08 SES 12, The Role of Food and Sleep in Education and Health Promotion
Compared to research on occupational burnout and sleep, there is a paucity of research concerning the relation between sleep and burnout in adolescents and young adults still attending formal education. Though causal relationship between poor sleep and burnout is still to be investigated in detail, there is some evidence supporting the conclusion that poor sleep precedes burnout, rather than vice versa (Jansson-Fröjmark & Lindblom, 2010; Söderström, Jeding, Ekstedt, Perski, & Åkerstedt, 2012). Recently, inadequate amount of sleep and daytime sleepiness have been reported to be correlated with higher levels of burnout among medical students (Wolf & Rosenstock, 2016). Particularly daytime sleepiness seems to have a major role in medical student burnout symptoms (Pagnin et al., 2014). One previous study (Gerber et al., 2015) has presented evidence suggesting that school burnout is linked to sleep disturbances and low sleep quality in vocational school students. The present study was targeted to explore how sleep duration, sleep quality, daytime tiredness, and diurnal preferences of sleep are related to school burnout and its different aspects in 15- to 20-year-old students.
School burnout refers to persistent school-related stress in students. Similarly to adult occupational burnout (Masclah, Schaufeli, & Leiter, 2001) it includes three separate but relatively closely correlating aspects: exhaustion, cynicism, and lack of school-related efficacy (inadequacy) or depersonalization in other terms (Kiuru et al., 2008; Salmela-Aro, Kiuru, et al., 2009; Schaufeli et al., 2002). Exhaustion consists of school-related feelings of strain and particularly chronic sleep-unrelated fatigue due to school demands whereas cynicism is indicated by lack of interest for schoolwork and senses of meaningless studying. Lack of efficacy can be described as a state of feeling incompetence and decreased school achievement. Cynicism and particularly emotional exhaustion predict later upcoming feelings of inadequacy (Parker & Salmela-Aro, 2011).
Prevalence and several aspects of school burnout are known by now. Girls and women compared to boys and men as well as students in upper secondary high school (giving general possibilities to enter universities) compared to students in vocational school suffer more from school burnout. In addition, compared to vocational schools, school burnout seems to be more common in upper secondary high school for both girls and boys. (Salmela-Aro & Tynkkynen, 2012). Most prominent factors leading directly or indirectly to school burnout are low study resources, poor personal resources (e.g., low self-efficacy) and high study demands (Salmela-Aro & Upadyaya, 2014).
School burnout is negatively linked to several indicators of well-being (Salmela-Aro, Kiuru, et al., 2009; Salmela-Aro, Savolainen, & Holopainen, 2009). Of the three components of burnout, cynicism towards school often co-occurring with poor school achievement appears to predict school drop-out (Bask & Salmela-Aro, 2013). Moreover, high level of school burnout during secondary education seems to predict low satisfaction of life (Raiziene et al., 2014), low schoolwork engagement (Salmela-Aro & Upadyaya, 2014; Tuominen-Soini & Salmela-Aro, 2014) and poor academic success after secondary education (Tuominen-Soini & Salmela-Aro, 2014).
In conclusion, school burnout has been studied in several respects to well-being and academic performance. However, the relation between it and sleep has remained relatively unknown. The present study was aimed at fulfilling this gap. Based on previous work we hypothesized that high level of school burnout is related to short sleep duration and day-time tiredness (Wolf & Rosenstock, 2016), poor sleep quality (Gerber et al., 2015) and preference to late bedtime and late wake up (evening-type chronotype, see, e.g., Cavallera & Giudici, 2008; Roenneberg, Wirz-Justice, & Merrow, 2003) (Merikanto et al., 2016). Because school burnout is more common in upper secondary high schools than in vocational schools (Salmela-Aro & Tynkkynen, 2012), we also took into consideration these different forms of education.
The study design was approved by an ethical board at the University of Helsinki. The participants were recruited from different upper secondary high schools (49% of the sample) and vocational schools (51% of the sample). In Finland, after 9-year compulsory comprehensive school, nearly the whole cohort enters to upper secondary high school or to vocational school. Data were collected in three major metropolitan cities (together comprising about 1 million inhabitants) and two small towns (54 000 and 21 000 inhabitants) in southern Finland. School burnout was investigated using the nine-item version of the School Burnout Inventory (SBI, Salmela-Aro, Kiuru, et al., 2009). All the items were rated on a 6-point Likert-type scale ranging from 1 (completely disagree) to 6 (strongly agree). To analyze sleep factors explaining school burnout, participants in the lowest and the highest quartile of the burnout measures, school burnout, exhaustion, cynicism and inadequacy, were compared. Sleep duration during the school week was inquired using two questions: “When did you go to sleep yesterday?” and “When did you wake up today?” The length of hours asleep was calculated using these data. The Epworth Sleepiness Scale (Johns, 1991) is an eight-item measure of daytime sleepiness. The participants were asked to evaluate how likely it was that they would doze or fall asleep in everyday situations (e.g., “Sitting and reading” and “As a passenger in a car for an hour without a break”). Each item is answered using hour options: 0 = would never doze, 1 = slight chance of dosing, 2 = moderate chance of dozing, and 3 = high chance of dozing. Daytime tiredness was estimated using two questions (1 = very alert – 5 = very tired) concerning how tired the participant was in the morning and during the day on weekdays. Poor sleep quality were assessed using the following four items of the Athens Insomnia Scale (Soldatos, Dikeos, & Paparrigopoulos, 2000): sleep induction, awakenings during the night, final awakening earlier than desired, and overall quality of sleep. Each item was scored from zero (no problem) to three (very problematic). A shortened version (Hätönen, Forsblom, Kieseppä, Lönnqvist, & Partonen, 2008) of the Morningness-Eveningness Questionnaire (Horne & Östberg, 1976) was used to assess the chronotypes of the participants. This version includes six items, yielding 5–27 points. Participants were classified as M-types, I-types or E-types (Merikanto et al., 2012).
Except for sleep duration during the school week all other sleep measures correlated statistically significantly with total school burnout and its subscales. How a participant subjectively experienced tiredness and how likely she or he would doze off in everyday situations as well as poor sleep quality were positively linked to the level of all school burnout measures. The correlational pattern also suggests that, on the continuum of morningness–eveningness, individuals with morning orientation reported less school burnout compared to those with stronger evening orientation. Finally, we made a step-wise logistic regression analysis to evaluate which sleep variables (daytime tiredness, daytime sleepiness and sleep quality) and education forms (vocational school vs upper secondary high school) are related to school burnout. Four variables were independently associated with increased risk of burnout. Students that attended to upper secondary high school had higher risk for school burnout compared to vocational school students. Students were also at higher risk for school burnout if they suffered from daytime sleepiness, daytime tiredness, or poor sleep quality. We separately analyzed the predictive values of sleep measures on different sub scales of school burnout. Compared to the aforementioned analysis sleep-related measures explained Exhaustion, Cynicism, and Inadequacy in a similar way with minor exceptions. The results of this study are consistent with previous research suggesting that school burnout is more common among upper secondary high school students compared to vocational schools’ students. From sleep related factors, daytime tiredness, daytime sleepiness and poor sleep quality may be associated with risk factors for school-burnout. This study also suggests that there is no link between sleep length and school burnout. The findings of this study raise a question regarding a long-term care for students who are at risk for potential school burnout.
Åkerstedt, T. (2006). Psychosocial stress and impaired sleep. Scandinavian Journal of Work, Environment & Health, 32(6), 493–501. https://doi.org/10.5271/sjweh.1054 Bianchi, R., Schonfeld, I. S., & Laurent, E. (2015). Burnout–depression overlap: A review. Clinical Psychology Review, 36, 28–41. https://doi.org/10.1016/j.cpr.2015.01.004 Gerber, M., Lang, C., Feldmeth, A. K., Elliot, C., Brand, S., Holsboer-Trachsler, E., & Pühse, U. (2015). Burnout and Mental Health in Swiss Vocational Students: The Moderating Role of Physical Activity. Journal of Research on Adolescence, 25(1), 63–74. https://doi.org/10.1111/jora.12097 Jansson-Fröjmark, M., & Lindblom, K. (2010). Is There a Bidirectional Link Between Insomnia and Burnout? A Prospective Study in the Swedish Workforce. International Journal of Behavioral Medicine, 17(4), 306–313. https://doi.org/10.1007/s12529-010-9107-8 Kiuru, N., Aunola, K., Nurmi, J.-E., Leskinen, E., & Salmela-Aro, K. (2008). Peer group influence and selection in adolescents’ school burnout: A longitudinal study. Merrill-Palmer Quarterly (1982-), 23–55. Merikanto, I., Kronholm, E., Peltonen, M., Laatikainen, T., Lahti, T., & Partonen, T. (2012). Relation of chronotype to sleep complaints in the general Finnish population. Chronobiology International, 29(3), 311–7. https://doi.org/10.3109/07420528.2012.655870 Merikanto, I., Suvisaari, J., Lahti, T., & Partonen, T. (2016). Eveningness relates to burnout and seasonal sleep and mood problems among young adults. Nordic Journal of Psychiatry, 70(1), 72–80. https://doi.org/10.3109/08039488.2015.1053519 Pagnin, D., de Queiroz, V., Carvalho, Y. T. M. S., Dutra, A. S. S., Amaral, M. B., & Queiroz, T. T. (2014). The Relation Between Burnout and Sleep Disorders in Medical Students. Academic Psychiatry. https://doi.org/10.1007/s40596-014-0093-z Salmela-Aro, K., Kiuru, N., Leskinen, E., & Nurmi, J.-E. (2009). School Burnout Inventory (SBI): Reliability and Validity. European Journal of Psychological Assessment, 25(1), 48–57. https://doi.org/10.1027/1015-5722.214.171.124 Salmela-Aro, K., Savolainen, H., & Holopainen, L. (2009). Depressive Symptoms and School Burnout During Adolescence: Evidence from Two Cross-lagged Longitudinal Studies. Journal of Youth and Adolescence, 38(10), 1316–1327. https://doi.org/10.1007/s10964-008-9334-3 Salmela-Aro, K., & Tynkkynen, L. (2012). Gendered pathways in school burnout among adolescents. Journal of Adolescence, 35(4), 929–939. https://doi.org/10.1016/j.adolescence.2012.01.001 Salmela-Aro, K., & Upadyaya, K. (2014). School burnout and engagement in the context of demands-resources model. British Journal of Educational Psychology, 84(1), 137–151. https://doi.org/10.1111/bjep.12018 Söderström, M., Jeding, K., Ekstedt, M., Perski, A., & Åkerstedt, T. (2012). Insufficient sleep predicts clinical burnout. Journal of Occupational Health Psychology, 17(2), 175–183. https://doi.org/10.1037/a0027518 Wolf, M. R., & Rosenstock, J. B. (2016). Inadequate Sleep and Exercise Associated with Burnout and Depression Among Medical Students. Academic Psychiatry, 1–6. https://doi.org/10.1007/s40596-016-0526-y
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