MGEN Foundation for Public Health, 3 square Max Hymans, 75748 Paris Cedex 15, France
Abstract
Background
Although only a few studies have been published on teachers' health, certain ideas are widely accepted, such as for example, the preconceived notion that teachers suffer from an excessively high rate of mental health problems. The objective of this study is to compare teachers' mental and physical health to that of a control group.
Methods
A cross-sectional postal survey was conducted among a sample of 3,679 teachers and 1,817 non-teachers aged 20 to 60 years old.
Results
No lifetime prevalence of any psychiatric disorder (with the exception of undifferentiated somatoform disorder in men) or mean scores of psychological distress were found to be significantly higher in teachers. However, multiple analyses, adjusted for all confounding variables, revealed a higher risk of lifetime anxiety disorders in male teachers. On the other hand, significant differences were observed for some physical ailments: a higher lifetime prevalence of rhinopharyngitis/laryngitis in both male and female teachers, of conjunctivitis and lower urinary tract infection in male teachers and of bronchitis, eczema/dermatitis and varicose veins in female teachers. No significant difference was found for chronic pain between the two groups.
Conclusion
Teachers do not seem to have poorer mental health. However, their physical condition is characterized by a higher prevalence of health problems related to the ENT tract, and to a lesser extent, depending on the gender, to skin, eyes, legs and lower urinary tract.
Background
The idea that teachers suffer from an excessively high rate of mental health problems is widely accepted among not only the general public, but among teachers themselves
Mental health
Although a person's socioprofessional category is acknowledged to be a decisive factor in his or her mental health
Studies on teachers' mental health can be divided into two groups. The first group includes studies involving a wide variety of professions, among which teachers, and the second group includes studies on teachers only, with or without a control group.
The Eaton et al. study
The second group includes a larger number of studies, among which only two studies using a control group
The Finlay-Jones study
In the De Heus and Diekstra study
A number of other studies on teachers can be found in the literature which lack control groups and are limited to factors such as stress and psychological distress. According to these studies, teachers apparently showed quite a high level of stress and burnout
Physical health
As in the case of mental health, only a few studies of varying quality have been published on teachers' physical health. When considering the main classes of diagnoses of physical diseases (musculoskeletal, respiratory, cardiovascular, nervous and hormonal disorders), Seibt et al.
However, some studies have demonstrated that for small number of more specific physical disorders, the prevalence is clearly higher for teachers. Impaired phonation represents the most characteristic teachers' physical disorder because it is directly related to their specific occupational demands when teaching. According to a number of studies aimed at identifying which occupational groups were at an increased risk of suffering from occupational voice disorders
Probably because of their occupational environment, characterized by permanent contact with people and particularly with children, the Lerman et al. study
It is worth mentioning that there are a few additional studies that have shown a different impact of a few other diseases on teachers: an excessive rate of some major cancers, in particular breast
The study presented here was aimed at determining if the teaching profession differs from other occupations in its impact on workers' mental and physical health by comparing the prevalence of a wide variety of mental health disorders and level of psychological distress, together with the prevalence of several physical ailments in teachers to a control group. This comparison was made possible by way of a cross-sectional postal survey conducted among persons covered by French health care insurance provided by the MGEN (
Methods
Sample
Between June 1999 and March 2000, we carried out an epidemiological survey on the population of MGEN policyholders. A self-rated questionnaire was sent by mail to 10,000 persons aged 20 to 60 inclusive, selected at random using the national health plan records of policyholders living in continental France. Three reminder notices were sent to those who had not responded. The response rate obtained was respectively 39.4% on the first run, 23% on the second run and 26% on the third run for an overall response rate of 66.5% (n = 6,518).
The sample was weighted for all issues related to sample design in order to ensure a truly representative sampling of the population of MGEN policyholders. All analyses conducted were performed using the weighted population.
Since the objective of this study was to determine whether there was a connection between being a teacher and having health problems, we only used respondents who were actually employed and excluded job seekers, retirees and unemployed persons. Housewives were not included in the analyses, nor were non-working students. In contrast, the respondents included in this study could be healthy workers, as well as workers on sick leave. It should be noted that at the time health insurance coverage is provided by the MGEN, no information on current mental and physical health is gathered. The analyses were thus conducted on a weighted total of 5,496 employed respondents, of which 3,679 teachers and 1,817 non-teachers. Persons qualified as teachers had to actually be giving classes to students.
Instruments
The self-administered, anonymous questionnaire covered questions on general health and use of the health care system, as well as sick days and sick leave.
The sociodemographic variables included gender, age, family composition, educational level, place of residence and naturally included a precise description of employment and occupational status. A number of questions delved into quality of life, social network and activities, as well as feelings about work.
The parameters used to measure physical and mental health are summarized in Table
List of parameters used to measure mental and physical health
Health problems
Measuring instruments
Mental health
Psychological distress
Ilfeld's version of the Hopkins Symptom Checklist (HSC): the Psychiatric Symptom Index (PSI)
Mood disorders, Anxiety disorders, Alcohol abuse/dependency disorders, Anorexia nervosa, Bulimia, Somatization disorders, Undifferentiated somatoform disorders
CIDI-SA according to DSM-IV criteria
Alcohol abuse
CAGE screening test
Physical health
Ophthalmologic diseases; Cardiovascular diseases; Osteo-articular diseases; Oto Rhino Laryngological diseases; Diseases of the digestive system; Diseases of the breathing apparatus; Diseases of the nervous system; Endocrinological diseases and diseases of the metabolism; Diseases of the mouth and the teeth; Diseases of the genital-urinary bodies; Skin diseases; Insomnia; Other diseases
a series of questions concerning physical illnesses over lifetime (in case of a positive answer, a question was asked about any current episode)
Migraines; Nausea; Difficulties in swallowing; Vomiting; Diarrhoea; Bloating; Bad taste in the mouth; Abdominal pains (apart from menstruation); Back pains; Articular pains; Feeling of losing the breath (apart from physical effort); Chest pains; Palpitations or spasmophilia; Extremity pains; Marks or discoloration of the skin; Numbness or itching; Muscular weakness; Frequent urge to urinate or difficulties in urinating; Burning feeling around the mouth or the sexual organs; Periods of amnesia of a few hours or days; Sensation of loss of balance; Fainting; Fuzzy, double or scrambled vision a few times (apart from a problem with glasses); Excessively painful menstrual periods; Unusual or abundant vaginal discharge
a series of questions concerning chronic symptoms over lifetime (lasting 6 months or longer)
To measure mental health, we opted for a dual approach. First, we used questions based on the CIDIS (Composite International Diagnostic Interview Simplified
Physical health was studied through two series of questions: a list of illnesses presented by subtypes (cardiovascular, endocrine, etc.) and a list of chronic symptoms (i.e., lasting 6 months or longer), such as diverse types of pain that could be involved in somatoform disorders (i.e., disorders characterized by physical complaints that appear to be medical in origin but that cannot be explained in terms of a physical disease).
To measure disease frequency, we used period prevalence, which represents the proportion of the sample that are cases at any time within a stated period. Two reference periods were used to determine prevalence rates: lifetime and the twelve previous months. The prevalence rates of both mental and physical health problems are presented for a lifetime period. One-year prevalence was used in multiple analysis only.
Data analysis
We used the chi-square test to compare the sociodemographic and employment features of the teacher and control groups. Given the distortion observed between some of the basic features of the two groups, Mantel-Haenszel's chi-square tests were used to compare ratios and prevalence rates, and linear regression analyses were applied to compare mean values.
Multiple logistic regression models were used to measure the effect of a panel of sociodemographic and employment variables on the presence of a psychiatric disorder.
Statistical processing was performed using SPSS 13.0 software.
Results
Sociodemographic and employment features
Table
Sociodemographic and employment features of the teacher and control groups
Features
Teachers (N = 3,679)
Controls (N = 1,817)
p
n
%
n
%
Sociodemographic
Gender
0.000***
Male
1,496
40.7
875
48.2
Female
2,183
59.3
942
51.8
Age
0.003**
20 – 39 years♣
1,191
32.5
541
30.1
40 – 49 years◆
1,216
33.2
553
30.8
≥ 50 years♠
1,259
34.3
702
39.1
Marital status
0.056
Married or living with someone
2,866
78.2
1,392
76.9
Single
467
12.7
213
11.8
Separated or divorced
285
7.8
176
9.7
Widowed
45
1.2
28
1.5
Educational level
0.000***
Lower than Baccalaureate degree
48
1.3
674
37.5
Baccalaureate degree
675
18.3
273
15.2
≤ 2 years at university
724
19.7
273
15.2
3 – 4 years at university
1,582
43.0
339
18.9
≥ 5 years at university
650
17.7
239
13.3
Career cycle
Number of years in current profession
0.000***
< 5 years
417
11.4
315
17.9
5 – 9 years
473
12.9
259
14.7
10 – 19 years
723
19.8
370
21.0
20 – 29 years
1,173
32.1
502
28.5
≥ 30 years
873
23.9
315
17.9
Long-term sick leave
0.509
At least one in the past five years
96
2.6
42
2.3
None
3,583
97.4
1,774
97.7
Working environment
Work schedule
0.000***
Irregular
1,860
51.2
668
37.8
Regular
1,770
48.8
1,099
62.2
Commuting time from home to work
0.000***
≤ 15 minutes
1,228
34.0
586
34.2
16 – 30 minutes
1,194
33.1
500
29.2
31 – 60 minutes
831
23.0
382
22.3
> 60 minutes
356
9.9
243
14.2
n = number of cases in each category for each group. % = proportion of cases in each category for each group. p = p-value from Chi-square test (*p < 0.05; **p < 0.01; ***p < 0.001). Mean age of the subjects in each group: ♣ Teacher: 32.1, Control: 31.4 ; ◆ Teacher: 44.8, Control: 45.3 ; ♠ Teacher: 53.3, Control: 53.6.
Mental health
Lifetime prevalence of psychiatric disorders
Table
Comparison of lifetime prevalence of mental disorders (DSM-IV) by gender between teacher and control groups
Lifetime DSM-IV diagnoses
Males
Females
Teachers (N = 1,496)
Controls (N = 875)
Teachers (N = 2,183)
Controls (N = 942)
N
n
%
N
n
%
N
n
%
N
n
%
Mood disorders
Major Depressive Episode (MDE)
1,455
337
23.2
835
173
20.7
2,116
862
40.8
863
348
40.3
MDE moderate
1,455
163
11.2
835
84
10.1
2,116
424
20.0
863
179
20.7
MDE severe
1,455
58
4.0
835
34
4.1
2,116
214
10.1
863
95
11.0
Other mood disorders†
1,468
179
12.2
847
98
11.6
2,142
453
21.1
885
166
18.8
Any mood disorder
1,455
373
25.6
835
195
23.4
2,116
943
44.6
863
372
43.1
Anxiety disorders
Social phobia
1,469
29
2.0
850
27
3.2
2,109
64
3.0
876
43
4.9
Specific phobia
1,468
37
2.5
835
27
3.2
2,114
87
4.1
868
53
6.1
Agoraphobia
1,470
66
4.5
850
29
3.4
2,110
237
11.2
874
115
13.2
Agoraphobia without history of panic disorder
1,470
56
3.8
850
27
3.2
2,110
222
10.5
874
103
11.8
Any phobia (social, specific or agoraphobia)
1,457
94
6.5
834
47
5.6
2,081
306
14.7
860
140
16.3
Panic disorder without agoraphobia
1,441
9
0.6
829
4
0.5
2,095
19
0.9
866
7
0.8
Panic disorder with agoraphobia
1,441
5
0.3
829
1
0.1
2,095
13
0.6
866
11
1.3
Any panic disorder (with or without agoraphobia)
1,441
15
1.0
829
5
0.6
2,095
34
1.6
866
18
2.1
Obsessive-Compulsive Disorder (OCD)
1,434
15
1.0
824
6
0.7
2,080
18
0.9
860
8
0.9
Any anxiety disorder (phobia, panic disorder or OCD)
1,417
109
7.7
807
52
6.4
2,017
330
16.4
820
152
18.5
Other disorders
Alcohol abuse
1,445
13
0.9
844
8
0.9
2,045
8
0.4
842
3
0.4
Alcohol dependency
1,445
16
1.1
844
9
1.1
2,045
8
0.4
842
6
0.7
CAGE ≥ 2
1,429
176
12.3
818
92
11.2
1,948
86
4.4
756
48
6.3
Anorexia nervosa
1,485
0
0.0
791
0
0.0
2,152
5
0.2
850
5
0.6*
Bulimia
1,413
17
1.2
815
13
1.6
2,018
100
5.0
872
47
5.4
Somatization disorder
1,439
2
0.1
801
4
0.5
2,081
23
1.1
862
13
1.5
Undifferentiated somatoform disorder
1,439
44
3.1
801
14
1.7*
2,081
76
3.7
862
45
5.2
N = Total weighted number of respondents in each category for each group. n = number of cases in each category for each group. % = proportion of cases in each category for each group. p = p-value from Mantel-Haenszel chi-square test adjusted for age and educational level (*p < 0.05 ; **p < 0.01 ; ***p < 0.001). † Other mood disorders: adjustment disorder with depressed mood acute (<6 months), chronic (> 6 months) and dysthymic disorder.
Factors associated with the presence of a mental health disorder
Multiple analyses were used to measure the effect of occupation on the presence of a mental health disorder on a lifelong and one-year basis for both men (Table
Factors influencing the probability of having a mental disorder among males (N = 2,371)
Factors
Major Depressive Episode (MDE)
Anxiety disorder
CAGE ≥ 2
Lifetime †
One year ‡
Lifetime †
One year ‡
Lifetime †
One year ‡
OR
95% CI
OR
95% CI
OR
95% CI
OR
95% CI
OR
95% CI
OR
95% CI
Sociodemographic features
Age
40 – 49 years
1.97
1.40–2.77***
1.73
0.99–2.98
3.54
2.03–6.18***
2.28
1.06–4.91*
2.68
1.72–4.17***
1.88
0.54–6.63
≥ 50 years
1.34
0.89–2.02
0.60
0.29–1.22
3.99
2.07–7.70***
1.68
0.62–4.56
2.72
1.62–4.56***
0.78
0.16–3.76
Marital status
Single
1.81
1.30–2.50***
1.35
0.78–2.34
2.03
1.21–3.42**
2.64
1.35–5.18**
1.24
0.80–1.93
2.57
0.90–7.35
Separated or divorced
1.65
1.08–2.52*
1.15
0.55–2.41
1.59
0.84–3.02
1.19
0.40–3.50
0.62
0.31–1.23
0.52
0.07–4.14
Widowed
1.42
0.28–7.07
5.99
1.08–33.3*
4.18
0.75–23.35
0.00
-
0.36
0.02–7.60
0.00
-
Educational level
Lower than Baccalaureate degree
0.58
0.38–0.87**
0.92
0.46–1.84
1.56
0.81–2.99
1.04
0.36–2.98
1.41
0.85–2.32
0.49
0.12–2.07
Baccalaureate degree
0.82
0.57–1.20
1.08
0.56–2.09
1.38
0.76–2.52
1.80
0.78–4.17
0.91
0.55–1.49
0.51
0.12–2.12
≤
3 – 4 years at university
0.91
0.68–1.23
1.48
0.88–2.50
1.08
0.64–1.84
1.24
0.59–2.59
0.80
0.53–1.20
0.92
0.33–2.55
≥ 5 years at university
0.68
0.49–0.96*
1.35
0.75–2.42
0.77
0.42–1.42
0.52
0.21–1.34
0.85
0.55–1.32
1.14
0.38–3.46
Career cycle features
Number of years in current profession
5 – 9 years
1.01
0.68–1.52
0.91
0.44–1.87
1.00
0.50–1.98
2.65
1.01–6.95*
1.55
0.91–2.64
1.74
0.31–9.82
10 – 19 years
0.99
0.66–1.47
1.38
0.71–2.69
0.81
0.42–1.54
1.54
0.55–4.29
0.71
0.41–1.24
2.41
0.44–13.34
20 – 29 years
0.72
0.46–1.12
1.30
0.62–2.75
0.41
0.20–0.84*
0.88
0.28–2.76
0.68
0.38–1.22
3.61
0.57–22.77
≥ 30 years
0.87
0.52–1.47
1.50
0.60–3.77
0.35
0.15–0.79*
1.07
0.28–4.03
0.55
0.28–1.07
3.30
0.36–30.63
Working environment features
Work schedule
Irregular
0.94
0.75–1.17
0.82
0.57–1.19
0.69
0.47–1.01
1.09
0.64–1.87
1.10
0.82–1.48
0.76
0.34–1.69
Commuting time from home to work
≤
16 – 30 minutes
1.10
0.84–1.44
1.07
0.68–1.70
1.36
0.86–2.14
1.38
0.74–2.57
1.15
0.81–1.62
0.37
0.10–1.40
31 – 60 minutes
1.45
1.10–1.90**
1.58
1.02–2.45*
1.35
0.84–2.17
1.07
0.54–2.12
1.23
0.86–1.76
2.49
1.06–5.85*
> 60 minutes
1.31
0.93–1.86
0.87
0.45–1.65
1.86
1.07–3.22*
1.05
0.44–2.48
1.17
0.75–1.84
0.79
0.19–3.22
Occupational group
Teacher
1.03
0.80–1.34
0.82
0.54–1.26
1.74
1.10–2.73*
1.55
0.79–3.03
1.41
0.99–1.98
0.66
0.28–1.55
All variables included in the logistic regression analyses are mentioned in the table. Only subjects with no data missing for any of the variables were included in these models. † Existence of the disease during lifetime. ‡ Existence of the disease during the previous year. OR = odd ratio. 95% CI = 95% confidence interval. *p < 0.05; **p < 0.01; ***p < 0.001.
Factors influencing the probability of having a mental disorder among females (N = 3,125)
Factors
Major Depressive Episode (MDE)
Anxiety disorder
Cage ≥ 2
Lifetime †
One year ‡
Lifetime †
One year ‡
Lifetime †
One year ‡
OR
95% CI
OR
95% CI
OR
95% CI
OR
95% CI
OR
95% CI
OR
95% CI
Sociodemographic features
Age
40 – 49 years
0.89
0.69–1.17
0.97
0.67–1.40
1.18
0.83–1.68
0.71
0.43–1.17
1.50
0.80–2.81
3.91
0.57–26.63
≥ 50 years
0.94
0.69–1.29
0.91
0.58–1.43
1.23
0.82–1.86
0.49
0.26–0.92*
1.68
0.81–3.45
0.65
0.07–6.16
Marital status
Single
1.36
1.07–1.72*
1.52
1.11–2.08**
1.36
1.01–1.85*
1.24
0.82–1.88
1.27
0.68–2.35
7.37
1.97–27.52**
Separated or divorced
2.30
1.80–2.95***
1.38
0.98–1.93
1.46
1.06–2.00*
1.82
1.17–2.83**
2.89
1.83–4.57***
16.09
5.52–46.87***
Widowed
2.00
1.16–3.44*
0.85
0.35–2.07
1.62
0.84–3.11
3.09
1.38–6.94**
0.00
-
0.00
-
Educational level
Lower than Baccalaureate degree
0.95
0.68–1.33
1.15
0.70–1.88
1.74
1.14–2.64*
0.76
0.40–1.47
1.07
0.52–2.23
1.07
0.17–6.66
Baccalaureate degree
0.98
0.76–1.25
1.08
0.74–1.58
1.02
0.74–1.42
0.97
0.61–1.54
0.56
0.31–1.02
0.09
0.01–0.69*
≤
3 – 4 years at university
0.98
0.78–1.23
1.26
0.90–1.75
0.86
0.63–1.16
0.70
0.46–1.06
0.67
0.40–1.13
0.04
0.01–0.22***
≥ 5 years at university
0.65
0.48–0.87**
1.26
0.83–1.92
0.62
0.41–0.94*
0.76
0.45–1.29
0.74
0.40–1.42
0.61
0.20–1.87
Career cycle features
Number of years in current profession
5 – 9 years
1.32
0.97–1.80
1.33
0.86–2.04
0.57
0.37–0.89*
0.34
0.19–0.63***
1.58
0.63–3.96
0.06
0.00–0.86*
10 – 19 years
1.37
1.01–1.85*
1.37
0.89–2.09
0.98
0.66–1.46
0.64
0.39–1.06
1.97
0.84–4.65
0.02
0.00–0.40*
20 – 29 years
1.71
1.21–2.42**
1.45
0.89–2.37
1.00
0.64–1.57
0.76
0.41–1.40
2.01
0.81–5.01
0.38
0.07–2.16
≥ 30 years
1.74
1.16–2.59**
1.17
0.66–2.09
1.05
0.63–1.76
0.94
0.44–2.01
1.52
0.54–4.27
0.38
0.04–3.53
Working environment features
Work schedule
Irregular
1.02
0.86–1.21
0.94
0.74–1.20
1.09
0.87–1.36
1.31
0.96–1.79
0.92
0.61–1.38
1.62
0.60–4.40
Commuting time from home to work
≤
16 – 30 minutes
0.83
0.69–1.01
0.83
0.63–1.10
0.97
0.76–1.25
1.29
0.90–1.85
1.75
1.10–2.78*
4.50
1.47–13.82**
31 – 60 minutes
1.05
0.85–1.30
1.15
0.85–1.55
1.06
0.80–1.41
1.04
0.68–1.58
1.41
0.82–2.42
0.09
0.00–2.85
> 60 minutes
1.40
1.06–1.85*
1.42
0.98–2.07
1.48
1.04–2.11*
1.16
0.68–1.96
1.46
0.72–2.96
1.20
0.15–9.80
Occupational group
Teacher
1.01
0.82–1.25
1.03
0.76–1.40
1.12
0.85–1.49
1.01
0.68–1.49
0.99
0.59–1.65
2.06
0.50–8.47
All variables included in the logistic regression analyses are mentioned in the table. Only subjects with no data missing for any of the variables were included in these models. † Existence of the disease during lifetime. ‡ Existence of the disease during the previous year. OR = odd ratio. 95% CI = 95% confidence interval. *p < 0.05; **p < 0.01; ***p < 0.001.
With regard to sociodemographic features, ageing in men was clearly associated with an increased risk for lifetime anxiety and alcohol disorders. Living alone appeared to be a factor leading to a higher risk for both men and women of all disorders, except for alcohol disorders in men. Having completed graduate level training was associated with a lower risk of depressive disorders in both men and women and of anxiety disorders in women only. Low educational level showed a different pattern depending on the gender and diagnosis. Not having completed a baccalaureate degree was associated with a decreased risk for depressive disorders in men, whereas a higher risk for anxiety disorders was observed in women.
As regards employment features, work schedule had no significance. The number of years in current profession showed a different pattern depending on the gender and diagnosis. Men with less seniority showed a higher risk of anxiety disorders, whereas the opposite results were found for women. Moreover, higher seniority in women appeared to be clearly associated with an increased risk for lifetime depressive disorders. A commute from home to work of over one hour was clearly associated with a higher risk of lifetime anxiety disorders for both genders. It was also associated with a higher risk of lifetime depression in women only.
Levels of psychological distress
There was no significant difference in mean scores between the two groups (Teachers: 11.2; Controls: 11.3; p > 0.05).
As expected, there was a significant difference in mean scores between the two genders (Men: 8.6; Women: 13.3; p < 0.001), but no significant interaction between occupation and gender was found (p > 0.05).
An increase in psychological distress with age was observed. For the group in the 20–39 age bracket, the mean score was 9.6 (SD = 9.9). For subjects aged 40–49, the score was 11.8 (SD = 10.4) and for those 50 and older, the score reached 12.3 (SD = 11.4). Here, a significant interaction between age and occupation was found (p < 0.01). Ageing in teachers was clearly associated with a higher psychological distress score (p < 0.001), while no difference was identified in controls (p > 0.05).
Life satisfaction levels and social networks
As regards life satisfaction, teachers reported they were more satisfied with their lives than non-teachers when it came to aspects such as housing (p < 0.001), environment (p < 0.05), amount (p < 0.001) and use (p < 0.01) of free time. However, in the area of human relations, no significant difference in terms of level of satisfaction in their relationships with their children, parents, friends or in their love life was observed.
As regards social activities, such as meeting family members, going out with friends, participating in clubs and volunteer organizations or practicing sports, no significant difference in frequency (p > 0.05) was found between teacher and control groups.
Physical health
Body mass index
Table
Mean BMI values of the teacher and control groups by gender
Age
Mean values
Males
Females
Teachers (N = 1,496)
Controls (N = 875)
Teachers (N = 2,183)
Controls (N = 942)
20 – 39 years
23.7
23.9
21.7
22.6
40 – 49 years
24.8
25.1
22.5
22.9
≥ 50 years
25.0
25.8
23.0
23.3
Total
24.5
25.0
22.4
22.9
BMI = Body Mass Index. Mean value = observed mean age of the subjects in each category for each group. For both males and females, a linear regression analysis was applied to test the difference in mean values between the two groups, while controlling for age and educational level. No significant difference was found.
Lifetime prevalence of physical health problems
Table
Most frequent physical health problems and chronic pain over lifetime by gender for the teacher and control groups
Physical health
Males
Females
Teachers (N = 1,496)
Controls (N = 875)
Teachers (N = 2,183)
Controls (N = 942)
N
n
%
N
n
%
N
n
%
N
n
%
Physical health problems
Rhinopharyngitis/laryngitis
1,454
497
34.2(1)
838
198
23.6(1) ***
2,169
1,018
46.9(1)
919
256
27.9(1)***
Bronchitis
1,454
307
21.1(2)
838
163
19.5(2)
2,169
482
22.2(5)
919
164
17.8(6)*
Otitis
1,454
264
18.2(3)
838
155
18.5(3)
2,169
424
19.6(7)
919
147
16.0(9)
Eczema/dermatitis
1,454
252
17.3(4)
838
118
14.1(4)
2,169
492
22.7(4)
919
153
16.7(8)*
Arthrosis
1,454
167
11.5(5)
838
104
12.4(5)
2,169
356
16.4(9)
919
186
20.3(4)
Conjunctivitis
1,454
155
10.7(6)
838
61
7.3(10)*
2,169
419
19.3(8)
919
158
17.2(7)
Asthma
1,454
143
9.8(7)
838
75
8.9(8)
2,169
180
8.3(12)
919
56
6.1(12)
Urinary tract infection
1,454
130
8.9(8)
838
54
6.4(11)
2,169
574
26.5(2)
919
206
22.4(3)
Infections
1,454
128
8.8(9)
838
63
7.5(9)
2,169
316
14.6(10)
919
133
14.5(10)
Varicose veins
1,454
127
8.7(10)
838
80
9.5(7)
2,169
434
20.0(6)
919
166
18.1(5)*
Hypertension
1,454
119
8.2(11)
838
82
9.8(6)
2,169
220
10.1(11)
919
96
10.5(11)
Cystitis
1,454
47
3.2(12)
838
11
1.3(12)*
2,169
563
26.0(3)
919
220
24.0(2)
Chronic pains
Back pain
1,440
444
30.8(1)
801
278
34.7(1)
2,081
782
37.6(1)
862
373
43.3(1)
Articular pain
1,440
292
20.3(2)
801
179
22.3(3)
2,081
467
22.4(3)
862
225
26.1(3)
Headache/migraine
1,440
250
17.4(3)
801
180
22.5(2)
2,081
692
33.3(2)
862
346
40.1(2)
N = Total weighted number of respondents in each category for each group. n = number of cases in each category for each group. % = proportion of cases in each category for each group. p = p-value from Mantel-Haenszel chi-square test adjusted for age and educational level (*p < 0.05 ; **p < 0.01 ; ***p < 0.001). Numbers in brackets represent the order of appearance in the ranking of physical health problems or chronic pain according to prevalence
With regard to physical health problems, lifetime prevalence of rhinopharyngitis/laryngitis was found to be higher in teachers for both genders (p < 0.001). In male teachers only, conjunctivitis and cystitis were also more prevalent (p < 0.05). For female teachers, the prevalence of bronchitis, eczema/dermatitis and varicose veins was found to be significantly higher (p < 0.05).
As for chronic pain (i.e., symptoms experienced during a period of at least six months over lifetime), the three most reported types of pain were: back pain (roughly one-third of respondents), articular pain and headaches. No significant difference between the two groups was found in either gender.
Discussion
To date, only a few studies of varying quality have been published on teachers' health. The present study is one of the very few studies comparing teachers' health – both physical and mental – to that of an appropriate control group.
The results of this study would tend to indicate that teachers do not seem to have poorer mental health. No lifetime prevalence of any psychiatric disorder (with the exception of undifferentiated somatoform disorder in men) or mean scores of psychological distress were found to be significantly higher in teachers. However, multiple analyses, adjusted for all confounding variables, revealed a higher risk of lifetime anxiety disorders in male teachers. On the other hand, in terms of physical health, significant differences were found between teacher and control groups, with higher lifetime prevalence in teachers of rhinopharyngitis/laryngitis in both genders, of conjunctivitis and lower urinary tract infection in men and of bronchitis, eczema/dermatitis and varicose veins in women. No significant difference between teacher and control groups was found for chronic pain.
This study shows that the preconceived notion that teachers have a higher risk of developing mental health problems is apparently a myth. First, as reported in previous publications
In contrast, this study does show that there is a higher prevalence in teachers of a number of physical disorders. The most affected organs are in the ENT tract. The throat, in particular, is affected and several studies have already reported that teachers seem to be prone to such problems, particularly those related to voice
There are, however, several limitations to this study. First, health problems are self-reported. Reporting on minor or past events is likely to be particularly prone to anamnestic error since information was collected for a lifetime period. This could result in an underestimated prevalence of disorders. On the other hand, as regards physical health, an approximate knowledge of medical terms, together with long lists of physical disorders could potentially result in some erroneous answers. However, this normally would not have any impact on the results of our comparison. Second, selecting the controls from the population of MGEN policyholders could introduce a source of potential bias, as some of them, essentially the headmasters or school inspectors, could be former teachers. However, Table
Professions of the teacher and control groups
Professions
n
%
Teachers (N = 3,679)
Nursery school
401
10.9
Elementary school
934
25.4
Intermediate school
868
23.6
Regular secondary school
422
11.5
Vocational secondary school
464
12.6
Special education school
118
3.2
Post-secondary school
351
9.5
Other
122
3.3
Controls (N = 1,817)
Headmaster, principal, school inspector
165
9.1
School counselor, school psychologist, documentalist
91
5.0
Professional occupation†
49
2.7
Craftsman, shopkeeper, company head, farmer
50
2.8
Executive, manager
334
18.4
Health professional, social worker
112
6.2
Technician, supervisor
154
8.5
Office worker, shop assistant
367
20.2
Worker, maintenance personnel
458
25.2
Other
36
1.9
n = number of cases in each category for each group. % = proportion of cases in each category for each group. † For example, physician, dentist, pharmacist, lawyer...
Nevertheless, a good number of the results of the present study are important for the potential they have in terms of public health and policy implications, especially because some easy to implement measures to change conditions or behavior at work could definitely be of help to improve on prevention of some of the health problems identified. Better information for teachers and adjusting their training (for example, advice given by a speech therapist to encourage good voice habits) and workplace conditions (for example, short breaks and adequate toilet facilities) could certainly improve teachers' behavior, which would very likely have an impact on the occurrence of the disease.
Conclusion
This study shows that teachers do not seem to have poorer mental health, although multiple analyses revealed a higher risk of lifetime anxiety disorders in male teachers. In contrast, their physical condition is characterized by a higher prevalence of health problems related to the ENT tract, and to a lesser extent, depending on the gender, to skin, eye, leg and lower urinary tract disorders. In our study, no analysis was done to identify potential at-risk subgroups in teachers or the specific occupational factors that could be related to the increased prevalence observed in teachers for certain diseases. Further studies, preferably prospective, are thus required to thoroughly pursue research in this area. This could be a step forward to improve on prevention of some of the occupational-related diseases in teachers, especially if easy to implement measures could be recommended to modify potential at-risk conditions or habits at work.
Abbreviations
BMI Body Mass Index
CAGE Cut down, Annoyed, Guilty, Eye-opener
CIDIS Composite International Diagnostic Interview Simplified
CIDI-SA Composite International Diagnostic Interview – Self-Administered
DIS Diagnostic Interview Schedule
DSM Diagnostic and Statistical Manual of mental disorders (III: third edition, IV: fourth edition)
ECA Epidemiologic Catchment Area
ENT Ear, Nose and Throat
GHQ General Health Questionnaire
HSC Hopkins Symptom Checklist
MDE Major Depressive Episode
PSI Psychiatric Symptom Index
Competing interests
The author(s) declare that they have no competing interests.
Authors' contributions
Viviane Kovess-Masféty, MD, PhD, designed the study and participated in drafting the manuscript. Christine Sevilla-Dedieu, PhD, contributed substantively by extensively revising the initial draft of the manuscript (statistical analysis, interpretation of the data and writing). Carmen Rios-Seidel, MD, performed statistical analysis, interpreted the data and managed the initial drafting of the manuscript. Eléna Nerrière, PhD, assisted in extensively revising the initial draft of the manuscript. Christine Chan Chee, MD, participated in designing and implementing the study.
Acknowledgements
This project was funded by the Mutuelle Générale de l'Education Nationale (MGEN).
Pre-publication history
The pre-publication history for this paper can be accessed here: