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August 16, 2021

Is it time to get rid of homework? Mental health experts weigh in

by Sara M Moniuszko

It's no secret that kids hate homework. And as students grapple with an ongoing pandemic that has had a wide-range of mental health impacts, is it time schools start listening to their pleas over workloads?

Some teachers are turning to social media to take a stand against homework .

Tiktok user @misguided.teacher says he doesn't assign it because the "whole premise of homework is flawed."

For starters, he says he can't grade work on "even playing fields" when students' home environments can be vastly different.

"Even students who go home to a peaceful house, do they really want to spend their time on busy work? Because typically that's what a lot of homework is, it's busy work," he says in the video that has garnered 1.6 million likes. "You only get one year to be 7, you only got one year to be 10, you only get one year to be 16, 18."

Mental health experts agree heavy work loads have the potential do more harm than good for students, especially when taking into account the impacts of the pandemic. But they also say the answer may not be to eliminate homework altogether.

Emmy Kang, mental health counselor at Humantold, says studies have shown heavy workloads can be "detrimental" for students and cause a "big impact on their mental, physical and emotional health."

"More than half of students say that homework is their primary source of stress, and we know what stress can do on our bodies," she says, adding that staying up late to finish assignments also leads to disrupted sleep and exhaustion.

Cynthia Catchings, a licensed clinical social worker and therapist at Talkspace, says heavy workloads can also cause serious mental health problems in the long run, like anxiety and depression.

And for all the distress homework causes, it's not as useful as many may think, says Dr. Nicholas Kardaras, a psychologist and CEO of Omega Recovery treatment center.

"The research shows that there's really limited benefit of homework for elementary age students, that really the school work should be contained in the classroom," he says.

For older students, Kang says homework benefits plateau at about two hours per night.

"Most students, especially at these high-achieving schools, they're doing a minimum of three hours, and it's taking away time from their friends from their families, their extracurricular activities. And these are all very important things for a person's mental and emotional health."

Catchings, who also taught third to 12th graders for 12 years, says she's seen the positive effects of a no homework policy while working with students abroad.

"Not having homework was something that I always admired from the French students (and) the French schools, because that was helping the students to really have the time off and really disconnect from school ," she says.

The answer may not be to eliminate homework completely, but to be more mindful of the type of work students go home with, suggests Kang, who was a high-school teacher for 10 years.

"I don't think (we) should scrap homework, I think we should scrap meaningless, purposeless busy work-type homework. That's something that needs to be scrapped entirely," she says, encouraging teachers to be thoughtful and consider the amount of time it would take for students to complete assignments.

The pandemic made the conversation around homework more crucial

Mindfulness surrounding homework is especially important in the context of the last two years. Many students will be struggling with mental health issues that were brought on or worsened by the pandemic, making heavy workloads even harder to balance.

"COVID was just a disaster in terms of the lack of structure. Everything just deteriorated," Kardaras says, pointing to an increase in cognitive issues and decrease in attention spans among students. "School acts as an anchor for a lot of children, as a stabilizing force, and that disappeared."

But even if students transition back to the structure of in-person classes, Kardaras suspects students may still struggle after two school years of shifted schedules and disrupted sleeping habits.

"We've seen adults struggling to go back to in-person work environments from remote work environments. That effect is amplified with children because children have less resources to be able to cope with those transitions than adults do," he explains.

'Get organized' ahead of back-to-school

In order to make the transition back to in-person school easier, Kang encourages students to "get good sleep, exercise regularly (and) eat a healthy diet."

To help manage workloads, she suggests students "get organized."

"There's so much mental clutter up there when you're disorganized... sitting down and planning out their study schedules can really help manage their time," she says.

Breaking assignments up can also make things easier to tackle.

"I know that heavy workloads can be stressful, but if you sit down and you break down that studying into smaller chunks, they're much more manageable."

If workloads are still too much, Kang encourages students to advocate for themselves.

"They should tell their teachers when a homework assignment just took too much time or if it was too difficult for them to do on their own," she says. "It's good to speak up and ask those questions. Respectfully, of course, because these are your teachers. But still, I think sometimes teachers themselves need this feedback from their students."

©2021 USA Today Distributed by Tribune Content Agency, LLC.

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More than two hours of homework may be counterproductive, research suggests.

A Stanford education researcher found that too much homework can negatively affect kids, especially their lives away from school, where family, friends and activities matter.   "Our findings on the effects of homework challenge the traditional assumption that homework is inherently good," wrote Denise Pope , a senior lecturer at the Stanford Graduate School of Education and a co-author of a study published in the Journal of Experimental Education .   The researchers used survey data to examine perceptions about homework, student well-being and behavioral engagement in a sample of 4,317 students from 10 high-performing high schools in upper-middle-class California communities. Along with the survey data, Pope and her colleagues used open-ended answers to explore the students' views on homework.   Median household income exceeded $90,000 in these communities, and 93 percent of the students went on to college, either two-year or four-year.   Students in these schools average about 3.1 hours of homework each night.   "The findings address how current homework practices in privileged, high-performing schools sustain students' advantage in competitive climates yet hinder learning, full engagement and well-being," Pope wrote.   Pope and her colleagues found that too much homework can diminish its effectiveness and even be counterproductive. They cite prior research indicating that homework benefits plateau at about two hours per night, and that 90 minutes to two and a half hours is optimal for high school.   Their study found that too much homework is associated with:   • Greater stress : 56 percent of the students considered homework a primary source of stress, according to the survey data. Forty-three percent viewed tests as a primary stressor, while 33 percent put the pressure to get good grades in that category. Less than 1 percent of the students said homework was not a stressor.   • Reductions in health : In their open-ended answers, many students said their homework load led to sleep deprivation and other health problems. The researchers asked students whether they experienced health issues such as headaches, exhaustion, sleep deprivation, weight loss and stomach problems.   • Less time for friends, family and extracurricular pursuits : Both the survey data and student responses indicate that spending too much time on homework meant that students were "not meeting their developmental needs or cultivating other critical life skills," according to the researchers. Students were more likely to drop activities, not see friends or family, and not pursue hobbies they enjoy.   A balancing act   The results offer empirical evidence that many students struggle to find balance between homework, extracurricular activities and social time, the researchers said. Many students felt forced or obligated to choose homework over developing other talents or skills.   Also, there was no relationship between the time spent on homework and how much the student enjoyed it. The research quoted students as saying they often do homework they see as "pointless" or "mindless" in order to keep their grades up.   "This kind of busy work, by its very nature, discourages learning and instead promotes doing homework simply to get points," said Pope, who is also a co-founder of Challenge Success , a nonprofit organization affiliated with the GSE that conducts research and works with schools and parents to improve students' educational experiences..   Pope said the research calls into question the value of assigning large amounts of homework in high-performing schools. Homework should not be simply assigned as a routine practice, she said.   "Rather, any homework assigned should have a purpose and benefit, and it should be designed to cultivate learning and development," wrote Pope.   High-performing paradox   In places where students attend high-performing schools, too much homework can reduce their time to foster skills in the area of personal responsibility, the researchers concluded. "Young people are spending more time alone," they wrote, "which means less time for family and fewer opportunities to engage in their communities."   Student perspectives   The researchers say that while their open-ended or "self-reporting" methodology to gauge student concerns about homework may have limitations – some might regard it as an opportunity for "typical adolescent complaining" – it was important to learn firsthand what the students believe.   The paper was co-authored by Mollie Galloway from Lewis and Clark College and Jerusha Conner from Villanova University.

Clifton B. Parker is a writer at the Stanford News Service .

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Health Hazards of Homework

March 18, 2014 | Julie Greicius Pediatrics .

A new study by the Stanford Graduate School of Education and colleagues found that students in high-performing schools who did excessive hours of homework “experienced greater behavioral engagement in school but also more academic stress, physical health problems, and lack of balance in their lives.”

Those health problems ranged from stress, headaches, exhaustion, sleep deprivation, weight loss and stomach problems, to psycho-social effects like dropping activities, not seeing friends or family, and not pursuing hobbies they enjoy.

In the Stanford Report story about the research, Denise Pope , a senior lecturer at the Stanford Graduate School of Education and a co-author of the  study published in the  Journal of Experimental Education , says, “Our findings on the effects of homework challenge the traditional assumption that homework is inherently good.”

The study was based on survey data from a sample of 4,317 students from 10 high-performing high schools in California communities in which median household income exceeded $90,000. Of the students surveyed, homework volume averaged about 3.1 hours each night.

“It is time to re-evaluate how the school environment is preparing our high school student for today’s workplace,” says Neville Golden, MD , chief of adolescent medicine at Stanford Medicine Children’s Health and a professor at the School of Medicine. “This landmark study shows that excessive homework is counterproductive, leading to sleep deprivation, school stress and other health problems. Parents can best support their children in these demanding academic environments by advocating for them through direct communication with teachers and school administrators about homework load.”

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Associations of time spent on homework or studying with nocturnal sleep behavior and depression symptoms in adolescents from Singapore

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Trending Today

Spending Too Much Time on Homework Linked to Lower Test Scores

A new study suggests the benefits to homework peak at an hour a day. After that, test scores decline.

Samantha Larson

Polls show that American public high school teachers assign their students an average of 3.5 hours of homework a day . According to a  recent study from the University of Oviedo in Spain, that’s far too much.

While doing some homework does indeed lead to higher test performance, the researchers found the benefits to hitting the books peak at about an hour a day. In surveying the homework habits of 7,725 adolescents, this study suggests that for students who average more than 100 minutes a day on homework, test scores start to decline. The relationship between spending time on homework and scoring well on a test is not linear, but curved.

This study builds upon previous research that suggests spending too much time on homework leads to higher stress, health problems and even social alienation. Which, paradoxically, means the most studious of students are in fact engaging in behavior that is counterproductive to doing well in school. 

Because the adolescents surveyed in the new study were only tested once, the researchers point out that their results only indicate the correlation between test scores and homework, not necessarily causation. Co-author Javier Suarez-Alvarez thinks the most important findings have less to do with the  amount of homework than with how that homework is done.

From Education Week :

Students who did homework more frequently – i.e., every day – tended to do better on the test than those who did it less frequently, the researchers found. And even more important was how much help students received on their homework – those who did it on their own preformed better than those who had parental involvement. (The study controlled for factors such as gender and socioeconomic status.)

“Once individual effort and autonomous working is considered, the time spent [on homework] becomes irrelevant,” Suarez-Alvarez says. After they get their daily hour of homework in, maybe students should just throw the rest of it to the dog.  

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Samantha Larson | | READ MORE

Samantha Larson is a freelance writer who particularly likes to cover science, the environment, and adventure. For more of her work, visit SamanthaLarson.com

Are You Down With or Done With Homework?

• Posted January 17, 2012
• By Lory Hough

The debate over how much schoolwork students should be doing at home has flared again, with one side saying it's too much, the other side saying in our competitive world, it's just not enough.

It was a move that doesn't happen very often in American public schools: The principal got rid of homework.

This past September, Stephanie Brant, principal of Gaithersburg Elementary School in Gaithersburg, Md., decided that instead of teachers sending kids home with math worksheets and spelling flash cards, students would instead go home and read. Every day for 30 minutes, more if they had time or the inclination, with parents or on their own.

"I knew this would be a big shift for my community," she says. But she also strongly believed it was a necessary one. Twenty-first-century learners, especially those in elementary school, need to think critically and understand their own learning — not spend night after night doing rote homework drills.

Brant's move may not be common, but she isn't alone in her questioning. The value of doing schoolwork at home has gone in and out of fashion in the United States among educators, policymakers, the media, and, more recently, parents. As far back as the late 1800s, with the rise of the Progressive Era, doctors such as Joseph Mayer Rice began pushing for a limit on what he called "mechanical homework," saying it caused childhood nervous conditions and eyestrain. Around that time, the then-influential Ladies Home Journal began publishing a series of anti-homework articles, stating that five hours of brain work a day was "the most we should ask of our children," and that homework was an intrusion on family life. In response, states like California passed laws abolishing homework for students under a certain age.

But, as is often the case with education, the tide eventually turned. After the Russians launched the Sputnik satellite in 1957, a space race emerged, and, writes Brian Gill in the journal Theory Into Practice, "The homework problem was reconceived as part of a national crisis; the U.S. was losing the Cold War because Russian children were smarter." Many earlier laws limiting homework were abolished, and the longterm trend toward less homework came to an end.

The debate re-emerged a decade later when parents of the late '60s and '70s argued that children should be free to play and explore — similar anti-homework wellness arguments echoed nearly a century earlier. By the early-1980s, however, the pendulum swung again with the publication of A Nation at Risk , which blamed poor education for a "rising tide of mediocrity." Students needed to work harder, the report said, and one way to do this was more homework.

For the most part, this pro-homework sentiment is still going strong today, in part because of mandatory testing and continued economic concerns about the nation's competitiveness. Many believe that today's students are falling behind their peers in places like Korea and Finland and are paying more attention to Angry Birds than to ancient Babylonia.

But there are also a growing number of Stephanie Brants out there, educators and parents who believe that students are stressed and missing out on valuable family time. Students, they say, particularly younger students who have seen a rise in the amount of take-home work and already put in a six- to nine-hour "work" day, need less, not more homework.

Who is right? Are students not working hard enough or is homework not working for them? Here's where the story gets a little tricky: It depends on whom you ask and what research you're looking at. As Cathy Vatterott, the author of Rethinking Homework , points out, "Homework has generated enough research so that a study can be found to support almost any position, as long as conflicting studies are ignored." Alfie Kohn, author of The Homework Myth and a strong believer in eliminating all homework, writes that, "The fact that there isn't anything close to unanimity among experts belies the widespread assumption that homework helps." At best, he says, homework shows only an association, not a causal relationship, with academic achievement. In other words, it's hard to tease out how homework is really affecting test scores and grades. Did one teacher give better homework than another? Was one teacher more effective in the classroom? Do certain students test better or just try harder?

"It is difficult to separate where the effect of classroom teaching ends," Vatterott writes, "and the effect of homework begins."

Putting research aside, however, much of the current debate over homework is focused less on how homework affects academic achievement and more on time. Parents in particular have been saying that the amount of time children spend in school, especially with afterschool programs, combined with the amount of homework given — as early as kindergarten — is leaving students with little time to run around, eat dinner with their families, or even get enough sleep.

Certainly, for some parents, homework is a way to stay connected to their children's learning. But for others, homework creates a tug-of-war between parents and children, says Liz Goodenough, M.A.T.'71, creator of a documentary called Where Do the Children Play?

"Ideally homework should be about taking something home, spending a few curious and interesting moments in which children might engage with parents, and then getting that project back to school — an organizational triumph," she says. "A nag-free activity could engage family time: Ask a parent about his or her own childhood. Interview siblings."

Instead, as the authors of The Case Against Homework write, "Homework overload is turning many of us into the types of parents we never wanted to be: nags, bribers, and taskmasters."

Leslie Butchko saw it happen a few years ago when her son started sixth grade in the Santa Monica-Malibu (Calif.) United School District. She remembers him getting two to four hours of homework a night, plus weekend and vacation projects. He was overwhelmed and struggled to finish assignments, especially on nights when he also had an extracurricular activity.

"Ultimately, we felt compelled to have Bobby quit karate — he's a black belt — to allow more time for homework," she says. And then, with all of their attention focused on Bobby's homework, she and her husband started sending their youngest to his room so that Bobby could focus. "One day, my younger son gave us 15-minute coupons as a present for us to use to send him to play in the back room. … It was then that we realized there had to be something wrong with the amount of homework we were facing."

Butchko joined forces with another mother who was having similar struggles and ultimately helped get the homework policy in her district changed, limiting homework on weekends and holidays, setting time guidelines for daily homework, and broadening the definition of homework to include projects and studying for tests. As she told the school board at one meeting when the policy was first being discussed, "In closing, I just want to say that I had more free time at Harvard Law School than my son has in middle school, and that is not in the best interests of our children."

One barrier that Butchko had to overcome initially was convincing many teachers and parents that more homework doesn't necessarily equal rigor.

"Most of the parents that were against the homework policy felt that students need a large quantity of homework to prepare them for the rigorous AP classes in high school and to get them into Harvard," she says.

Stephanie Conklin, Ed.M.'06, sees this at Another Course to College, the Boston pilot school where she teaches math. "When a student is not completing [his or her] homework, parents usually are frustrated by this and agree with me that homework is an important part of their child's learning," she says.

As Timothy Jarman, Ed.M.'10, a ninth-grade English teacher at Eugene Ashley High School in Wilmington, N.C., says, "Parents think it is strange when their children are not assigned a substantial amount of homework."

That's because, writes Vatterott, in her chapter, "The Cult(ure) of Homework," the concept of homework "has become so engrained in U.S. culture that the word homework is part of the common vernacular."

These days, nightly homework is a given in American schools, writes Kohn.

"Homework isn't limited to those occasions when it seems appropriate and important. Most teachers and administrators aren't saying, 'It may be useful to do this particular project at home,'" he writes. "Rather, the point of departure seems to be, 'We've decided ahead of time that children will have to do something every night (or several times a week). … This commitment to the idea of homework in the abstract is accepted by the overwhelming majority of schools — public and private, elementary and secondary."

Brant had to confront this when she cut homework at Gaithersburg Elementary.

"A lot of my parents have this idea that homework is part of life. This is what I had to do when I was young," she says, and so, too, will our kids. "So I had to shift their thinking." She did this slowly, first by asking her teachers last year to really think about what they were sending home. And this year, in addition to forming a parent advisory group around the issue, she also holds events to answer questions.

Still, not everyone is convinced that homework as a given is a bad thing. "Any pursuit of excellence, be it in sports, the arts, or academics, requires hard work. That our culture finds it okay for kids to spend hours a day in a sport but not equal time on academics is part of the problem," wrote one pro-homework parent on the blog for the documentary Race to Nowhere , which looks at the stress American students are under. "Homework has always been an issue for parents and children. It is now and it was 20 years ago. I think when people decide to have children that it is their responsibility to educate them," wrote another.

And part of educating them, some believe, is helping them develop skills they will eventually need in adulthood. "Homework can help students develop study skills that will be of value even after they leave school," reads a publication on the U.S. Department of Education website called Homework Tips for Parents. "It can teach them that learning takes place anywhere, not just in the classroom. … It can foster positive character traits such as independence and responsibility. Homework can teach children how to manage time."

Annie Brown, Ed.M.'01, feels this is particularly critical at less affluent schools like the ones she has worked at in Boston, Cambridge, Mass., and Los Angeles as a literacy coach.

"It feels important that my students do homework because they will ultimately be competing for college placement and jobs with students who have done homework and have developed a work ethic," she says. "Also it will get them ready for independently taking responsibility for their learning, which will need to happen for them to go to college."

The problem with this thinking, writes Vatterott, is that homework becomes a way to practice being a worker.

"Which begs the question," she writes. "Is our job as educators to produce learners or workers?"

Slate magazine editor Emily Bazelon, in a piece about homework, says this makes no sense for younger kids.

"Why should we think that practicing homework in first grade will make you better at doing it in middle school?" she writes. "Doesn't the opposite seem equally plausible: that it's counterproductive to ask children to sit down and work at night before they're developmentally ready because you'll just make them tired and cross?"

Kohn writes in the American School Board Journal that this "premature exposure" to practices like homework (and sit-and-listen lessons and tests) "are clearly a bad match for younger children and of questionable value at any age." He calls it BGUTI: Better Get Used to It. "The logic here is that we have to prepare you for the bad things that are going to be done to you later … by doing them to you now."

According to a recent University of Michigan study, daily homework for six- to eight-year-olds increased on average from about 8 minutes in 1981 to 22 minutes in 2003. A review of research by Duke University Professor Harris Cooper found that for elementary school students, "the average correlation between time spent on homework and achievement … hovered around zero."

So should homework be eliminated? Of course not, say many Ed School graduates who are teaching. Not only would students not have time for essays and long projects, but also teachers would not be able to get all students to grade level or to cover critical material, says Brett Pangburn, Ed.M.'06, a sixth-grade English teacher at Excel Academy Charter School in Boston. Still, he says, homework has to be relevant.

"Kids need to practice the skills being taught in class, especially where, like the kids I teach at Excel, they are behind and need to catch up," he says. "Our results at Excel have demonstrated that kids can catch up and view themselves as in control of their academic futures, but this requires hard work, and homework is a part of it."

Ed School Professor Howard Gardner basically agrees.

"America and Americans lurch between too little homework in many of our schools to an excess of homework in our most competitive environments — Li'l Abner vs. Tiger Mother," he says. "Neither approach makes sense. Homework should build on what happens in class, consolidating skills and helping students to answer new questions."

So how can schools come to a happy medium, a way that allows teachers to cover everything they need while not overwhelming students? Conklin says she often gives online math assignments that act as labs and students have two or three days to complete them, including some in-class time. Students at Pangburn's school have a 50-minute silent period during regular school hours where homework can be started, and where teachers pull individual or small groups of students aside for tutoring, often on that night's homework. Afterschool homework clubs can help.

Some schools and districts have adapted time limits rather than nix homework completely, with the 10-minute per grade rule being the standard — 10 minutes a night for first-graders, 30 minutes for third-graders, and so on. (This remedy, however, is often met with mixed results since not all students work at the same pace.) Other schools offer an extended day that allows teachers to cover more material in school, in turn requiring fewer take-home assignments. And for others, like Stephanie Brant's elementary school in Maryland, more reading with a few targeted project assignments has been the answer.

"The routine of reading is so much more important than the routine of homework," she says. "Let's have kids reflect. You can still have the routine and you can still have your workspace, but now it's for reading. I often say to parents, if we can put a man on the moon, we can put a man or woman on Mars and that person is now a second-grader. We don't know what skills that person will need. At the end of the day, we have to feel confident that we're giving them something they can use on Mars."

Read a January 2014 update.

Homework Policy Still Going Strong

Ed. Magazine

The magazine of the Harvard Graduate School of Education

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Stress, Burnout, Anxiety and Depression among Teachers: A Scoping Review

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Background: Worldwide, stress and burnout continue to be a problem among teachers, leading to anxiety and depression. Burnout may adversely affect teachers’ health and is a risk factor for poor physical and mental well-being. Determining the prevalence and correlates of stress, burnout, anxiety, and depression among teachers is essential for addressing this public health concern. Objective: To determine the extent of the current literature on the prevalence and correlates of stress, burnout, anxiety, and depression among teachers. Method: This scoping review was performed using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Relevant search terms were used to determine the prevalence and correlates of teachers’ stress, burnout, anxiety, and depression. Articles were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Data Base), APA PsycINFO, CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature), Scopus Elsevier and ERIC (Education Resources Information Center). The articles were extracted, reviewed, collated, and thematically analyzed, and the results were summarized and reported. Results: When only clinically meaningful (moderate to severe) psychological conditions among teachers were considered, the prevalence of burnout ranged from 25.12% to 74%, stress ranged from 8.3% to 87.1%, anxiety ranged from 38% to 41.2% and depression ranged from 4% to 77%. The correlates of stress, burnout, anxiety, and depression identified in this review include socio-demographic factors such as sex, age, marital status, and school (organizational) and work-related factors including the years of teaching, class size, job satisfaction, and the subject taught. Conclusion: Teaching is challenging and yet one of the most rewarding professions, but several factors correlate with stress, burnout, anxiety, and depression among teachers. Highlighting these factors is the first step in recognizing the magnitude of the issues encountered by those in the teaching profession. Implementation of a school-based awareness and intervention program is crucial to resolve the early signs of teacher stress and burnout to avoid future deterioration.

1. Introduction

The teaching profession can be highly stressful, and this stress may lead to reduced job satisfaction, burnout, and poor work performance. Stress is a normal response to upsetting or threatening events and becomes pathological when chronic [ 1 ]. Chronic stress can impede day-to-day functioning and emotional balance, and it is a risk factor for developing other psychiatric illnesses, such as anxiety and depression [ 1 , 2 , 3 ]. Prolonged teacher stress negatively correlates with job satisfaction and positively correlates with intending to leave the teaching profession. It may also result in withdrawal behaviour, including physically or psychologically leaving the work setting [ 4 , 5 ]. Chronic stress may also lead to inappropriate anger and increased alcohol and drug consumption [ 6 , 7 ], and it can cause an individual to experience excessive anxiety, mental fatigue, and burnout, while also predicting increased depression [ 8 , 9 , 10 ]. According to Maslach, stress occurs when a person perceives an external demand as exceeding their capability to deal with it [ 11 ]. Teacher stress can be associated with demoralization, and a disrupted sense of self-consistency [ 8 , 9 ]. Canadian teachers, like their global counterparts, also experience high-stress levels. A study by Biron et al. showed that the proportion of Quebec teachers who reported a high level of psychological distress was twice as high (40%) as that reported for a Quebec-wide general population sample (20%) [ 12 ]. During the COVID-19 pandemic, survey results indicated that nearly 70% of respondents worried about their mental health and well-being [ 13 ]. Meanwhile, a cross-sectional study showed that two-thirds of teachers perceived stress at work at least 50% of the time [ 14 ]. Teacher workload is one of the most common sources of stress [ 15 ]; however, there is a lack of systematic understanding about how stress is measured, its prevalence globally, what factors lead to stress and what causes the associated negative outcomes among teachers.

Burnout is considered a stress-related problem for individuals who work in interpersonally oriented occupations such as healthcare and education [ 16 , 17 ]. According to Shukla et al., burnout among professionals such as teachers can result from excessive demands on their energy, strength and resources [ 7 ]. There is increasing evidence that burnout as a negative stress response represents a risk factor not only for depression but also for cardiovascular and other somatic diseases [ 17 ]. Researchers conceptualize burnout as having three interrelated components: emotional exhaustion, depersonalization, and reduced personal accomplishment [ 6 , 7 , 11 , 16 ]. Emotional exhaustion represents emotional depletion and a loss of energy. Depersonalization is the interpersonal dimension of burnout. It refers to a negative, callous, or excessively detached response to other people. There is evidence that job satisfaction is negatively associated with emotional exhaustion and positively associated with self-perceived accomplishment, but not significantly related to cynicism [ 18 ]. Additionally, reduced accomplishment describes the self-evaluation dimension of burnout, including feelings of incompetence and a lack of achievement and productivity at work [ 6 , 16 , 18 , 19 ]. Mild burnout involves short-lived irritability, fatigue, worry, or frustration. Moderate burnout has the same symptoms but lasts for at least two weeks, whereas severe burnout may also entail physical ailments such as ulcers, chronic back pain, and migraine headaches [ 20 ]. Research suggests that workplace improvements to reduce burnout could prevent adverse sequelae, improve health outcomes, and reduce healthcare expenditures [ 21 ]. More systematic research is needed to further understand the factors in the workplace to address burnout and improve teacher health outcomes.

Anxiety and perceived stress are predicted by workload, student behaviour, and employment conditions [ 22 ]. According to Kamal et al., a considerable lack of administrative support is the single biggest factor increasing anxiety [ 23 ]. Those with low job satisfaction are more susceptible to experiencing burnout, high anxiety levels and depression [ 24 , 25 ]. Teacher stress contributes to teacher anxiety and may trigger anger, further intensifying anxiety [ 5 , 26 ]. The published literature shows that participants who reported high anxiety levels also reported high burnout levels [ 27 ]. Moreover, some studies report a very high prevalence of stress (100%), anxiety (67.5%), and depression (23.2%) among teachers [ 28 ], prompting calls for research and interventions to address this critical issue [ 23 ]. Despite this, more research is needed to understand what factors play key roles in triggering anxiety symptoms among educators and how stress, burnout, anxiety, and depression relate to each other.

Depression can lead to numerous deficiencies and is considered the worldwide primary cause of work disability [ 29 , 30 ]. Depression among teachers can also significantly impact their health, productivity, and function [ 31 ], with particularly pervasive effects on personal and professional life [ 32 ]. Individuals with depression often experience difficulties meeting interpersonal, time-management, and productivity demands. They may also encounter psychological problems, decreased work quality, absences due to illness, and increased work disability, all of which can profoundly impact worker productivity [ 30 , 31 , 33 ]. One study found that teachers’ most robust major depressive disorder (MDD) predictors included a low job satisfaction, high perceived stress, somatization disorder, and anxiety disorder [ 31 ]. Like with anxiety symptoms, more research is needed to understand what factors play key roles in triggering depression symptoms among educators and how depression relates to other psychological conditions including stress, burnout, and anxiety.

Currently, the authors are planning a study to assess the prevalence and correlates of stress, burnout, anxiety, and depression among elementary, junior high and high school teachers in Alberta and Nova Scotia, Canada [ 34 ]. This planned study will also evaluate the effectiveness of a daily supportive text message intervention, the Wellness4Teachers program, to address stress, burnout, anxiety, and depression among elementary and high school teachers in Canada [ 34 ]. Within this context, this scoping review aims to identify and summarize the literature on the prevalence and correlates of teachers’ stress, burnout, anxiety, and depression and to determine the problem’s extent in different jurisdictional contexts. The review also aims to identify the gaps in knowledge for future research. Identifying the correlates of these emotional and mental conditions may also facilitate the research and development of early interventions which can be implemented to address this phenomenon.

2.1. Study Design

This scoping review was planned and conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement [ 35 ]. We adopted a comprehensive search strategy that allows replicability, reliability, and transparency. This scoping review also followed Arksey and O’Malley’s five-stage approach to scoping reviews: identifying the research question, searching for relevant studies, the study selection, charting the data, and collating, summarizing and reporting the results [ 36 ].

2.2. Developing the Research Question

Our research question was: “What are the prevalence and correlates of primary and secondary teachers’ stress, burnout anxiety and depression in different jurisdictions?”

2.3. Information Sources and Search Strategy

The search was performed by using relevant terms to identify and select articles in the following databases: MEDLINE (Medical Literature Analysis and Retrieval System Online; Ovid MEDLINE ALL), EMBASE (Excerpta Medica Database; Ovid interface), APA PsycINFO (Ovid interface), CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text (EBSCOhost interface), Scopus Elsevier and ERIC (Education Resources Information Center (EBSCOhost interface). The search consisted of keywords representing the concepts of stress, burnout, depression and anxiety among teachers and their correlates and prevalence. The specific MeSH terms, keyword and descriptors included: (depress* OR depression OR “depressive disorder” OR “depressive symptoms” OR “major depressive disorder” OR anxiety OR “anxiety disorder” OR “generalized anxiety disorder”) AND (burnout OR “burn out” OR stress OR “occupational stress” OR “mental exhaustion” OR “emotional exhaustion”) AND (teacher* OR educator* OR tutor* OR schoolteacher* OR “school teacher*”). The database search was completed on the 20th of February 2022.

2.4. Selection of Studies

The search strategy was developed based on specific inclusion criteria. Articles were considered eligible for inclusion in this scoping review if they addressed either the prevalence or correlates of burnout, stress, depression, or anxiety among teachers or educators. The articles were limited to original, peer-reviewed quantitative articles written in English. Articles were excluded from the review if the study participants were tertiary or university teachers or students. Studies on interventions’ outcomes, case reports, meta-analyses, systematic reviews, opinion pieces, commentaries, editorials, or grey literature such as non-peer-reviewed graduate student theses, non-research articles or conference reports were excluded. The search was not limited by publication year. Two researchers independently reviewed the citations during the title, abstract screening, and full-text review phase. All discrepancies were resolved through discussion and consensus. We identified 190 articles for full-text review, of which 120 articles were excluded. The PRISMA flow diagram summarizes this information in detail ( Figure 1 ).

PRISMA flow chart.

2.5. Data Charting and Extraction Process

The research team extracted data for each selected article according to the following domains: author(s) name, year of publication, country of study, study design, assessment tools used, sample size (N), age, main findings, and conclusion.

2.6. Collating, Summarizing, and Reporting the Results

This study presents an overview of existing evidence relating to the prevalence and the correlates of stress, burnout, anxiety, and depression among teachers. All the relevant data were organized into tables and validated by at least two team members. The characteristics and results reported in each included article were summarized. In addition, the prevalence range for the psychological conditions in high-quality studies were determined after identifying the high-quality studies for each psychological condition in this scoping review using the Joanna Briggs Institute’s (JBI) critical appraisal checklist for prevalence studies [ 37 ]. The JBI checklist includes: studies with an adequate sample size, studies which provided an appropriate sample frame to address the target population, studies with an adequate response rate, studies which had a high response rate, studies in which a systematic approach was used for the data capture to ensure the study sample was representative of the study population, and studies with an adequate statistical analysis.

3.1. Study Characteristics

The search strategy identified 10,493 citations. Covidence software [ 38 ] was used to automatically remove 5711 duplicates. One hundred and ninety articles remained for a full-text screening, and seventy of these were eligible for inclusion. Overall, 67 articles were quantitative cross-sectional studies. One study was a mixed quantitative and qualitative study, and two studies were randomized controlled trials. The seventy articles included a total of 143,288 participants, who were all teachers. The sample size for an individual article ranged from 50 to 51,782 participants, with an age range from 18 years to 75 years. The minimum response rate was 13% and the maximum was 97.4% with the median response rate of 77%. The articles included studies from 1974 to 2022. Most studies (79%) were published between 2007 and 2022, and 21% were from 1974 to 2006. Most of the studies were conducted in Europe (40%), followed by Asia (30%) and North America (19%). In contrast, African, South America and Oceanian studies represented 6%, 1% and 4%, respectively, as shown in Figure 2 . One study [ 39 ] was conducted across multiple continents.

Summary of studies by continents.

From Figure 3 : Most studies reported on multiple outcomes, indicating the interrelatedness of stress, burnout, anxiety, and depression. Some articles reported on a single outcome, such as stress (N = 9), burnout (N = 8), or depression (N = 6). Burnout and depression (N = 15), stress and depression (N = 5), burnout and anxiety (N = 2), anxiety and depression (N = 4), and stress and anxiety (N = 4), were commonly paired outcomes. One study (N = 1) specifically examined the paired outcomes of burnout and stress. In addition, the outcome of the interaction between three or four of these psychological problems were explored by some studies: anxiety, depression, and stress (N = 10); anxiety, burnout and depression (N = 1); stress, burnout and anxiety (N = 1); stress, burnout, and depression (N = 2). Finally, two articles reported the interaction between stress, burnout, anxiety, and depression.

Distribution of stress, burnout, anxiety and depression among the included studies.

Figure 4 shows that depression was the most reported psychological problem among the included studies and the least reported was anxiety.

Number of studies reporting each psychological problem.

Most of the articles (27 of 32; 84%) used Maslach’s Burnout Inventory to explore the three interrelated components of burnout. Five of thirty-two (16%) studies used the Oldenburg Burnout Inventory, the Shirom–Melamed Burnout Inventory, or the Teacher Burnout Scale. The most frequently utilized scales for measuring depressive or anxiety symptoms (55 studies) were the Center for Epidemiological Studies Depression Scale (CES-D) (N = 14; 25%), Depression, Anxiety and Stress Scale (DASS), (N = 10 18%), the Patient Health Questionnaire-9 (PHQ-9), (N = 9; 16%), and the Beck Depression Inventory (BDI), (N = 6; 11%). The less popular scales included the Goldberg Anxiety and Depression Questionnaire, COVID-19 Anxiety Scale, Zung Self-Rating Depression Scale (SDS), and the Manifest Anxiety Scale. For the 29 studies measuring stress, the most common scales utilized were the (DASS) (N = 9; 31%), the Teacher Stress Inventory (N = 5; 17%), and the Perceived Stress Scale (PSS) (N = 3; 10%). Other scales included: the Occupational Stress Inventory, Job Stress Inventory, Ongoing Stressor Scale (OSS), Episodic Stressor Scale, and Bruno’s Teacher Stress.

3.2. Prevalence and Correlates of Burnout, Stress, Anxiety and Depression

The prevalence and correlates of stress, burnout, anxiety, and depression as identified in the literature search are summarized in Table A1 and Table A2 in Appendix A .

3.3. Prevalence of Stress

The reported stress prevalence rates were heterogenous, which may reflect, in part, the use of different stress measures. The prevalence of stress in all forms ranged from 6.0% to 100% [ 28 , 40 ], with a median of about 32.5%. In addition, the lowest, highest and median stress prevalence ranges from 2020 to 2022 (after the pandemic and lockdown) were, respectively, 6.0% [ 40 ], 66.0% [ 41 ] and 10.7%. Similarly, the lowest, highest and median stress prevalence up until 2019 (prior to the pandemic and lockdown) were, respectively, 7.0% [ 42 ], 100% [ 28 ] and 33.9%.

Early studies of teacher stress found a relatively high degree of stress. For example, 76% [ 43 ] and 87.1% [ 44 ] of teachers described their stress levels at their school as moderate or significant, respectively. In some studies, 45.6% reported “much stress” [ 44 ] or “almost unbearable” stress (20%) [ 43 ]. Another study echoed these findings, reporting 32% ‘slightly’ stressed and 67% ‘extremely’ stressed teachers, with only 1% indicating no stress [ 45 ].

Earlier studies on teacher stress are consistent with more recent findings, indicating teacher stress is a long-standing issue and is challenging to tackle. A 2021 study completed during the COVID-19 pandemic reported a 6.0% prevalence of severe to highly severe stress among teachers [ 40 ]. This is similar to another recent but pre-pandemic study which reported a 7.0% prevalence of “severe to extremely severe” stress, a 32.3% prevalence of stress, and 25.3% prevalence of mild to moderate stress [ 42 ].

3.4. Prevalence of Burnout

Published studies have identified three different burnout profiles among teachers with the prevalence ranging from 25.12% to 48.37% [ 11 , 46 ]. These are, (1) groups of teachers with predominantly low levels of emotional exhaustion and high levels of personal accomplishment, (2) teachers with high levels of emotional exhaustion and depersonalization, and (3) teachers with low levels of depersonalization and personal accomplishment [ 46 ]. These groups show the combination of the three interrelated components of burnout reported by Maslach et al. [ 6 , 7 , 11 , 16 ].

Variable prevalence of burnout and psychological distress have been reported among teachers [ 47 ], with the burnout prevalence at all levels ranging from a low of 2.81% [ 7 ] to a high of 70.9% [ 48 ], with a median of 28.8% ( Table A1 ). The lowest, highest and median burnout prevalences from 2020 to 2022 (after the pandemic and lockdown) were, respectively, 3.1% [ 48 ], 70.9% [ 48 ] and 27.6%. Similarly, the lowest, highest and median burnout prevalences up until 2019 (prior to the pandemic and lockdown) were, respectively, 2.81%, 63.43% [ 7 ] and 25.09%.

In an early study, only 11% of the teachers were classified as burnt out, and more than half (68.5%) of the teachers reported they did not experience any burnout [ 49 ]. Some studies reported burnout prevalence in the three subdimensions [ 50 ]. For instance, four studies reported a burnout prevalence of 11% to 40% for emotional exhaustion, depersonalization and for reduced personal accomplishment [ 3 , 46 , 49 , 50 ]. Studies have also reported that 18.3% to 34.9% of teachers may be at risk of or are threatened by burnout syndrome [ 3 , 25 , 51 ]. Higher burnout scores and subdimensions such as emotional exhaustion and depersonalization burnout were significantly higher among female teachers than male teachers [ 51 , 52 , 53 ]. Likewise, a higher percentage of males (59.38%) showed low burnout than did females (53%) [ 54 ]; however, other studies have reported contradictory results where males had a slightly higher burnout prevalence of 56.0% than females of 53.0% [ 55 ] and 31.88% of males and fewer females (25%) reported a lack of personal accomplishment [ 54 ].

There are also studies reporting various levels of burnout ranging from low/no burnout (58.12%) to moderate (2.81% to 70.9%) and severe levels of burnout (3.1% to 33.3%) [ 7 , 25 , 47 ]. Regarding the subjects taught by teachers, science stream and science teachers reported experiencing slightly more burnout (14.38% to 26.26%) than arts stream and art teachers, who reported an average burnout prevalence of 12.5% to 25% [ 7 ].

3.5. Prevalence of Anxiety

The anxiety symptoms prevalence ranged from 4.9% to 68.0% [ 42 , 56 ], with a median prevalence of 26.0%. Furthermore, the lowest, highest, and median anxiety prevalences from 2020 to 2022 (after the pandemic and lockdown) were, respectively, 10.5% [ 57 ] 66.0% [ 41 ] and 38.9%. Similarly, the lowest, highest, and median anxiety prevalences up until 2019 (prior to the pandemic and lockdown) were, respectively, 7.0% [ 28 ], 68.0% [ 42 ] and 26.0%.

Early studies indicated that teachers’ anxiety prevalence ranged from 26% for borderline anxiety, 36% for minimal or no anxiety, and 38% for clinically significant anxiety [ 45 ]. Recent studies have reported a similar prevalence for low anxiety at 17.6%, mild at 23.2% [ 28 ] and 7.0% to 23.3% for severe to extremely severe anxiety [ 28 , 39 , 41 ]. Another study reported an anxiety prevalence of 43% among teachers. The prevalence of anxiety did not change significantly during the COVID-19 pandemic, with most teachers (56.2%) reporting no change in their anxiety during the pandemic compared with before the pandemic, and only 4.9% of teachers reported an increase in anxiety levels from the baseline during the first week of the 2020–2021 school year [ 58 ].

3.6. Prevalence of Depression

The prevalence of depression among teachers ranged from 0.6% to 85.7% [ 48 , 59 ], with a median of 30.7%. The lowest, highest, and median depression prevalences from 2020 to 2022 (after the pandemic and lockdown) were, respectively, 0.6% [ 48 ], 85.7% [ 59 ] and 23.5%. Similarly, the lowest, highest and median depression prevalences up until 2019 (prior to the pandemic and lockdown) were, respectively, 0.7% [ 28 ], 85% [ 60 ] and 24.1%.

Early studies showed a highly varied prevalence of depression, with 79% of teachers scoring at the low or no depression levels in one study. This study also reported that 17% of teachers had borderline depression scores, and 4% had scores that indicated clinical depression [ 45 ]. Studies from 2008 onwards identified that the prevalence of depression ranged from 17.86% to 49.1% [ 3 , 41 , 55 , 60 , 61 ] and the prevalence of severe to extremely severe depression ranged from 0.7 to 9.9% [ 42 ], whilst the prevalence of mild depression ranged from 20 to 43.9% [ 41 , 42 , 60 , 62 ]. Soria-Saucedo et al. reported a particularly high prevalence (16%) of severe depression symptoms among teachers [ 61 ]. Depression was also found to range from 45% to 84.6%, depending on the educational level and teaching experience, and was highest among those with a lower education level, followed by teachers with more teaching experience [ 42 ].

Studies during the pandemic demonstrated higher rates of mild depression but similar rates of severe depression symptoms among teachers. In one study, 58.9% of teachers had mild depression, 3.5% had moderate, and 0.6% had severe depression. [ 48 ]. Another study reported that 3.2% of teachers had severe to extremely severe depression [ 40 ]. According to Keyes, ‘flourishing’ denotes being filled with positive emotion and functioning well psychologically and socially while ‘languishing’ in life signifies the individual has poor mental health with low well-being [ 59 , 62 ]. Capone and Petrillo reported that 38.7% of ‘flourishing’ teachers reported a lower prevalence of depression but higher levels of job satisfaction. A severe rating of depression was also reported by 85.7% of ‘languishing’ teachers [ 59 ].

3.7. Prevalence Range and Median for Stress, Burnout, Anxiety and Depression Reported in High Quality Studies

After applying the JBI checklist [ 37 ] to identify high-quality studies, the clinically meaningful (moderate to severe) burnout among teachers recorded by three studies ranged from 25.12% to 74% [ 25 , 46 , 47 ]. Similarly, three studies reported stress at clinically meaningful levels which included severe, extremely severe, moderate to high or very stressful, and a great deal of stress, with a prevalence ranging from 8.3% to 87.1% [ 43 , 44 , 57 ]. Likewise, two studies reported the prevalence of clinically meaningful anxiety among teachers ranging from 38% to 41.2% [ 45 , 57 ]. Furthermore, five studies [ 44 , 47 , 57 , 63 , 64 ] reported the prevalence of depression in clinically significant levels, which included terminologies such as major, moderate, moderate to severe, and extremely severe depression symptoms. The lowest prevalence in this category was 4% [ 45 ] and the highest category was 77% [ 65 ]. Finally, the median prevalence of stress, burnout, anxiety, and depression among these studies were, respectively, 67.0%, 60.9%, 39.6%, and 14.%.

3.8. Correlates of Stress, Burnout, Anxiety and Depression

The correlates of stress, burnout, anxiety, and depression, as extracted from Table A1 and Table A2 , are summarized in Table 1 . A wide range of variables are significantly associated with teachers’ stress, burnout, anxiety and depression and can be divided into socio-demographics, school, organizational and professional factors, and social and other factors, including intrapersonal factors. The most reported correlates were sex, age, gender, marital status, job satisfaction, subject taught and years of teaching [ 28 , 40 , 57 , 63 , 66 , 67 ]. Socio-demographic factors, such as age and sex, and work-related factors correlate with depression, anxiety and stress [ 42 ]. Emotional exhaustion is correlated with age, gender and marital status. [ 39 , 52 , 53 , 68 ]. Other studies, however, refute these, indicating that no significant demographic variable correlations were found between burnout and depression, and that depressive symptoms in men and women were similar [ 64 , 69 ]. Capone et al. also noted that all the school climate factors, such as social support, were negatively related to depression [ 70 ]. Higher levels of co-worker support were related to lower levels of anxiety and depression [ 71 ].

Demographic, school and professional correlates of burnout, stress, anxiety and depression.

Organizational factors associated with anxiety included: work overload, time pressures causing teachers to work during their free time, and role conflict. There were significant correlations between the reported anxiety and those stressors relating to pupils and parents [ 45 ]. In addition, interpersonal conflict, organizational constraints and workload were reported to result in depression through increasing job burnout [ 73 ]. Furthermore, depressive symptoms correlated with teaching special needs students and had a significant and robust relationship with the general burnout factor [ 50 ]. Self-perceived accomplishment was also positively associated with autonomy and negatively associated with low student motivation [ 18 ]. Personal accomplishment had a significant positive relationship with the number of teaching hours per week [ 40 ]. On the contrary, a cross-sectional study by Baka reported that increased work hours are usually accompanied by job demands, job burnout, and depression [ 73 ]. Job strain, job demand and job insecurity all showed positive associations with depressive symptoms [ 80 , 94 ]. Work-related factors, such as workload, were also correlated with stress, burnout, depression, and anxiety [ 42 , 73 ].

Furthermore, the educational level and teaching experience also predict depression. Depression was highest among teachers with a lower education followed by teachers with the most teaching experience [ 42 ]. Teacher stress was reported to be significantly associated with psychological distress, and social support could moderate the influence of stress; hence, the high-stress and the low-support group were most vulnerable to anxiety [ 74 ]. Studies have also reported that 55% of teachers without spousal support had depression [ 42 ]. In addition, stress was reported to be associated with missed work days, high anxiety and high role conflict [ 43 , 89 ] and 53.2% of teachers identified work as a source of long-term stress, leading to burnout [ 55 ]. According to Fei Liu et al. resilience significantly correlated with job burnout and turnover intention, and low resilience could result in a high job burnout [ 86 ]. The research also showed that personality trait neuroticism was the best predictor of burnout (28–34%) [ 67 ].

3.9. Association between Stress, Burnout, Anxiety and Depression

A significant overlap was reported between stress, burnout, anxiety and depression. Eighteen articles reported a correlation between burnout and depression, with differences in depressive symptomatology depending on the prevalence of burnout [ 3 , 18 , 25 , 41 , 42 , 48 , 50 , 52 , 54 , 60 , 64 , 69 , 84 , 86 , 92 , 95 ]. Three articles reported a correlation between burnout and anxiety symptoms [ 52 , 64 ]. Seven articles reported a correlation between stress and anxiety [ 28 , 58 , 65 , 71 ]. Six articles reported a correlation between stress and depression [ 28 , 31 , 43 , 61 , 68 , 71 ]. A correlation exists between moderate depressive disorder and anxiety disorder as well as stress [ 31 , 96 ]. Negative affectivity (a tendency to feel depression, anxiety, or stress) plays a role in the development of burnout among teachers. Teachers who developed a more markedly negative affectivity also felt more burnt out, and the opposite was true [ 41 ]. This may be related to rumination. According to Nolen-Hoeksema, rumination is a pain response which entails a recurrent and passive focus on the symptoms of pain and their likely causes and outcomes [ 97 ]. Ruminative responses may prolong depression by overly focusing on negative thinking and may affect one’s behaviour and problem-solving [ 97 ]. Liu et al. reported that rumination moderated the association between job burnout and depression and that burnout was a stronger predictor of depression in teachers who experienced low rumination rather than high rumination [ 98 ]. This was explained by the importance of rumination for depression; with an improvement in the rumination level, job burnout had less ability to predict depression for those with high rumination levels.

There is a strong association between burnout and depression, as reported in several studies. High frequencies of burnout symptoms were identified among clinically depressed teachers [ 92 ], with 86% to 90% of the teachers identified as burnt out meeting the diagnostic criteria for a depressive disorder [ 60 , 64 ], mainly for major depression (85%) [ 60 ]. In 25% to 85% of teachers with no burnout, depression ranged from 1% to 15% of the study sample. Specifically, only 1% to 3% of the participants in the no-burnout group were identified as having minor depression or depression not otherwise specified (2%) [ 60 , 64 ]. A history of depression was reported by about 63% of the teachers with burnout and 15% of the burnout-free teachers [ 60 ]. The high overlap between depression and burnout was emphasized in one study, which categorized depression as “low burnout-depression” (30%), “medium burnout-depression” (45%), and “high burnout-depression” (25%) [ 92 ]. Notably, the report suggests that although teacher burnout leads to subsequent depressive symptoms, it is not true vice versa [ 95 ]. Furthermore, burnout symptoms at ‘time one’ did not necessarily predict depressive symptoms at ‘time two’ [ 99 ]. Another study reported a positive relationship between burnout and depression [ 84 ]. This was confirmed by a study which suggested that depressive symptoms had a significant and robust association with the general burnout factor [ 50 ].

Anxiety disorder is also associated with higher perceived stress and major depression [ 65 ]. In one study, higher ongoing stressors were positively associated with higher anxiety levels. Continuous and episodic stressors were significantly and positively associated with anxiety and depression. They accounted for 28% (adjusted 25%) of the variability in anxiety and 27% (adjusted 24%) of the variability in depression. [ 71 ]. In contrast, higher levels of co-worker support were related to lower levels of anxiety and depression [ 71 ]. Teachers reported a high prevalence of depressive symptomatology relating to subjective and school-related stress [ 43 ].

4. Discussion

This scoping review included 70 articles. The prevalences of stress, burnout, anxiety and depression reported in this scoping review are similar to those reported in two systematic reviews and meta-analysis conducted among teachers during the pandemic. For example, the prevalence of stress reported by Ma et al., from a meta-analysis of 54 studies was 62.6%, whereas the prevalence of anxiety was 36.3% and depression was 59.9% among teachers during the pandemic [ 100 ]. In another meta-analysis, the prevalence range of anxiety was 10% to 49.4%; depression was 15.9% to 28.9%; and stress was 12.6% to 50.6% [ 101 ], which all fall within the range reported in this scoping review for stress [ 28 , 40 ], anxiety [ 42 , 56 ], and depression [ 48 , 59 ]. However, the minimum in all cases was higher during the pandemic, suggesting an increase in psychological problems during the pandemic.

The varying prevalence for stress, burnout, anxiety and depression reported by different studies in this review may be attributable to heterogeneous study designs, including the sample size, location, period of data collection, diversity in the standardized scales used for the assessment, and other factors such as the class size and grade taught [ 102 , 103 ]. In this scoping review, the studies used combinations of terminologies such as “none,” “slightly,” “significant,” “much,” “extremely,” “considerably”, “almost unbearable”, “quite a bit” or “a great deal” to describe the level of stress experienced by teachers according to the measures utilized,, such as the Teachers Stress Inventory [ 44 , 77 ] or the Bruno Teachers Inventory [ 43 ]. The prevalence rates also varied with population, for example, in the case of Fimian, the teachers were teaching special needs students, and this may explain the relatively high prevalence (87.1%) recorded [ 44 ]. More recent studies which used other scales, such as the Perceived Stress Scale (PSS), and the Depression Anxiety Stress Scales (DASS), used terminologies such as “symptoms of stress”, ranging from “mild,” “moderate,” “mild to moderate” or “extremely severe”, to describe the stress levels. For burnout, although most studies used a combination of the three interrelated components of burnout reported by Maslach et al. [ 6 , 7 , 11 , 16 ], some studies focused on reporting the sub-dimensions of burnout, whilst others reported general burnout. Varying expressions such as “low burnout”, “high burnout, “severe burnout”, and moderate were used to describe burnout, making it difficult to make an effective comparison. It was also not clear whether the stress and burnout experienced by the participants were everyday existential life experiences that everyone faces or chronic ones that needed intervention, as these were not specifically stated in the studies. It is essential that future research clarifies this to estimate their prevalence rates more accurately. Secondly, as indicated in the review, the studies applied various scales to measure the prevalence of psychological disorders; however, there was a lack of consensus. This scoping review provides a comprehensive picture of the prevalence of the target outcomes and sets up a foundation for future systematic reviews and meta-analysis to accurately estimate the prevalence of these outcomes among teachers.

The essential correlates of stress, burnout, anxiety, and depression identified in this review include socio-demographic factors such as sex, age, gender, marital status, school (organizational) factors and work-related factors (years of teaching, class size, job satisfaction, subject taught and absenteeism). Most studies were published in the last fifteen years (2007–2022), indicating a recent increase in interest in this area of research.

4.1. Socio-Demographic, School and Work-Related Factors as Determinants of Stress

Socio-demographic factors such as sex, age and marital status significantly influence teacher stress [ 54 ]. Sex correlates with stress although there are some conflicting reports [ 42 , 53 , 76 ], especially between the levels of stress experienced by males and females. Some studies suggest that female teachers experience more stress than their male counterparts [ 28 , 75 , 77 ]. Working women often have additional demands at home, and trying to accomplish both roles may increase their stress levels [ 104 ] compared to males who may have less demand from home. However, this may be context-dependent, as no sex difference in occupational stress was reported among police officers [ 105 ], for example. The demand from female teachers’ personal lives, including marital issues and home, may be a source of increased stress levels [ 104 ]. Among the general workforce, work–family conflict has been reported to be significantly associated with work stress [ 106 ], and this is not confined only to females. This argument is confirmed in three separate studies, which reported that gender, per se, was not a significant predictor of perceived stress [ 39 , 85 , 89 ]; thus, it is possible that these differences may, rather, be due to differences in the scales used or the effect of organizational factors. For example, the organisational effect experienced by female teachers in a female only elementary or high school may differ from that experienced in a male only or mixed sex teaching environment; however, further research is needed in this area of gender influencing stress factors. Findings from the Canadian Community Health Survey data nonetheless endorsed a difference between males and females regarding work stress, in particular supervisor support. Higher levels of supervisor support seemed to lower work stress amongst women but not men [ 107 ]. Among the general population, social support at work could be more strongly related to a stress reduction in women than in their male counterparts [ 108 ] Sex difference was also observed in relation to student behaviour, with women experiencing increased stress [ 42 , 77 ]. In particular, female teachers’ collective efficacy and beliefs about their school staff group capabilities may lower their stress from student behaviour. Findings from the study by Klassen support the hypothesis that teachers’ collective efficacy serves as a job resource that mediates the effect of stress from student behaviour [ 77 ]. Interventions addressing gender/sex differences may also be considered in supporting female educators’ mental health and work productivity.

A study among refugee teachers also endorsed sex differences in stress [ 42 , 57 ]; however this was in relation to self-care and the association was moderated by age [ 57 ]. Higher occupational stress scores were observed among teachers over 40 years [ 28 ]; nonetheless, among the general population, the published literature reports that the ageing process can worsen or counter the effects of stress [ 109 ], indicating that age does not necessarily increase stress. The cause of increased stress, hence, shifts to other factors such as the poor academic performance of students, or a lack of assistance [ 78 ], which may be influencing an increase in stress.

The class size, grade level taught, workload, poor student performance or lack of progress and other work and school-related factors contribute to teachers’ stress. According to Fimian et al., when stressful events or the perception of them are not ultimately resolved or improved, this may result in several physiological manifestations [ 44 ]. There is clear data indicating that teacher stress was intensified among primary school teachers, special needs teachers, and teachers in private schools who provided more support and input to students than other teachers [ 28 , 78 , 85 , 110 ]. The additional time and energy teachers may invest in primary school kids, who are usually much younger and may require more support, may explain the increased stress among primary school teachers. Again, teaching special needs students may require significant teacher input and assistance, depending on the nature and degree of the disabilities. There is also an increased expectation from teachers in private schools regarding the students’ performances, leading to increased stress [ 28 ]. A study conducted among primary and secondary school teachers in Pakistan concluded that government school teachers were more satisfied with their working conditions than private school teachers [ 110 ], and thus, may experience less stress. In addition, the school location (rural vs. urban), teacher role ambiguity and coherence further exacerbated teacher stress [ 3 , 75 , 89 , 111 ]. An excessive use of technological devices, such as mobile phones, has also been associated with social disruption [ 112 ] and may result in a lack of concentration or poor student performance at school [ 112 , 113 ], leading to teacher stress. Teachers experiencing more significant stress were also burnt out [ 68 ]. For example, during the pandemic, teachers had to adopt and adjust to teaching online, and virtual instruction teachers had the most increased anxiety [ 58 ]. Nonetheless, a rapid systematic review with a meta-analysis reported that teacher stress during the pandemic was still comparatively lower in school teachers with a prevalence of 13% ([95% CI: 7–22%]) in comparison to studies with university teachers as the participants of 35% ([95% CI: 12–66%]) [ 114 ].

While there are complex interactions among several factors which contribute to teacher stress, there have been limited evidence-based interventions to help teachers alleviate these stress sources despite some self-reported coping strategies. This research gap started to receive attention during the COVID-19 pandemic through the application of mindfulness-based interventions [ 115 ], warranting more advanced research on how to best address these challenges in education.

4.2. Socio-Demographic, Years of Teaching, School and Work-Related Factors as Determinants of Burnout

Burnout continues to pose problems within the teaching profession, and factors such as gender, sex, age, marital status and the number of years teaching correlated with the degree of burnout [ 40 , 47 , 51 , 52 , 53 , 54 , 55 , 63 , 67 , 68 , 72 , 73 ], although conflicting results were reported with potentially different explanations. Differences in the study design, particularly the scales used to assess burnout as well as geographical and organizational factors, may account for some of the conflicting results. In addition, there could be an interplay between some personal and professional factors. For example, younger teachers are more likely to be enthusiastic about their new teaching careers, whilst older teachers may experience boredom leading to increased exhaustion. Consistent with this hypothesis, one study reported that teachers who had taught for the fewest (0–5) years experienced the lowest burnout prevalence [ 54 ]. On the contrary, more experienced teachers were likely to have gained exposure, learnt students’ characteristics and classroom management skills and the necessary tools to help them prevent and address burnout. Additionally, teachers who lacked self-fulfilment may have been mostly younger and lacked personal accomplishments [ 47 ], leading to more burnout.

Significantly higher burnout scores, including for emotional exhaustion, depersonalization, and intellectual burnout were found among female teachers than among male teachers in some studies [ 51 , 52 , 53 ], whilst other studies reported that burnout was higher among male teachers. These results are contrary to findings reported among police officers, which indicated no significant difference in the levels of occupational burnout reported by male and female police officers [ 105 ]. Further studies are needed to investigate the contradictory gender differences in teachers’ burnout by different studies. In addition, research is needed on innovative gender-neutral ways of addressing burnout in teachers. Other structural factors, such as the number of children teachers have and class sizes which are associated with increased teacher burnout, require an increased investment in teachers and schools to address them. Governments providing teachers with affordable childcare and other supports for their own children, and building more schools to reduce the class sizes, may lead to a reduced burnout among teachers.

There is also a relationship between burnout and school or work-related factors. The subjects and grades taught and the medium of instruction all contribute to teachers’ burnout [ 7 , 51 ]. Teachers’ perceptions of the difficulty of a subject taught appears to determine their degree of burnout experienced; however, no particular subject seems to be the leading cause of burnout. High school teachers may perceive an increased workload in terms of the amount of time attributed to class preparation due to the difficulty of a subject taught. A cross-sectional study among nurses also found that role overload contributed to higher levels of emotional exhaustion [ 116 ] and this was also endorsed among healthcare managers where prolonged job strain resulted in burnout and an increased turnover intention [ 117 ]. This suggests there is a complex interaction between self-perception and burnout, which makes burnout in teachers a complex problem to address. Differences were also noted in the prevalence of burnout among teachers working in different countries [ 84 ]. For example, 58% of the variance in burnout in Cyprus could be explained by job satisfaction and anxiety, whereas 57.5% of the variance in burnout in Germany was explained by job satisfaction alone [ 84 ]. Different countries have different working conditions which may explain the differences in job satisfaction and associated burnout prevalence among teachers in different countries.

4.3. Effect of Resilience on Burnout

Resilience involves adapting well in the face of stress, difficulty, trauma, disaster, and threats. Resilient people use positive emotions to rebound and find positive meaning even in stressful circumstances [ 118 ]. Resilience had a significantinverse correlation with job burnout and turnover intention, and resilience could negatively predict job burnout [ 86 ]. Resilience was also reported to have an inverse association with burnout symptoms [ 119 ]; thus, increased resilience is linked to decreased burnout and, hence, the tendency for a teacher to remain in their job and thrive no matter what they encounter. Job burnout had a significant positive predictive effect and correlation with turnover intention, which suggests that the more severe the job burnout is, the higher the turnover intention [ 86 ]. Teachers require positive emotions and an increased resilience to remain in the profession and succeed without quitting. Conversely, among physicians, a survey indicated that the burnout prevalence was still significant even among the most resilient physicians; however, West et al. suggested that physicians exhibited higher levels of resilience than the general working population [ 119 ], including teachers. Additionally, resilience was also a significant predictor of depression and anxiety [ 88 ]; thus, the higher the resilience, the less likely teachers will experience depression or anxiety.

4.4. Socio-Demographic, School and Work-Related Factors as Determinants of Depression and Anxiety

Socio-demographic, school and work-related factors are all associated with both anxiety and depression [ 42 , 50 , 51 , 80 ]. This association is consistent with what was reported in a systematic review and meta-analysis by Ma et al., which suggested that teachers’ experiences of psychological issues were associated with various socio-demographic factors such as gender, institutional factors, teaching experience, and workload volume [ 100 ]. In this scoping review, conflicting results were found in relation to the association between teacher gender and depression. Whilst some studies reported that female teachers have higher depression levels than male teachers [ 42 , 51 , 70 , 79 , 81 , 82 ], other studies have reported no gender differences in teacher depression levels [ 53 ]. Contradictory results were also reported for the association between the age of teachers and depression, with some studies reporting higher depression levels in younger teachers [ 42 ] and others reporting higher depression in older teachers [ 51 ]. As discussed previously, it is likely that the use of different scales, coupled with organizational factors, contributed to these contradictory findings among the different studies. The findings also indicated that most female teachers who suffered from depression had been working for about 11 to 15 years [ 120 ].

A poor workplace environment has also been associated with increased anxiety and depressive symptoms [ 121 ] and school-related stress may transition to depressive symptoms among teachers [ 80 , 94 ]. As teachers’ workloads increase, their working hours will invariably increase, resulting in a rise in job demand and ultimately a surge in stress, leading to anxiety and depression. A systematic review reported similar findings where the main risk factors associated with anxiety and depression included job overload and job demands. [ 122 ]. The research also shows that teachers are not the only exception regarding experiencing a poor workplace environment which may lead to increased anxiety and depression [ 122 , 123 ]. Improving teachers’ workplace environments may, therefore, reduce the prevalence of anxiety and depression among teachers. Anxiety has also been linked to stressors relating to pupils and parents. For example, the possibility of a parental complaint increased anxiety scores [ 45 ]. Generally, parents want their children to succeed academically, which sometimes creates friction between teachers and parents. The underperformance of students or failure may be blamed on teachers or construed as the responsibility of schools and teachers [ 124 ], which may result in increased stress and subsequently anxiety and depression for teachers.

Social support was also reported to predict anxiety and depression symptoms, with high support levels indicating fewer symptoms related to anxiety and severe depression [ 121 , 125 ]; thus, teachers who perceived social support at school (e.g., the personnel relation dimension) expressed a lower stress level than those who did not [ 75 ]. According to Peele and Wolf 2020, anxiety and depressive symptoms increase for all teachers over the school year, and poor social support plays a significant role in the development of anxiety and depression symptoms [ 121 ]. Organizational policies that include the provision of adequate social support for teachers may, therefore, be a useful strategy to prevent and mitigate anxiety and depressive symptoms among teachers.

5. Limitations

The scoping review is not without limitations. This scoping review searched for articles in the English language only. Though every effort was made to identify all relevant studies for this review considering our eligibility criteria, we may have left out some relevant studies, particularly those published in other languages. Our search included six databases, yet the overall search strategy may have been biased toward health and sciences. Searching other bibliographic databases may have yielded additional published articles. Furthermore, different studies included in this scoping review used various screening tools and worldwide diagnostic classifications to determine stress, burnout, anxiety, and depression, leading to variations in the prevalence estimates. The scoping review included studies from 1974 till date; therefore, it is possible that the theoretical approaches to the concept of burnout may have changed. Notwithstanding these potential changes in the theoretical approaches to the concept of burnout, the burnout prevalence among teachers has appeared to have remained stable over the years. There was also no evaluation of the risk of bias for the included studies. Despite these limitations, this scoping review provides an excellent perspective on the prevalence and correlates of stress, burnout, anxiety and depression among teachers.

6. Conclusions

Teachers’ psychological and mental health is of utmost importance as it indirectly affects the students they teach. The stress associated with the teaching profession can be linked to three major overlapping issues: burnout, anxiety, and depression, which have a myriad of effects, including an impact on teachers’ health, well-being, and productivity. A wide range of prevalences and correlates were reported for stress, burnout, anxiety, and depression. Differences in the severity were observed in different articles resulting in the diverse prevalence reported among the various studies. The differences in the measurement instruments creates critical knowledge gaps, making it difficult for researchers to make effective comparisons between the different studies. Future research should focus on addressing these research gaps arising from methodological issues, especially the use of different scales to allow for a meaningful comparison. Researchers, educators, and policy makers could benefit from an international consensus meeting and agree on common scales to be used when assessing stress, burnout, anxiety, and depression in teachers. Such an international consensus meeting can also help to streamline the definition of stress and can be used as a forum for addressing other methodological issues related to research and innovations involving elementary and high school teachers. Future research can also focus on exploring the gender differences in these psychological issues further, especially, defining the various subsets of gender being referred to and the specific prevalence in each case. In addition, the high prevalence of stress, burnout, anxiety, and depression reported particularly by several high-quality studies suggests that these psychological problems are widespread among teachers and deserves special attention both at the level of policy and practice.

This scoping review also highlights the risk factors associated with stress, burnout, anxiety, and depression. Identifying these risk factors is a significant step toward addressing these issues among teachers. Schools need to prioritize and promote interventions aimed at teachers’ personal wellbeing. Testing and implementing the interventions aiming to improve teachers’ well-being and ability to cope are important to address stress and burnout, with the expectation that this will prevent or reduce anxiety and depression. This may include school-based awareness and intervention programs to detect the early signs of teacher stress and burnout, or programs that incorporate meditation techniques or text-based support. Meditation techniques have been proposed to be effective in improving psychological distress, fatigue and burnout [ 126 ]. For example, mindfulness practice has been suggested as beneficial in coping with job-related stress, improving the sense of efficacy and reducing burnout in the teaching profession [ 127 ]. Interventions such as mobile text technology are an evidence-based, unique, and innovative way that offers a convenient, low cost and easily accessible form of delivering psychological interventions to the public with mental health problems [ 128 , 129 , 130 ]. Mobile text-based programs can be easily implemented at the school level to support teachers’ psychological needs. Future studies need to explore the development, implementation, monitoring, and evaluation of intervention programs for improving mental health outcomes among teachers. For instance, the Wellness4Teachers program which is planned for implementation in Alberta and Nova Scotia, Canada [ 34 ], is expected to provide evidence of effectiveness for the use of daily supportive text messaging to combat stress, burnout, anxiety, and depression among teachers. Finally, governments, school boards and policymakers need to collaborate with researchers on the design and implementation of measures to enhance teachers’ mental health, productivity (teaching) and quality of life.

Summary of studies with prevalence and correlates of Burnout/Stress.

* Katsantonis 2020 (15 countries)—Japan and Korea form the East-Asian model. France and Spain form the Latin model. Denmark and Sweden form the Northern model. Australia and the United Kingdom represent the Anglo-Saxon model and finally, Belgium and the Netherlands form the Germanic model. Sample Size: SS; Emotional Exhaustion: EE; Personal Accomplishment: PA; Depersonalization: DP; Occupational Stress: OS; Sense of Coherence: SOC; Science Stream: SCIS; Art Stream: AS.

Summary of studies with prevalence and correlates of Depression/Anxiety.

Sample Size: SS; Major Depressive Disorder: MDD.

Funding Statement

This study was supported by the Mental Health Foundation and the Douglas Harden Trust Fund.

Author Contributions

Conceptualization, B.A; software, and validation, B.A., G.O.-D. and L.B.; methodology and formal analysis, B.A.; data curation, B.A. and G.O.-D.; investigation and resources, B.A. and Y.W.; writing—original draft preparation, B.A.; writing—review and editing, B.A, G.O.-D., L.B. and Y.W.; supervision, L.B. and Y.W. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest. The funder had no role in the design and conduct of the study; collection, management, analysis, the interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the results for publication.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The Truth About Homework Stress: What Parents & Students Need to Know

• Fact Checked

Written by:

published on:

• December 21, 2023

Updated on:

• January 9, 2024

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Homework is generally given out to ensure that students take time to review and remember the days lessons. It can help improve on a student’s general performance and enhance traits like self-discipline and independent problem solving.

Parents are able to see what their children are doing in school, while also helping teachers determine how well the lesson material is being learned. Homework is quite beneficial when used the right way and can improve student  performance.

This well intentioned practice can turn sour if it’s not handled the right way. Studies show that if a student is inundated with too much homework, not only do they get lower scores, but they are more likely to get stressed.

The age at which homework stress is affecting students is getting lower, some even as low as kindergarten. Makes you wonder what could a five year old possibly need to review as homework?

One of the speculated reasons for this stress is that the complexity of what a student is expected to learn is increasing, while the breaks for working out excess energy are reduced. Students are getting significantly more homework than recommended by the education leaders, some even nearly three times more.

To make matters worse, teachers may give homework that is both time consuming and will keep students busy while being totally non-productive.

Remedial work like telling students to copy notes word for word from their text books will  do nothing to improve their grades or help them progress. It just adds unnecessary stress.

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Effects of homework stress at home

Both parents and students tend to get stressed out at the beginning of a new school year due to the impending arrival of homework.

Nightly battles centered on finishing assignments are a household routine in houses with students.

Research has found that too much homework can negatively affect children. In creating a lack of balance between play time and time spent doing homework, a child can get headaches, sleep deprivation or even ulcers.

And homework stress doesn’t just impact grade schoolers. College students are also affected, and the stress is affecting their academic performance.

Even the parent’s confidence in their abilities to help their children with homework suffers due increasing stress levels in the household.

Fights and conflict over homework are more likely in families where parents do not have at least a college degree. When the child needs assistance, they have to turn to their older siblings who might already be bombarded with their own homework.

Parents who have a college degree feel more confident in approaching the school and discussing the appropriate amount of school work.

“It seems that homework being assigned discriminates against parents who don’t have college degree, parents who have English as their second language and against parents who are poor.” Said Stephanie Donaldson Pressman, the contributing editor of the study and clinical director of the New England Center for Pediatric Psychology.

With all the stress associated with homework, it’s not surprising that some parents have opted not to let their children do homework. Parents that have instituted a no-homework policy have stated that it has taken a lot of the stress out of their evenings.

The recommended amount homework

The standard endorsed by the National Education Association is called the “10 minute rule”; 10 minutes per grade level per night. This recommendation was made after a number of studies were done on the effects of too much homework on families.

The 10 minute rule basically means 10 minutes of homework in the first grade, 20 minute for the second grade all the way up to 120 minutes for senior year in high school. Note that no homework is endorsed in classes under the first grade.

Parents reported first graders were spending around half an hour on homework each night, and kindergarteners spent 25 minutes a night on assignments according to a study carried out by Brown University.

Making a five year old sit still for half an hour is very difficult as they are at the age where they just want to move around and play.

A child who is exposed to 4-5 hours of homework after school is less likely to find the time to go out and play with their friends, which leads to accumulation of stress energy in the body.

Their social life also suffers because between the time spent at school and doing homework, a child will hardly have the time to pursue hobbies. They may also develop a negative attitude towards learning.

The research highlighted that 56% of students consider homework a primary source of stress.

And if you’re curious how the U.S stacks up against other countries in regards to how much time children spend on homework, it’s pretty high on the list .

Signs to look out for on a student that has homework stress

Since not every student is affected by homework stress in the same way, it’s important to be aware of some of the signs your child might be mentally drained from too much homework.

Here are some common signs of homework stress:

• Sleep disturbances
• Frequent stomachaches and headaches
• Decreased appetite or changed eating habits
• New or recurring fears
• Not able to relax
• Regressing to behavior they had when younger
• Bursts of anger crying or whining
• Becoming withdrawn while others may become clingy
• Drastic changes in academic performance
• Having trouble concentrating or completing homework
• Constantly complains about their ability to do homework

If you’re a parent and notice any of these signs in your child, step in to find out what’s going on and if homework is the source of their stress.

If you’re a student, pay attention if you start experiencing any of these symptoms as a result of your homework load. Don’t be afraid to ask your teacher or parents for help if the stress of homework becomes too much for you.

What parents do wrong when it comes to homework stress

Most parents push their children to do more and be more, without considering the damage being done by this kind of pressure.

Some think that homework brought home is always something the children can deal with on their own. If the child cannot handle their homework then these parents get angry and make the child feel stupid.

This may lead to more arguing and increased dislike of homework in the household. Ultimately the child develops an even worse attitude towards homework.

Another common mistake parents make is never questioning the amount of homework their children get, or how much time they spend on it. It’s easy to just assume whatever the teacher assigned is adequate, but as we mentioned earlier, that’s not always the case.

Be proactive and involved with your child’s homework. If you notice they’re spending hours every night on homework, ask them about it. Just because they don’t complain doesn’t mean there isn’t a problem.

How can parents help?

• While every parent wants their child to become successful and achieve the very best, it’s important to pull back on the mounting pressure and remember that they’re still just kids. They need time out to release their stress and connect with other children.
• Many children may be afraid to admit that they’re overwhelmed by homework because they might be misconstrued as failures. The best thing a parent can do is make home a safe place for children to express themselves freely. You can do this by lending a listening ear and not judging your kids.
• Parents can also take the initiative to let the school know that they’re unhappy with the amount of homework being given. Even if you don’t feel comfortable complaining, you can approach the school through the parent-teacher association available and request your representative to plead your case.
• It may not be all the subjects that are causing your child to get stressed. Parents should find out if there is a specific subject of homework that is causing stress. You could also consult with other parents to see what they can do to fix the situation. It may be the amount or the content that causes stress, so the first step is identifying the problem.
• Work with your child to create a schedule for getting homework done on time. You can set a specific period of time for homework, and schedule time for other activities too. Strike a balance between work and play.
• Understanding that your child is stressed about homework doesn’t mean you have to allow them not to try. Let them sit down and work on it as much as they’re able to, and recruit help from the older siblings or a neighbor if possible.
• Check out these resources to help your child with their homework .

The main idea here is to not abolish homework completely, but to review the amount and quality of homework being given out. Stress, depression and lower grades are the last things parents want for their children.

The schools and parents need to work together to find a solution to this obvious problem.

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Is Homework Necessary? Education Inequity and Its Impact on Students

The Problem with Homework: It Highlights Inequalities

How much homework is too much homework, when does homework actually help, negative effects of homework for students, how teachers can help.

Schools are getting rid of homework from Essex, Mass., to Los Angeles, Calif. Although the no-homework trend may sound alarming, especially to parents dreaming of their child’s acceptance to Harvard, Stanford or Yale, there is mounting evidence that eliminating homework in grade school may actually have great benefits , especially with regard to educational equity.

In fact, while the push to eliminate homework may come as a surprise to many adults, the debate is not new . Parents and educators have been talking about this subject for the last century, so that the educational pendulum continues to swing back and forth between the need for homework and the need to eliminate homework.

One of the most pressing talking points around homework is how it disproportionately affects students from less affluent families. The American Psychological Association (APA) explained:

“Kids from wealthier homes are more likely to have resources such as computers, internet connections, dedicated areas to do schoolwork and parents who tend to be more educated and more available to help them with tricky assignments. Kids from disadvantaged homes are more likely to work at afterschool jobs, or to be home without supervision in the evenings while their parents work multiple jobs.”

[RELATED] How to Advance Your Career: A Guide for Educators >> 

While students growing up in more affluent areas are likely playing sports, participating in other recreational activities after school, or receiving additional tutoring, children in disadvantaged areas are more likely headed to work after school, taking care of siblings while their parents work or dealing with an unstable home life. Adding homework into the mix is one more thing to deal with — and if the student is struggling, the task of completing homework can be too much to consider at the end of an already long school day.

While all students may groan at the mention of homework, it may be more than just a nuisance for poor and disadvantaged children, instead becoming another burden to carry and contend with.

Beyond the logistical issues, homework can negatively impact physical health and stress — and once again this may be a more significant problem among economically disadvantaged youth who typically already have a higher stress level than peers from more financially stable families .

Yet, today, it is not just the disadvantaged who suffer from the stressors that homework inflicts. A 2014 CNN article, “Is Homework Making Your Child Sick?” , covered the issue of extreme pressure placed on children of the affluent. The article looked at the results of a study surveying more than 4,300 students from 10 high-performing public and private high schools in upper-middle-class California communities.

“Their findings were troubling: Research showed that excessive homework is associated with high stress levels, physical health problems and lack of balance in children’s lives; 56% of the students in the study cited homework as a primary stressor in their lives,” according to the CNN story. “That children growing up in poverty are at-risk for a number of ailments is both intuitive and well-supported by research. More difficult to believe is the growing consensus that children on the other end of the spectrum, children raised in affluence, may also be at risk.”

When it comes to health and stress it is clear that excessive homework, for children at both ends of the spectrum, can be damaging. Which begs the question, how much homework is too much?

The National Education Association and the National Parent Teacher Association recommend that students spend 10 minutes per grade level per night on homework . That means that first graders should spend 10 minutes on homework, second graders 20 minutes and so on. But a study published by The American Journal of Family Therapy found that students are getting much more than that.

While 10 minutes per day doesn’t sound like much, that quickly adds up to an hour per night by sixth grade. The National Center for Education Statistics found that high school students get an average of 6.8 hours of homework per week, a figure that is much too high according to the Organization for Economic Cooperation and Development (OECD). It is also to be noted that this figure does not take into consideration the needs of underprivileged student populations.

In a study conducted by the OECD it was found that “after around four hours of homework per week, the additional time invested in homework has a negligible impact on performance .” That means that by asking our children to put in an hour or more per day of dedicated homework time, we are not only not helping them, but — according to the aforementioned studies — we are hurting them, both physically and emotionally.

What’s more is that homework is, as the name implies, to be completed at home, after a full day of learning that is typically six to seven hours long with breaks and lunch included. However, a study by the APA on how people develop expertise found that elite musicians, scientists and athletes do their most productive work for about only four hours per day. Similarly, companies like Tower Paddle Boards are experimenting with a five-hour workday, under the assumption that people are not able to be truly productive for much longer than that. CEO Stephan Aarstol told CNBC that he believes most Americans only get about two to three hours of work done in an eight-hour day.

In the scope of world history, homework is a fairly new construct in the U.S. Students of all ages have been receiving work to complete at home for centuries, but it was educational reformer Horace Mann who first brought the concept to America from Prussia. 

Since then, homework’s popularity has ebbed and flowed in the court of public opinion. In the 1930s, it was considered child labor (as, ironically, it compromised children’s ability to do chores at home). Then, in the 1950s, implementing mandatory homework was hailed as a way to ensure America’s youth were always one step ahead of Soviet children during the Cold War. Homework was formally mandated as a tool for boosting educational quality in 1986 by the U.S. Department of Education, and has remained in common practice ever since.  

School work assigned and completed outside of school hours is not without its benefits. Numerous studies have shown that regular homework has a hand in improving student performance and connecting students to their learning. When reviewing these studies, take them with a grain of salt; there are strong arguments for both sides, and only you will know which solution is best for your students or school. 

Homework improves student achievement.

• Source: The High School Journal, “ When is Homework Worth the Time?: Evaluating the Association between Homework and Achievement in High School Science and Math ,” 2012. 
• Source: IZA.org, “ Does High School Homework Increase Academic Achievement? ,” 2014. **Note: Study sample comprised only high school boys. 

Homework helps reinforce classroom learning.

• Source: “ Debunk This: People Remember 10 Percent of What They Read ,” 2015.

Homework helps students develop good study habits and life skills.

• Sources: The Repository @ St. Cloud State, “ Types of Homework and Their Effect on Student Achievement ,” 2017; Journal of Advanced Academics, “ Developing Self-Regulation Skills: The Important Role of Homework ,” 2011.
• Source: Journal of Advanced Academics, “ Developing Self-Regulation Skills: The Important Role of Homework ,” 2011.

Homework allows parents to be involved with their children’s learning.

• Parents can see what their children are learning and working on in school every day. 
• Parents can participate in their children’s learning by guiding them through homework assignments and reinforcing positive study and research habits.
• Homework observation and participation can help parents understand their children’s academic strengths and weaknesses, and even identify possible learning difficulties.
• Source: Phys.org, “ Sociologist Upends Notions about Parental Help with Homework ,” 2018.

While some amount of homework may help students connect to their learning and enhance their in-class performance, too much homework can have damaging effects. 

Students with too much homework have elevated stress levels. 

• Source: USA Today, “ Is It Time to Get Rid of Homework? Mental Health Experts Weigh In ,” 2021.
• Source: Stanford University, “ Stanford Research Shows Pitfalls of Homework ,” 2014.

Students with too much homework may be tempted to cheat. 

• Source: The Chronicle of Higher Education, “ High-Tech Cheating Abounds, and Professors Bear Some Blame ,” 2010.
• Source: The American Journal of Family Therapy, “ Homework and Family Stress: With Consideration of Parents’ Self Confidence, Educational Level, and Cultural Background ,” 2015.

Homework highlights digital inequity. 

• Sources: NEAToday.org, “ The Homework Gap: The ‘Cruelest Part of the Digital Divide’ ,” 2016; CNET.com, “ The Digital Divide Has Left Millions of School Kids Behind ,” 2021.
• Source: Investopedia, “ Digital Divide ,” 2022; International Journal of Education and Social Science, “ Getting the Homework Done: Social Class and Parents’ Relationship to Homework ,” 2015.
• Source: World Economic Forum, “ COVID-19 exposed the digital divide. Here’s how we can close it ,” 2021.

Homework does not help younger students.

• Source: Review of Educational Research, “ Does Homework Improve Academic Achievement? A Synthesis of Researcher, 1987-2003 ,” 2006.

To help students find the right balance and succeed, teachers and educators must start the homework conversation, both internally at their school and with parents. But in order to successfully advocate on behalf of students, teachers must be well educated on the subject, fully understanding the research and the outcomes that can be achieved by eliminating or reducing the homework burden. There is a plethora of research and writing on the subject for those interested in self-study.

For teachers looking for a more in-depth approach or for educators with a keen interest in educational equity, formal education may be the best route. If this latter option sounds appealing, there are now many reputable schools offering online master of education degree programs to help educators balance the demands of work and family life while furthering their education in the quest to help others.

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Is it time to get rid of homework? Mental health experts weigh in.

It's no secret that kids hate homework. And as students grapple with an ongoing pandemic that has had a wide range of mental health impacts, is it time schools start listening to their pleas about workloads?

Some teachers are turning to social media to take a stand against homework. 

Tiktok user @misguided.teacher says he doesn't assign it because the "whole premise of homework is flawed."

For starters, he says, he can't grade work on "even playing fields" when students' home environments can be vastly different.

"Even students who go home to a peaceful house, do they really want to spend their time on busy work? Because typically that's what a lot of homework is, it's busy work," he says in the video that has garnered 1.6 million likes. "You only get one year to be 7, you only got one year to be 10, you only get one year to be 16, 18."

Mental health experts agree heavy workloads have the potential do more harm than good for students, especially when taking into account the impacts of the pandemic. But they also say the answer may not be to eliminate homework altogether.

Emmy Kang, mental health counselor at Humantold , says studies have shown heavy workloads can be "detrimental" for students and cause a "big impact on their mental, physical and emotional health."

"More than half of students say that homework is their primary source of stress, and we know what stress can do on our bodies," she says, adding that staying up late to finish assignments also leads to disrupted sleep and exhaustion.

Cynthia Catchings, a licensed clinical social worker and therapist at Talkspace , says heavy workloads can also cause serious mental health problems in the long run, like anxiety and depression. 

And for all the distress homework  can cause, it's not as useful as many may think, says Dr. Nicholas Kardaras, a psychologist and CEO of Omega Recovery treatment center.

"The research shows that there's really limited benefit of homework for elementary age students, that really the school work should be contained in the classroom," he says.

For older students, Kang says, homework benefits plateau at about two hours per night. 

"Most students, especially at these high achieving schools, they're doing a minimum of three hours, and it's taking away time from their friends, from their families, their extracurricular activities. And these are all very important things for a person's mental and emotional health."

Catchings, who also taught third to 12th graders for 12 years, says she's seen the positive effects of a no-homework policy while working with students abroad.

"Not having homework was something that I always admired from the French students (and) the French schools, because that was helping the students to really have the time off and really disconnect from school," she says.

The answer may not be to eliminate homework completely but to be more mindful of the type of work students take home, suggests Kang, who was a high school teacher for 10 years.

"I don't think (we) should scrap homework; I think we should scrap meaningless, purposeless busy work-type homework. That's something that needs to be scrapped entirely," she says, encouraging teachers to be thoughtful and consider the amount of time it would take for students to complete assignments.

The pandemic made the conversation around homework more crucial 

Mindfulness surrounding homework is especially important in the context of the past two years. Many students will be struggling with mental health issues that were brought on or worsened by the pandemic , making heavy workloads even harder to balance.

"COVID was just a disaster in terms of the lack of structure. Everything just deteriorated," Kardaras says, pointing to an increase in cognitive issues and decrease in attention spans among students. "School acts as an anchor for a lot of children, as a stabilizing force, and that disappeared."

But even if students transition back to the structure of in-person classes, Kardaras suspects students may still struggle after two school years of shifted schedules and disrupted sleeping habits.

"We've seen adults struggling to go back to in-person work environments from remote work environments. That effect is amplified with children because children have less resources to be able to cope with those transitions than adults do," he explains.

'Get organized' ahead of back-to-school

In order to make the transition back to in-person school easier, Kang encourages students to "get good sleep, exercise regularly (and) eat a healthy diet."

To help manage workloads, she suggests students "get organized."

"There's so much mental clutter up there when you're disorganized. ... Sitting down and planning out their study schedules can really help manage their time," she says.

Breaking up assignments can also make things easier to tackle.

"I know that heavy workloads can be stressful, but if you sit down and you break down that studying into smaller chunks, they're much more manageable."

If workloads are still too much, Kang encourages students to advocate for themselves.

"They should tell their teachers when a homework assignment just took too much time or if it was too difficult for them to do on their own," she says. "It's good to speak up and ask those questions. Respectfully, of course, because these are your teachers. But still, I think sometimes teachers themselves need this feedback from their students."

More: Some teachers let their students sleep in class. Here's what mental health experts say.

More: Some parents are slipping young kids in for the COVID-19 vaccine, but doctors discourage the move as 'risky'

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Is Homework a Waste of Students' Time? Study Finds It's the Biggest Cause of Teen Stress

As the debate over the need for homework continues, a new study found that it's the biggest cause of teen stress, leading to sleepless nights and poor academic performance

Julie Mazziotta is the Sports Editor at PEOPLE, covering everything from the NFL to tennis to Simone Biles and Tom Brady. She was previously an Associate Editor for the Health vertical for six years, and prior to joining PEOPLE worked at Health Magazine. When not covering professional athletes, Julie spends her time as a (very) amateur athlete, training for marathons, long bike trips and hikes.

It’s the bane of every teen’s existence. After sitting through hours at school, they leave only to get started on mountains of homework. And educators are mixed on its effectiveness . Some say the practice reinforces what students learned during the day, while others argue that it put unnecessary stress on kids and parents , who are often stuck nagging or helping.

According to a new study, conducted by the Better Sleep Council , that homework stress is the biggest source of frustration for teens, with 74 percent of those surveyed ranking it the highest, above self-esteem (51 percent) parental expectations (45 percent) and bullying (15 percent).

Homework is taking up a large chunk of their time , too — around 15-plus hours a week, with about one-third of teens reporting that it’s closer to 20-plus hours.

The stress and excessive homework adds up to lost sleep, the BSC says. According to the survey, 57 percent of teenagers said that they don’t get enough sleep, with 67 reporting that they get just five to seven hours a night — a far cry from the recommended eight to ten hours. The BSC says that their research shows that when teens feel more stressed, their sleep suffers. They go to sleep later, wake up earlier and have more trouble falling and staying asleep than less-stressed teens.

“We’re finding that teenagers are experiencing this cycle where they sacrifice their sleep to spend extra time on homework, which gives them more stress — but they don’t get better grades,” said Mary Helen Rogers, the vice president of marketing and communications for the BSC.

RELATED VIDEO: To Help Or Not To Help: Moms Talk About Whether Or Not They Help Their Children With Homework

Another interesting finding from this study: students who go to bed earlier and wake up earlier do better academically than those who stay up late, even if those night owls are spending that time doing homework.

To end this cycle of sleep deprivation and stress, the BSC recommends that students try setting a consistent time to go to sleep each night, regardless of leftover homework. And their other sleep tips are good for anyone, regardless of age — keep the temperature between 65 and 67 degrees, turn off the electronic devices before bed, make sure the mattress is comfy and reduce noise with earplugs or sound machines.

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Does Homework Cause Stress? Exploring the Impact on Students’ Mental Health

How much homework is too much?

Jump to: The Link Between Homework and Stress | Homework’s Impact on Mental Health | Benefits of Homework | How Much Homework Should Teacher’s Assign? | Advice for Students | How Healium Helps

Homework has become a matter of concern for educators, parents, and researchers due to its potential effects on students’ stress levels. It’s no secret students often find themselves grappling with high levels of stress and anxiety throughout their academic careers, so understanding the extent to which homework affects those stress levels is important. 

By delving into the latest research and understanding the underlying factors at play, we hope to curate insights for educators, parents, and students who are wondering  is homework causing stress in their lives?

The Link Between Homework and Stress: What the Research Says

Over the years, numerous studies investigated the relationship between homework and stress levels in students. 

One study published in the Journal of Experimental Education found that students who reported spending more than two hours per night on homework experienced higher stress levels and physical health issues . Those same students reported over three hours of homework a night on average.

This study, conducted by Stanford lecturer Denise Pope, has been heavily cited throughout the years, with WebMD eproducing the below video on the topic– part of their special report series on teens and stress : 

Additional studies published by Sleep Health Journal found that long hours on homework on may be a risk factor for depression while also suggesting that reducing workload outside of class may benefit sleep and mental fitness .

Lastly, a study presented by Frontiers in Psychology highlighted significant health implications for high school students facing chronic stress, including emotional exhaustion and alcohol and drug use.

Homework’s Potential Impact on Mental Health and Well-being

Homework-induced stress on students can involve both psychological and physiological side effects. 

1. Potential Psychological Effects of Homework-Induced Stress:

• Anxiety: The pressure to perform academically and meet homework expectations can lead to heightened levels of anxiety in students. Constant worry about completing assignments on time and achieving high grades can be overwhelming.

• Sleep Disturbances : Homework-related stress can disrupt students’ sleep patterns, leading to sleep anxiety or sleep deprivation, both of which can negatively impact cognitive function and emotional regulation.

• Reduced Motivation: Excessive homework demands could drain students’ motivation, causing them to feel fatigued and disengaged from their studies. Reduced motivation may lead to a lack of interest in learning, hindering overall academic performance.

2. Potential Physical Effects of Homework-Induced Stress:

• Impaired Immune Function: Prolonged stress could weaken the immune system, making students more susceptible to illnesses and infections.

• Disrupted Hormonal Balance : The body’s stress response triggers the release of hormones like cortisol, which, when chronically elevated due to stress, can disrupt the delicate hormonal balance and lead to various health issues.

• Gastrointestinal Disturbances: Stress has been known to affect the gastrointestinal system, leading to symptoms such as stomachaches, nausea, and other digestive problems.

• Cardiovascular Impact: The increased heart rate and elevated blood pressure associated with stress can strain the cardiovascular system, potentially increasing the risk of heart-related issues in the long run.

• Brain impact: Prolonged exposure to stress hormones may impact the brain’s functioning , affecting memory, concentration, and cognitive abilities.

The Benefits of Homework

It’s important to note that homework also offers many benefits that contribute to students’ academic growth and development, such as: 

• Development of Time Management Skills: Completing homework within specified deadlines encourages students to manage their time efficiently. This valuable skill extends beyond academics and becomes essential in various aspects of life.

• Preparation for Future Challenges : Homework helps prepare students for future academic challenges and responsibilities. It fosters a sense of discipline and responsibility, qualities that are crucial for success in higher education and professional life.

• Enhanced Problem-Solving Abilities: Homework often presents students with challenging problems to solve. Tackling these problems independently nurtures critical thinking and problem-solving skills.

While homework can foster discipline, time management, and self-directed learning, the middle ground may be to  strike a balance that promotes both academic growth and mental well-being .

How Much Homework Should Teachers Assign?

As a general guideline, educators suggest assigning a workload that allows students to grasp concepts effectively without overwhelming them . Quality over quantity is key, ensuring that homework assignments are purposeful, relevant, and targeted towards specific objectives. 

Advice for Students: How to balance Homework and Well-being

Finding a balance between academic responsibilities and well-being is crucial for students. Here are some practical tips and techniques to help manage homework-related stress and foster a healthier approach to learning:

• Effective Time Management : Encourage students to create a structured study schedule that allocates sufficient time for homework, breaks, and other activities. Prioritizing tasks and setting realistic goals can prevent last-minute rushes and reduce the feeling of being overwhelmed.

• Break Tasks into Smaller Chunks : Large assignments can be daunting and may contribute to stress. Students should break such tasks into smaller, manageable parts. This approach not only makes the workload seem less intimidating but also provides a sense of accomplishment as each section is completed.

• Find a Distraction-Free Zone : Establish a designated study area that is free from distractions like smartphones, television, or social media. This setting will improve focus and productivity, reducing time needed to complete homework.

• Be Active : Regular exercise is known to reduce stress and enhance mood. Encourage students to incorporate physical activity into their daily routine, whether it’s going for a walk, playing a sport, or doing yoga.

• Practice Mindfulness and Relaxation Techniques : Encourage students to engage in mindfulness practices, such as deep breathing exercises or meditation, to alleviate stress and improve concentration. Taking short breaks to relax and clear the mind can enhance overall well-being and cognitive performance.

• Seek Support : Teachers, parents, and school counselors play an essential role in supporting students. Create an open and supportive environment where students feel comfortable expressing their concerns and seeking help when needed.

How Healium is Helping in Schools

Stress is caused by so many factors and not just the amount of work students are taking home.  Our company created a virtual reality stress management solution… a mental fitness tool called “Healium” that’s teaching students how to learn to self-regulate their stress and downshift in a drugless way. Schools implementing Healium have seen improvements from supporting dysregulated students and ADHD challenges to empowering students with body awareness and learning to self-regulate stress . Here’s one of their stories. 

By providing students with the tools they need to self-manage stress and anxiety, we represent a forward-looking approach to education that prioritizes the holistic development of every student. 

To learn more about how Healium works, watch the video below.

About the Author

Sarah Hill , a former interactive TV news journalist at NBC, ABC, and CBS affiliates in Missouri, gained recognition for pioneering interactive news broadcasting using Google Hangouts. She is now the CEO of Healium, the world’s first biometrically powered immersive media channel, helping those with stress, anxiety, insomnia, and other struggles through biofeedback storytelling. With patents, clinical validation, and over seven million views, she has reshaped the landscape of immersive media.

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School Stress Takes A Toll On Health, Teens And Parents Say

Patti Neighmond

Colleen Frainey, 16, of Tualatin, Ore., cut back on advanced placement classes in her junior year because the stress was making her physically ill. Toni Greaves for NPR hide caption

Colleen Frainey, 16, of Tualatin, Ore., cut back on advanced placement classes in her junior year because the stress was making her physically ill.

When high school junior Nora Huynh got her report card, she was devastated to see that she didn't get a perfect 4.0.

Nora "had a total meltdown, cried for hours," her mother, Jennie Huynh of Alameda, Calif., says. "I couldn't believe her reaction."

Nora is doing college-level work, her mother says, but many of her friends are taking enough advanced classes to boost their grade-point averages above 4.0. "It breaks my heart to see her upset when she's doing so awesome and going above and beyond."

And the pressure is taking a physical toll, too. At age 16, Nora is tired, is increasingly irritated with her siblings and often suffers headaches, her mother says.

Teens Talk Stress

When NPR asked on Facebook if stress is an issue for teenagers, they spoke loud and clear:

• "Academic stress has been a part of my life ever since I can remember," wrote Bretta McCall, 16, of Seattle. "This year I spend about 12 hours a day on schoolwork. I'm home right now because I was feeling so sick from stress I couldn't be at school. So as you can tell, it's a big part of my life!"
• "At the time of writing this, my weekend assignments include two papers, a PowerPoint to go with a 10-minute presentation, studying for a test and two quizzes, and an entire chapter (approximately 40 pages) of notes in a college textbook," wrote Connor West of New Jersey.
• "It's a problem that's basically brushed off by most people," wrote Kelly Farrell in Delaware. "There's this mentality of, 'You're doing well, so why are you complaining?' " She says she started experiencing symptoms of stress in middle school, and was diagnosed with panic disorder and generalized anxiety disorder in high school.
• "Parents are the worst about all of this," writes Colin Hughes of Illinois. "All I hear is, 'Work harder, you're a smart kid, I know you have it in you, and if you want to go to college you need to work harder.' It's a pain."

Parents are right to be worried about stress and their children's health, says Mary Alvord , a clinical psychologist in Maryland and public education coordinator for the American Psychological Association.

"A little stress is a good thing," Alvord says. "It can motivate students to be organized. But too much stress can backfire."

Almost 40 percent of parents say their high-schooler is experiencing a lot of stress from school, according to a new NPR poll conducted with the Robert Wood Johnson Foundation and the Harvard School of Public Health. In most cases, that stress is from academics, not social issues or bullying, the poll found. (See the full results here .)

Homework was a leading cause of stress, with 24 percent of parents saying it's an issue.

Teenagers say they're suffering, too. A survey by the American Psychological Association found that nearly half of all teens — 45 percent — said they were stressed by school pressures.

Chronic stress can cause a sense of panic and paralysis, Alvord says. The child feels stuck, which only adds to the feeling of stress.

Parents can help put the child's distress in perspective, particularly when they get into what Alvord calls catastrophic "what if" thinking: "What if I get a bad grade, then what if that means I fail the course, then I'll never get into college."

Then move beyond talking and do something about it.

Colleen pets her horse, Bishop. They had been missing out on rides together because of homework. Toni Greaves for NPR hide caption

Colleen pets her horse, Bishop. They had been missing out on rides together because of homework.

That's what 16-year-old Colleen Frainey of Tualatin, Ore., did. As a sophomore last year, she was taking all advanced courses. The pressure was making her sick. "I didn't feel good, and when I didn't feel good I felt like I couldn't do my work, which would stress me out more," she says.

Mom Abigail Frainey says, "It was more than we could handle as a family."

With encouragement from her parents, Colleen dropped one of her advanced courses. The family's decision generated disbelief from other parents. "Why would I let her take the easy way out?" Abigail Frainey heard.

But she says dialing down on academics was absolutely the right decision for her child. Colleen no longer suffers headaches or stomachaches. She's still in honors courses, but the workload this year is manageable.

Even better, Colleen now has time to do things she never would have considered last year, like going out to dinner with the family on a weeknight, or going to the barn to ride her horse, Bishop.

Psychologist Alvord says a balanced life should be the goal for all families. If a child is having trouble getting things done, parents can help plan the week, deciding what's important and what's optional. "Just basic time management — that will help reduce the stress."

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Will less homework stress make California students happier?

A bill from a member of the Legislature’s happiness committee would require schools to come up with homework policies that consider the mental and physical strain on students.

Update: The Assembly education committee on April 24 approved an amended version of the bill that softens some requirements and gives districts until the 2027-28 school year.

Some bills before California’s Legislature don’t come from passionate policy advocates, or from powerful interest groups.

Sometimes, the inspiration comes from a family car ride.

While campaigning two years ago, Assemblymember Pilar Schiavo ’s daughter, then nine, asked from the backseat what her mother could do if she won.

Schiavo answered that she’d be able to make laws. Then, her daughter Sofia asked her if she could make a law banning homework.

“It was a kind of a joke,” the Santa Clarita Valley Democrat said in an interview, “though I’m sure she’d be happy if homework were banned.”

Still, the conversation got Schiavo thinking, she said. And while Assembly Bill 2999 — which faces its first big test on Wednesday — is far from a ban on homework, it would require school districts, county offices of education and charter schools to develop guidelines for K-12 students and would urge schools to be more intentional about “good,” or meaningful homework.

Among other things, the guidelines should consider students’ physical health, how long assignments take and how effective they are. But the bill’s main concern is mental health and when homework adds stress to students’ daily lives.

Homework’s impact on happiness is partly why Schiavo brought up the proposal last month during the first meeting of the Legislature’s select committee on happiness , led by former Assembly Speaker Anthony Rendon .

“This feeling of loneliness and disconnection — I know when my kid is not feeling connected,” Schiavo, a member of the happiness committee, told CalMatters. “It’s when she’s alone in her room (doing homework), not playing with her cousin, not having dinner with her family.”

The bill analysis cites a survey of 15,000 California high schoolers from Challenge Success, a nonprofit affiliated with the Stanford Graduate School of Education. It found that 45% said homework was a major source of stress and that 52% considered most assignments to be busywork.

The organization also reported in 2020 that students with higher workloads reported “symptoms of exhaustion and lower rates of sleep,” but that spending more time on homework did not necessarily lead to higher test scores.

Homework’s potential to also widen inequities is why Casey Cuny supports the measure. An English and mythology teacher at Valencia High School and 2024’s California Teacher of the Year , Cuny says language barriers, unreliable home internet, family responsibilities or other outside factors may contribute to a student falling behind on homework.

“I never want a kid’s grade to be low because they have divorced parents and their book was at their dad’s house when they were spending the weekend at mom’s house,” said Cuny, who plans to attend a press conference Wednesday to promote the bill.

In addition, as technology makes it easier for students to cheat — using artificial technology or chat threads to lift answers, for example — Schiavo says that the educators she has spoken to indicate they’re moving towards more in-class assignments.

Cuny agrees that an emphasis on classwork does help to rein in cheating and allows him to give students immediate feedback. “I feel that I should teach them what I need to teach them when I’m with them in the room,” he said.

The bill says the local homework policies should have input from teachers, parents, school counselors, social workers and students; be distributed at the beginning of every school year; and be reevaluated every five years.

The Assembly Committee on Education is expected to hear the bill Wednesday. Schiavo says she has received bipartisan support and so far, no official opposition or support is listed in the bill analysis.

The measure’s provision for parental input may lead to disagreements given the recent culture war disputes between Democratic officials and parental rights groups backed by some Republican lawmakers.

Because homework is such a big issue, “I’m sure there will be lively (school) board meetings,” Schiavo said.

Nevertheless, she says she hopes the proposal will overhaul the discussion around homework and mental health. The bill is especially pertinent now that the state is also poised to cut spending on mental health services for children with the passage of Proposition 1 .

Schiavo said the mother of a student with attention deficit/hyperactivity disorder told her that the child’s struggle to finish homework has raised issues inside the house, as well as with the school’s principal and teachers.

“And I’m just like, it’s sixth grade!” Schaivo said. “What’s going on?”

CalMatters  is a nonprofit, nonpartisan media venture explaining California policies and politics. 

• Open access
• Published: 23 April 2024

Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives

• Basma Salameh   ORCID: orcid.org/0000-0003-1372-7199 1 ,
• Jihad Abdallah 2 ,
• Sameer A Alkubati 3 , 5 &
• Mohammed ALBashtawy 4  

BMC Nursing volume  23 , Article number:  261 ( 2024 ) Cite this article

135 Accesses

Metrics details

The frequency of alarms generated by monitors and other electro-medical devices is undeniably valuable but can simultaneously escalate the workload for healthcare professionals, potentially subjecting intensive care unit nurses to alarm fatigue. The aim of this study is to investigate alarm fatigue and stress levels among critical care nursing personnel. Additionally, the study aims to assess predictors for both alarm fatigue and perceived stress.

Methodology

: A descriptive cross-sectional study recruited 187 Intensive Care Unit (ICU) nurses from hospitals located in the northern and central regions of the West Bank, Palestine. Data were gathered through online surveys due to logistic concerns using the Alarm Fatigue Scale and the Perceived Stress Scale. The research was conducted between November 2023 and January 2024.

The mean overall alarm fatigue score was 23.36 (SD = 5.57) out of 44. The study showed that 62.6% of the participating ICU nurses experience average to high degree of alarm fatigue, while 69.5% experience average to high levels of perceived stress. A significant positive Pearson correlation was found between stress and alarm fatigue (0.40, P  < 0.01). Important predictors of alarm fatigue include perceived stress, nurse-to-patient ratio, gender, and years of experience, while important predictors of perceived stress include alarm fatigue, type of working shift and hospital unit.

Alarm fatigue can compromise the timely intervention required to prevent adverse outcomes by causing delayed responses or missed critical alarm, which can have major ramifications for patient safety. Addressing stress is crucial for mitigating alarm fatigue and fostering a supportive work environment to ensure optimal patient care. Consequently, exploring strategies to alleviate the negative impacts of alarm fatigue on critical care nurses’ stress merits further investigation in future research studies.

Peer Review reports

Today’s healthcare organizations have access to a wide range of technologies and resources to assist everyday clinical practice, particularly in intensive care units, where patients are continuously monitored with specialized alarm systems to alert health care providers [ 1 , 2 , 3 ].

However, continuous monitors frequently produce excessive alarm warnings that may not always indicate significant changes in the patient’s clinical status. [ 4 – 5 ]

Every day, nurses in intensive care units (ICUs) deal with 350 alarms per bed, 85–99% of which are not actionable. [ 6 – 7 ] As a result, nurses often find themselves grappling with alarm fatigue, which affects their ability to react to alarms effectively and reduce their receptivity to these notifications [ 8 , 9 , 10 , 11 , 12 ]. Alarm fatigue poses a significant risk for critical care nurses, who serve as the frontline healthcare providers interacting directly with patients and monitoring them around the clock [ 13 ]. Critical care nurses are often subjected to excessively frequent and burdensome alarms, potentially impeding their ability to concentrate on tasks and responsibilities, leading to lapses in `attention and increased likelihood of errors [ 14 ]. Alarm fatigue, a concerning phenomenon, is triggered by the constant stream of alarms in the ICU [ 6 , 14 ]. Alarm fatigue occurs when healthcare professionals become desensitized to the frequent occurrence of alarms, particularly those with non-actionable character [ 6 ]. This tendency may cause crucial alarms to be missed or responded to slowly, endangering the safety and wellbeing of patients, which could lead to patient mortality [ 10 ].

Increased levels of alarm fatigue may be associated with suboptimal nursing practices, such as altering alarm parameters outside of acceptable ranges, turning down alert volume, or even turning off alarm systems entirely. Such acts may put patient safety in danger [ 15 , 16 ]. Recognizing the severity of this issue, The Joint Commission, reaffirmed alarm fatigue management as a global priority for patient safety in recognition of the seriousness of this problem (Joint Commission, 2022). [ 9 – 10 ] This reiteration emphasizes how crucial it is to address alarm fatigue in healthcare settings in order to protect the wellbeing and safety of patients.

Critical care units are widely recognized as highly stressful work environments, attributed to several factors including demanding and complex job descriptions, escalating admissions, unpredictability schedule changes, unrealistic expectations from patients and their families, and the frequent encounters with moral and end-of-life dilemmas. Nurses within these units contend with extended work hours, time constrains, limited breaks, staffing shortage, and substandard working conditions [ 7 , 8 ]. Research consistently associated work-related stress with diminished performance, reduced quality of life, and a host of health issues encompassing physical, psychological, and interpersonal problems [ 9 , 10 ]. Given the overwhelming responsibilities and demands associated with providing care in today’s healthcare systems, especially in critical care units, nurses are frequently exposed to high levels of stress [ 17 ]. Additionally, studies have consistently shown that nurses working in critical care units experience significantly higher levels of stress compared to their counterparts in other nursing specialties [ 18 , 19 ]. Consequently, prolonged exposure to such heightened stress levels poses a grave risk to patient safety and the overall care quality of care provided [ 20 ].

When multiple alarms in the critical care unit sound simultaneously, nurses often feel overburdened. A monitor that emits unnecessary sounds or false alert has been identified as a stress-inducing factors for healthcare providers [ 21 ]. According to previous studies, a significant and positive correlation has been observed between the socio-demographic characteristics of nurses, such as work experience, education level, age, gender, nurse-patient ratio and the occurrence of alarm fatigue [ 22 , 23 , 24 ]. Furthermore, there is abundant evidence indicating that psychological factors such as stress and anxiety among nurses, play a substantial role in contributing to alarm fatigue [ 25 ].

To our knowledge, no previous studies have addresses alarm fatigue in Palestine. Therefore, the aim of the current study is to examine alarm fatigue among nurses working in critical care units. Additionally, the study aims to assess the relationship between alarm fatigue and perceived stress. This knowledge can be used to create strategies aimed at mitigating the adverse consequences of alarm fatigue among critical care nurses. The adverse effects of alarm fatigue on the professional achievements of nurses and patients’ outcomes can be reduced by education, planning, and providing counseling to nurses regarding the factors that have the greatest impact on the development of alarm fatigue.

Study design

Descriptive cross-sectional study was conducted. The target population ( N  = 251) included critical care nurses working in hospitals located in the northern and central regions of the West Bank, Palestine. Due to the constrains imposed by the October 7th war in Palestine, which rendered physical access to all hospitals challenging, data were gathered through online surveys. The research was carried out between November 2023 and January of 2024.

The researcher initiated contact with the nursing directors of each hospital. Subsequently, they obtained consent to distribute the survey to all nurses working in intensive care units (ICUs) via email and social media groups, with the assistance of the head of ICU nurses. An explanatory letter detailing the study goals and purpose was attached to the online survey to ensure data quality and accuracy during data collection process. Additionally, the researchers included a cell phone number in the explanatory letter to address any potential questions or concerns from the participants.

Sample size

The required sample size was determined using an Excel calculation sheet developed by Abdallah (2024) [ 26 ], (available at: https://www.researchgate.net/publication/378550258_Sample_size_calculation_sheet ) based on the formula by Daniel (1999) [ 27 ], which adjusts for finite population size as follows:

n* = \( \frac{nN}{n+(N-1)}\) , where \( n=\frac{{\left({Z}_{\frac{\alpha }{2}}+{Z}_{\beta }\right)}^{2}\left[P\left(1-P\right)\right]}{{d}^{2}}\) for two-sided tests. N is the population size (= 251), P is the assumed population proportion (= 0.50), d is the margin of error (= 0.05), α is the significance level (= 0.05), and β is the probability of Type II error (= 0.20, i.e., statistical power = 80%). \( {Z}_{\frac{\alpha }{2}} \) and 𝑍 𝛽 (1.64 and 1.28, respectively) are the standard normal values such that 𝑃 ( 𝑍 ≥ \( {Z}_{\frac{\alpha }{2}}\) ) = 𝛼 /2 and 𝑃 ( 𝑍 ≥ 𝑍 𝛽 ) = 𝛽 . The calculated sample size was 191. The actual sample included 187 ICU nurses who completed the questionnaire out of the 251 nurses targeted in the study (a response rate of 74.5%).

Inclusion / exclusion criteria

All nurses working in the ICU units for at least one year in Palestinian hospitals in the central and northern regions of the West Bank were included in the study. Student nurses and nurses on leave such as maternity leave was excluded from the study.

Tool of the study

Structured questionnaire consisting of demographic characteristics of the nurses including age, gender, marital status, experience, qualifications, type of hospital, hospital unit, nurse to patient ratio, type of work shift, and extra outside work.

Alarm Fatigue Questionnaire. It comprises 13 items. The tool was originally developed by Torabizadeh et al. (2017) [ 28 ] with approval obtained to use this scale for conducting the study. Answers to each item are given using the 5-Point Likert scale: “always”, “usually”, “sometimes”, “rarely”, and “never”. These are scored from 0 (never) to 4 (always) except items 1 and 9 which are scored reversely. The total score range of the questionnaire is between 8 (minimum) and 44 (maximum), with higher scores indicating a greater impact of alarm fatigue on nurse’s performance.

Perceived Stress Scale: is a classic stress assessment instrument. The tool, while originally developed in 1983, remains a popular choice to help understand how different situations affect feelings and perceived stress. The scale is publicly available and consists of 10 items which ask about feelings and thoughts during the last month [ 29 ].

The overall alarm fatigue scale (AFS) and perceived stress scale (PSS) scores were obtained as the sum of points of individual items and then converted into three categories using the sten (standard ten) scale (Canfield, 1951) [ 30 ]. As applied by Nagórska et al. (2021) [ 31 ], a final sten score of 1–4 is defined as low, 5–6 is defined as average, and 7–10 is defined as high.

After creating the questionnaire, it was presented to 5 nursing PhDs and experts in scientific research and the field of critical care nursing to assess its face and content validity and obtain comments and feedback. Cronbach’s Alpha was determined for the Alarm fatigue scale (13 items, Chronbach’s α = 0.60) and for the Perceived stress scale (10 items, Chronbach’s α = 0.73).

The questionnaire was translated into Arabic and reverse -translated to ensure accuracy. The validity of the tool was assessed by consulting five experts in the field: two university professors and three ICU nurses. They were asked to review and approve its validity, provide feedback on clarity, and assess whether the items reflected the main objectives of the study. Any necessary modifications were made based on their feedback.

Pilot study

Twenty ICU nurses completed the questionnaire as a pre-test before the full data collection process. This allowed the nurses to identify any ambiguities in the questionnaire’s wording, estimate the response rate, determine the actual time required for completion, and assess the questionnaire’s suitability and validity. Completing the surveys takes approximately 15 to 20 min.

Ethical approval

was obtained from Ministry of Health, Helsinki Committee in Palestine and from the Arab American University (Approval number: PHRC/HC/23). Participation in the study was entirely voluntary for nurses, and declining to participate would not result in any negative consequences or penalties. Furthermore, the study meticulously safeguarded the confidentiality of the participants by not disclosing any names or personal information, which were kept securely for research purposes only. Informed consent was obtained from all participants, and all procedures were conducted in compliance with the guidelines outlined in the Declaration of Helsinki.

Data analysis

The statistical analyses of data were conducted using the Statistical Package for Social Sciences (SPSS), version 21.0. Chronbach’s α was obtained as a measure of reliability. The distributions of the overall AFS and PSS scores were assessed graphically using Boxplots and Normal Probability Plots. Boxplots of the data showed symmetric distributions with no extreme values, and the Normal Probability Plots did not reveal any serious deviations from normality. Therefore, we adopted a parametric statistical approach for the analysis of data. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the data. Correlation analysis was performed to obtain Pearson correlation coefficients between the overall AFS and PSS scores, while Fisher’s Exact test was performed to test the association between AFS and PSS score categories. Independent samples t-test and one-way ANOVA were carried out to test differences in means of overall AFS and PSS scores among levels of categorical variables (e.g., socio-demographic, and other characteristics of participating nurses). The Linear Automatic Modeling regression function of SPSS was utilized to determine which factors are important predictors of alarm fatigue and perceived stress using the forward stepwise method based on the adjusted-R 2 criterion for entry and removal of predictor variables. The factors assessed for prediction are summarized in Table  1 . Assessment of the distribution of the studentized residuals from the final prediction models showed that the distributions are fairly close to the normal distribution (Fig.  1 ).

Histograms of studentized residuals from the final prediction models using Linear Automatic Modelling. The smooth line represents the normal distribution. The closer the frequencies of the residuals to the line, the closer the distribution of the residuals is to the normal distribution

Alarm fatigue scale (AFS)

Table  2 presents the means of individual item and overall AFS scores. The mean overall AFS score was 23.36 (SD = 5.57) out of 44. Among all participating nurses, 70 (37.4%) experience low alarm fatigue, 62 (33.2%) experience average alarm fatigue, and 55 (29.4%) experience high alarm fatigue.

The responses to individual items by the ICU nurses participating in the study indicated a greater impact of alarm fatigue on their performance when they were asked about item 5 “I pay more attention to the alarms in certain shifts” (3.58 out of 4), and item 4 “I believe much of the noise in the ward is from the alarms of the monitoring equipment ” (3.06 out of 4). On the other hand, the lowest impact of alarm fatigue on ICU nurses’ performance were for item 11 “When alarms go off repeatedly, I become in different to them” (0.80 out of 4), and item 2 “I turn off the alarms at the beginning of every shift” (0.82 out of 4).

Among all characteristics of participating nurses, only gender have a significant effect ( P  < 0.05) on the overall AFS score, with female nurses having a higher average score (24.60) than male nurses (22.65). All the other characteristics showed non-significant effects ( P  > 0.05), as shown in Table  3 .

Perceived stress scale (PSS)

The means of PSS scores for individual items and the overall scores for nurses working in the ICU units are presented in Table  3 . The mean of the overall PSS scores was 16.99 out of 40. Among all participating nurses, 57 (30.5%) were categorized as having low perceived stress level, 73 (39.0%) were categorized as having an average perceived stress level, and 57(30.5%) were categorized as having a high perceived stress level.

The response of the ICU nurses to individual PSS items regarding their feelings and thoughts in the last month showed that the highest average scores were for item 3 “how often have you felt nervous and “stressed?” (2.09 out of 4), item 6 “how often have you found that you could not cope with all the things that you had to do?” (1.95out of 4), and item 1 “how often have you been upset because of something that happened unexpectedly” (1.88 out of 4). While the lowest averages for ICU nurse’s responses were for item 8 “how often have you felt that you were on top of things” (1.28 out of 4), for item 4 “how often have you felt confident about your ability to handle your personal problems?” (1.45 out of 4), and item 7 “how often have you been able to control irritations in your life?” (1.48 out of 4).

The analysis of variance showed a statistically significant effect of the type of work shift on ICU nurses’ perceived stress ( P  < 0.05), where nurses working double shifts had the lowest average score (15.23), and nurses working regular morning shifts had the highest average score (17.92). Conversely, there were no statistically significant effects ( P  > 0.05) of age, marital status, experience, qualification, hospital unit, nurse-to- patient ratio, and extra work on ICU nurses’ alarm fatigue and perceived stress (see Table  4 ).

Relationship of alarm fatigue scores and perceived stress scores

A significant positive Pearson correlation coefficient of 0.40 was found between AFS and PSS overall scores ( P  < 0.01). Fisher’s Exact test showed a highly significant association ( P  < 0.001) between the AFS and PSS score categories. A high frequency of nurses in the low AFS score category were in the low PSS score category (50.9%) and vice versa (41.4%); a high frequency of nurses in the average AFS score category were in the average PSS score category (49.3%) and vice versa (58.1%); and a high frequency of nurses in the high AFS category were in the high PSS category (61.4) and vice versa (63.6%) (refer to Table  5 ). Furthermore, the results from One-way ANOVA showed significant differences ( P  < 0.001) among AFS categories in mean PSS scores where nurses in the high AFS category had a significantly higher mean PSS score (19.45) than nurses in the low and average AFS categories (15.53 and 16.45, respectively). Similarly, significant differences ( P  < 0.001) were found among PSS categories in mean AFS scores where nurses in the high PSS category had significantly higher mean AFS score (26.79) than nurses in the low and average AFS categories (21.37 and 22.23, respectively).

Prediction model for the overall AFS (alarm fatigue scale) scores

The variables retained for predicting the AFS overall score using the Linear Automatic Modeling procedure included (in order of importance): PSS score category ( P  < 0.001, importance = 0.689), nurse-to-patient ratio ( P  = 0.034, importance = 0.176), gender ( P  = 0.024, importance = 0.085), and experience ( P  = 0.216, importance = 0.051) with adjusted R 2  = 0. 217 (Fig.  2 ; Table  6 ). Nurses in the low and average PSS score categories had -ve coefficients (− 5.533 and − 4.706, respectively) compared to those in the high PSS score category; nurses caring for fewer than 5 patients had–ve coefficients compared to those caring for 5 or more patients; female nurses had + ve coefficient (1.732) compared to male nurses; and nurses with less than 5 year experiences and those with 5–10 year experience have + ve coefficients compared to those with more than 10-year experience (see Table  6 ).

Important predictors of overall AFS (Alarm Fatigue Scale) scores of nurses working in the critical care units in Palestine

Prediction model for the overall PSS (perceived stress scale) scores

For predicting the PSS overall score, the prediction model included AFS score category ( P  < 0.001, importance = 0.674), type of working shift ( P  = 0.099, importance = 0.195), and hospital unit ( P  = 0.375, importance = 0.131), with adjusted R 2  = 0.138 (Fig.  3 ; Table  7 ). Nurses in the low and average AFS score categories have -ve coefficients (− 3.582 and − 2.463, respectively) compared to those in the high AFS score category; nurses working double shifts and irregular shifts had–ve coefficients compared to those working regular morning shifts (-2.144 and − 0.288, respectively) while nurses working regular evening shifts had a slight positive coefficient (0.029); nurses working in the emergency care units, general critical care units, medical critical care units, and other types of hospital units had positive coefficients (0.619, 0.655, 1.566, and 2.114, respectively) compared to nurses working in the surgical cardiac units, (Table  7 ).

Important predictors of overall PSS (Perceived Stress Scale) scores of nurses working in the critical care units in Palestine

To the best of our knowledge, no previous study has been conducted to examine the impact of alarm fatigue on nurses’ performance, its associated factors, and its relationship with perceived stress in Palestine. Our study revealed that the mean total score of the Alarm Fatigue Scale was 23.36, indicating that critical care nurses in Palestine experience moderate levels of alarm fatigue. Critical care nurses are particularly susceptible to alarm fatigue due to the extensive time they devote for patient care and monitoring, necessitating continuous vigilance and prompt response to alarms generated by numerous medical devices [ 14 ]. Consequently, health care professionals may develop a desensitization to the frequent alarm occurrences. This desensitization could lead to crucial alarms being missed or responded to slowly, resulting in decrease concentration and physical exhaustion, thereby jeopardizing patient safety and wellbeing, potentially leading to adverse outcomes, including patient mortality. These findings are in line with studies conducted in Iran, Italy, and China [ 32 , 33 , 34 ]. Conversely, a study conducted in Ghana found that the majority of nurses experienced severe alarm fatigue [ 35 ].

Additionally, our findings revealed that the item with the highest average score was “I pay more attention to the alarms in certain shifts”. This tendency may be attributed to the nature of work in intensive care units, where alarm fatigue is prevalent, and behaviors during specific shifts may be influenced by factors such as nurse-patient ratio, patient acuity, and varying workload. For example, during morning shifts, the workload on nurses may increase, leading to heightened attention to alarms [ 36 ]. Conversely, in Korea the highest scoring item was “I hear a certain amount of noise in the ward” [ 38 ]. The items with the lowest scores were “I turn off the alarms at the beginning of every shift” and “I regularly readjust the limits of alarms based on the clinical symptoms of patients”. These findings sugest that ICU nurses, despite experiencing alarm fatigue, promptly respond to any alterations in patients’ conditions. These findings are consistent with previous studies [ 37 , 38 ]. However, they contrast with a study conducted in Ireland, where the majority of nurses either disregarded the alarm or exhibited delayed responses when experiencing alarm fatigue [ 39 ].

Another important finding of this study was that the majority of respondents reported an average to high level of perceived stress. In addition to work and social factors, this can also be attributed to the prolonged conflict between Israel and Palestine, which increases the risk of anxiety and stress among Palestinians [ 40 ]. Furthermore, healthcare professionals in Palestine are more likely to experience stress and burnout when working in an extremely restricted healthcare system under Israeli military occupation [ 41 , 42 ]. This finding aligns with a previous study conducted in India, which found that the majority of NICU nurse experienced a moderate level of stress [ 43 ]. In contrast to our findings, a previous study conducted in Qatar reported that nurses experienced a high level of perceived stress [ 44 ]. Given the demanding nature of the healthcare professionals, nurses are particularly susceptible to issues related to occupational stress [ 45 ].

The PSS Score category emerged as the most important predictor of the AFS overall score and vice versa (the AFS Score category emerged as the most important predictor of the PSS overall score). Nurses in the low and average PSS score categories are expected to have lower AFS scores than the high PSS category by an average of 5.53 and 4.71 points, respectively. Nurses in the low and average PSS score categories are expected to have lower AFS scores than the high PSS category by an average of 3.582 and 2.463 points, respectively This suggests that ICU noises may be stressful to healthcare professionals [ 46 ], but also suggests that stressed nurses may have aggravated alarm fatigue. Research has shown that loud noise in intensive care units (ICUs) can negatively impact health care professionals, leading to increased stress and decreased performance [ 47 ]. Alarms contribute to this noise and can be disruptive to nurses, hindering their ability to effectively carry out their tasks [ 48 ]. Therefore, it is essential to reduce noise-induced stress among critical care nurses to improve the working environment and patient care [ 49 ]. Furthermore, healthcare institutions should consider evaluating their alarm policies and procedures, potentially integrating artificial intelligence technologies for more efficient alarm management.

In intensive care units, the utilization of numerous medical devices contributes to the escalating noise level and increasingly loud alarms, which are reported psychological issues by nurses [ 38 ]. Health professionals exposed to this sensory overload for extended periods of time experience both cognitive and physical stress [ 50 , 51 ].

Additionally, nurse- to-patient ratio and gender were identified as predictors of alarm fatigue, with female nurses being more susceptible experiencing it. This could be attributed to the heavier workload carried by female ICU nurses, not only due to stressful working environment but also compounded by personal responsibilities such as housework, childcare, and balancing work -life commitments [ 36 , 52 ]. Our results align with a previous study, which also indicated a higher likelihood of alarm fatigue among female nurses [ 32 ]. However, this contrasts with the findings of Bourji H, et al. (2020), which found that male nurses experience alarm fatigue more frequently than female nurses [ 25 ].

The study’s results also revealed that nurses working regular morning shifts experienced high levels of perceived stress. This could be attributed to the heavy workload of morning shift nurses, which includes tasks such as patient admission and discharge, patient care responsibilities, and managing visitors. Occasionally, these demands may lead them to skip their breaks [ 53 , 54 , 55 , 56 ].

A Self-administered survey was considered a limitation in this study. Future research should consider employing observational checklist and qualitative research designs to address alarm fatigue more accurately among critical care nurses. Furthermore, certain factors were not addressed, such as the consequences of alarm fatigue on quality of patient care, resilience, and burnout. These aspects warrant further investigation in future studies.

Implications for clinical practice

To mitigate alarm fatigue among critical care nurses, managers should implement comprehensive alarm management protocols, including regular adjustment of alarm settings and the integration of artificial intelligence technologies for efficient alarm management. Continuous training and education programs on alarm management best practices are also essential. Addressing nurses’ stress levels is imperative to ensure patient safety and improve the quality of care. Identifying sources of stress and implementing effective stress reduction intervention, such as mindfulness-based techniques, is crucial. Further studies are warranted to explore these interventions. Additionally, it is essential to assess the complex relationship between alarm fatigue, stress and patient outcomes. This will facilitate the development of evidence-based practices and policies that support critical care nurses and enhance patient care outcomes.

Alarm fatigue can compromise the timely intervention necessary to prevent adverse outcomes by causing delayed responses or missed critical alarm, thereby posing a major risk for patient safety. The study indicated that the highest score was related to nurses’ attention to alarm varying according to shift, a factor not addressed in the current study. Therefore, future research should examine the impact of different shifts on alarm fatigue and patient outcomes. Additionally, it is imperative that healthcare providers address stress, as it has been found to be an important predictor of alarm fatigue. This will aid in mitigating alarm fatigue and fostering a supportive work environment conducive to providing optimal patient care. Furthermore, future research studies are needed to assess the effectiveness of educational training in managing alarm fatigue and reducing stress levels among critical care nurses.

Data availability

The data utilized to support the results of the research are accessible to the corresponding author upon request.

Abbreviations

Intensive Care Unit

Alarm Fatigue Scale

Perceived Stress Scale

Collen MF, Ball MJ. Specialized High-Intensity Clinical Settings: A Brief Review. The History of Medical Informatics in the United States. 2015:407– 18.

Carelli L, Terzoni S, Destrebecq A, Formenti P, Soumahoro F, Esposito A, Ferrara P. Alarm fatigue in nurses working in intensive care units: a multicenter study. Work. 2022;72(2):651–6.

Article   PubMed   Google Scholar  

Borowski M, Görges M, Fried R, Such O, Wrede C, Imhoff M. Medical device alarms.

Cvach M. Monitor alarm fatigue: an integrative review. Biomedical Instrum Technol. 2012;46(4):268–77.

Article   Google Scholar  

Pater CM, Sosa TK, Boyer J, Cable R, Egan M, Knilans TK, Schondelmeyer AC, Schuler CL, Madsen NL. Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital. BMJ Qual Saf. 2020;29(9):717–26.

Sendelbach S, Funk M. Alarm fatigue: a patient safety concern. AACN Adv Crit Care. 2013;24(4):378–86.

Association for the Advancement of Medical Instrumentation. Clinical alarms: 2011 Summit convened by AAMI, FDA, TJC, ACCE, and ECRI Institute.

McFarlane DC, Doig AK, Agutter JA, Brewer LM, Syroid ND, Mittu R. Faster clinical response to the onset of adverse events: a wearable metacognitive attention aid for nurse triage of clinical alarms. PLoS ONE. 2018;13(5):e0197157.

Article   PubMed   PubMed Central   Google Scholar  

The Joint Commission. National Patient Safety Goals Effective January,2021.

The Joint Commission. Sentinel Event Alert 50: medical device alarm safety in hospitals. www.jointcommission.org/en/resources/patient-safety-topics/sentinel-event/sentinel-event-alert-newsletters/sentinel-event-alert-issue-50-medical-device-alarm-safety-in-hospitals .

Sowan AK, Staggers N, Reed CC, Austin T, Chen Q, Xu S, Lopez E. State of Science in Alarm System Safety: implications for researchers, vendors, and clinical leaders. Biomedical Instrum Technol. 2022;56(1):19–28.

Dee SA, Tucciarone J, Plotkin G, Mallilo C. Determining the impact of an alarm management program on alarm fatigue among ICU and telemetry RNs: an evidence based research project. SAGE Open Nurs. 2022;8:23779608221098713.

PubMed   PubMed Central   Google Scholar  

Nyarko BA, Yin Z, Chai X, Yue L. Nurses’ alarm fatigue, influencing factors, and its relationship with burnout in the critical care units: a cross-sectional study. Australian Crit Care. 2023 Aug 12.

Lewandowska K, Weisbrot M, Cieloszyk A, Mędrzycka-Dąbrowska W, Krupa S, Ozga D. Impact of alarm fatigue on the work of nurses in an intensive care environment—a systematic review. Int J Environ Res Public Health. 2020;17(22):8409.

Hall KK, Shoemaker-Hunt S, Hoffman L, Richard S, Gall E, Schoyer E, Costar D, Gale B, Schiff G, Miller K, Earl T. Making healthcare safer III: a critical analysis of existing and emerging patient safety practices.

Alsaad AA, Alman CR, Thompson KM, Park SH, Monteau RE, Maniaci MJ. A multidisciplinary approach to reducing alarm fatigue and cost through appropriate use of cardiac telemetry. Postgrad Med J. 2017;93(1101):430–5.

Johnson-Coyle L, Opgenorth D, Bellows M, Dhaliwal J, Richardson-Carr S, Bagshaw SM. Moral distress and burnout among cardiovascular surgery intensive care unit healthcare professionals: a prospective cross-sectional survey. Can J Crit Care Nurs. 2016;27(4).

McMeekin DE, Hickman RL, Douglas SL, Kelley CG. Stress and coping of critical care nurses after unsuccessful cardiopulmonary resuscitation. Am J Crit Care. 2017;26(2):128–35.

Andolhe R, Barbosa RL, Oliveira EM, et al. Stress, coping and burnout among intensive care unit nursing staff: associated factors. Rev Esc Enferm USP. 2015;49:58–64.

Bulbuloglu S, Kapikiran G, Saritas S. Perceived and sources of occupational stress in surgical intensive care nurses. Proc Singap Healthc. 2021;30(3):200–5.

Wilken M, Hüske-Kraus D, Klausen A, Koch C, Schlauch W, Röhrig R. Alarm fatigue: causes and effects. InGMDS 2017 Sep 17 (pp. 107–11).

Ding S, Huang X, Sun R, Yang L, Yang X, Li X, Liu J, Yang H, Zhou H, Huang X, Su F. The relationship between alarm fatigue and burnout among critical care nurses: A cross-sectional study. Nursing in Critical Care. 2023 Apr 18.

Bonafide CP, Localio AR, Holmes JH, Nadkarni VM, Stemler S, MacMurchy M, Zander M, Roberts KE, Lin R, Keren R. Video analysis of factors associated with response time to physiologic monitor alarms in a children’s hospital. JAMA Pediatr. 2017;171(6):524–31.

Storm J, Chen HC. The relationships among alarm fatigue, compassion fatigue, burnout and compassion satisfaction in critical care and step-down nurses. J Clin Nurs. 2021;30(3–4):443–53.

Bourji H, Sabbah H, Al’Jamil A, Khamis R, Sabbah S, Droubi N, Sabbah IM. Evaluating the alarm fatigue and its associated factors among clinicians in critical care units. Eur J Clin Med. 2020;1(1).

Abdallah J. A review of sample size determination for common experimental designs: further simplified equations. An-Najah Univ J Research-A (Natural Sciences). 2024;38(1):8–16. https://doi.org/10.35552/anujr.a.38.1.2121 .

Daniel WW. Biostatistics: A foundation for analysis in the health sciences. 7th edition. New York: John Wiley & Sons; 1999.

Torabizadeh C, Yousefinya A, Zand F, Rakhshan M, Fararooei M. A nurses’ alarm fatigue questionnaire: development and psychometric properties. J Clin Monit Comput. 2017;31:1305–12.

Cohen S, Kamarck T, Mermelstein R. (1983). A global measure of perceived stress. J Health Soc Behav, 385–96.

Canfield AA. The Sten Scale-A modified C-Scale. Educ Psychol Meas. 1951;11(2):295–7. https://doi.org/10.1177/001316445101100213 .

Nagórska M, Obrzut B, Ulman D, Darmochwał-Kolarz D. The need of Personalized Medicine in coping with stress during infertility treatment. J Pers Med. 2021;11:56. https://doi.org/10.3390/jpm11010056 .

Asadi N, Salmani F, Asgari N, Salmani M. Alarm fatigue and moral distress in ICU nurses in COVID-19 pandemic. BMC Nurs. 2022;21(1):1–7.

Ferrara, P., Carelli, L., Ruta, F., Poggi, A. D., Marasigan, M., Pinna, B.,… Terzoni,S. (2023). Alarm Fatigue in Nursing Students Undertaking Clinical Training in Intensive Care Units: A Multicenter Study. La Medicina del Lavoro , 114 (2).

Ding, S., Huang, X., Sun, R., Yang, L., Yang, X., Li, X.,… Wang, X. (2023). The relationship between alarm fatigue and burnout among critical care nurses: A cross-sectional study. Nursing in Critical Care .

Nyarko BA, Yin Z, Chai X, Yue L. (2023). Nurses’ alarm fatigue, influencing factors, and its relationship with burnout in the critical care units: a cross-sectional study. Australian Crit Care.

Moghadam KN, Chehrzad MM, Masouleh SR, Mardani A, Maleki M, Akhlaghi E, Harding C. Nursing workload in intensive care units and the influence of patient and nurse characteristics. Nurs Crit Care. 2021;26(6):425–31.

Cho OM, Kim H, Lee YW, Cho I. Clinical alarms in intensive care units: perceived obstacles of alarm management and alarm fatigue in nurses. Healthc Inf Res. 2016;22(1):46–53.

Seok Y, Cho Y, Kim N, Suh EE. Degree of Alarm Fatigue and Mental Workload of Hospital Nurses in Intensive Care Units. Nurs Rep. 2023;13(3):946–55.

Casey S, Avalos G, Dowling M. Critical care nurses’ knowledge of alarm fatigue and practices towards alarms: a multicentre study. Intensive Crit Care Nurs. 2018;48:36–41.

Marie M, SaadAdeen S, Battat M. Anxiety disorders and PTSD in Palestine: a literature review. BMC Psychiatry. 2020;20:1–8.

Salameh B, Daibes AG, Qaddumi J. Assessing the prevalence, predictors, and consequences of secondary traumatic stress among emergency nurses in Palestine during the COVID-19 pandemic. SAGE Open Nurs. 2023;9:23779608231207224.

Ahmead M, El Sharif N, Asad S. Healthcare Workers’ emotions, Perceived stressors, and coping strategies at Workplace during the COVID-19 pandemic in Palestine. Int J Environ Res Public Health. 2022;19(19):11966.

Shivani, Sharma, M., Sonakshi, Singh, J., Arora, K., Kumar, A.,… Bajaj, N. (2023).Correlates of Perceived Stress and Professional Quality of Life Among Nurses Working in Neonatal Intensive Care Units (NICU) in North India: A Multicenter Study. Journal of Neonatology , 37 (1), 6–13.

Kader N, Elhusein B, Chandrappa NSK, Nashwan AJ, Chandra P, Khan AW, Alabdulla M. Perceived stress and post-traumatic stress disorder symptoms among intensive care unit staff caring for severely ill coronavirus disease 2019 patients during the pandemic: a national study. Ann Gen Psychiatry. 2021;20(1):1–8.

Lu L, Shiau C, Cooper CL. Occupational stress in clinical nurses. Counselling Psychol Q. 1997;10(1):39–50.

Schmidt, N., Gerber, S. M., Zante, B., Gawliczek, T., Chesham, A., Gutbrod, K.,…Jeitziner, M. M. (2020). Effects of intensive care unit ambient sounds on healthcare professionals: results of an online survey and noise exposure in an experimental setting.Intensive care medicine experimental, 8(1), 1–12.

Pal J, Taywade M, Pal R, Sethi D. Noise pollution in intensive care unit: a hidden enemy affecting the physical and mental health of patients and caregivers. Noise Health. 2022;24(114):130–6.

Alkubati SA, Alsaqri SH, Alrubaiee GG, Almoliky MA, Alqalah TA, Pasay-An E, Alrasheeday AM, Elsayed SM. Levels and factors of nurses’ alarm fatigue in critical care settings in Saudi Arabia: a Multicenter cross-sectional study. J Multidisciplinary Healthc 2024 Dec 31:793–803.

Schmidt N, Gerber SM, Zante B, Gawliczek T, Chesham A, Gutbrod K, Müri RM, Nef T, Schefold JC, Jeitziner MM. Effects of intensive care unit ambient sounds on healthcare professionals: results of an online survey and noise exposure in an experimental setting. Intensive care Med Experimental. 2020;8:1–2.

Epp K. Burnout in critical care nurses: a literature review. Dynamics. 2012;23(4):25–31.

PubMed   Google Scholar  

Ruskin KJ, Hueske-Kraus D. Alarm fatigue: impacts on patient safety. Curr Opin Anesthesiology. 2015;28(6):685–90.

Papazian L, Sylvestre A, Herridge M. Should all ICU clinicians regularly be tested for burnout? Yes. Intensive Care Med. 2018;44:681–3.

Armstrong E, de Waard MC, de Grooth HJS, Heymans MW, Miranda DR, Girbes AR, Spijkstra JJ. Using nursing activities score to assess nursing workload on a medium care unit. Anesth Analgesia. 2015;121(5):1274–80.

Bruyneel A, Tack J, Droguet M, et al. Measuring the nursing workload in intensive care with the nursing activities score (NAS): a prospective study in 16 hospitals in Belgium. J Crit Care. 2019;54:205–11.

Jones G, Hocine M, Salomon J, Dab W, Temime L. Demographic and occupational predictors of stress and fatigue in French intensive-care registered nurses and nurses’ aides: a cross-sectional study. Int J Nurs Stud. 2015;52(1):250–9.

Juang DF, Lee CH, Yang T, Chang MC. Noise pollution and its effects on medical care workers and patients in hospitals. Int J Environ Sci Technol. 2010;7:705–16.

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We would like to express our thanks to all critical nurses who participated in the study.

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Basma Salameh

Department of Animal Production, An-Najah National University,Nablus, Jenin, Palestine

Jihad Abdallah

Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen

Sameer A Alkubati

Princess Salma Faculty of Nursing, AL al-Bayt University, Mafraq, Jordan

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Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail, Saudi Arabia

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B.S, J.A, S.A, M.A designed the study B.S, J.A, collected the data B.S, J.A, S.A & M.A analyzed the data All authors prepared the manuscript All authors approved the final version for submission.

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Salameh, B., Abdallah, J., Alkubati, S.A. et al. Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives. BMC Nurs 23 , 261 (2024). https://doi.org/10.1186/s12912-024-01897-x

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DOI : https://doi.org/10.1186/s12912-024-01897-x

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