The Effects of Effort-Reward Imbalance and Sleep Quality on Depressive Symptoms in Train Drives: Wenhui ZHOU,et al.Henan Provincial Institute of Occupational Health,China—To investigate the relationships for effort-reward imbalance(ERI),sleep quality,and depressive symptoms in train drivers,a cross-sectional epidemiological study was conducted in 1402 train drivers including 75 EMU drivers or high-speed rail drivers,301 passenger train drivers,678 train freight drivers,and 348 passenger shunting drivers from a Railway Bureau in China.Extrinsic effort,occupational reward,and overcommitment were measured using the Chinese version of effort-reward imbalance questionnaire.Depressive symptoms were assessed by the Chinese version of Center for Epidemiologic Studies Depression Scale(CES-D).Sleep quality were evaluated by the Chinese version of Pittsburgh Sleep Quality Index(PSQI).This study showed that 955 subjects(68.1%)were classified as people with depressive symptoms(DES-D score≥19)among the1402 subjects.In particular,a depressive symptoms rate in EMU drivers or high-speed train drivers was highest(74.7%); After adjusted for confounders,both high efforts and low rewards(OR=4.93,95%CI=3.46~7.01)was the greatest contributors to depression symptoms in ERI model; ERI and sleep quality were shown to be independently associated with depressive symptoms,importantly,sleep quality could estimate the risk of depression symptoms(OR=6.18,95%CI=4.73~8.07)more accurately than that of ERI; Combined effect of ERI and sleep quality was a risk factor for depressive symptoms,and the combined effect was larger than the separate one; Both high ERI and poor sleep quality(OR=15.40,95%CI=6.76~35.10)were the greatest contributors to depression symptoms in combined effect model of ERI and sleep quality.Moreover,this study found that high educational level and no drinking were not the protectors of depression symptoms.