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The present study adds sleep disturbances and fatigue to the list of adverse consequences of effort-reward imbalance.

High ERI is associated with a situation characterized by being locked-in within an occupation or/and within a place of work. The results thereby support the theoretical model of Effort-reward imbalance. The results show that high ERI and being locked in are associated with long-term sick leave. ERI is a potential mediator of the association between being locked in and sick leave.

Background: Effort-reward imbalance (ERI) is an established conceptualisation of work stress.