Abstract Job stress is a risk factor for poor quality of life), but the mediating role of sleep quality is underexplored, particularly among medical university employees. This study examined the direct and indirect effects of job stress, measured using the effort-reward imbalance (ERI) model, on quality of life, with sleep quality as a hypothesized mediator. A cross-sectional analysis was conducted using data from 1,250 employees of Qazvin University of Medical Sciences in Iran. Participants completed validated instruments, including the effort-reward imbalance (ERI) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the World Health Organization Quality of life Instrument (WHOQOL-BREF). Structural equation modeling was employed to test the mediating role of sleep quality in the relationship between job stress and quality of life. Of the study participants, 61.0% exhibited effort-reward imbalance. This group reported poorer sleep quality and lower quality of life across all domains (physical, psychological, social, environmental). Structural equation modeling revealed that a higher ER ratio had a significant negative direct effect on quality of life (B = -1.31, p < 0.001) and a significant negative total effect (B = -2.80, p < 0.001). The total effect was partially mediated by global sleep quality (indirect effect B = -1.50, p < 0.001). Analysis of specific sleep components identified subjective sleep quality, and daytime dysfunction as significant mediating factors. This study demonstrated that job stress, conceptualized as effort-reward imbalance, is associated with the quality of life through both direct and indirect pathways, with sleep quality serving as a significant mediator. These findings highlight the need for integrated workplace interventions that enhance rewards, manage overcommitment, and promote sleep health to protect the well-being of medical university employees.
Hosseinkhani et al. (Sun,) studied this question.