Modelling occupational stress and health: the impact of the demand–control model on academic research and on workplace practice

Karesek's demand–control model has been extremely influential and is widely used to predict a range of health outcomes, yet there have been comparatively few intervention studies and relatively little evidence of its impact on the design of work to improve health. This article discusses the tension between meeting the need for a model of psychosocial work factors and health outcomes which is simple enough to be theoretically useful in multidisciplinary research over a wide range of occupations yet is specific enough to generate useful information to influence policies and guide interventions. It is suggested that the success of the model in driving research has led to the neglect of a range of other psychosocial factors. Furthermore, while the appeal of the model lies in its apparent simplicity, variables are too broadly defined and complex to easily translate research findings into practical recommendations. To provide more practically useful evidence about risk factors, it is suggested that epidemiological studies should employ more clearly defined and specific variables incorporated in more complex psychosocial models which take into account the work context and the changing nature of work.