6):352–63. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. Third edition. New York ; London: The Guilford Press; 2022. 732 S. (Methodology in the social sciences). Beck AT, Steer RA, Brown G. Beck Depression Inventory–II [Internet]. 2011 [zitiert 19. Januar 2024]. Verfügbar unter: http://doi.apa.org/getdoi.cfm?doi=10.1037/t00742-000 Siegrist J, Diego Montano JL. Psychometric properties of the Effort-Reward Imbalance Questionnaire [Internet]. University of Duesseldorf; 2014 [zitiert 10. September 2023]. Verfügbar unter: https://www.uniklinik-duesseldorf.de/fileadmin/Fuer-Patienten-und-Besucher/Kliniken-Zentren-Institute/Institute/Institut_fuer_Medizinische_Soziologie/Dateien/ERI/ERI_Psychometric-New.pdf Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1994. Gillet N, Morin AJS, Mokounkolo R, Réveillère C, Fouquereau E. A person-centered perspective on the factors associated with the work recovery process. Anxiety Stress Coping. 3. September 2021;34(5):571–96. Jung S, Shin YC, Lee MY, Oh KS, Shin DW, Kim ES, u. a. Occupational stress and depression of Korean employees: Moderated mediation model of burnout and grit. J Affect Disord. Oktober 2023;339:127–35. Preckel D, Känel RV, Kudielka BM, Fischer JE. Overcommitment to work is associated with vital exhaustion. Int Arch Occup Environ Health. März 2005;78(2):117–22. Tzeng DS, Chung WC, Lin CH, Yang CY. Effort-reward imbalance and quality of life of healthcare workers in military hospitals: a cross-sectional study. BMC Health Serv Res. Dezember 2012;12(1):309. Siegrist J, Li J. Associations of Extrinsic and Intrinsic Components of Work Stress with Health: A Systematic Review of Evidence on the Effort-Reward Imbalance Model. Int J Environ Res Public Health. 19. April 2016;13(4):432. Hinsch DM, Spanier K, Radoschewski FM, Bethge M. Associations between overcommitment, effort–reward imbalance and mental health: findings from a longitudinal study. Int Arch Occup Environ Health. Mai 2019;92(4):559–67. Du Prel JB, Runeson-Broberg R, Westerholm P, Alfredsson L, Fahlén G, Knutsson A, u. a. Work overcommitment: Is it a trait or a state? Int Arch Occup Environ Health. Januar 2018;91(1):1–11. Feldt T, Hyvönen K, Mäkikangas A, Rantanen J, Huhtala M, Kinnunen U. Overcommitment as a predictor of effort–reward imbalance: evidence from an 8-year follow-up study. Scand J Work Environ Health. Juli 2016;42(4):309–19. Rugulies R, Aust B, Madsen IE. Effort–reward imbalance at work and risk of depressive disorders. A systematic review and meta-analysis of prospective cohort studies. Scand J Work Environ Health. Juli 2017;43(4):294–306. Lehr D, Hillert A, Keller S. What Can Balance the Effort? Associations between Effort-Reward Imbalance, Overcommitment, and Affective Disorders in German Teachers. Int J Occup Environ Health. Oktober 2009;15(4):374–84. Lin T, Lin H, Cheng S, Wu L, Ou‐Yang M. Work stress, occupational burnout and depression levels: a clinical study of paediatric intensive care unit nurses in T aiwan. J Clin Nurs. April 2016;25(7–8):1120–30. Violanti JM, Mnatsakanova A, Andrew ME, Allison P, Gu JK, Fekedulegn D. Effort–Reward Imbalance and Overcommitment at Work: Associations With Police Burnout. Police Q. Dezember 2018;21(4):440–60. Martin F, Poyen D, Bouderlique E, Gouvernet J, Rivet B, Disdier P, u. a. Depression and Burnout in Hospital Health Care Professionals. Int J Occup Environ Health. Juli 1997;3(3):204–9. Beasley TM. Tests of Mediation: Paradoxical Decline in Statistical Power as a Function of Mediator Collinearity. J Exp Educ. 3. Juli 2014;82(3):283–306. Herr RM, Bosch JA, Loerbroks A, Van Vianen AEM, Jarczok MN, Fischer JE, u. a. Three job stress models and their relationship with musculoskeletal pain in blue- and white-collar workers. J Psychosom Res. November 2015;79(5):340–7. Blackburn‐Munro G, Blackburn‐Munro RE. Chronic Pain, Chronic Stress and Depression: Coincidence or Consequence? J Neuroendocrinol. Dezember 2001;13(12):1009–23. Lundberg U. Psychophysiology of work: Stress, gender, endocrine response, and work‐related upper extremity disorders*. Am J Ind Med. Mai 2002;41(5):383–92. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 May, 2025 Read the published version in Journal of Occupational Medicine and Toxicology → Version 1 posted Editorial decision: Revision requested 13 Mar, 2025 Reviews received at journal 11 Mar, 2025 Reviewers agreed at journal 18 Feb, 2025 Reviews received at journal 13 Feb, 2025 Reviewers agreed at journal 24 Jan, 2025 Reviewers invited by journal 16 Jan, 2025 Editor assigned by journal 16 Jan, 2025 Submission checks completed at journal 14 Jan, 2025 First submitted to journal 14 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5825856","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":402042855,"identity":"20bc6d67-8f2e-42cf-aa97-c2dd9d74b6e7","order_by":0,"name":"Laura Manns","email":"","orcid":"","institution":"University of Luxembourg","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Manns","suffix":""},{"id":402042858,"identity":"c9779d13-7a9f-438d-a6d8-676f62b5b844","order_by":1,"name":"Claus Vögele","email":"","orcid":"","institution":"University of Luxembourg","correspondingAuthor":false,"prefix":"","firstName":"Claus","middleName":"","lastName":"Vögele","suffix":""},{"id":402042860,"identity":"8adecbc2-47f0-4ac9-9d5e-d3c0fe64cda6","order_by":2,"name":"Pascal Stammet","email":"","orcid":"","institution":"University of Luxembourg","correspondingAuthor":false,"prefix":"","firstName":"Pascal","middleName":"","lastName":"Stammet","suffix":""},{"id":402042862,"identity":"26bbb142-eeaf-429f-8049-875fe33c8ba1","order_by":3,"name":"André Schulz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYHACAyjJ3MDwgYGBh4GdeC2MDYwzQFqYSdHCzANiEdLCP7t524cPDHXy5hKJzZ9t2+7IMDDzGODVInHnWPHMGQyHDXfOSGwwzm17xkNQC8ONHGOgew4kGNxIbEjObTtMWIs8SMsfhjqwlsOWxGgxAGkBehmkpbGZkRgthjfSihl7DA4bbjjzsJmx59xhHjZmtgK8WuRuJG9m+FFRJ29wPPnwhx9lh+352Zs34NUCdR4Sm40I9aNgFIyCUTAKCAAAirE+3YiBVP4AAAAASUVORK5CYII=","orcid":"","institution":"University of Luxembourg","correspondingAuthor":true,"prefix":"","firstName":"André","middleName":"","lastName":"Schulz","suffix":""}],"badges":[],"createdAt":"2025-01-14 09:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5825856/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5825856/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12995-025-00461-w","type":"published","date":"2025-05-21T15:58:39+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73989541,"identity":"d04f966d-dab7-4d4b-855b-8df474627988","added_by":"auto","created_at":"2025-01-16 16:44:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18538,"visible":true,"origin":"","legend":"\u003cp\u003eMediation hypothesis based on Hayes’ model 81. It is hypothesized that OC will lead to depression symptoms, mediated by ERI in a first step, as well as burnout symptoms and physical pain in a second step.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5825856/v1/2afc133456c59a1323f814e3.png"},{"id":83460143,"identity":"185b337c-afd7-489a-a26e-75c17e26b2e4","added_by":"auto","created_at":"2025-05-26 16:11:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":684457,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5825856/v1/f79a2bc4-4fc1-40c8-92fc-79ac3f7648bf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effort-reward-imbalance, burnout, and physical pain mediate the relationship between overcommitment and depression in German Emergency Medical Technicians","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe rising prevalence of depression\u0026nbsp;in German health-care employees in recent years, especially in Emergency Medical Technicians (EMT), and the resulting inability to work, constitutes an important public concern (1). The increasing number of emergency calls- and responses has led to escalating workloads for EMTs (2), and those who are overcommitted to their work may be at particular risk. Previous studies found a strong link between overcommitted behavior and the occurrence of depression symptoms (3). Little is known, however, about the interaction and mediating factors between overcommitment (OC) and depression symptoms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOC as a personality trait can contribute to occupational stress (4). The Effort-Reward Imbalance (ERI) model is a well-established theoretical framework in occupational health. The model was developed and introduced by (5), positing that occupational stress arises from an imbalance between efforts at work and rewards received. It comprises the three main components \u003cem\u003eeffort, reward\u0026nbsp;\u003c/em\u003eand \u003cem\u003eOC\u003c/em\u003e. Effort refers to demands or pressure at work, whereas rewards include salary, esteem and career opportunities. OC describes a personality trait, contributing to high work-related commitment (6). Stress results from an imbalance between perceived efforts and perceived rewards. Overcommitted behavior could, therefore, lead to an imbalance by expanding work-related efforts but not increasing rewards. Previous studies showed that especially occupational groups working in health care are prone to experiencing OC and ERI (7,8). In their review (9) conclude that OC in health care employees occurs due to feelings of responsibility for their patients’ care. With increasing numbers of emergency calls and -responses, which is not accompanied by a concomitant rise in the number of employees, overcommitted EMTs may be at increased risk for experiencing ERI, resulting in work-related stress.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(10) found that depression among Emergency medical service (EMS) employees mainly occurs due to work-life characteristics, such as OC and ERI. Recent studies explored the direct link between OC and depression, assuming that OC directly affects the occurrence of depression symptoms (11,12). Some findings, however, suggest that the relationship between OC and depression is complex and multifaceted, in that the effect of OC on depression is due to ERI and prolonged experiences of work-related stress (13,14). The question arises whether the relationship between OC and depression symptoms is mediated by ERI. Hence, in the current study we aimed at testing for this partial mediation effect (i.e. direct and indirect effect of OC on depression).\u003c/p\u003e\n\u003cp\u003eProlonged exposure to job-related stress may result in burnout (15) with the main dimensions emotional exhaustion, depersonalization and reduced personal accomplishment. Several studies investigating the link between OC, ERI, and burnout, as well as between burnout and depression symptoms, found that ERI and OC are determinants of burnout (16), which in turn predicts depression (17). A model explaining the link between OC, ERI, burnout and depression symptoms is the Job Demands-Resources (JD-R) model (18), stating that high job demands but low job resources lead to a state of cynicism and emotional exhaustion. If this state persists, it may result in an inability to effectively cope with job demands, leading to chronic stress and, therefore, increasing depression symptoms (19). (20) pointed out that increasing numbers of emergency calls and -responses and decreasing recovery or relaxation periods are amongst the main factors leading to burnout in EMS-employees. Moreover, it was found that high levels in ERI and symptoms of burnout in EMTs lead to lower quality of perceived patient care (21,22), suggesting a significant negative effect for the patients concerned. Due to their relationship with OC, ERI, and depression, we included burnout dimensions as additional factors in our mediation model.\u003c/p\u003e\n\u003cp\u003eIn addition to mental health impairments the prolonged exposure to job-related stress has been associated with musculoskeletal pain and other physical health issues. A review by (23) found that mainly ERI, but not OC, was directly related to musculoskeletal pain, in that employees who showed high levels of ERI reported musculoskeletal pain more frequently than employees reporting low levels of ERI. Other studies report similar findings, indicating that ERI is associated with neck-shoulder pain (24), and low back and hip pain (25), especially in high-stress professions, such as EMS or police work. Furthermore, previous studies suggest that physical pain has an impact on the occurrence of depression symptoms (26). A review by (27) not only showed a relationship between pain and depression, but also that the coexistence of depression and pain leads to the prolonged presence of symptoms. Given that physical pain is correlated with ERI, but not with OC (Koch et al., 2014), it appears plausible that physical pain also mediates the relationship between ERI and depression.\u003c/p\u003e\n\u003cp\u003eGiven the complexity of the associations between OC, ERI, burnout, pain, and depression, particularly in the high-stress context of EMS work, the aim of the current study was to examine a two-step mediation model to explain their inter-relationship. A better understanding of the mechanisms underlying work stress and health in EMTs may contribute to the development of more effective prevention and intervention approaches. We expected to find a direct effect of OC on depression symptoms. First, we hypothesized that OC increases ERI. Second, we expected the relationship between ERI and depression symptoms to be mediated by burnout and physical pain. To test these assumptions, we collected data using an online questionnaire, addressing German EMTs. To examine the relationship between the variables, a mediation analysis was conducted using Hayes’ model 81 in the PROCESS Macro (28). We hypothesized that OC directly predicts depression symptoms. We also hypothesized that OC has an indirect effect on depression symptoms, first, through ERI, and second, through ERI, as well as burnout and physical pain as chain mediator variables.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Participants and Procedure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this cross-sectional study 325 volunteers all over Germany participated. The sample size after exclusion of participants, who did not meet the inclusion criteria was \u003cem\u003eN\u003c/em\u003e = 303 participants. Inclusion criteria were the job qualifications EMT-P and EMT-I, based in Germany as well as employment more than 10%. Two-hundred-twenty participants were EMT-Paramedic (EMT-P) and 93 EMT-Intermediate (EMT-I), based in Germany. The sample consisted of 197 men, 112 women and one non-binary participant. Two-hundred-twenty participants worked twelve-hour shifts, 25 worked eight-hours, 47 worked 24-hours shifts, seven worked ten-hours, three eleven-hours and one participant worked six-hours shifts. The mean age was 33.1 years (SD = 10.27 years). The mean for years in job was 10.7 years (\u003cem\u003eSD\u003c/em\u003e = 9.01). The average weekly working hours were 93.85% for a full-time position (\u003cem\u003eSD\u003c/em\u003e = 17.09). Exclusion criteria were part-time employment less than 10% and a job qualification as a Medical Doctor.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe recruitment took place from 10/11/2023 to 12/15/2023 via social media, EMS-Platforms (e.g. QM-Platform) or invitations via E-Mail, including the link to the online survey. The survey was designed as self-assessment. All questionnaires were approved for self-assessment and online suitable. Since there was no compensation offered, it is likely only EMTs took part in the survey. Participants provided informed consent and were informed of their right to discontinue their participation at any time. Ethics approval was obtained according to the ethics regulations of the psychology study programs of the University of Luxembourg.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.1 Socio-demographics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSocio-demographic\u003c/em\u003e data was collected including age, gender, and long-term medication intake (yes or no). Job-related data was collected including qualification (EMT-P, EMT-I), employment status (in percent) and years employed as EMT. These items were used as descriptive and confounding variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.2 Depression symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepression symptoms were assessed with the 21-items Beck Depression Inventory-II (BDI-II) (29). Responses were rated on a four-point scale (0-3). Items are summed up to create a scale score ranging from 0-36. Scores ranging from 14-19 indicate a mild level of depression, scores ranging from 20-28 indicate a moderate level of depression and scores ranging from 29-63 indicate a severe level of depression. Cronbach’s α coefficient for the BDI-II in this study was .93.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.3 OC and ERI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOC and ERI were measured with the 22-items version of the ERI Questionnaire (30), consisting of the three scales Effort, Reward and OC. Responses are provided on a four-point Likert scale assessing the level of agreement ranging from \u003cem\u003eStrongly disagree\u003c/em\u003e (1) to \u003cem\u003eStrongly agree\u0026nbsp;\u003c/em\u003e(4). Scale scores are summed up. OC was measured by six items, with scores ranging from 6-24. Effort was measured by six items with scores ranging from 6-24, and Reward was measured by ten items with scores ranging from 10-40. Higher scores indicate higher levels for the respective scale. The recommended analysis procedure for the ERI involves computing the ER-Ratio, with a cut-off point of one. Scores above one indicate a high ERI.In this study, Cronbach’s α coefficients in this study were .68 for OC, .67 for Effort and .82 for Reward.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.4 Burnout\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe assessed burnout with the 22-items version of Maslach Burnout Inventory-Human Services Survey (MBI-HSS) (15). The MBI-HSS measures Burnout in three dimensions: Emotional Exhaustion (MBI EE) with nine items, Depersonalization (MBI DP) with five items, and Personal Accomplishment (MBI PA) with eight items. Responses are given on a seven-point Likert scale ranging from \u003cem\u003enever\u003c/em\u003e (1) to \u003cem\u003eevery day\u0026nbsp;\u003c/em\u003e(7). Item scores of the respective scales are summed up to create scale scores. For MBI EE, a score less than 17 indicates a low level of MBI EE, a score ranging from 18-29 indicates a moderate level and a score above 30 a high level. For MBI DP a score less than 5 indicates a low level, a score ranging from six to eleven indicates a moderate level and a score above twelve a high level. For MBI PA, a score less than 33 indicates a low level, a score ranging from 34-39 indicates a moderate level and a score above 40 a high level. High levels for MBI EE and MBI DP, as well as a low level for MBI PA indicate a severe Burnout level. In this study, Cronbach’s α coefficients were .91for Emotional Exhaustion, .73 for Depersonalization and .74 for Personal Accomplishment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.5 Physical pain\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysical pain (SF-36 BP) was assessed with the subscale bodily pain of the SF-36 health survey questionnaire (31). The subscale consists of two items. The first item “How much bodily pain have you had over the past 4 weeks?” is measured with a six-point scale from \u003cem\u003eNone\u0026nbsp;\u003c/em\u003e(1) to \u003cem\u003eVery severe\u0026nbsp;\u003c/em\u003e(6). The second item, “During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?” is assessed with a five-point scale from \u003cem\u003eNot at all\u003c/em\u003e (1) to \u003cem\u003eExtremely\u003c/em\u003e (5). Item scales are summed up to a total score ranging from two to eleven. The higher the score the higher the level of pain indicated for the past four weeks. In this study, Cronbach’s α coefficient for Bodily Pain was .85.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe calculated Pearson correlations to examine the zero-order relationships between the dependent, independent and mediator variables.\u003c/p\u003e\n\u003cp\u003eThe mediation analysis was computed using IBM SPSS Statistics 29.0 and Hayes’ model 81 in the PROCESS Macro (28). For the mediation analysis, the dependent (depression symptoms), independent (OC) and mediator variables (ERI, burnout and physical pain), as well as confounds (age, qualification, long-term medication intake, years employed as EMT and time type) were added. The mediation model is shown in Fig. 1. Assumptions for mediation analysis were tested. Due to heteroscedasticity, the HC3 method was used. The number of bootstrap samples was 5000. The estimation of confidence intervals (CI) was 95%. If zero was included in CI, no mediating effect can be assumed.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Descriptives and correlations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean scores of OC in this sample was 15.08 (\u003cem\u003eSD\u003c/em\u003e = 2.62), for ERI 1.43 (\u003cem\u003eSD\u003c/em\u003e = 0.49), for MBI EE 29.79 (\u003cem\u003eSD\u003c/em\u003e = 11.14), for MBI DP 15.40 (\u003cem\u003eSD\u003c/em\u003e = 6.29), for MBI PA 34.85 (\u003cem\u003eSD\u0026nbsp;\u003c/em\u003e= 7.87), for SF-36 BP 4.36 (\u003cem\u003eSD\u003c/em\u003e = 2.3) and for BDI-II 15.41 (\u003cem\u003eSD\u003c/em\u003e = 10.48). The dependent (depression/BDI-II), independent (OC) and mediator variables (ERI, emotional exhaustion, depersonalization, personal accomplishment) are all positively inter-correlated (see Table 1), except for personal accomplishment, which showed a negative correlation with all other variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003ePearson correlations of dependent (DV), independent (IV) and mediator variables (MV).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"566\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1. OC (IV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2. ERI (MV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.461\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3. MBI EE (MV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.485\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.662\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4. MBI DP (MV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.347\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.471\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.692\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5. MBI PA (MV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.341\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.379\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.253\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.253\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6. SF-36 BP (MV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.247\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.382\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.369\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.282\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.346\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7. BDI II (DV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.474\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.581\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.697\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.496\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.472\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.471\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eN\u003c/em\u003e = 303\u003c/p\u003e\n\u003cp\u003e** \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Mediation analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results for each path of the mediation analysis are displayed in Table 2 and results for indirect effects are displayed in Table 3. The analysis showed a significant positive direct effect for OC on BDI-II, and a positive significant indirect effect on BDI-II, indicating a partial mediation effect. OC predicted ERI, and ERI positively predicted BDI-II scores. In addition, ERI positively predicted the burnout dimensions MBI EE and MBI DP, as well as SF-36 BP. There was a significant negative association between ERI and the burnout dimension MBI PA. MBI EE and SF-36 BP positively predicted BDI-II scores, whereas MBI PA negatively predicted BDI-II scores. MBI DP and BDI-II scores were unrelated.\u003c/p\u003e\n\u003cp\u003eFor the parallel mediators, a contrast in indirect effects was observed for MBI EE and SF-36 BP, \u003cem\u003eb\u003c/em\u003e = .313, BCa 95% CI [.135, .514], indicating a larger effect for MBI EE.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eResults of the serial and parallel mediation analysis for each mediation model\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003cimg src=\"data:image/png;base64,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\" width=\"609\" height=\"693\"\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e = 303; \u003cem\u003eB\u0026nbsp;\u003c/em\u003e= regression coefficient; \u003cem\u003eSE\u0026nbsp;\u003c/em\u003e= standard error; \u003cem\u003et\u003c/em\u003e = t-test value; \u003cem\u003eLCI\u003c/em\u003e = lower limit of the 95 % confidence interval; \u003cem\u003eUCI\u0026nbsp;\u003c/em\u003e= upper limit of the 95 % confidence interval\u003c/p\u003e\n\u003cp\u003eModel 1: OC \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e ERI;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eModel 2: OC \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e ERI \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e MBI EE;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eModel 3: OC \u003cstrong\u003e\u0026rarr;\u0026nbsp;\u003c/strong\u003eERI \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e MBI DP;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eModel 4: OC \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e ERI \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e MBI PA;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eModel 5: OC \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e ERI \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e SF-36 BP;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eModel 6: OC \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e ERI \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e MBI EE, MBI DP, MBI PA, SF-36 BP \u003cstrong\u003e\u0026rarr;\u003c/strong\u003e BDI-II\u003c/p\u003e\n\u003cp\u003e*** \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001; ** \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01; * \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eEffects and indirect effects of the mediation analysis of OC on depression via ERI, burnout and physical pain, shown for the different paths\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eBootstrap LCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eBootstrap UCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eTotal effect OC on BDI-II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.935\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2.369\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e8.753\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eDirect effect OC on BDI-II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e.494\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2.799\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eTotal indirect effect OC on BDI-II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eIndirect effect via ERI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eIndirect effect via ERI and MBI EE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eIndirect effect via ERI and MBI DP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eIndirect effect via ERI and MBI PA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eIndirect effect via ERI and SF-36 BP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e = 303; \u003cem\u003eB\u0026nbsp;\u003c/em\u003e= regression coefficient; \u003cem\u003eSE\u0026nbsp;\u003c/em\u003e= standard error; \u003cem\u003et\u003c/em\u003e = t-test value; \u003cem\u003eLCI\u003c/em\u003e = lower limit of the 95 % confidence interval; \u003cem\u003eUCI\u0026nbsp;\u003c/em\u003e= upper limit of the 95 % confidence interval\u003c/p\u003e\n\u003cp\u003e*** \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001; ** \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01; * \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eTo the best of our knowledge this is the first study to investigate the relationship betweenOC and depression, and the mediating role of ERI, burnout and physical pain in German EMTs. We hypothesized that OC directly and indirectly predicts depression. Furthermore, it was hypothesized that the relationship is mediated by ERI in a first step, and by burnout and physical pain in a second step. Our findings support both hypotheses, as a partial mediation effect was observed, although limited to the burnout facets of emotional exhaustion and personal accomplishment, as well as to physical pain.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study we found that OC has both a direct and an indirect effect on depression in EMTs. This finding demonstrates that EMTs who are overcommitted to their work, such as to be expected increasing emergency calls and -responses, are more at risk to experience higher levels of depression. (32) reported that individuals who are overcommitted might struggle to detach from their work, leading to difficulties in relaxation. An inadequate detachment from work can result in insufficient recovery periods, thereby leading to elevated levels of stress and facilitating depression symptoms. Our results are also in line with previous studies examining the relation between OC and reduced overall mental health (Jung et al., 2023; Preckel et al., 2005). For example, OC has been directly linked to increased anxiety (11), higher job stress levels (35), sleep disturbances, and cardiovascular disorders that are linked to stress (36). Our findings support the key role of OC for mental health in EMTs, suggesting that prevention and intervention programs should target EMTs with high OC.\u003c/p\u003e\n\u003cp\u003eThe results further support our hypothesis that ERI mediates the association of OC and depression. EMTs who are overcommitted might experience higher levels of ERI, which might contribute to increasing depression symptoms. The ERI-Model (5) suggests that stress at work can be caused by the mismatch in perceived effort compared to perceived reward. Employees who show overcommitted behavior tend to work beyond their capacities, thus exerting excessive effort (37), which contributes to the mismatch in perceived effort compared to perceived reward. Other studies (38,39) also found evidence that OC as a personality trait is a risk factor for experiencing ERI and work-related stress. Further contributing to our findings, Rugulies et al. (2017) reported in their meta-analysis ERI to be a significant risk factor for depression symptoms. There is no consistent evidence, however, for ERI mediating between OC and depression. (41) found that OC alone was not directly predictive for affective disorders in schoolteachers. Moreover, they found a strong link between ERI and depression symptoms, which was even stronger when introducing OC as a moderating variable. Another study examining the relationship between OC, ERI and mental health (37) found that ERI had no direct effect on mental health, unless OC was introduced as a mediator variable, stating OC to be a mediator between ERI and mental health. These findings are in contrast to our finding, that ERI mediates the association between OC and depression. An explanation for these inconsistencies might be that previous studies conceptualized OC as a coping mechanism rather than a personality trait as in the present study. If OC is conceived as a personality trait leading to an increase in job effort without concomitant increases in reward, this might result in ERI.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn partial disagreement with our hypothesis for burnout as a chain mediator between OC, ERI and depression, not all burnout dimensions turned out to be significant mediators, in that MBI DP did not show a significant mediating effect in our model. This suggests that overcommitted EMTs are more likely to experience higher levels in ERI, leading to higher levels in emotional exhaustion and lower levels in personal accomplishment, in turn leading to elevated levels in depression. The inconsistent mediation effect of the burnout scales differs from previous studies (12,42), who found burnout to mediate between work-related stress and depression symptoms. In Violanti et al. (2018) people with higher scores in ERI and OC showed higher scores in depersonalization and emotional exhaustion, whereas in Martin et al. (1997) higher scores in depersonalization and emotional exhaustion strongly predicted the severity of depression symptoms. Our findings of emotional exhaustion as the strongest chain mediator between ERI and depression imply that future prevention and intervention programs in EMTs should particularly focus on the reduction of emotional exhaustion.\u003c/p\u003e\n\u003cp\u003eAn explanation for this contradicting finding might be that due to high correlations between emotional exhaustion and depersonalization, it is possible that both dimensions affect depression levels, resulting in a non-mediating effect of depersonalization (45). This assumption is supported by our finding that, concerning the parallel mediators, the burnout dimension of emotional exhaustion seems to have the strongest mediating effect. An alternative explanation is that the role of emotional exhaustion as a chain mediator of OC, ERI and depression may be a specific characteristic of EMTs. Future studies should compare EMTs with comparable social services with regard to OC, ERI, burnout and depression to test the specificity of this pattern.\u003c/p\u003e\n\u003cp\u003eOur findings further demonstrate a mediating effect through physical pain as a chain mediator between OC, ERI and depression. There is evidence (Herr et al., 2015) suggesting that work-related stress enhances the probability of musculoskeletal pain. Due to higher work-related stress experiences, muscle tensions can be enhanced, hence causing physical pain, which may contribute to depression symptoms (47,48). Our findings not only suggest that burnout, but also physical symptoms may be affected by OC/ERI, finally contributing to mental health in EMTs. Hence, the modification of the antecedents of OC and ERI, such as a reduction of workload, an increase of monetary compensation or an extension of relaxation periods, have the potential to positively affect both physical and mental health in EMTs.\u003c/p\u003e\n\u003cp\u003eOur findings have theoretical implications for the mechanisms linking occupational stress and mental health, by contributing to a better understanding of the interaction between OC and depression in EMTs. The complexity of the mediation model suggests that simple linear models might not be sufficient to understand the relationship between occupational stress and mental health outcomes. Moreover, our findings emphasize the importance of integrating indicators of physical and mental health. Furthermore, the differences between the burnout dimensions in mediating effects demonstrate the necessity to integrate emotional exhaustion, depersonalization and personal accomplishment as separate variables to predict mental health in EMTs.\u003c/p\u003e\n\u003cp\u003eThese results have important practical implications in the field of EMS, in that they demonstrate the need to support mental health and decrease the number of EMTs experiencing depression symptoms by managing OC effectively. Especially EMTs who are highly overcommitted, and those with high levels of emotional exhaustion are at risk of experiencing physical and mental health impairments. Therefore, EMS organizations should consider implementing stress management programs and trainings on effective coping strategies to handle work related stress and OC. EMS organizations should also consider organizational changes, reducing excessive job demands and improving rewards, thereby reducing perceived ERI. Considering the increase in emergency calls and -responses over the last years, and the associated strain (= \u003cem\u003eeffort\u003c/em\u003e), our findings highlight the importance to increase \u003cem\u003erewards\u003c/em\u003e, thereby protecting EMTs from occupational stress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLimitations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, the current study used a cross-sectional design. As the mediation model was based on theoretical assumptions, it might well be that statistical effects show equal significance levels when re-arranging them, although with a lower conceptual validity of the model. To draw conclusions on causalities between these variables a longitudinal design is needed. Furthermore, a longitudinal design would provide insights into the evolvement of the relationship between OC and depression, as well as their mediation over time. Notwithstanding, the current results suggest a complex relationship between OC and depression, as well as their mediation by ERI, burnout and physical pain. Second, the sample in this study was relatively young with a mean age of 33.1 years (SD = 10.27 years) and this may, therefore, limit the results’ generalizability to EMTs in general. As age was unrelated to all other variables in our mediation models, however, this assumption seems not to be supported by our data. Third, this study included only EMS employees in Germany, limiting the applicability of the results to EMTs in general. Future studies should examine the mediation model in other professions as well. The data in this study relies on self-reported data, introducing biases such as social desirability. However, the data was anonymously collected via online platforms, keeping biases like social desirability at a minimum.\u0026nbsp;\u003c/p\u003e\n\n"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrates that the relationship between OC and depression is partially mediated by ERI (first step), as well as burnout (emotional exhaustion, personal accomplishment) and physical pain (second step) in German EMTs. Emotional exhaustion was identified as strongest chain mediator of the second step. Furthermore, OC still has a direct positive effect on depression symptoms. Our findings demonstrate the need for prevention and intervention programs to target OC/ERI and burnout (e.g., effective stress management strategies and organizational changes in EMS) to reduce risk factors for mental- and physical health impairments.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBDI-II \u0026nbsp;Beck Depression Inventory-II\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;confidence interval\u003c/p\u003e\n\u003cp\u003eDV \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;dependent variable\u003c/p\u003e\n\u003cp\u003eERI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Effort-Reward Imbalance\u003c/p\u003e\n\u003cp\u003eEMS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;emergency medical service\u003c/p\u003e\n\u003cp\u003eEMT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;emergency medical technicians\u003c/p\u003e\n\u003cp\u003eEMT-P \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;EMT-Paramedic\u003c/p\u003e\n\u003cp\u003eEMT-S \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;EMT-Intermediate\u003c/p\u003e\n\u003cp\u003eOC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;overcommitment\u003c/p\u003e\n\u003cp\u003eIV\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;independent variable\u003c/p\u003e\n\u003cp\u003eJD-R model \u0026nbsp; \u0026nbsp;\u0026nbsp;Job Demands-Resources model\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;lower limit of the 95 % confidence interval\u003c/p\u003e\n\u003cp\u003eMBI DP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Maslach Burnout Inventory, scale \u0026lsquo;Depersonalization\u0026rsquo;\u003c/p\u003e\n\u003cp\u003eMBI EE \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Maslach Burnout Inventory, scale \u0026lsquo;Emotional Exhaustion\u0026rsquo;\u003c/p\u003e\n\u003cp\u003eMBI HSS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Maslach Burnout Inventory-Human Services Survey\u003c/p\u003e\n\u003cp\u003eMBI PA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Maslach Burnout Inventory, scale \u0026lsquo;Personal Accomplishment\u0026rsquo;\u003c/p\u003e\n\u003cp\u003eMV \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;mediator variable\u003c/p\u003e\n\u003cp\u003eSD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; standard deviation SE standard error\u003c/p\u003e\n\u003cp\u003eSF-36 PP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Short Form 36, scale \u0026lsquo;Phyiscal Pain\u0026rsquo;\u003c/p\u003e\n\u003cp\u003eUCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; upper limit of the 95 % confidence interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study adhered to the guidelines of the Helsinki Declaration for the experimental investigation with human participants required by the University of Luxembourg. Ethics approval was obtained according to the ethics regulations of the psychology study programs of the University of Luxembourg. All participants provided informed consent before data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Moritz Igelmund for his help in data acquisition\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data reported in this article are available on reasonable request. The data are not publicly available because the informed consent did not cover publication of raw or processed data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcecptualization: LM, AS. Study design: LM, CV, PS, AS. Data collection: LM. Data curation: LM. Data analysis: LM, CV, PS, AS. Manuscript writing/first draft: LM, AS. Manuscript writing/review and editing: LM, CV, PS, AS.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMay T, Arnold C, Klas T, M\u0026ouml;ckel C, Maa\u0026szlig; L, Hofmann T, u. a. Arbeitsunf\u0026auml;higkeit bei pr\u0026auml;klinischen Rettungskr\u0026auml;ften in Deutschland: Ergebnisse der EMS-Health-Studie. Zentralblatt F\u0026uuml;r Arbeitsmedizin Arbeitsschutz Ergon. Mai 2023;73(3):120\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eHerr D, Bhatia S, Breuer F, Poloczek S, Pommerenke C, Dahmen J. Increasing emergency number utilisation is not driven by low-acuity calls: an observational study of 1.5 million emergency calls (2018\u0026ndash;2021) from Berlin. BMC Med. 16. Mai 2023;21(1):184. \u003c/li\u003e\n\u003cli\u003eWirtz PH, Siegrist J, Rimmele U, Ehlert U. Higher overcommitment to work is associated with lower norepinephrine secretion before and after acute psychosocial stress in men. Psychoneuroendocrinology. Januar 2008;33(1):92\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eChen SW, Pikhart H, Peasey A, Pajak A, Kubinova R, Malyutina S, u. a. Work stress, overcommitment personality and alcohol consumption based on the Effort\u0026ndash;Reward Imbalance model: A population\u0026ndash;based cohort study. SSM - Popul Health. M\u0026auml;rz 2023;21:101320. \u003c/li\u003e\n\u003cli\u003eSiegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996;1(1):27\u0026ndash;41. \u003c/li\u003e\n\u003cli\u003eSiegrist J, Starke D, Chandola T, Godin I, Marmot M, Niedhammer I, u. a. The measurement of effort\u0026ndash;reward imbalance at work: European comparisons. Soc Sci Med. April 2004;58(8):1483\u0026ndash;99. \u003c/li\u003e\n\u003cli\u003eJasper S, Stephan M, Al-Khalaf H, Rennekampff HO, Vogt PM, Mirastschijski U. Too little appreciation for great expenditure? Workload and resources in ICUs. Int Arch Occup Environ Health. Oktober 2012;85(7):753\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eLi J, Galatsch M, Siegrist J, M\u0026uuml;ller BH, Hasselhorn HM. Reward frustration at work and intention to leave the nursing profession\u0026mdash;Prospective results from the European longitudinal NEXT study. Int J Nurs Stud. Mai 2011;48(5):628\u0026ndash;35. \u003c/li\u003e\n\u003cli\u003eVan Vegchel N, De Jonge J, Bosma H, Schaufeli W. Reviewing the effort\u0026ndash;reward imbalance model: drawing up the balance of 45 empirical studies. Soc Sci Med. M\u0026auml;rz 2005;60(5):1117\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eBentley MA, Crawford JM, Wilkins JR, Fernandez AR, Studnek JR. An Assessment of Depression, Anxiety, and Stress Among Nationally Certified EMS Professionals. Prehosp Emerg Care. Juli 2013;17(3):330\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eBergin AJ, Jimmieson NL. Explaining psychological distress in the legal profession: The role of overcommitment. Int J Stress Manag. Mai 2013;20(2):134\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eZhong J, You J, Gan Y, Zhang Y, Lu C, Wang H. Job Stress, Burnout, Depression Symptoms, and Physical Health among Chinese University Teachers. Psychol Rep. Dezember 2009;105(3_suppl):1248\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eKinman G, Jones F. Effort‐reward imbalance, over‐commitment and work‐life conflict: testing an expanded model. Heraty N, Herausgeber. J Manag Psychol. 28. M\u0026auml;rz 2008;23(3):236\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003ePreckel D, Meinel M, Kudielka BM, Haug H, Fischer JE. Effort‐reward‐imbalance, overcommitment and self‐reported health: Is it the interaction that matters? J Occup Organ Psychol. M\u0026auml;rz 2007;80(1):91\u0026ndash;107. \u003c/li\u003e\n\u003cli\u003eMaslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory: Third edition. In: Evaluating stress: A book of resources. Lanham, MD, US: Scarecrow Education; 1997. S. 191\u0026ndash;218. \u003c/li\u003e\n\u003cli\u003eSzigeti R, Bal\u0026aacute;zs N, Bikfalvi R, Urb\u0026aacute;n R. Burnout and depressive symptoms in teachers: Factor structure and construct validity of the Maslach Burnout inventory‐educators survey among elementary and secondary school teachers in Hungary. Stress Health. Dezember 2017;33(5):530\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAhola K, Honkonen T, Isomets\u0026auml; E, Kalimo R, Nykyri E, Aromaa A, u. a. The relationship between job-related burnout and depressive disorders\u0026mdash;results from the Finnish Health 2000 Study. J Affect Disord. September 2005;88(1):55\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eBakker AB, Demerouti E. The Job Demands‐Resources model: state of the art. J Manag Psychol. 3. April 2007;22(3):309\u0026ndash;28. \u003c/li\u003e\n\u003cli\u003eNaylor R. Key factors influencing psychological distress in university students: the effects of tertiary entrance scores. Stud High Educ. 4. M\u0026auml;rz 2022;47(3):630\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eHering T, Beerlage I. Arbeitsbedingungen, Belastungen und Burnout im Rettungsdienst. Notf Rettungsmedizin. Oktober 2004;7(6):415\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eBaier N, Roth K, Felgner S, Henschke C. Burnout and safety outcomes - a cross-sectional nationwide survey of EMS-workers in Germany. BMC Emerg Med. Dezember 2018;18(1):24. \u003c/li\u003e\n\u003cli\u003eLoerbroks A, Weigl M, Li J, Angerer P. Effort-reward imbalance and perceived quality of patient care: a cross-sectional study among physicians in Germany. BMC Public Health. Dezember 2016;16(1):342. \u003c/li\u003e\n\u003cli\u003eKoch P, Schablon A, Latza U, Nienhaus A. Musculoskeletal pain and effort-reward imbalance- a systematic review. BMC Public Health. Dezember 2014;14(1):37. \u003c/li\u003e\n\u003cli\u003eHalonen JI, Virtanen M, Leineweber C, Rod NH, Westerlund H, Magnusson Hanson LL. Associations between onset of effort-reward imbalance at work and onset of musculoskeletal pain: analyzing observational longitudinal data as pseudo-trials. Pain. August 2018;159(8):1477\u0026ndash;83. \u003c/li\u003e\n\u003cli\u003eRugulies R, Krause N. Effort-reward imbalance and incidence of low back and neck injuries in San Francisco transit operators. Occup Environ Med. 21. November 2007;65(8):525\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eOhayon MM, Schatzberg AF. Chronic pain and major depressive disorder in the general population. J Psychiatr Res. Mai 2010;44(7):454\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eIsHak WW, Wen RY, Naghdechi L, Vanle B, Dang J, Knosp M, u. a. Pain and Depression: A Systematic Review. Harv Rev Psychiatry. November 2018;26(6):352\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eHayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. Third edition. New York ; London: The Guilford Press; 2022. 732 S. (Methodology in the social sciences). \u003c/li\u003e\n\u003cli\u003eBeck AT, Steer RA, Brown G. Beck Depression Inventory\u0026ndash;II [Internet]. 2011 [zitiert 19. Januar 2024]. Verf\u0026uuml;gbar unter: http://doi.apa.org/getdoi.cfm?doi=10.1037/t00742-000\u003c/li\u003e\n\u003cli\u003eSiegrist J, Diego Montano JL. Psychometric properties of the Effort-Reward Imbalance Questionnaire [Internet]. University of Duesseldorf; 2014 [zitiert 10. September 2023]. Verf\u0026uuml;gbar unter: https://www.uniklinik-duesseldorf.de/fileadmin/Fuer-Patienten-und-Besucher/Kliniken-Zentren-Institute/Institute/Institut_fuer_Medizinische_Soziologie/Dateien/ERI/ERI_Psychometric-New.pdf\u003c/li\u003e\n\u003cli\u003eWare JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1994. \u003c/li\u003e\n\u003cli\u003eGillet N, Morin AJS, Mokounkolo R, R\u0026eacute;veill\u0026egrave;re C, Fouquereau E. A person-centered perspective on the factors associated with the work recovery process. Anxiety Stress Coping. 3. September 2021;34(5):571\u0026ndash;96. \u003c/li\u003e\n\u003cli\u003eJung S, Shin YC, Lee MY, Oh KS, Shin DW, Kim ES, u. a. Occupational stress and depression of Korean employees: Moderated mediation model of burnout and grit. J Affect Disord. Oktober 2023;339:127\u0026ndash;35. \u003c/li\u003e\n\u003cli\u003ePreckel D, K\u0026auml;nel RV, Kudielka BM, Fischer JE. Overcommitment to work is associated with vital exhaustion. Int Arch Occup Environ Health. M\u0026auml;rz 2005;78(2):117\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eTzeng DS, Chung WC, Lin CH, Yang CY. Effort-reward imbalance and quality of life of healthcare workers in military hospitals: a cross-sectional study. BMC Health Serv Res. Dezember 2012;12(1):309. \u003c/li\u003e\n\u003cli\u003eSiegrist J, Li J. Associations of Extrinsic and Intrinsic Components of Work Stress with Health: A Systematic Review of Evidence on the Effort-Reward Imbalance Model. Int J Environ Res Public Health. 19. April 2016;13(4):432. \u003c/li\u003e\n\u003cli\u003eHinsch DM, Spanier K, Radoschewski FM, Bethge M. Associations between overcommitment, effort\u0026ndash;reward imbalance and mental health: findings from a longitudinal study. Int Arch Occup Environ Health. Mai 2019;92(4):559\u0026ndash;67. \u003c/li\u003e\n\u003cli\u003eDu Prel JB, Runeson-Broberg R, Westerholm P, Alfredsson L, Fahl\u0026eacute;n G, Knutsson A, u. a. Work overcommitment: Is it a trait or a state? Int Arch Occup Environ Health. Januar 2018;91(1):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eFeldt T, Hyv\u0026Atilde;\u0026para;nen K, M\u0026Atilde;\u0026curren;kikangas A, Rantanen J, Huhtala M, Kinnunen U. Overcommitment as a predictor of effort\u0026ndash;reward imbalance: evidence from an 8-year follow-up study. Scand J Work Environ Health. Juli 2016;42(4):309\u0026ndash;19. \u003c/li\u003e\n\u003cli\u003eRugulies R, Aust B, Madsen IE. Effort\u0026ndash;reward imbalance at work and risk of depressive disorders. A systematic review and meta-analysis of prospective cohort studies. Scand J Work Environ Health. Juli 2017;43(4):294\u0026ndash;306. \u003c/li\u003e\n\u003cli\u003eLehr D, Hillert A, Keller S. What Can Balance the Effort? Associations between Effort-Reward Imbalance, Overcommitment, and Affective Disorders in German Teachers. Int J Occup Environ Health. Oktober 2009;15(4):374\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eLin T, Lin H, Cheng S, Wu L, Ou‐Yang M. Work stress, occupational burnout and depression levels: a clinical study of paediatric intensive care unit nurses in T aiwan. J Clin Nurs. April 2016;25(7\u0026ndash;8):1120\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eViolanti JM, Mnatsakanova A, Andrew ME, Allison P, Gu JK, Fekedulegn D. Effort\u0026ndash;Reward Imbalance and Overcommitment at Work: Associations With Police Burnout. Police Q. Dezember 2018;21(4):440\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eMartin F, Poyen D, Bouderlique E, Gouvernet J, Rivet B, Disdier P, u. a. Depression and Burnout in Hospital Health Care Professionals. Int J Occup Environ Health. Juli 1997;3(3):204\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eBeasley TM. Tests of Mediation: Paradoxical Decline in Statistical Power as a Function of Mediator Collinearity. J Exp Educ. 3. Juli 2014;82(3):283\u0026ndash;306. \u003c/li\u003e\n\u003cli\u003eHerr RM, Bosch JA, Loerbroks A, Van Vianen AEM, Jarczok MN, Fischer JE, u. a. Three job stress models and their relationship with musculoskeletal pain in blue- and white-collar workers. J Psychosom Res. November 2015;79(5):340\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eBlackburn‐Munro G, Blackburn‐Munro RE. Chronic Pain, Chronic Stress and Depression: Coincidence or Consequence? J Neuroendocrinol. Dezember 2001;13(12):1009\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eLundberg U. Psychophysiology of work: Stress, gender, endocrine response, and work‐related upper extremity disorders*. Am J Ind Med. Mai 2002;41(5):383\u0026ndash;92. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-occupational-medicine-and-toxicology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jmet","sideBox":"Learn more about [Journal of Occupational Medicine and Toxicology](http://occup-med.biomedcentral.com/)","snPcode":"12995","submissionUrl":"https://submission.nature.com/new-submission/12995/3","title":"Journal of Occupational Medicine and Toxicology","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Burnout, depression, effort-reward imbalance, overcommitment, paramedic, physical pain","lastPublishedDoi":"10.21203/rs.3.rs-5825856/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5825856/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eOvercommitment (OC) is highly prevalent in health care employees, and may predict depression symptoms. The literature suggests that the relationship between OC and depression is mediated by Effort-Reward-Imbalance (ERI), burnout and physical pain. This study tested a two-step mediation effect between OC and depression by ERI in a first, and burnout and physical pain in a second step using a cohort of German Emergency Medical Technicians (EMTs).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study was carried out on a volunteer sample of 303 EMTs in Germany. OC and ERI were assessed using the ERI questionnaire, burnout with the Maslach Burnout Inventory, physical pain with the Short Form 36, and depression with the BDI-II. The relationship between these variables was tested using a mediation analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eWe found a partial mediation effect between OC and depression via ERI, burnout (emotional exhaustion, personal accomplishment) and physical pain. The mediation effect of emotional exhaustion is significantly higher than those of depersonalization and physical pain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The partial mediation effect suggests the validity of our model assumptions, but also indicates direct relationships between variables (i.e. OC, ERI and depression). The identification of emotional exhaustion as key mediator implies that prevention and intervention approaches in EMTs should be based on this indicator.\u003c/p\u003e","manuscriptTitle":"Effort-reward-imbalance, burnout, and physical pain mediate the relationship between overcommitment and depression in German Emergency Medical Technicians","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-16 16:44:23","doi":"10.21203/rs.3.rs-5825856/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-13T12:12:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-11T18:38:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20416856094685034515715608652690379285","date":"2025-02-18T12:46:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-13T13:25:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151284816877354091798139926540055116531","date":"2025-01-24T12:50:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-16T15:51:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-16T15:50:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-14T13:44:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Occupational Medicine and Toxicology","date":"2025-01-14T09:24:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-occupational-medicine-and-toxicology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jmet","sideBox":"Learn more about [Journal of Occupational Medicine and Toxicology](http://occup-med.biomedcentral.com/)","snPcode":"12995","submissionUrl":"https://submission.nature.com/new-submission/12995/3","title":"Journal of Occupational Medicine and Toxicology","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b925e0f0-bd62-4cfa-8732-de2571b5fd56","owner":[],"postedDate":"January 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-26T16:04:59+00:00","versionOfRecord":{"articleIdentity":"rs-5825856","link":"https://doi.org/10.1186/s12995-025-00461-w","journal":{"identity":"journal-of-occupational-medicine-and-toxicology","isVorOnly":false,"title":"Journal of Occupational Medicine and Toxicology"},"publishedOn":"2025-05-21 15:58:39","publishedOnDateReadable":"May 21st, 2025"},"versionCreatedAt":"2025-01-16 16:44:23","video":"","vorDoi":"10.1186/s12995-025-00461-w","vorDoiUrl":"https://doi.org/10.1186/s12995-025-00461-w","workflowStages":[]},"version":"v1","identity":"rs-5825856","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5825856","identity":"rs-5825856","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}