Ill health and early retirement among school principals in Bavaria

Objectives: School principals play an important role in maintaining the performance and health of teachers but often feel over-burdened themselves and suffer illnesses, which not only impairs their health-promoting function but also leads to limitations in their fitness for the occupation. The aim of our study was, therefore, using objective parameters and larger numbers of cases, to obtain a differentiated insight into the morbidity and the health-related early retirement of school principals. Methods: In a prospective total assessment (the whole of Bavaria, a state in southern Germany) in the period from 1997 to 1999 all medical examinations of school principals performed to decide the question of early retirement were evaluated. The analysis included, e.g., socio-demographic/occupational factors, diagnoses, assessment of performance and rehabilitation. The data were sampled in a standardised, anonymous questionnaire, which provided the database. Evaluation was carried out by means of descriptive statistics. Results: The median age of the 408 school principals included in the evaluation (heads and vice-heads, 30% of whom were women) was 58 years (minimum 41 years, maximum 64 years). The most frequent workplaces were primary schools (63%). A total of 84% (n=342) of the headmasters was assessed to be unfit for work. The main reasons for early retirement were psychiatric/psychosomatic disorders (F-ICD 10) which made up 45% of the cases. The relative frequency was higher in women than in men. Depressive disorders and exhaustion syndromes (burnout) dominated among the psychiatric diagnoses (proportion 57%). The most frequent somatic illnesses were cardiovascular diseases (I-ICD10) in 19% of cases, then muscular/skeletal diseases (M-ICD10) in 10% and malignant tumours (C-ICD 10) in 9% of cases. Cardiovascular diseases, in particular arterial hypertension and ischaemic heart disease, were found in headmasters significantly more frequently than in teachers without a headship function (P≤0.05). A total of 63% (n=257) of the school principals had participated in at least one medical rehabilitation before the proceedings for determining unfitness for work were instigated. The performance of 66% (n=226) of those judged unfit for work was assessed to be so severely impaired that no other employment could be expected of them. Conclusions: The morbidity spectrum of school principals prematurely unfit for work is characterised by stress-associated diseases. The health disorders objectified are of considerable relevance for policy and administration. Specific prevention and intervention must, therefore, also include this occupational group. Activity should not be limited to the prevention of behavioural problems but should also take into account important aspects for preventing adverse circumstances arising at the school workplace.