The health-related impact of qualitative psychosocial work characteristics has been amply demonstrated, but research has predominantly focused on paid labour. In this context, a variety of studies have examined the health-related impact of effort-reward imbalance (ERI) [1
]. This model postulates that work characterized by high effort and low reward reflects a state of failed reciprocity between 'costs' and 'gains'. In case of an imbalance between high effort and low reward strong emotions of anger and frustration may emerge resulting in a sense of being treated unfairly. In the long run sustained activation of the autonomic nervous system may contribute to the development of physical and mental disease [2
]. A specific personality trait characterized by excessive work-related overcommitment increase the risk of ERI and is the most important reason for maintaining a high cost/low gain condition. Although the ERI model has primarily been used as a theoretical framework for explaining work-related health risks, Siegrist [4
] stresses that reciprocity of exchange is not confined to working life. It may be experienced in a similar way also in other domains, such as marital and parental relationships. Against this background, Knesebeck and Siegrist [5
] extended the ERI model to social relationships beyond paid work, namely marital and parental roles and less specific civic roles. Li et al. [6
] applied the model to school settings in order to analyse students' psychosocial stress and its association with self-rated health in adolescents. These studies provided first evidence that the ERI model may also be important outside the work-life.
As far as we know no studies exist where Siegrist's model had been applied to unpaid household and family work. However, there are analogies between paid and unpaid work justifying such an extension. Firstly, similarly to paid employment, household and family work are defining one's social identity and social status to a substantial degree. Secondly, unpaid work might be equally demanding, and some services such as caring, cooking and cleaning can also be purchased on the labour market. Thirdly and lastly, household and family work may also offer 'rewards' in terms of promoting self-esteem and may therefore provide the potential of experiencing a favourable self-concept.
However, there are also important differences between paid and unpaid work need to be taken into account. Constraints of demands in household and family work are often less pervasive and less obvious. Rewards received are more often of an emotional than of a material nature [5
]. For that reason, rewards as assessed with the original ERI questionnaire in terms of 'financial and career-related rewards', 'esteem rewards' and 'gratification of job security' cannot be generalized to unpaid work. Thus, we developed a new questionnaire taking the specific efforts given and rewards received in household and family work into account. Initially, a review of the literature was carried out to identify the relevant aspects of effort and reward in this domain. This review revealed that some crucial efforts of the original ERI also hold for work at home, in particular 'time pressure', 'interruptions and disturbances' and 'pressure to work overtime'. A more specific expression of effort in household and family work was 'unappreciated work' and 'the feeling of being available to others'. The household and family work was characterised as 'diffuse' and 'never-ending' [7
]. With respect to 'rewards' the review yielded that this work foremost provides interpersonal rewards, particularly with respect to child care [8
]. Baruch and Barnett [10
] concluded that women found the most rewarding aspects of the mother-role in the love of children, liking the kind of people they are, and pleasure in their accomplishments. For the role as a wife they also identified aspects related to the partner as important, in particular having an emotionally supporting partnership. Another source of reward is the meaning of the role as a mother and wife in persons' self-conception. In this perception a high value of being a mother and taking care for the family provides self-rewards resulting in better psychological well-being [11
]. On the other hand, it was reported that household and family work has little institutional recognition and social prestige, and the recognition of being a housewife has significantly decreased over the last decades [8
On the base of the literature review questionnaire items were generated and discussed with mothers as part of qualitative interviews. With their feedback in mind the questionnaire was developed and tested for reliability using clinical data of mothers with burnout [14
This paper reports findings of this questionnaire using data of a cross-sectional population survey of German mothers. In more detail, the study addresses the following questions:
1.) Can the theoretical model of ERI in household and family work be confirmed in a population sample?
2.) Does ERI differ with respect to socio-demographic factors and family-related characteristics?
3.) Is lack of reciprocity in household and family work associated with increased health risks in mothers?