Teaching is a stressful job. Teachers, especially female teachers who are often involved in work at home as well, are at the risk of developing minor psychiatric morbidity (MPM) as a manifestation of stress. This may result in a significant reduction in their teaching effectiveness and the development of adverse health consequences, if not detected early and managed appropriately. No published research on female teachers in the Kingdom of Saudi Arabia (KSA) was found.
Research studies on female teachers are particularly hampered by cultural constraints. It was possible to trace only two studies done on work-related MPM among school workers in Jeddah by Milaat in 1997,1 and among attendants of an academic primary care department in Riyadh by Al Faris in 1992.2 These reported a prevalence of 38.2% and 30-47% respectively. Their findings conform to primary care figures of 10 to 40% in various parts of the world.2
A report on occupational stress in the year 2000, pointed out that among many other occupational groups teachers were the most vulnerable.3 MPM include such health problems as anxiety, depression, sleep disturbances, relationship disharmony, gastrointestinal disturbances, and various minor illnesses.4 A high proportion of these disorders are not detected at the primary care level where they frequently present, although they can be easily diagnosed and managed at that level. This study is to estimate the extent of MPM among female secondary school teachers in Tabuk and determine some of the socio-demographic characteristics associated with such problems.
A cross-sectional study of the prevalence of MPM and some of the important associated factors among female teachers in girls’ secondary schools in Tabuk City, KSA was performed during one week in March 2002. Tabuk has 20 secondary schools for girls, staffed by 517 female teachers. The schools belong to three sectors as follows: Ministry of Defense and Aviation, Administration of Girls Education, and privately owned.
Cluster sampling was carried out by means of a proportional random sample of schools from each sector. We enrolled all teachers in the selected schools in the study, giving a sample size of 198 participants. Those who were on leave or who were temporarily working in other schools while their employee number was retained by the selected schools were excluded.
Data collected by GHQ30 was developed as a screening instrument for detection of non-psychotic psychiatric disorders in the general population, and subsequently validated and extensively used.5 Each item in the questionnaire had four responses: not at all, less than usual, usual, and more than usual.
It was a self-administered question-naire. A telephone line was opened during distribution time for any questions to the investigator. The responses were scored by the usual GHQ scoring method (0-0-1-1) marks along the continuum of the rating scale. A cut-off point of 5/6 indicated a probable case. In the demographic characteristics section, participants were specifically asked about: age, nationality, marital status, number of children in the family and the number of family members, participants family history of medical and psychiatric problems, housing type and monthly income. Data were compiled and analyzed by descriptive and analytical statistics using Epi-Info Versions 6 and SPSSPC software packages.
The initial sample size to whom the questionnaires were sent consisted of 198 participants who were working at the time of the study in the selected schools. Five did not respond. Six questionnaires were excluded from the study because they were not properly completed. The final study sample size was 187 participants, giving a response rate of 94.4%. Table 1 shows the frequency distribution of the subjects′ characteristics.
Among all the participants, 111 (59.4%) were probable cases of MPM. The ages ranged from 23 to 46 years, with a mean age of 29.5 (SD 4.5). By nationality, 174 (93.6%) were Saudis. One hundred and 140 (74.9%) were married, 40 (21.4%) were single and (3.7%) were divorced/ widowed.
There was statistically significantly association between MPM, and the mean age though this was slightly lower in MPM subjects than the others 29.1 + 3.96 and 30.1 + 5.23 respectively (p < 0.05), while the average number of children and family member showed no statistically significant differences in the two groups (Table 2).
Table 3 shows that MPM was significantly more frequent in Saudi citizens, either divorced or widowed, with positive family history of medical and of mental disease. The characteristics which showed statistically positive significant association with MPM were: Saudi nationality, divorced/widowed status, participant and/or family psychiatric history, and family medical history.
Our study response rate among female secondary school teachers was high (94.4%). Using a cut-off point of 5/6, almost two thirds of our subjects (111) (59.4%) were identified as probable cases. This is a higher prevalence than both local studies in Jeddah (38.2%)1 and Riyadh (46%)2 mentioned earlier. It is also higher than what had been estimated for the general population in the KSA (22-33%).6 However, the high prevalence of MPM among teachers is an expected result because teaching is considered the most stressful job,3 and many studies outside the KSA had similar results.7–9
Most of our study group were young, and 139 (74.3%) of them were below the age of 32. Their age frequency distribution showed that the incidence of MPM (Table 1) among the younger teachers was less. Comparing the mean age of groups with MPM (29% + 4.0) and the normal group (30% + 5.2), there was a difference of one year, which was statistically significant (p < 0.05). Some studies clearly showed that the younger the age, the less association there was with MPM.1–3 Unlike the findings in Jeddah and some international studies, we found no statistically significant difference between single and married status.1310 However, the difference between the married and the divorced/widowed was highly significant (Table 3).
A participant's history of psychiatric problems or a family history of such problems are strongly associated with MPM (Table 3). All those with family psychiatric history were among the probable cases. This finding agrees with the Al Faris study.2 Though disease of the body is expected to affect the mind and reduce the body's resistance to stress, an unexpected result was the lack of significant statistical association between participant's medical problems and MPM. Also, income was not associated with MPM manifestations. This might be due to the narrow variation of income and the fact that 140 (74.9%) of the participants were in the same income category (Table 3).
There was no description of the work environment of the girls’ secondary school teachers in Tabuk in our study. Such a description may have pointed to some of the probable causes of the high prevalence of MPM. Interviewing some teachers might have also given some insight into the magnitude and the causes of the problems encountered. Other studies had emphasized the need for social support to prevent or relieve the morbid effects of stress in schools.11–13
Reducing stress and improving the psychological health of teachers is expected to result in the improvement of the teaching process. Social support strategies vary greatly in different cultures,11 and studies are needed to find strategies suitable to the Saudi culture.
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