Effort-reward imbalance and long-term benzodiazepine use: longitudinal findings from the CONSTANCES cohort

J Epidemiol Community Health. 2019 Nov;73(11):993-1001. doi: 10.1136/jech-2019-212703. Epub 2019 Aug 12.

Abstract

Objectives: To examine the association between effort-reward imbalance and incident long-term benzodiazepine use (LTBU).

Methods: We included 31 077 employed participants enrolled in the French population-based CONSTANCES cohort between 2012 and 2014 who had not undergone LTBU in the 2 years before enrolment. LTBU was examined using drug reimbursement administrative databases. The effort-reward imbalance was calculated in quartiles. We computed ORs (95% CIs) for LTBU according to effort-reward imbalance over a 2-year follow-up period. We adjusted for age, gender, education, occupational grade, income, marital status, tobacco smoking, risk of alcohol use disorder, depressive symptoms and self-rated health.

Results: Over the 2-year follow-up, 294 (0.9%) participants experienced incident LTBU. In the univariable analysis, effort-reward imbalance was associated with subsequent LTBU with ORs of 1.79 (95% CI 1.23 to 2.62) and 2.73 (95% CI 1.89 to 3.95) for the third and fourth quartiles, respectively, compared with the first quartile. There was no interaction between effort-reward imbalance and any of the considered variables other than tobacco smoking (p=0.033). The association remained significant in both smokers and non-smokers, with higher odds for smokers (p=0.031). In the fully adjusted model, the association remained significant for the third and fourth quartiles, with ORs of 1.74 (95% CI 1.17 to 2.57) and 2.18 (95% CI 1.50 to 3.16), respectively. These associations were dose dependent (p for trend <0.001).

Conclusions: Effort-reward imbalance was linked with incident LTBU over a 2-year follow-up period after adjustment for sociodemographic and health-related factors. Thus, screening and prevention of the risk of LTBU should be systematised among individuals experiencing effort-reward imbalance, with special attention paid to smokers.

Keywords: addictive behaviour/addiction; depression; drug misuse; longitudinal studies; occupational health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Benzodiazepines / therapeutic use*
  • Depression / epidemiology*
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Humans
  • Insurance, Health, Reimbursement / statistics & numerical data*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Occupational Health
  • Occupational Stress / psychology*
  • Population Surveillance / methods*
  • Prospective Studies
  • Reward*
  • Stress, Psychological / epidemiology
  • Surveys and Questionnaires

Substances

  • Benzodiazepines