Effort-Reward Imbalance Linked to Depression and Suicidal Ideation in German Dentists

A nationwide survey of German dentists has found that more than half of practising clinicians experience an unfavourable imbalance between the effort they invest in their work and the rewards they receive in return, and that this imbalance is significantly associated with depressive symptoms and suicidal ideation. The study, published in BMC Psychology, surveyed 589 practising dentists across Germany between July 2021 and February 2022 using a validated self-report questionnaire based on the Effort-Reward Imbalance model.

The Effort-Reward Imbalance model holds that a mismatch between professional effort and the rewards received—whether financial, esteem-related, or in terms of job security and career prospects—is linked to adverse mental health outcomes. Dentistry is considered a profession with substantial physical, psychological, and organizational demands, and the authors note that increasing administrative tasks and structural changes in dental health care may exacerbate such imbalances.

In the survey, the mean effort-reward ratio was 1.1, meaning that reported effort exceeded reported reward on average. Overall, 53.1 percent of participants showed an unfavourable imbalance. Depressive symptoms, measured with the Patient Health Questionnaire-2, were identified in 21.1 percent of respondents, and 11.7 percent reported suicidal ideation within the last two weeks, assessed with item 9 of the Patient Health Questionnaire-9.

Higher imbalance was significantly associated with increased depressive symptoms and with current suicidal ideation. The researchers used Spearman correlations to examine these associations, and a hierarchical linear regression analysis to identify predictors of the effort-reward ratio itself.

Three factors emerged as significant predictors of effort-reward imbalance: bureaucratic burden, age, and taking care of children. The identification of bureaucratic workload as a predictor is particularly notable because, unlike age or family circumstances, administrative burden is a modifiable feature of the working environment. The authors conclude that reducing bureaucratic workload and improving structural working conditions may help prevent and restore effort-reward balance, and may contribute to reducing depressive symptoms and suicidal ideation among dentists in Germany.

Sociodemographic, family-related, and occupational variables were collected via self-report. When the researchers compared male and female participants using chi-square tests and t-tests, they found no significant gender differences in the pattern of results.

Because the survey was cross-sectional, it captured a single point in time and cannot establish whether effort-reward imbalance causes depressive symptoms or suicidal ideation, or whether the reverse relationship holds. The findings describe associations within a self-selected sample of 589 practising dentists who responded to an online survey, and the questionnaire-based measures rely on self-report.

Within those limits, the study provides a nationwide snapshot of occupational stress in a profession facing growing administrative and structural pressures. The prevalence figures are striking: one in five respondents reported current depressive symptoms, and more than one in ten reported suicidal thoughts in the preceding two weeks, with these outcomes clustering among dentists reporting the greatest effort-reward imbalance.

The authors frame administrative burden as an important modifiable stressor and suggest that interventions targeting bureaucratic workload and structural working conditions could support both the prevention and restoration of effort-reward balance in the profession. Whether such interventions actually reduce depressive symptoms or suicidal ideation among dentists remains to be tested in future research.

Subject of Research: Effort-reward imbalance and its association with depression and suicidal ideation among German dentists

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

Article References: Geupel, A., Gaillard, P., Haak, R., & Glaesmer, H. (2026). Effort-Reward Imbalance, related risk factors and the association with depression and suicidal ideation in German dentists- BMC Psychology. BMC Psychology, 14(1), Article 1271. https://doi.org/10.1186/s40359-026-05490-6

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05490-6

Keywords: effort-reward imbalance, dentists, depression, suicidal ideation, occupational stress, bureaucratic burden, cross-sectional survey, Germany, mental health, PHQ-2, PHQ-9, Effort-Reward