The demand‐control‐support model: Methodological challenges for future research

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Abstract
The demand‐control‐support model was developed by R. Karasek and his colleagues during the 1980s. The model operates with three main dimensions: job demands, job decision latitude and job social support. According to the model, workers with jobs characterized by high demands, low decision latitude and low social support (so‐called iso‐strain) have a higher risk of poor psychological well‐being and cardiovascular diseases (CVD). The model has been tested in relation to CVD in 16 epidemiological studies of which only two have been negative. Moreover, the model has been used in studies with a large number of other endpoints. Recently the model and the methods used in connection with the model have been criticized by several research workers. In this article the studies on iso‐strain and CVD are reviewed and a number of methodological problems are discussed. It is recommended that future studies are prospective and use non‐representative population samples of well‐chosen occupations. Each of the key variables ‐job stressors, stress and sickness ‐ should be measured in three independent ways in order to increase the methodological and theoretical strength of the research performed.