Common psychiatric symptoms among public school teachers in Palmas, Tocantins, Brazil. An observational cross-sectional study

CONTEXT AND OBJECTIVE: Teachers are at great risk of physical and mental stress due to material or psychological difficulties associated with their work. This study aimed to assess the prevalence of common psychiatric symptoms measured on the Self-Reporting Questionnaire (SRQ-20) scale that would suggest a diagnosis of psychiatric disorders among public school teachers in Palmas, Tocantins, Brazil, in 2012. DESIGN AND SETTING: Observational cross-sectional study in Palmas, Tocantins, Brazil. METHOD: We assessed 110 municipal teachers in the city of Palmas, Tocantins, Brazil. They were selected randomly from a list of employees of the Municipal Education Department of Palmas. All of them answered the SRQ-20 questionnaire after giving their consent. RESULTS: Between the years 2008 and 2011, 24 cases of absence from work due to mental disorders were found. We excluded one case and 109 teachers answered the SRQ-20questionnaire. Out of the 109 teachers assessed, 54 had ≥ 7 points on the SRQ-20 scale. This finding suggests that 49.5% of the teachers had symptoms that were sufficient to consider a diagnosis of mental disorder, with the need for treatment. CONCLUSION: Our study found that the prevalence of mental disorders among teachers is as high as seen in the literature. Our results suggest that recognition of mental disorders is low and that the current statistics fail to reach the occupational health sector.


INTRODUCTION
Research worldwide has shown that school teachers are at great risk of physical and mental stress due to material or psychological difficulties associated with their work. 13][4][5] In Brazil, changes to how the job of teaching is organized, the advent of new requirements and competencies that are changing teaching activity, but without the means to provide compatibility, has created work overload.The factors mentioned above may be a source of complaints, mental disorders and absence from work. 1 The United Nations Educational, Scientific and Cultural Organization (UNESCO) has reported a progressive increase in violence in schools throughout the world and has interpreted violence in schools as one of the main causes of teachers' distress. 6

OBJECTIVE
This study aimed to assess the prevalence of psychiatric symptoms measured by means of the Self-Reporting Questionnaire (SRQ-20) scale, that would suggest a diagnosis of psychiatric disorders among public school teachers in Palmas, Tocantins, Brazil, in 2012.

Subjects
We assessed teachers working at public schools in the city of Palmas, Tocantins, Brazil.They were selected by randomization in groups from a list of employees of the Municipal Education Department of Palmas.Each group had five workers, i.e., five were called to the survey, five ignored, five were called and so on until the number of 110 subjects was reached (randomization in blocks).They answered the SRQ-20 [7][8][9] questionnaire after giving their consent.
The inclusion criteria were that the subjects needed to be more than 20 years of age and to have been public teachers for at least a year.The exclusion criteria were the presence of severe physical disease that compromised their mental capacity and working for less than a year as a public teacher.One subject refused to participate after having answered the questionnaire.
The sample size was calculated in accordance with the National Statistical Service, 10 using a 95% confidence level, population size of 2,300, proportion of psychiatric disorders of 50% (based on previous studies) and relative standard error of 10%.The minimum sample size was 96 subjects, but we used 110 to avoid losses.

Diagnostic and symptom assessment
We used the Self-Reporting Questionnaire (SRQ), [7][8][9]  Questionnaire N 2 (PGI), which was developed in India; and the Patient Symptom Self Report (PASSR), which is an instrument developed in Colombia.This is a self-reporting questionnaire and the optimum cutoff value for the SRQ-20 was 7.

Statistical analysis
We compared teachers with 7 points or more (≥ 7 points) from the SRQ-20 with teachers with less than 7 points (< 7 points).
Age was a continuous variable and was presented as the mean and standard deviation.

RESULTS
One teacher was excluded from this study because he refused to complete the examination for personal reasons.Among the 109 teachers assessed, 54 had ≥ 7 points on the SRQ-20 scale.
This finding suggests that 49.5% of the teachers had symptoms that were sufficient to consider a diagnosis of mental disorder, with the need for treatment.
We compared teachers with ≥ 7 points with teachers with < 7 points and observed that there were no differences in relation to gender, age, marital status, workload and working exclusively in a public school or not.In addition, the proportion of the teachers who practiced physical activity was lower in the group with ≥ 7 points (n = 24, 44.4%) on the SRQ-20 scale, than in the group with < 7 points (n = 32; 58.2%; P = 0.08) (Table 1).Teachers who did not practice physical activity and had ≥ 7 points had an odds ratio of 1.74.

DISCUSSION
The Reference Center for Occupational Health (Centro de In Australia, Tuettemann found that the prevalence of mental disorders among high school teachers was 44.6%. 11Another study conducted in Hong Kong recently also showed that the teaching profession is highly stressful. 2About a third of the teachers surveyed showed signs of stress and burnout among their major health problems. 2In Brazil, the prevalence of common mental disorders among teachers in Belo Horizonte was 50.3%. 1 The frequency of psychiatric disorders found among teachers surveyed in Vitória da Conquista, Bahia, Brazil, was twice the frequency in the general population, with no significant difference between men and women.The presence of disorders was related to working conditions (physical and organizational), and the presence of violence. 12me risk factors found in previous studies investigat- We found that the frequency of doing physical activities was lower among subjects with ≥ 7 points on the SRQ-20 scale, and that the teachers who did not practice exercises presented a 1.74 times greater chance of having a mental disorder.5][16] Therefore, these data show a possibility for preventive action that could be taken.

CONCLUSION
Our study found that the prevalence of mental disorders among teachers is as high as seen in the literature.
Referência em Saúde do Trabalhador, CEREST) in Palmas, Tocantins, assessed the prevalence of mental disorders among teachers in municipal schools between the years 2008 and 2011 and observed 24 cases of absence from work due to mental disorders.Since there were 2,300 municipal teachers in the city of Palmas, the prevalence was 1% over four years.The prevalence was one case in 2008, one case in 2009, 11 cases in 2010 and 11 cases in 2011.Although there was an increase in the number of absences due to mental disorders, this number was lower than expected.Therefore, the SRQ-20 questionnaire was administered in order to assess the prevalence of significant psychiatric symptoms and the likelihood of mental illness among 110 municipal teachers in Palmas, Tocantins.
ing psychiatric disorders among teachers included: behavior relating to health and morbidity, difficulty in integrating at work, heavy workload; violence at school, perception of work, resources available for work, and physical environment of the school.1,2,13Reports of violence in schools are made very frequently among teachers, and all forms of aggression committed by students, students' parents, staff or colleagues at work, or people outside of the school have been strongly associated with mental disorders.1