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Occupational Medicine Advance Access originally published online on July 5, 2007
Occupational Medicine 2007 57(5):367-376; doi:10.1093/occmed/kqm055
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© The Author 2007. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Prevalence and causes of self-reported work-related stress in head teachers

Samantha Phillips1, Dil Sen2 and Roseanne McNamee3

1 Adastral Health Ltd, Globe House, Chichester, West Sussex, PO19 8DN, UK
2 Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
3 Biostatistics Group, Division of Epidemiology and Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK

Correspondence to: Samantha Phillips, Adastral Health Ltd, Globe House, Chichester, West Sussex, PO19 8DN, UK. Tel: +44 1243 782826; fax: +144 1243 782827; e-mail: sam.phillips{at}adastral.co.uk


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Funding
 Conflicts of interest
 Appendix 1
 Appendix 2
 References
 
Background Work-related stress (WRS) is the leading cause of occupational ill-health in the education sector in the UK. Headship is believed to be a stressful role although there is little current research into stress in head teachers. Changes in the education sector since the late 1980s have meant that the findings of many existing studies are outdated.

Aim To investigate prevalence and causes of self-reported, WRS in head teachers in West Sussex, UK.

Methods A cross-sectional study using postal questionnaire in a population of 290 head teachers and principals. The measuring instrument was a short stress evaluation tool (ASSET) plus additional questions derived from previous studies. Stress cases were defined as respondents who felt their work was ‘very or extremely stressful’.

Results Prevalence of self-reported, WRS was 43%. Using ASSET scoring, work overload and work-life imbalance were the key stressors. Females were significantly more stressed than males for a number of stressors including overload and control. Although there was some evidence that primary head teachers fared worse than their secondary counterparts, once the confounding effects of gender were included, there were few significant differences.

Conclusions The prevalence of self-reported stress in head teachers in West Sussex is significantly increased compared to recent studies of workers in the UK. The recurring theme in existing studies of workload as a main stressor is confirmed in the findings of this study. Gender and type of school does affect outcome and female head teachers have more reported stressors than their male colleagues.

Keywords      Head teachers; stressors; work-related stress


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Funding
 Conflicts of interest
 Appendix 1
 Appendix 2
 References
 
The Health & Safety Executive (HSE) defines work-related stress (WRS) as ‘the adverse reaction people have to excessive pressures or other types of demand placed on them’ [1]. Stress is the second most common cause of work-related ill-health with 500 000 people in the UK experiencing it at a level which they believe is making them ill and with 12.8 million working days lost to stress, anxiety and depression in 2004–05 [2]. It is the leading cause of work-related ill-health in the education sector [3]. The prevalence of WRS in the Bristol Stress and Health at Work Study 2000 [4], defined as work which is ‘very or extremely stressful’, was 20%. Numerous studies have linked stress in the workplace to an increased risk of disease and ill-health [5–7] with resulting sickness absence and decreased productivity. It is not surprising given these findings that the HSE is targeting stress in its strategy to reduce work-related illness [8].

During the 1980s, a series of Acts culminating in the Education Reform Act 1988 (ERA) led to significant changes in the organization of education and the role of the head teacher. Local management of schools, the National Curriculum, league tables and inspection of schools were all introduced in quick succession. The ERA ‘radically altered the statutory and professional context in which head teachers operate and changed their relationships with Local Education Authorites (LEAs), governors, parents, staff and children’ [9]. The emphasis of their role shifted in line with the Secretary of State, Kenneth Clarke's plan for head teachers to be ‘managers first and teachers second’ [10].

In the last 20 years there has also been a major shift in the gender balance among head teachers. Recent figures show that the majority of head teachers are now female although male head teachers still dominate in secondary schools [11]. This may have altered the dynamic for head teachers and led to a difference in prevalence and causes of WRS in the overall group.

While there has been much research into stress in teachers [12,13], in comparison there has been relatively little work in the UK specifically on head teachers and many of the studies predate the ERA [14–18]. The only UK study to provide comparisons between primary and secondary schools is the national study of head teachers and college principals by Cooper and Kelly [14]. (Prevalence of stress is measured indirectly by consideration of stressors, outcomes of stress and job dissatisfaction.) It suggests that there are gender and institutional differences in health and job satisfaction of head teachers. To date, it is the only study whose findings have sufficient external validity to be applicable to all UK head teachers, though its relevance today is limited as it was conducted in 1988 prior to the introduction of ERA. Overall, the studies seem to indicate that head teachers are at risk of WRS because of the long hours worked, constant change and work overload [19].

The effect of educational change on head teachers today is unknown. Review of the relevant literature (confined to studies published in the last 20 years) identified through Medline, PsycInfo and ERIC (searches using key words head teacher, principal, administrator and stress) identified only two studies of head teachers in the UK since 2000 [20,21]. The influence of head teachers on the successful outcome of their school is well known [22]. The purpose of this study, therefore, was to investigate the prevalence and reported causes of WRS (stressors) in head teachers and principals of Colleges of Further Education in West Sussex and to compare them with a general population norm group (GPN) and a peer group of managers/professionals (MPN). The second part of the study, which will be reported separately, sought to identify risk factors that may predict cases of WRS and to examine health and other outcomes.


   Methods
Top
 Abstract
 Introduction
 Methods
Results
 Discussion
 Funding
 Conflicts of interest
 Appendix 1
 Appendix 2
 References
 
A cross-sectional survey of head teachers and principals in West Sussex was conducted by postal questionnaire between September and December 2005.

The study population consisted of head teachers from all maintained schools listed on the West Sussex Grid for Learning website and government-funded further education colleges in the county. Special schools were not included. The total population was 290 head teachers and principals.

The instrument used was a short stress evaluation tool (ASSET) [23], produced by Robertson Cooper Limited; it is a validated questionnaire measuring stress, which has been widely used both commercially and in research [24,25]. It provides access to a large database, allowing the study results to be compared with data on reported causes and outcomes of WRS obtained in similar studies of the general population and other professional groups, the so-called ASSET ‘norm’ groups. The responses from head teachers were compared to the mean results for the ASSET norm groups using one-sample t-tests. Head teachers were also compared with ASSET norms by converting their mean score into a ‘sten’ score (a ‘standardized ten’ score based on a scale of 1–10, with a mean of 5.5 and standard deviation of 2) [23]. In the ASSET guidelines, a group sten score between 4 and 7 is regarded as being an ‘average outcome’. Higher sten scores indicate higher levels of stress. In statistics, ‘average’ implies a mean rather than a range, however this ASSET terminology will be used for consistency when referring to sten scores. Appendix 1 gives an overview of the content of the four sections of the questionnaire, the eight categories of stressors under consideration and the sten scoring system. The norm groups used are a GPN of >25 000 workers and a MPN group of nearly 6000 from public and private sector organizations in the UK.

An additional questionnaire, separate from ASSET, sought responses on perception of WRS, job satisfaction and causes of managerial stress specific to education (Appendix 2). These questions were derived from previous work by Kelly [26] and Chaplain [21] (with their permission) or were new questions altogether. They were scored from 0 (extreme stress) to 4 (low stress). Question 15 was used to define cases of WRS as individuals who felt that their work was very or extremely stressful (following the Bristol study design) [4].

The questionnaires (including numbered front sheet) were posted to participants' work addresses. A list of participants and their corresponding number was held separately in order to identify non-responders, so that a follow-up questionnaire could be sent, 1 month later, in order to maximize the response rate. Background data on gender and age groups for the study population, sickness absence figures and number of head teachers leaving in 2005 were obtained from West Sussex County Council (WSCC).

Ethical clearance was obtained from the University of Manchester ethics committee.

Statistical analysis was carried out using SPSS for Windows 11.5 and the ASSET database. Mann–Whitney U-tests, t-tests and chi-square were used to determine whether differences between groups was significant and Spearman correlation coefficients used to measure the strength and significance of relationships between variables. To correct for confounding of the relationship between potential stressors and one variable (e.g. gender) by another (school type), regression models, which included both variables were used. For scores with a five-category scale, a proportional odds regression model was used while logistic regression was used for binary outcomes. For summary scales formed by adding together a number of scores, ordinary (linear) regression was used but standard errors for tests were estimated using 1000 bootstrap samples because of the non-normality of the scores.

Missing data were dealt with by exclusion from the data analysis altogether. Where answers to a number of questions were combined to give an overall value, if any of the constituent questions were not answered then no overall value was given for the individual.


   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 Funding
 Conflicts of interest
 Appendix 1
 Appendix 2
 References
 
The response rate (RR) was 64%. The distribution by gender, school type and age for respondents was very similar to that of the survey population based on information from the Education department of WSCC (Table 1). No principals of further education colleges responded to the questionnaire.


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  		Table 1. Distribution of the survey and respondent populations by gender, age group and school type

 
Average hours worked per week by head teachers were 57.5 (range 35–80). Secondary school head teachers worked significantly longer hours than primary heads on average (t-test, mean difference 5.9, P < 0.001). Females worked longer hours than males but the difference was not statistically significant (t-test, mean difference 1.6, P = 0.18.).

Prevalence of WRS was 43% (79 head teachers who felt that their job was ‘extremely or very stressful’). Seventy-three per cent (136) of head teachers were satisfied or very satisfied with their job, only 4% (7) were not satisfied. There was a significant inverse relationship between WRS and job satisfaction (Spearman correlation = –0.369, P < 0.001). All the seven head teachers who were stressed and dissatisfied were from primary schools, six were women.

From the supplementary questionnaire, which addressed managerial stress in education (Appendix 2), Office for Standards in Education (Ofsted)/HM Inspectorated (HMI) inspection, new or changed legislation, maintaining pupil performance and staff standards and the demands of the LEA were given the lowest scores (highest stress). Issues of management training and relationships with staff and governors were associated with the least stress. The scores for all causes of stress were significantly correlated with cases of WRS. Spearman correlations ranged from 0.27 to 0.46 and were significantly different from 0 (P < 0.01) in all cases.

When compared with findings in the GPN and MPN groups, head teachers reported significantly more stress due to work overload and lack of work-life balance than the GPN and MPN groups (Table 2). Compared to the MPN, head teachers were also significantly more stressed by ‘aspects of the job’ and issues over pay and benefits. They were significantly less stressed in terms of work relationships, job security, control and resources and communication.


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  		Table 2. Respondents' mean results for the 12 categories of sources of stress and comparison with the GPN and MPN mean values

 
Using the ASSET sten scoring system, head teacher means for causes of stress were found to be in the average range compared to the GPN and MPN groups (Figure 1) other than for work overload and work-life imbalance, for which they had scores of 10 when compared against the GPN norm indicating ‘very high stressors’.


Figure 1
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  		Figure 1. Causes of stress in head teachers from the ASSET questionnaire in comparison to the GPN and MPN norm groups.

 
Sixty-eight per cent of primary school head teachers were female compared to 32% in secondary schools. Differences in prevalence of stress between different types of school or by gender (Table 3) were not significant in univariate analyses or regression analysis. Males and secondary head teachers were significantly more satisfied than their counterparts using crude analyses (Mann–Whitney P = 0.02 and 0.03, respectively). However, in regression analysis where the effect of each factor was adjusted for potential confounding by the other, the differences in satisfaction were no longer statistically significant (Table 3).


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  		Table 3. Self-reported stress, job satisfaction and managerial causes of stress by gender and school type

 
When ‘sources of managerial stress in education’ were compared by gender and school type using regression analysis to remove confounding, significant differences were found for
Primary head teachers who attributed higher levels of stress to curriculum changes than secondary head teachers.
Secondary head teachers declared higher levels of stress when handling pupil discipline and allocating resources.
Female head teachers attributed higher levels of stress than males for new or changed legislation, pupil performance, acting as a buffer, interpersonal problems with others in management team, allocating resources and inadequate management training (Table 3).

Results by gender and school type for causes of stress as measured by ASSET sten scores were compared to the MPN norms. Apart from for work overload in female head teachers, stressors all fell into the average range (Figure 2).


Figure 2
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  		Figure 2. Causes of stress in head teachers by gender and school type in comparison to the ASSET MPN group.

 
When the unstandardized ASSET results for gender and school type were compared, females were significantly more stressed than males by overload and issues of control. There were no significant differences for stressors between primary and secondary head teachers (Table 4).


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  		Table 4. Causes of stress from ASSET by gender and type of school

 
Respondents were invited to provide additional comments on other likely work stressors not already mentioned. Fifty-four per cent (100) of respondents made comments. In the words of one head teacher, ‘It is not any one thing but the total of all the things that causes stress. One minute handling £1million budget the next unblocking toilets’. The three most frequently reported stressors were parents (22%, e.g. difficult relationships, not supportive, ‘irate and unreasonable’, ‘aggressive’), workload (20%, e.g. long hours, lack of time to do job, ‘worked 51 evenings in last 12 months’) and government initiatives and time frame for changes (20%, e.g. workforce reform: planning, preparation and assessment (PPA) time, network initiative, inclusion projects).


   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Funding
 Conflicts of interest
 Appendix 1
 Appendix 2
 References
 
The prevalence of self-reported stress in head teachers in our study was high at more than double that found in workers in the HSE Bristol study [4] which used the same definition and higher than findings from the majority of existing studies into head teacher stress [21,27–30]. Despite the high prevalence of stress, most respondents were satisfied with their job and had an above average level of commitment to their organization when compared to the ASSET norm groups. Other studies of head teachers and teachers [27,31,32] show similar findings. It is possible that some stressors inherent to the role of a head teacher, such as multitasking, accountability, pupil performance and discipline, are also factors which make the job unique, stimulating and satisfying. As ‘Chief Executive Officers’ of their schools, head teachers may also derive satisfaction from the amount of control which they have over their job.

Workload was identified as one of the two main stressors, the other was work-life imbalance (in particular working long hours and work interfering with home life) and this was also reflected in the head teachers' free comments. The average hours worked by the respondents was in excess of the Working Time Directive [33]. Recent initiatives to address similar issues of workload in teachers with PPA time may have added to the pressure felt by head teachers. Dedicated Headship Time introduced during the study period seems to have had little impact at this stage [34].

When compared to the ASSET general population of workers (GPN) group, overload and work-life imbalance were very high stressors for head teachers in our study. The head teachers' profile for stressors was average compared to the MPN group. The 1988 national study of head teachers [14] found workload and work relationships to be the main stressors. In our study, head teachers were less stressed than the norm groups (GPN, MPN) for work relationships, which may be partly due to the recent improvements in their management training. In addition, and with respect to stressors specific to managers in education, inadequate management training was least stressful along with other management issues such as allocation of resources, relationship with governors or other members of the management team, also ranked low stressors; the highest ranked stressors related more to issues of inspection by Ofsted, legislation and performance.

Other stressors that ranked high for head teachers in our study, compared to the GPN, were change, performance monitoring and difficult customers. This is also reflected in the free comments. Change as a stressor is not surprising given the well-documented, constant changes in education since the ERA 1988. Also, parents are now viewed as consumers in the education marketplace with the often associated increase in demands from them [35].

Analysis of the impact of gender and school type controlled for possible confounding by one factor on relationships with the other. Female gender was independently associated with higher reporting of stressors, in keeping with other studies considering gender-related differences in stress which also demonstrate higher prevalence of stress or related outcomes in women [5,36,37]. It is postulated that the difference might be related to a greater willingness on the part of women to declare stress than their male colleagues or to the increased pressures of work-life balance on women who may still have the major role in child care/domestic arrangements alongside their work or both.

School type was also an independent predictor. Primary head teachers were more stressed by curriculum changes, possibly because of the greater responsibility which primary head teachers have for implementing changes compared to secondary head teachers with larger management teams. Secondary head teachers were more stressed by resource allocating issues, pupil performance and pupil discipline. This may be explained by the demands of an older age group of pupils and the larger school environment of secondary schools.

Though the response rate to our study was good, we cannot discount the possibility that responders and non-responders might differ. However, the respondent and survey population—head teachers of maintained primary and secondary schools in West Sussex—were very similar with regards to school type, gender and age range. The respondent population was also similar, in terms of gender and school type, to the total population of head teachers in England and Wales [11,38]. There is no reason to expect major variations in responses from head teachers elsewhere in the country, although some anecdotal evidence suggests there may be variations in the support that they receive from their authorities.

As with all cross-sectional studies, one weakness of our study may be that we have a survivor population. Those with significant symptoms may have already left the job or have been absent from work at the time through illness. According to WSCC figures, nearly one-third of head teachers who left in 2005 took early retirement and two-thirds have been head teachers for 10 years or less. As the questionnaires went to work addresses this may have led to a bias towards healthy workers. A longitudinal study considering stress at different parts of the school year would be useful as there is some evidence that stress may vary over the course of the academic year [12,39]. It would also allow us to consider the effect of premorbid personality and emotional resistance in addition to the effect of occupational stressors [40].

Studies have indicated that the single most influential factor in a successful school is the head teacher [15,16,22,]. A high prevalence of stress, excessive workload and long hours may increase risks of health problems, lead to reduced productivity and impact significantly on the head teachers themselves and the school, its staff, children and the community as a whole.


Key points
  • Prevalence of WRS in head teachers is possibly higher than previously estimated, with work overload and work-life imbalance as the main reported stressors.
  • Stressors vary by gender and type of school.
  • Despite high levels of reported WRS, the majority of head teachers were satisfied with their job and showed above average levels of commitment.

 


   Funding
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Funding
Conflicts of interest
 Appendix 1
 Appendix 2
 References
 
Adastral Health Ltd.


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Funding
 Conflicts of interest
Appendix 1
 Appendix 2
 References
 
None declared.


   Appendix 1
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Funding
 Conflicts of interest
 Appendix 1
Appendix 2
 References
 
ASSET has four sections (25):

  • Background demographics
  • Stressors: perceptions of your job: scored 1 (strongly disagree) to 6 (strongly agree)
  • Stressors/outcomes of stress: attitudes towards your organization: scored 1 (strongly disagree) to 6 (strongly agree).
  • Outcomes of stress: your health: scored from 1 (never) to 4 (often).

The responses on sources of stress are grouped into eight categories:

  • Work relationships
  • Work-life balance
  • Overload
  • Job security
  • Control
  • Resources and communication
  • Aspects of the job
  • Pay and benefits

ASSET scoring system: mean scores from responses are converted into a ‘sten’ score. A sten is a standardized score based on a scale of 1–10, with a mean of 5.5 and a standard deviation of 2 (25). Most people (68%) score between sten 3 and sten 8. Thus, in the ASSET guidelines, sten scores between 4 and 7 are regarded as being an ‘average outcome’ with scores outside this range taken to be above or below ‘average’. While in statistics ‘average’ implies a single mean score rather than a range, this ASSET terminology will be used for consistency.

In the ASSET scoring system mean scores of:

  • Less than sten 3 indicate very low levels of the stressor/commitment or very good health,
  • Less than sten 4 indicate low levels of the stressor/commitment or good health,
  • Sten 4–7 average levels of the stressor/commitment or average health,
  • Greater than sten 7 high levels of the stressor/commitment or poor health,
  • Greater than sten 8 very high levels of the stressor/commitment or very poor health (25).


   Appendix 2
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Funding
 Conflicts of interest
 Appendix 1
 Appendix 2
References
 
Additional questions on sources of managerial stress in education

Formula


   Acknowledgements
 
We thank all the participating head teachers and West Sussex County Council. The paper is based on work done for a dissertation for the MSc in Occupational Medicine at the University of Manchester.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Funding
 Conflicts of interest
 Appendix 1
 Appendix 2
 References
 

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