[School principals--too ill for healthy schools?].

School principals on the one hand play an important role in maintaining the performance and health of teachers, but on the other hand often feel over-burdened themselves and suffer from illnesses which not only impair their health-promoting function, but also lead 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 type and extent of morbidity spectrum and the health-related early retirement of school principals.In a prospective total assessment (the whole of Bavaria in the period 1997-1999), all the reports about the premature unfitness for work of school directors were evaluated. The analysis included for example socio-demographic/occupational factors, diagnoses, assessment of performance and rehabilitation. The answers given in a standardised, anonymous questionnaire provided the database. Evaluation was carried out by means of descriptive statistics.The median age of the 408 school principals included in the evaluation (heads and vice-heads, 30% of whom were women) was 58 (min: 41 years old, max: 64 years old). The most frequent workplaces were primary schools (38%) and secondary schools (25%). 84% (n=342) of the headmasters were assessed to be unfit for work. The main reasons for early retirement were psychic/psychosomatic illnesses (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 diseases were cardio-vascular 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. Cardio-vascular diseases, in particular arterial hypertonia and ischaemic heart disease, were, in addition, found in headmasters significantly more frequently than in teachers without a leadership function (p < or = 0.05). 63% (n=257) of the school principals had participated in at least one medical rehabilitation measure 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.The morbidity spectrum of school principals prematurely unfit for work is characterised by stress-associated illnesses. The health disorders objectified are of considerable relevance for public health. Specific measures of 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.