Relationship between quality of life and occupational stress among teachers

Relationship between quality of life and occupational stress among teachers

Public Health 123 (2009) 750–755 Contents lists available at ScienceDirect Public Health journal homepage: www.elsevierhealth.com/journals/pubh Ori...

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Public Health 123 (2009) 750–755

Contents lists available at ScienceDirect

Public Health journal homepage: www.elsevierhealth.com/journals/pubh

Original Research

Relationship between quality of life and occupational stress among teachers X. Yang, C. Ge, B. Hu, T. Chi, L. Wang* Department of Social Medicine, School of Public Health, China Medical University, No.92 North Second Road, Heping District, Shenyang 110001, China

a r t i c l e i n f o

s u m m a r y

Article history: Received 23 April 2009 Received in revised form 18 September 2009 Accepted 27 September 2009 Available online 2 November 2009

Objectives: With major changes in the education system and limited resources supplied by the Government, Chinese teachers have been suffering from greater occupational stress in recent years, which is believed to affect their physical and mental health. The aim of this study was to explore the relationship between quality of life and occupational stress in primary and middle school teachers. Study design: Originals. Methods: A cross-sectional study was conducted using cluster sampling. The study population was composed of 3570 school teachers working in 64 primary and middle schools in Heping District in Shenyang, China. A demographic questionnaire, the 36-item Short-Form Health Survey (SF-36) and the Occupational Stress Inventory Revised Edition were employed to collect demographic variables and assess quality of life and occupational stress. Multivariate stepwise linear regression analyses were performed to study the relationship between quality of life and occupational stress. Results: The mean scores for both male and female teachers in this study were significantly lower than those for the Chinese general population for all dimensions of quality of life, except mental health and vitality (P < 0.05). Male teachers scored significantly higher than female teachers for physical functioning, bodily pain, vitality and physical health (P < 0.05). Age, role overload, role insufficiency, vocational strain, psychological strain, physical strain, recreation and rational coping were significantly associated with both the physical and mental component summaries of the SF-36 (P < 0.05). Gender, physical environment and self-care appeared to be robust indicators of physical health (P < 0.05), while role insufficiency, interpersonal strain and social support were strong indicators of mental health (P < 0.05). Conclusions: In China, teachers have a lower health status than the general population. The quality of life of female teachers is worse than that of male teachers, and deteriorates with age. Occupational stress and strain induce worsening physical and mental conditions for teachers, while coping resources could promote their health. This study suggests that having adequate coping resources, especially social support, in workplaces may be an important factor for improving teachers’ quality of life. Moreover, psychological interventions should be set up for teachers, and psychological counselling should be provided to relieve stress and enhance quality of life. Ó 2009 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Keywords: Occupational stress Primary and middle school teachers Quality of life

Introduction Teaching has been reported to be one of the most stressful occupations in the world.1,2 Numerous studies have indicated that excessive stress may have an obvious effect on the physical and mental health status of teachers. Stress, a common problem in teachers, may have serious consequences. For example, some teachers retire early and some even quit their job.3,4 Job strain, a form of chronic stress, may increase the risk of both somatic and mental syndromes such as exhaustion, psychological distress and burnout.5,6 In addition, previous research has suggested that adverse psychological working * Corresponding author. Tel.: þ86 024 23256666x5404. E-mail address: [email protected] (L. Wang).

conditions may affect the overall health and well-being of workers.7,8 Teachers tend to perceive certain features of their jobs that are harmful to their health. In China, the education system has undergone major changes recently. However, despite the introduction of many reforms and innovations over the last decade, Chinese teachers still face stressful working conditions because of limited resources supplied by the Government, and they are at a high risk of developing stressrelated health problems. It has been well documented that teachers have a higher prevalence of anxiety, hypertension, headaches, psychosomatic disorders and cardiovascular diseases compared with other workers.9–12 A lower quality of life (QOL) and shorter life expectancy for teachers have been reported, and this has been attributed to their higher occupational stress.13

0033-3506/$ – see front matter Ó 2009 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2009.09.018

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Demographic characteristics have been regarded as important factors related to the QOL of teachers. Organizational factors (such as work overload, time pressure) and inadequate resources (such as lack of social support and rational coping) have emerged as strong stress factors that affect the health of teachers.14,15 However, few studies have been reported about Chinese teachers. Thus, the aim of this study was to analyse work-related and demographic parameters that may predicate the health of Chinese teachers. This study investigated the relationship between occupational stress and QOL. The findings from this study may be used to provide potential management strategies to attenuate the negative effects of occupational stress on the QOL of teachers. Methods Research design and sample A cross-sectional study was conducted from January to June 2008, supported by the Shenyang Heping Institution of Teachers Education; an agency that provides further education for primary and middle school teachers. Teachers were selected using cluster sampling. The study population consisted of 3570 school teachers working in 64 primary and middle schools in Heping District in Shenyang, China. Shenyang Heping Institution of Teacher Education sent copies of the questionnaires to the principals of each school, who disseminated the questionnaires to the teachers. In total, 3179 completed questionnaires were returned, and 2929 of these were valid (if more than half of the items in the questionnaire were missing, the questionnaire was excluded from the study). All of the participants were well informed about the content and the aim of the questionnaire. After obtaining written consent about conducting this survey, an anonymous questionnaire was distributed to individual subjects. The study protocol was in accordance with the ethical standards of the Committee on Human Experimentation of China Medical University. Questionnaires The instruments used in this study consisted of three parts: the 36-item Short-Form Health Survey (SF-36), the Occupational Stress Inventory Revised Edition (OSI-R), and a demographic questionnaire. The demographic details collected included gender, age, marital status and education. Assessment of QOL The SF-36 was applied to assess QOL among teachers. The SF-36 consists of 36 items that measure eight different dimensions of health: physical function, role limitations related to physical problems, bodily pain, general health perception, vitality, social functioning, role limitations due to emotional problems and mental health, which can be categorized into physical component summary (PCS) and mental component summary (MCS). The health concepts are described by a range in score from 0 to 100, with higher scores indicating better health.10,11,16 Assessment of occupational stress Occupational stress was assessed based on the Chinese version of the OSI-R, originally developed by Osipow.17 The OSI-R is divided into three subscales: the Occupational Role Questionnaire (ORQ), the Personal Strain Questionnaire (PSQ), and the Personal Resources Questionnaire (PRQ). The ORQ subscale measures the level of occupational stress, including role overload, role insufficiency, role ambiguity, role

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boundary, responsibility and physical environment. A high score for role overload indicates an increased, unreasonable and unsupported work load; a high score for role insufficiency indicates a poor fit between the subject’s skills and the job they are performing; a high score for role ambiguity indicates that the subject has an unclear sense of what they are expected to do; a high score for role boundary indicates that the subject feels caught between conflicting supervisory demands and factions; a high score for responsibility indicates high levels of responsibility for activities and work performance; and a high score for physical environment indicates high levels of noise, moisture, dust, heat, cold, light, poisonous substance or unpleasant odours, having an erratic work schedule or feeling personally isolated. The PSQ subscale measures the level of occupational strain, including vocational strain, psychological strain, interpersonal strain and physical strain. A high score for vocational strain indicates that the subject has a poor attitude towards their work; a high score for psychological strain indicates that the subject feels depressed, anxious, unhappy or irritable; a high score for interpersonal strain indicates frequent quarrels or excessive dependency on family members or friends; and a high score for physical strain indicates that the subject worries frequently about their health as well as a number of physical symptoms. For the PRQ subscale, high scores indicate highly developed coping resources, including recreation, self-care, social support and rational coping (10 items in each dimension). A high score for recreation indicates that the subject takes advantage of their recreational time and engages in a variety of activities; a high score for self-care indicates that the subject takes exercise regularly, sleeps 8 h/day, cares about their diet, practices relaxation techniques and avoids harmful substance; a high score for social support indicates that the subject has at least one person to rely on; and a high score for rational coping indicates that the subject has a systematic approach to problemsolving and think through the consequences of their choices. Statistical analysis QOL of the study sample and the Chinese general population were compared using Student’s t-test. Pearson’s correlation coefficient was used to determine the relationship between the PCS and MCS dimensions of QOL and occupational stress. The predictive value of QOL and occupational stress was assessed by multiple linear regression analyses. The dependent variables were the PCS and MCS scores, and the independent variables were occupational stress and Table 1 Sociodemographic characteristics and occupational stress of the sample (n ¼ 2929). Variables

n (%)

Gender Male Female

ORQ

PSQ

PRQ

419 (14.31) 186.7  20.3 107.4  18.8 126.2  19.5 2510 (85.69) 182.4  19.4* 106.3  16.4 123.0  18.4*

Age (years) <30 30–40 >40

768 (26.22) 184.7  18.2 106.9  16.0 123.6  18.0 1653 (56.45) 183.0  19.8 107.5  16.9 121.9  18.7 508 (17.34) 180.9  20.3* 102.3  17.1* 128.5  18.4*

Educational level Junior college or 508 (17.34) 182.7  18.9 103.7  17.2 126.2  18.1 lower Bachelor or higher 2421 (82.66) 183.2  19.6 107.0  16.8* 122.9  18.7** Marital status Unmarried 503 (17.17) 181.4  18.5 106.0  15.9 125.5  18.0 Married 2352 (80.30) 183.1  19.7 106.4  16.6 122.9  18.6 Divorced, separated 74 ( 2.53) 184.4  20.6 113.5  21.6* 123.2  20.5 or widow/er ORQ, Occupational Role Questionnaire; PSQ, Personal Strain Questionnaire; PRQ, Personal Resources Questionnaire. *P<0.05.

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differences in QOL scores were associated with level of education. The lowest scores for all dimensions were observed in divorced, separated or widowed teachers, except for role limitations due to emotional problems (P < 0.05).

Table 2 Short Form-36 scores of Chinese study sample compared with the Chinese general adult population. Male This study n Physical functioning Role limitation due to physical problems Role limitation due to emotional problems Social functioning Mental health Energy and vitality Bodily pain General perception of health

Female Chinese standarda

This study

Chinese standarda

Correlation between QOL and occupational stress

419 859 2510 828 80.1  22.3** 84.4  18.6 76.7  20.8** 79.9  20.7 75.1  35.7** 82.4  32.6 73.6  36.6** 79.9  34.5 83.2  46.9

84.3  32.3 83.1  32.4* 84.5  32.5

68.1  18.4** 61.9  18.4 56.7  20.2* 70.7  24.1** 54.7  21.1*

83.1  17.5 60.3  23.0 53.8  20.9 83.0  19.0 58.0  19.9

67.4  16.9** 62.7  18.4** 52.9  19.7** 67.3  22.8** 53.0  21.4**

The results of correlation between QOL and occupational stress are provided in Table 4. Occupational stress and strain dimensions were negatively correlated with both PCS and MCS (P < 0.01). In addition, all of the coping resources dimensions were positively correlated with both PCS and MCS (P < 0.01).

82.9  18.1 59.1  22.4 50.1  20.7 79.9  21.8 55.2  20.4

Indictors of QOL The indictors of PCS and MCS are presented in Table 5. Multiple linear regression analyses were conducted to explore independent variables predicting QOL. According to R2 statistics, 33.9% and 42.1% of variance in the score was explained by the independent variables, respectively. Age, role overload, role insufficiency, vocational strain, psychological strain, interpersonal strain, recreation and rational coping were significantly associated with both physical and mental health (P < 0.05). Gender also appeared to be a robust indicator of physical health, while role insufficiency and psychological strain were the strongest indicators of mental health. Additionally, physical environment and self-care were the most important indicators of PCS, while interpersonal strain and social support were the strongest indicators of MCS.

**P<0.001, *P<0.05. a Data resources: reference.20

demographic characteristics. The fit of the model was assessed using R2, and the significance of each independent variable was evaluated using t-test and one-way analysis of variance. Statistical analysis was performed using Statistical Package for the Social Sciences Version 11.5 (SPSS Inc., Chicago, IL, USA), and a two-tailed probability value of less than 0.05 was considered to indicate statistical significance. Results Description of the participants and QOL

Discussion In total, 2929 questionnaires were obtained for analysis, and the valid response rate was 82%. The mean age was 34.5  6.9 years, and 86% of subjects were females. Approximately 80% of the teachers had bachelor degrees, and about 80% were currently married (Table 1). The mean scores for both male and female teachers in this study were significantly lower than the scores for the Chinese general population for all dimensions of QOL, except for mental health and vitality (P < 0.05) (Table 2). The QOL scores and demographic characteristics are listed in Table 3. Compared with male teachers, poorer physical health was found for female teachers. Male teachers scored significantly higher than female teachers for physical functioning, bodily pain, general health perception, vitality and PCS (P < 0.05). Teachers aged 30–40 years had the lowest QOL scores for all dimensions, except physical functioning (P < 0.05). No significant

This study found that QOL among teachers was lower than that among the Chinese general population,18 and occupational strain was much higher than that reported for doctors in China.19 Therefore, teachers should be given more help to improve their QOL and well-being. Evidence was provided to support assertions made in previous studies20 that impaired QOL is associated with occupational stress and strain, and that coping resources could enhance physical and mental health. Age and gender were also confirmed as important indicators of QOL in teachers. Gender was found to be the most crucial factor for physical health. Female teachers had poorer physical health and higher occupational stress than male teachers. This is probably because, in China, female teachers are usually expected to take more responsibility in teaching

Table 3 Relationship between quality of life and demographic characteristics of the subjects. Variables

PF

Gender Male Female

80.1  22.3 75.1  35.7 76.7  20.8** 73.6  36.6

83.2  46.9 68.1  18.4 83.1  32.4 67.4  16.9

Age (years) <30 30–40 >40

83.1  19.8 77.6  21.4 76.5  21.0** 73.6  1.1* 74.8  22.1** 77.4  2.1

84.2  21.3 68.4  16.4 65.1  18.5 82.3  31.1 66.7  17.6** 62.5  18.6* 88.4  28.6 69.9  16.5 64.6  17.9

55.9  19.5 71.4  22.1 57.3  22.1 72.3  18.9 68.5  16.3 51.2  19.9** 66.6  23.3** 51.8  21.2** 67.1  19.5** 65.9  17.4** 54.0  19.9 68.5  19.5 67.4  15.8 69.2  22.7 56.4  19.2

83.9  30.5 68.9  16.9 83.3  35.5 67.4  17.1

54.8  19.4 53.3  19.9

Educational level Junior college or lower 76.5  21.3 Bachelor or higher 77.4  20.9 Marital status Unmarried Married Divorced

RP

73.1  36.6 74.2  36.3

RE

SF

83.9  19.5 78.3  21.7 84.2  30.3 68.1  16.2 76.9  21.3* 74.7  20.9 84.0  35.2 67.6  17.3 73.4  20.6** 58.1  25.8* 81.4  33.6 62.5  18.1*

MH

VT

61.9  18.4 62.7  18.4

56.7  20.2 70.7  24.1 52.9  19.7** 67.3  22.8*

63.7  18.4 62.5  18.4

BP

68.3  22.9 67.8  23.0

GH

PCS

54.7  21.1 53.0  21.4

70.8  19.2 68.5  19.7 67.8  19.4** 66.7  16.5

54.8  21.0 52.9  21.5

68.1  19.8 68.4  19.3

MCS

68.4  16.8 66.9  16.9

65.4  17.5 57.5  18.2 72.6  21.1 57.1  21.1 73.0  18.2 68.8  15.4 63.1  18.6 52.4  20.1 67.5  23.3 53.2  21.5 68.1  19.6 66.8  17.3 60.0  19.8** 49.4  19.6** 60.5  23.1** 49.7  19.3** 60.4  20.4** 63.3  17.4*

PF, physical function; RP, role limitations due to physical problems; RE, role limitations due to emotional problems; SF, social functioning; MH, mental health; VT, vitality; BP, bodily pain; GH, general health perception; PCS, physical component summary; MCS, mental component summary. *P<0.05, **P<0.01.

X. Yang et al. / Public Health 123 (2009) 750–755 Table 4 Pearson coefficient between quality of life and occupational stress.

Occupational stress Role overload Role insufficiency Role ambiguity Role boundary Responsibility Physical environment Occupational strain Vocational strain Psychological strain Interpersonal strain Physical strain Coping resources Recreation Self-care Social support Rational/cognitive coping

PCS

MCS

0.206 0.221 0.215 0.266 0.200 0.372

0.197 0.329 0.277 0.265 0.216 0.362

0.385 0.447 0.317 0.494

0.402 0.560 0.420 0.494

0.219 0.204 0.259 0.309

0.312 0.237 0.383 0.411

PCS, physical component summary; MCS, mental component summary. All P<0.01.

than males. They are given excessive work tasks and expected to communicate more efficiently with their students. Meanwhile, female teachers may also have to take care of their family, and face a variety of domestic duties, social pressures and challenges which may result in physical health problems.21 Furthermore, the difference in the psychological characteristics of men and women is another an important factor. Women are more emotional and heavily affected by negative emotions,20,22,23 while men generally have a strong sense of independence and more rugged feelings. As a result, men are less susceptible to the impact of the external environment. Age was inversely associated with PCS and MCS. This may be because younger teachers felt a lower level of personal accomplishment, and evaluated themselves as having relatively weaker abilities to guide their classes and cooperate with other faculties.24,25 The failure to feel a sense of accomplishment reduced the chance that a teacher would be dedicated to his work. In particular, concern about Table 5 Stepwise regression analysis for exploring the factors related to quality of life. Independent variables

Estimate (B) Standardized estimate (b) Model R2

PCS domain Intercept 104.376 Gender 4.774 Age 0.409 Role overload 0.322 Role insufficiency 0.375 Physical environment 0.205 Vocational strain 0.468 Psychological strain 0.358 Physical strain 0.870 Recreation 0.327 Self-care 0.285 Rational/cognitive coping 0.353 MCS domain Intercept Age Role overload Role insufficiency Vocational strain Psychological strain Interpersonal strain Physical strain Recreation Social support Rational/cognitive coping

0.3363** 0.085** 0.130** 0.088** 0.086** 0.070* 0.096* 0.106* 0.237** 0.109** 0.080* 0.120** 0.4190**

75.813 0.138 0.215 0.509 0.474 0.673 0.317 0.413 0.429 0.368 0.335

0.049* 0.066* 0.130** 0.104** 0.219** 0.074* 0.123** 0.158** 0.132** 0.127**

PCS, physical component summary; MCS, mental component summary. Note: the independent variable ‘age’ was entered as a continuous variable. Gender (1 ¼ male, 2 ¼ female) was entered as a categorical variable. *P<0.05, **P<0.01.

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their ability to cope with the intense competition led to fatigue, and gave rise to a series of psychological and physiological changes. In contrast, older teachers were proficient in routine work and were able to resolve problems independently. Older teachers may feel less stressed about basic working conditions such as time and the work environment. As well as demographic characteristics, role overload and role insufficiency also had a significant effect on PCS and MCS. Teachers in China have an excessive workload, including the preparation of lessons, communicating with parents and pupils, correcting test papers, and fulfilling administrative duties. Recent changes in education and the updating of modern education technologies have placed higher demands on teachers, requiring effort to absorb the latest knowledge to improve their ability and keep up with the development of society. This may contribute to a breakdown due to increasing work demands and lower resources. Greater insufficiency in the occupational role has been implicated with an adverse influence on health in similar studies conducted in other countries.26,27 Regarding the physical environment, another significant indicator of PCS, this led to greater occupational stress and lower work engagement, which could reduce QOL.28 Vocational strain, psychological strain and physical strain were predictive of both physical health and mental health, in agreement with Valeriek.29 Due to the single-child policy and intense competition for admission to China’s colleges due to the scarcity of higher education resources, parents are very concerned about education from an early stage of childhood, and view education as the only means of changing a child’s fate. A teacher’s performance is assessed by their students’ test scores and rate of entry in a high school. Teachers are faced with high demands in both the quantity and quality of their work, and increasing organizational competitiveness. Thus, the increasing competition leads to vocational and psychological strain and fatigue. These strains not only have a negative impact on teachers’ attitudes in terms of their job and anxiety, and their ability to cope with dilemmas, but also lead to inattentiveness, withdrawal or aggressiveness, worries about physical status, and increased risk of sleep problems, depression and cardiovascular diseases.30 Interpersonal strain was negatively related to mental health. Teachers need to be skilled in teaching and moral guidance activities that require emotional intelligence in empathy and social-interpersonal areas.31 Due to the high demands of their job, teachers may experience psychological or emotional problems. In addition, previous studies have revealed that a lack of teamwork and insufficient communication were crucial strain factors in the workplace. As a result, teachers often quarrel with family members or colleagues, and have an over-reliance on them. In summary, job strain may affect QOL by affecting one’s perception of health and well-being, and may also affect one’s sense of QOL by contributing to physical or mental disease. Another finding was the positive influence of coping resources on QOL for both physical and mental health. Through recreation, teachers were more able to act actively in society. In other studies, recreation has been found to alleviate work stress and promote QOL and well-being.32 With respect to rational coping, individuals who had a systematic approach to problem-solving and who could think through the consequences of their choices could deal with workrelated problems in a rational manner; previous research has indicated that this can improve mental and physical health.33 Selfcare, which appeared to be significant to physical health, played an important role in the prevention of physical ill health. Teachers with good self-care tended to enjoy better physical QOL, which may be due to their high awareness of self-care. Importantly, this study indicated that social support was positively associated with mental health. This observation was in line with previous studies demonstrating that social support could

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enhance mental health and well-being.34,35 Chinese teachers rarely communicate with their supervisors or colleagues, and they do not receive adequate emotional support to cope with stressful events. In the present study, teachers who were divorced, separated or widowed showed higher occupational strain and lower QOL. Less social support may conflict with interpersonal relations, induce a feeling of solitude, and result in poor QOL. Comfortable or good interpersonal relationships with one’s supervisor or colleagues, and social support from one’s supervisor or colleagues and family seem to be most effective to reduce stress and cope with demands. Therefore, it is essential to set up and maintain strong social networks for adequate social support in order to promote mental health. In China, there is a lack of psychological services such as psychological counselling clinics. Thus, school psychological interventions should be set up for teachers, and psychological counselling and training courses should be provided to deal with stress and enhance teachers’ QOL. Sufficient coping resources could buffer the stressful effects of work demands,36 serving to attenuate the negative effects of job stress on both mental and physical health. Further studies are needed to better understand coping resources as the mediators of occupational stress on QOL. The present study bears the limitations that it characterized by cross-sectional research based on self-reported measures, so one cannot derive any conclusions on the causality of the associations observed between occupational stress and QOL. Additionally, subjects were from a single prefecture in China, which may limit the generalizability of this study to other regions. Furthermore, teachers working in different types of schools should be considered and analysed. However, despite the above limitations, this study has notable strong points. Firstly, the sample size was quite large. Secondly, there was a high valid response rate, because the Agency of Shenyang Heping Institution of Teacher Education disseminated the questionnaires by administrative means. In conclusion, Chinese teachers have a lower health status compared with the general Chinese population. Also, QOL is worse in female teachers than male teachers, and deteriorates with age. Occupational stress and strain induce worsening physical and mental conditions for teachers, while coping resources could promote their health. This study suggests that having adequate coping resources, especially social support, in the workplace may be an important factor for improving the QOL of teachers. Moreover, psychological interventions should be set up for teachers, and psychological counselling should be provided to deal with stress and enhance QOL. Acknowledgements The authors wish to thank the Shenyang Heping Institution of Teacher Education for organization of this survey and distribution of the questionnaires to the subjects. Ethical approval The procedures followed were in accordance with the ethical standards of the Committee on Human Experimentation of China Medical University. Funding None declared. Competing interests None declared.

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