View in EDS HTML Full Text PDF Full Text

Mental Health Outcomes in Teachers of Students with Disabilities: A Systematic Review

Saved in:
Bibliographic Details
Title: Mental Health Outcomes in Teachers of Students with Disabilities: A Systematic Review
Language: English
Authors: Jorge Lopes Cavalcante Neto (ORCID 0000-0002-8396-2410), Soraya Dayanna Guimarães Santos (ORCID 0000-0003-2623-4430), David dos Santos Calheiros (ORCID 0000-0002-4761-5569)
Source: International Journal of Disability, Development and Education. 2025 72(1):149-166.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 18
Publication Date: 2025
Document Type: Journal Articles
Information Analyses
Reports - Research
Descriptors: Mental Health, Teacher Welfare, Work Environment, Stress Variables, Teacher Burnout, Students with Disabilities, Teacher Attitudes
DOI: 10.1080/1034912X.2024.2344013
ISSN: 1034-912X
1465-346X
Abstract: Teachers who work with students with disabilities may have high levels of mental health problems, such as burnout or stress. The aim of this systematic review was to summarise the evidence on mental health outcome assessments among teachers of students with disabilities in different work spaces and to compare the levels of burnout and stress among teachers from general/regular versus special schools. The results reveal high levels of symptoms of burnout or stress in teachers of students with disabilities, regardless of the type of school. Due to the heterogeneity and low quality observed across the studies, evidence remains unclear.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1454593
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwEIxxPK8OtbHUz_3bgY3EzoAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDPFglW5SKy8m-FzV0wIBEICBm08vLQPd5vzzeCCtXjVJIPl75TEzf_kBGOgDtDrj4ZMxIaBQRdzcrwWP6DmuV5QgGxvrY2TANHwm5Xb-XwFHKqiFi3wdGPtFaHvjcMI8QUBnmLa4Eb8reTqbqpsaAhsDtWowYb-g0JqqJJGs3QcJAb_-R78UO8ePP1O-5n7Mcy3F-MHfLoy4XFkeDP8eRRdc7E4D5XcXd4mfjlfu
Text:
  Availability: 1
  Value: <anid>AN0181776759;54q01jan.25;2024Dec23.04:20;v2.2.500</anid> <title id="AN0181776759-1">Mental Health Outcomes in Teachers of Students with Disabilities: A Systematic Review </title> <p>Teachers who work with students with disabilities may have high levels of mental health problems, such as burnout or stress. The aim of this systematic review was to summarise the evidence on mental health outcome assessments among teachers of students with disabilities in different work spaces and to compare the levels of burnout and stress among teachers from general/regular versus special schools. The results reveal high levels of symptoms of burnout or stress in teachers of students with disabilities, regardless of the type of school. Due to the heterogeneity and low quality observed across the studies, evidence remains unclear.</p> <p>Keywords: Diversity issues; job-related stress; mental health; burnout; motivation; positive behavioural supports</p> <hd id="AN0181776759-2">Introduction</hd> <p>An international report estimated that there are around one billion people living with disabilities worldwide, with 80% from low-resourced areas (World Health Organization WHO, [<reflink idref="bib52" id="ref1">52</reflink>]). This implies that efforts to promote education, health, and justice are needed to establish equality between these individuals and their peers without disabilities. In considering the status of education, several documents have addressed major achievements over the past few decades. Since the introduction of the Salamanca Statement (UNESCO, [<reflink idref="bib44" id="ref2">44</reflink>]), societies around the world have proclaimed efforts to guarantee education rights for children of all backgrounds, needs, and abilities; Salamanca Statement and societies have also established that special education has to be offered in regular schools as a priority. However, this has not been an easy issue to address, because during childhood, the prevalence of disability is estimated to be 5.1%; 95 million children (World Health Organization WHO, [<reflink idref="bib52" id="ref3">52</reflink>]) need special care and access to schools as well as all the assurances of attaining certain education levels, which places several demands upon states. Now, 27 years after the publication of the Salamanca Statement (UNESCO, [<reflink idref="bib44" id="ref4">44</reflink>]), many countries still have not achieved the key goals proposed within it, such as having all children enrolled at schools and offering ideal conditions for their inclusion at all levels of schooling. Among the barriers presented in the organisational settings of various countries, adjustments in the curriculum (Oliva, [<reflink idref="bib31" id="ref5">31</reflink>]), segregated environments (Dukes & Berlingo, [<reflink idref="bib13" id="ref6">13</reflink>]), accessibility (Papalia-Berardi et al., [<reflink idref="bib32" id="ref7">32</reflink>]) and teachers' working conditions (Billingsley et al., [<reflink idref="bib3" id="ref8">3</reflink>]) are important issues to address when seeking to ensure the quality of the education received by students with disabilities.</p> <p>Teaching students with disabilities demands more than the specific abilities required to be a teacher (Bryant et al., [<reflink idref="bib6" id="ref9">6</reflink>]), and teachers' working conditions must be taken into account as key elements of the educational success of those students. Some studies have investigated teachers of students with disabilities in different contexts (Cooc, [<reflink idref="bib10" id="ref10">10</reflink>]; Nazife & Umit, [<reflink idref="bib29" id="ref11">29</reflink>]; L. Wang et al., [<reflink idref="bib49" id="ref12">49</reflink>]). Among the various outcomes assessed, teachers' mental health and their working conditions have been addressed in recent publications (Pülschen & Pülschen, [<reflink idref="bib37" id="ref13">37</reflink>]; Sharp Donahoo et al., [<reflink idref="bib40" id="ref14">40</reflink>]; Ugwoke et al., [<reflink idref="bib43" id="ref15">43</reflink>]).</p> <p>Additionally, the type of schools at which these students receive their formal education can be a major issue affecting teachers' mental health outcomes because of the support needed to ensure teaching quality. Basically, there are two systems in which students with disabilities are educated, and this distinction has settled into two different perspectives: (<reflink idref="bib1" id="ref16">1</reflink>) general/regular schools or (<reflink idref="bib2" id="ref17">2</reflink>) special/specialised schools. While the conception can vary across countries, the fundamental idea behind a general/regular school is that all students can congregate in the same environment and study together, which may or may not be an inclusive perspective. In the case of students with disabilities, they are taught in the same context as their peers without disabilities and share the same classes and activities. However, special/specialised schools have specific and modified contents for students with disabilities, with specific resources to support their needs. Special/specialised schools are exclusive environments for students with disabilities, while general/regular schools are not (Karagiannis et al., [<reflink idref="bib21" id="ref18">21</reflink>]). Although students with disabilities receive special education in general/regular schools together with peers without disabilities, many of them learn through pull-out services and at different classes than peers without disabilities (Hayes & Bulat, [<reflink idref="bib17" id="ref19">17</reflink>]; Oliva, [<reflink idref="bib31" id="ref20">31</reflink>]).</p> <p>Moreover, working conditions of teachers might vary between types of schools. For instance, special schools have few students in a classroom, increased support from specialised professionals, and collaborative work among the pedagogical team. In contrast, general/regular schools allocate more students in a classroom, provide little support from specialised professionals, and lack collaborative work among the pedagogical team (Brunsting et al., [<reflink idref="bib5" id="ref21">5</reflink>]; Stempien & Loeb, [<reflink idref="bib42" id="ref22">42</reflink>]). These divergences determine mental health of teachers of students with disabilities. Unspecialised support, inadequate structure, and indiscipline of students may lead to psychological illness of special education teachers (Brunsting et al., [<reflink idref="bib5" id="ref23">5</reflink>]; Stempien & Loeb, [<reflink idref="bib42" id="ref24">42</reflink>]). However, the context of each school may vary depending on special education policy adopted by each country (Platsidou & Agaliotis, [<reflink idref="bib35" id="ref25">35</reflink>]).</p> <p>These differences in the type of work environment can affect the teachers' mental health outcomes, including job-related stress or burnout (Hirschle & Gondim, [<reflink idref="bib18" id="ref26">18</reflink>]). Whereas job-related stress is recognised as an alteration in psychophysiological health due to work-related conditions (Hurrell et al., [<reflink idref="bib19" id="ref27">19</reflink>]), burnout is a chronic condition attributed to long-term work-related stress that is characterised by diminished personal accomplishment, depersonalisation, and emotional exhaustion (Schaufeli et al., [<reflink idref="bib39" id="ref28">39</reflink>]).</p> <p>On the assumption that teachers who are dealing with job-related stress or burnout can compromise the entire education process, including students' performance, the evidence of this relationship should be reported in the literature. Previous reviews (Brunsting et al., [<reflink idref="bib5" id="ref29">5</reflink>]; Wisniewski & Gargiulo, [<reflink idref="bib51" id="ref30">51</reflink>]) synthesised findings regarding mental health of teachers. These studies only assessed burnout and occupational stress of teachers from special schools (Brunsting et al., [<reflink idref="bib5" id="ref31">5</reflink>]; Wisniewski & Gargiulo, [<reflink idref="bib51" id="ref32">51</reflink>]). Updating data is also required since reviews were published at least seven years ago. Efforts to promote inclusive spaces for people with disabilities increased worldwide and issues, such as regular school, reflect educational policies for students with disabilities. In this sense, comprehension of mental health of teachers (i.e. comparing those from special and regular schools) is crucial and should consider important differences between countries.</p> <p>A recent meta-analysis (Park & Shin, [<reflink idref="bib33" id="ref33">33</reflink>]) verified associations between dimensions of burnout in special education teachers. However, this recent study did not compare outcomes between teachers from special <emph>versus</emph> regular schools, as proposed in the present review. Although the study was quantitative, authors (Park & Shin, [<reflink idref="bib33" id="ref34">33</reflink>]) included no peer-reviewed studies, attributing bias to findings. Also, no systematic reviews comparing the mental health outcomes of teachers of students with disabilities from general/regular schools with those from special/specialised schools have been conducted so far.</p> <p>Thus, the objective of this systematic review was to summarise evidence on the mental health outcome assessments among teachers of students with disabilities from different work spaces, and to compare the levels of burnout and stress among teachers from general/regular schools and their peers from special/specialised schools.</p> <hd id="AN0181776759-3">Methods</hd> <p></p> <hd id="AN0181776759-4">Protocol and Registration</hd> <p>This systematic review followed all the recommended procedures according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Moher et al., [<reflink idref="bib28" id="ref35">28</reflink>]). This study was registered in the PROSPERO database under number CRD42020203113.</p> <hd id="AN0181776759-5">Eligibility Criteria</hd> <p>The following eligibility criteria were applied: a) original observational studies conducted with teachers who had students with disabilities in their classes or under their supervision in other schooling contexts/settings; b) studies addressing teachers' mental health outcomes and comparing them between teacher groups; c) studies that evaluated these outcomes through specific instruments, such as questionnaires, scales, or specific evaluations; and d) studies published in English from January 2010 to April 2021. We excluded systematic reviews and qualitative or case study designs.</p> <hd id="AN0181776759-6">Information Sources and Search</hd> <p>Searches for articles were conducted in the following databases: PubMed, ERIC, and Redalyc. For the search terms in the databases, we used the following: 'mental health' OR 'anxiety disorder' OR depression OR 'professional burnout' OR burnout OR 'occupational stress' OR 'self-esteem' AND teachers AND 'students with disability' OR 'autism spectrum disorder' OR 'exceptional children' AND 'school inclusion' OR 'special education' OR 'special school' OR 'specialised schools'. The Boolean operators AND and OR were used to combine the terms to facilitate the search.</p> <hd id="AN0181776759-7">Study Selection and Researchers</hd> <p>The initial searches in the databases were carried out independently by each researcher (first, second, and third author), and the number of articles in each selection phase was registered in a specific Excel file. Searches were performed in each database at a time. The next phase started in another database only after concluding searches in the first database. The articles that repeated across databases were excluded, and the titles of these articles were scanned and screened for at least two of the descriptors, as follows: mental health, anxiety disorder, depression, professional burnout, burnout, occupational stress, self-esteem, teachers, students with disability, autism spectrum disorder, exceptional children, school inclusion, special education, special school, specialised schools. The abstracts of these articles were read and then selected for the full-text reading. Only the studies meeting the full eligibility criteria were selected for the qualitative syntheses and comprised the final sample of this systematic review. The number of included and excluded articles in each selection step was duly recorded in the Excel file for later organisation of the results in a specific flowchart, following the PRISMA guidelines. The searches in the databases were conducted in April 2020, and final decisions were made by consensus when needed.</p> <hd id="AN0181776759-8">Data Analyses</hd> <p>The data analyses of the articles included in the qualitative syntheses were based on the following: study design, target population, context of carrying out studies, comparison or control group, assessed mental health outcomes, instruments used to evaluate the outcomes, and the main results. The synthesis of the results was based on the values of significance (<emph>p</emph>-value) to determine the significant differences in the mental health outcomes assessed between teachers of students with disabilities from regular/general school versus teachers from special/specialised schools. Effect sizes were not calculated because previous studies reported little statistical information regarding measures of dispersion. Therefore, only <emph>p</emph>-values were considered. A meta-analysis was not conducted due to heterogeneity among included studies.</p> <hd id="AN0181776759-9">Methodological Quality of Studies</hd> <p>The analysis of the methodological quality of the studies was performed using the Newcastle-Ottawa Scale (NOS) for cross-sectional and cohort study designs. NOS evaluates risk of bias in observational studies based on three criteria: 1 - Selection; 2 – Comparability; and 3 – Outcome (Luchini et al., [<reflink idref="bib26" id="ref36">26</reflink>]), scoring between 0 and 9 stars (for cohort design) or 0 and 10 stars (for cross-sectional design). The studies were classified according to the number of stars that were assigned to each NOS evaluation criterion. For cohort studies, scores of ≥ 7 stars were classified as being of high methodological quality, and those with scores between 5–6 stars were of moderate methodological quality (Xing et al., [<reflink idref="bib53" id="ref37">53</reflink>]). In the cross-sectional studies, scores of 0–4 were indicative of low methodological quality, 5–6 stars of moderate methodological quality, and ≥ 7 stars of high methodological quality (J. Wang et al., [<reflink idref="bib48" id="ref38">48</reflink>]). Item selection number 4, 'Ascertainment of the exposure (risk factor)', was not used for the cross-sectional studies because we agreed that in this context, it was difficult to ascertain the exposure (risk factor). As a result, the maximum score was nine (100%) and not 10 (100%), the latter of which was originally used for studies with cross-sectional designs. Age was the most important confounding factor for Comparability item, according to NOS instruction manual and current literature regarding mental health of adults (Dinapoli et al., [<reflink idref="bib12" id="ref39">12</reflink>]).</p> <hd id="AN0181776759-10">Results</hd> <p>In total, the database search yielded 5,599 records, and a total of 5,546 records remained after duplicates were removed. Of these, the abstracts of 199 were screened, and a total of 35 full texts were retrieved for eligibility. After this step, 191 studies were excluded for various reasons (164 were excluded based on the abstract reading, and 27 based on the full-text reading). Eight studies were finally included in this systematic review. All these steps were based on the PRISMA flowchart and are described in Figure 1.</p> <p>Graph: Figure 1. Flowchart of study selection process.</p> <p>Table 1 describes the information regarding country, study design, population/groups, sample, schooling context, teachers' mental health outcomes, instruments, purpose of study, and the main results observed in the studies.</p> <p>Table 1. Characteristics of the studies.</p> <p> <ephtml> <table><thead><tr><td>Authors/Year</td><td /><td>Design</td><td>Sample</td><td>Groups</td><td>Teachers' mental health outcomes</td><td>Teachers' mental health assessment</td><td>Purpose of study</td><td>Results of the mental health assessment</td></tr><tr><td>Country</td><td>General/ regular school</td><td>Specialized school/ institution</td><td>Control</td></tr></thead><tbody><tr><td>(Boujut et al., <xref ref-type="bibr" rid="bibr4">2016</xref>)</td><td>France</td><td>Cross-sectional</td><td>245</td><td>G1: 103</td><td>G2: 100</td><td>G3: 42</td><td>1 - Perceived Stress 2 - Burnout</td><td>1 - Appraisal of Life Events Scale (ALES) 2 - Maslach Burnout Inventory (MBI)</td><td>To compare the experiences of teachers dealing with students with ASD in different classroom environments.</td><td>Perceived stress: Teachers in regular inclusive school (G1) had significantly higher levels than teachers in the specialised school (G2) and control groups (G3). Burnout: Teachers in regular inclusive schools (G1) had significantly higher levels than teachers in specialised school (G2).</td></tr><tr><td>(Coman et al., <xref ref-type="bibr" rid="bibr9">2013</xref>)</td><td>U.S</td><td>Cohort</td><td>53</td><td>17 TEACCH, 15 LEAP, and 21 HQSEP</td><td>______</td><td>_______</td><td>Burnout</td><td>Maslach Burnout Inventory: Educators Survey</td><td>To investigate the dimensions of teacher burnout and teacher commitment in educators implementing three different preschool programs at high levels of fidelity: Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH); Learning Experiences and Alternative Program for Preschoolers and Their Parents (LEAP); and a non-ASD specific, but high-quality special education program (HQSEP).</td><td>Burnout: No significant difference among groups of teachers.</td></tr><tr><td>(Ervasti et al., <xref ref-type="bibr" rid="bibr15">2012</xref>)</td><td>Finland</td><td>Cohort</td><td>5760</td><td>GET: 4919</td><td>SE: 841</td><td>______</td><td>Mental Health Psychological Distress</td><td>General Health Questionnaire (GHQ-12)</td><td>To examine the differences between special education and general education teachers regarding health risk behaviours, illnesses, and exposure to violence at work.</td><td>Psychological distress: Special education teachers had significantly higher levels than general education teachers.</td></tr><tr><td>(Garwood et al., <xref ref-type="bibr" rid="bibr16">2018</xref>)</td><td>U.S</td><td>Cross-sectional</td><td>64 rural special education teacher</td><td>EI: 12 RR: 32 SCCR: 19 RTP: 1</td><td>______</td><td>______</td><td>Burnout</td><td>Maslach Burnout Inventory-Educator Survey (MBI-ES; Maslach & Jackson, <xref ref-type="bibr" rid="bibr27">1986</xref>)</td><td>To understand issues related to rural special education teachers' burnout.</td><td>Burnout: Varied from quite low to extremely high.</td></tr><tr><td>(Kebbi & Al-Hroub, <xref ref-type="bibr" rid="bibr22">2018</xref>)</td><td>Lebanon</td><td>Cross-sectional</td><td>139</td><td>GM: 100</td><td>SE: 39</td><td>______</td><td>Teachers' Stress</td><td>Modified version of the Pullis Inventory of Teacher Stress (PITS)</td><td>To shed light on sources of stress as well as the effects and coping strategies used by general (mainstream) classroom and special education teachers.</td><td>Teacher stress: No significant differences between special needs and general classroom teachers.</td></tr><tr><td>(Pepe & Addimando, <xref ref-type="bibr" rid="bibr34">2013</xref>)</td><td>Italy</td><td>Cross-sectional</td><td>306</td><td>GETs: 79.7</td><td>SETs: 20.3</td><td>______</td><td>Occupational stress</td><td>Challenging Students Standard Questionnaire</td><td>To investigate in-service primary teachers' perceptions of pupils' challenging behaviour in Italian schools as well as the relationship between misconduct and teachers' occupational stress.</td><td>Occupational stress: No significant difference between special education teachers and general education teachers.</td></tr><tr><td>(Platsidou & Agaliotis, <xref ref-type="bibr" rid="bibr36">2017</xref>)</td><td>Greece</td><td>Cross-sectional</td><td>190</td><td>GE: 102</td><td>SE: 88</td><td>______</td><td>Job-Related Stress</td><td>Inventory of Job-Related Stress Factors (IJRSF)</td><td>To investigate the empathy skills and instructional assignment-related stress factors of primary school teachers serving in general or special education; and to assess the role of empathy skills in predicting the instructional assignment-related stress factors tested.</td><td>Job-related stress factors: No significant difference between special and general educators.</td></tr><tr><td>(Küçüksüleymanoğlu, <xref ref-type="bibr" rid="bibr25">2011</xref>)</td><td>Turkey</td><td>Cross-sectional</td><td>67</td><td>______</td><td>SE: 67 (HI: 32; MR: 22; OI: 13)</td><td>______</td><td>Burnout</td><td>Maslach Burnout Inventory (MBI)</td><td>To determine whether the burnout levels of special education teachers working with hearing, orthopaedic, and mentally impaired students in Bursa, Turkey differ according to some independent variables, such as gender, family status, years of teaching experience, educational background, and school type.</td><td>Burnout: Very high levels. Teachers working with the orthopaedically impaired had significantly higher levels compared to the others.</td></tr></tbody></table> </ephtml> </p> <p>1 TEACCH – Treatment and Education of Autistic and Related Communication Handicapped Children; LEAP – Learning Experiences and Alternative Program for Preschoolers and Their Parents; HQSEPs – High-quality special education programs; GETs – General education teachers; SETs – Special education teachers; HI – Teachers working with hearing impaired students; OI – Teachers working with orthopaedically impaired students; MR – Teachers working with the mentally retarded.</p> <p>Country of origin varied: two studies were from the USA (Coman et al., [<reflink idref="bib9" id="ref40">9</reflink>]; Garwood et al., [<reflink idref="bib16" id="ref41">16</reflink>]) and one from France (Boujut et al., [<reflink idref="bib4" id="ref42">4</reflink>]), Finland (Ervasti et al., [<reflink idref="bib15" id="ref43">15</reflink>]), Italy (Pepe & Addimando, [<reflink idref="bib34" id="ref44">34</reflink>]), Greece (Platsidou & Agaliotis, [<reflink idref="bib36" id="ref45">36</reflink>]), Turkey (Küçüksüleymanoğlu, [<reflink idref="bib25" id="ref46">25</reflink>]) and Lebanon (Kebbi & Al-Hroub, [<reflink idref="bib22" id="ref47">22</reflink>]).</p> <p>The majority of studies (seven out of the eight studies included) were cross-sectional in nature, and only one was a cohort design study (Coman et al., [<reflink idref="bib9" id="ref48">9</reflink>]). The total sample size of the eight studies included was 6,824 teachers, 5,585 of whom worked in general/regular schools (Boujut et al., [<reflink idref="bib4" id="ref49">4</reflink>]; Coman et al., [<reflink idref="bib9" id="ref50">9</reflink>]; Ervasti et al., [<reflink idref="bib15" id="ref51">15</reflink>]; Garwood et al., [<reflink idref="bib16" id="ref52">16</reflink>]; Kebbi & Al-Hroub, [<reflink idref="bib22" id="ref53">22</reflink>]; Pepe & Addimando, [<reflink idref="bib34" id="ref54">34</reflink>]; Platsidou & Agaliotis, [<reflink idref="bib36" id="ref55">36</reflink>]); 1,197 in special/specialised schools (Boujut et al., [<reflink idref="bib4" id="ref56">4</reflink>]; Ervasti et al., [<reflink idref="bib15" id="ref57">15</reflink>]; Kebbi & Al-Hroub, [<reflink idref="bib22" id="ref58">22</reflink>]; Küçüksüleymanoğlu, [<reflink idref="bib25" id="ref59">25</reflink>]; Pepe & Addimando, [<reflink idref="bib34" id="ref60">34</reflink>]; Platsidou & Agaliotis, [<reflink idref="bib36" id="ref61">36</reflink>]); and 42 of whom did not have students with disabilities in their classes and were considered the control group in one study (Boujut et al., [<reflink idref="bib4" id="ref62">4</reflink>]).</p> <p>Regarding the assessment of teachers' mental health, we observed that burnout (Boujut et al., [<reflink idref="bib4" id="ref63">4</reflink>]; Coman et al., [<reflink idref="bib9" id="ref64">9</reflink>]; Garwood et al., [<reflink idref="bib16" id="ref65">16</reflink>]; Küçüksüleymanoğlu, [<reflink idref="bib25" id="ref66">25</reflink>]) and stress (Boujut et al., [<reflink idref="bib4" id="ref67">4</reflink>]; Ervasti et al., [<reflink idref="bib15" id="ref68">15</reflink>]; Kebbi & Al-Hroub, [<reflink idref="bib22" id="ref69">22</reflink>]; Pepe & Addimando, [<reflink idref="bib34" id="ref70">34</reflink>]; Platsidou & Agaliotis, [<reflink idref="bib36" id="ref71">36</reflink>]) were the assessed outcomes. The Maslach Burnout Inventory was used to assess burnout in all studies with burnout outcome measure (Boujut et al., [<reflink idref="bib4" id="ref72">4</reflink>]; Coman et al., [<reflink idref="bib9" id="ref73">9</reflink>]; Garwood et al., [<reflink idref="bib16" id="ref74">16</reflink>]; Küçüksüleymanoğlu, [<reflink idref="bib25" id="ref75">25</reflink>]). However, several instruments were used to assess the levels of stress in teachers, including the following: the Appraisal of Life Events Scale (ALES) (Boujut et al., [<reflink idref="bib4" id="ref76">4</reflink>]), the General Health Questionnaire (GHQ-12; Ervasti et al., [<reflink idref="bib15" id="ref77">15</reflink>]), a modified version of the Pullis Inventory of Teacher Stress (PITS; Kebbi & Al-Hroub, [<reflink idref="bib22" id="ref78">22</reflink>]), the Challenging Students Standard Questionnaire (Pepe & Addimando, [<reflink idref="bib34" id="ref79">34</reflink>]) and the Inventory of Job-Related Stress Factors (IJRSF; Platsidou & Agaliotis, [<reflink idref="bib36" id="ref80">36</reflink>]).</p> <p>Regarding the results for the mental health outcomes, we observed, in general, that the symptoms of stress and burnout were commonly reported by the teachers. Three out of eight studies (Kebbi & Al-Hroub, [<reflink idref="bib22" id="ref81">22</reflink>]; Pepe & Addimando, [<reflink idref="bib34" id="ref82">34</reflink>]; Platsidou & Agaliotis, [<reflink idref="bib36" id="ref83">36</reflink>]) did not find significant differences in the levels of stress between teachers from regular/general schools and teachers from special/specialised schools. One study (Ervasti et al., [<reflink idref="bib15" id="ref84">15</reflink>]) reported significantly higher levels of stress in special education teachers than regular/general school teachers. With regard to burnout, three studies investigated only special educators (Coman et al., [<reflink idref="bib9" id="ref85">9</reflink>]; Garwood et al., [<reflink idref="bib16" id="ref86">16</reflink>]; Küçüksüleymanoğlu, [<reflink idref="bib25" id="ref87">25</reflink>]), with one of them describing the levels of burnout, which ranged from quite low to extremely high (Garwood et al., [<reflink idref="bib16" id="ref88">16</reflink>]), and the others comparing subgroups of teachers, each of which worked with different approaches (Coman et al., [<reflink idref="bib9" id="ref89">9</reflink>]) or with different types of disabilities (Küçüksüleymanoğlu, [<reflink idref="bib25" id="ref90">25</reflink>]). Finally, one study (Boujut et al., [<reflink idref="bib4" id="ref91">4</reflink>]) evaluated both the levels of stress and burnout among teachers from inclusive general/regular schools, teachers from special/specialised schools, and teachers who did not work with students with disabilities, who made up a control group. In this case, teachers from inclusive general/regular schools reported significantly more stress and burnout than those from other settings.</p> <p>As observed in the Table 2 none of the studies exhibited a high quality according to the NOS items. Only two studies were classified as moderate quality (Boujut et al., [<reflink idref="bib4" id="ref92">4</reflink>]; Ervasti et al., [<reflink idref="bib15" id="ref93">15</reflink>]) and the scores of the majority (Coman et al., [<reflink idref="bib9" id="ref94">9</reflink>]; Garwood et al., [<reflink idref="bib16" id="ref95">16</reflink>]; Kebbi & Al-Hroub, [<reflink idref="bib22" id="ref96">22</reflink>]; Küçüksüleymanoğlu, [<reflink idref="bib25" id="ref97">25</reflink>]; Pepe & Addimando, [<reflink idref="bib34" id="ref98">34</reflink>]; Platsidou & Agaliotis, [<reflink idref="bib36" id="ref99">36</reflink>]) ranged from one to four stars, with most being classified as low quality. Among the NOS items, the major concern was related to comparability because only two studies filled this criterion: one cross-sectional study (Boujut et al., [<reflink idref="bib4" id="ref100">4</reflink>]) and another with a cohort design (Coman et al., [<reflink idref="bib9" id="ref101">9</reflink>]). The cross-sectional study (Boujut et al., [<reflink idref="bib4" id="ref102">4</reflink>]) controlled for the most important confounding factor (age) and other additional factors (sex and teachers' experiences) among the groups of teachers. Nonetheless, while the cohort study (Coman et al., [<reflink idref="bib9" id="ref103">9</reflink>]) did not control the groups for age, it did control for one additional confounding factors (teachers' experience).</p> <p>Table 2. Quality assessment of studies according to NOS items.</p> <p> <ephtml> <table><thead><tr><td>Studies</td><td>Design</td><td>NOS</td></tr><tr><td>Selection 1</td><td>Selection 2</td><td>Selection 3</td><td>Selection 4#</td><td>Comparability 1a</td><td>Comparability 1b</td><td>Outcome 1</td><td>Outcome 2</td><td>Outcome 3</td><td>NOS total score</td></tr></thead><tbody><tr><td>Boujut et al., (<xref ref-type="bibr" rid="bibr4">2016</xref>)</td><td>Cross-sectional</td><td>N/A</td><td>*</td><td>N/A</td><td>____</td><td>*</td><td>*</td><td>*</td><td>*</td><td>____</td><td>5/9 (55.5%)</td></tr><tr><td>Coman et al., (<xref ref-type="bibr" rid="bibr9">2013</xref>)</td><td>Cohort</td><td>N/A</td><td>*</td><td>*</td><td>N/A</td><td>N/A</td><td>*</td><td>N/A</td><td>N/A</td><td>*</td><td>4/9 (44.4%)</td></tr><tr><td>Ervasti et al., (<xref ref-type="bibr" rid="bibr15">2012</xref>)</td><td>Cross-sectional</td><td>*</td><td>*</td><td>N/A</td><td>____</td><td>*</td><td>*</td><td>*</td><td>*</td><td>____</td><td>6/9 (66.6%)</td></tr><tr><td>Garwood et al., (<xref ref-type="bibr" rid="bibr16">2018</xref>)</td><td>Cross-sectional</td><td>*</td><td>*</td><td>N/A</td><td>____</td><td>N/A</td><td>N/A</td><td>*</td><td>*</td><td>____</td><td>4/9 (44.4%)</td></tr><tr><td>Kebbi & Al-Hroub, (<xref ref-type="bibr" rid="bibr22">2018</xref>)</td><td>Cross-sectional</td><td>*</td><td>N/A</td><td>N/A</td><td>____</td><td>N/A</td><td>N/A</td><td>*</td><td>N/A</td><td>____</td><td>2/9 (22.2%)</td></tr><tr><td>Pepe & Addimando, (<xref ref-type="bibr" rid="bibr34">2013</xref>)</td><td>Cross-sectional</td><td>N/A</td><td>*</td><td>N/A</td><td>____</td><td>N/A</td><td>N/A</td><td>*</td><td>*</td><td>____</td><td>3/9 (33.3%)</td></tr><tr><td>Platsidou & Agaliotis, (<xref ref-type="bibr" rid="bibr36">2017</xref>)</td><td>Cross-sectional</td><td>N/A</td><td>N/A</td><td>N/A</td><td>____</td><td>N/A</td><td>N/A</td><td>*</td><td>N/A</td><td>____</td><td>1/9 (11.1%)</td></tr><tr><td>Küçüksüleymanoğlu, (<xref ref-type="bibr" rid="bibr25">2011</xref>)</td><td>Cross-sectional</td><td>N/A</td><td>N/A</td><td>N/A</td><td>____</td><td>N/A</td><td>N/A</td><td>*</td><td>*</td><td>____</td><td>2/9 (22.2%)</td></tr></tbody></table> </ephtml> </p> <p>2 NOS – Newcastle-Ottawa Scale; N/A – Not available; # The item Selection number 4 was not used for cross-sectional studies because we agreed that in this context, it is difficult to ascertain the exposure (risk factor); For the only cohort study (Coman et al., [<reflink idref="bib9" id="ref104">9</reflink>]), we assigned HQSEP teachers to exposed and LEAP and TEACCH teachers to non-exposed groups. NOS for cross-sectional studies: Selection 1 - Representativeness of the sample; Selection 2 - Sample size; Selection 3 - Non-respondents; Selection 4 - Ascertainment of the exposure (risk factor); Comparability 1- The subjects in different outcome groups are comparable, based on the study design or analysis. Confounding factors are controlled: a) The study controls for the most important factor (select one); b) The study control for any additional factor; Outcome 1 - Assessment of the outcome; Outcome 2 - Statistical test; NOS for cohort studies: Selection 1 - Representativeness of the exposed cohort; Selection 2 - Selection of the non exposed cohort; Selection 3 - Ascertainment of exposure; Selection 4 - Demonstration that outcome of interest was not present at start of study; Comparability 1 - Comparability of cohorts on the basis of the design or analysis; a) study controls for the most important factor; b) study controls for any additional factor; Outcome 1 - Assessment of outcome; Outcome 2 - Was follow-up long enough for outcomes to occur; Outcome 3 - Adequacy of follow up of cohort.</p> <hd id="AN0181776759-11">Discussion</hd> <p>To the best of our knowledge, this is the first systematic review with the purpose of summarising evidence on the mental health outcome assessments in teachers of students with disabilities from different work spaces/contexts along with studies comparing the levels of burnout and stress between teachers from general/regular schools and their peers from special/specialised schools. Broadly speaking, we observed that the symptoms of mental health outcomes were commonly reported by teachers regardless of the educational context in which they were placed.</p> <p>The present review included studies conducted in different countries with different intensities of job-related stress among cultures. Previous studies evidenced burnout and health problems of teachers dealing with inclusion processes, preventing them to fulfill students' demands.</p> <p>In France, Boujut et al. ([<reflink idref="bib4" id="ref105">4</reflink>]) showed no relevant burnout among teachers of students with disabilities due to coping strategies developed using specific training. In Greece, Platsidou and Agaliotis ([<reflink idref="bib35" id="ref106">35</reflink>]) found low and medium levels of stress and slightly high levels of satisfaction in 127 special education teachers. Authors (Platsidou & Agaliotis, [<reflink idref="bib35" id="ref107">35</reflink>]) justified findings by adequate working conditions in classroom and collaboration with other specialists and students' parents. In contrast, these positive findings were not observed in the USA. Stempien and Loeb ([<reflink idref="bib42" id="ref108">42</reflink>]) studied 116 teachers of regular and special education in Detroit (Michigan, USA) and found that special education teachers, mainly younger and less experienced, were the most unsatisfied group due to stress from inside and outside classrooms.</p> <hd id="AN0181776759-12">Evidence Synthesis for Burnout</hd> <p>For burnout, it was not possible to attribute any guidance because each study had different results with different ways of analysing the Maslach scores or comparing the groups. It was very difficult to compare the studies' results because they were very heterogeneous in various methodological aspects. Therefore, overall, the levels of burnout were frequent in teachers in both spaces/scenarios. Only one study (Boujut et al., [<reflink idref="bib4" id="ref109">4</reflink>]) found significantly higher levels of burnout in teachers from general/regular inclusive schools than teachers from special/specialised schools. In this sense, it is necessary to highlight that the authors (Boujut et al., [<reflink idref="bib4" id="ref110">4</reflink>]) investigated only teachers of students with autism spectrum disorder (ASD), which is a complex neurodevelopmental disorder with several adaptations in daily and school-life activities (American Psychiatric Association, [<reflink idref="bib2" id="ref111">2</reflink>]). ASD interferes with socialisation and communication children's skills (Campisi et al., [<reflink idref="bib7" id="ref112">7</reflink>]), and manifestations differ in intensity (Boujut et al., [<reflink idref="bib4" id="ref113">4</reflink>]), which might be a major challenge for teachers, even in schools that follow inclusive practices. Inclusive school principles are well documented in the literature (Ainscow et al., [<reflink idref="bib1" id="ref114">1</reflink>]; Efthymiou et al., [<reflink idref="bib14" id="ref115">14</reflink>]; Nind, [<reflink idref="bib30" id="ref116">30</reflink>]; Sant'ana, [<reflink idref="bib38" id="ref117">38</reflink>]; Stainback & Stainback, [<reflink idref="bib41" id="ref118">41</reflink>]) and are generally built on the idea that there should be universal opportunities and full participation for all students, regardless of their impairments. In addition, an inclusive system, particularly an inclusive society, requires a long-term process with strong approaches to ensuring accessibility, employability, social policies, people's well-being, and wide and diverse opportunities for all. In addition, inclusive systems require deliberate efforts to change mindsets, meaning that the entire society and each individual perspective about diversity have to change (United Nations Development Group, [<reflink idref="bib45" id="ref119">45</reflink>]).</p> <p>Coman et al. ([<reflink idref="bib9" id="ref120">9</reflink>]) also limited their investigation to only teachers of students with ASD working in general/regular schools and found higher levels of burnout with no significant differences between teachers' groups by type of teaching programs used. We can argue that teachers who work with students with more severe disabilities, like ASD, experience more challenges in including their students in general/regular schools. Therefore, they probably feel more frustrated with their jobs and anxious about the students' schooling and are likely to internalise more symptoms of burnout compared to their peers who work in a different environment or with students with minor disabilities. However, we need more studies to attest to this, and we can only hypothesise on this point thus far.</p> <hd id="AN0181776759-13">Evidence Synthesis for Stress</hd> <p>Regarding stress, we found two studies indicating significant differences in stress scores (Boujut et al., [<reflink idref="bib4" id="ref121">4</reflink>]; Ervasti et al., [<reflink idref="bib15" id="ref122">15</reflink>]), one with higher levels in teachers from general/regular schools compared to their peers from special/specialised schools (Boujut et al., [<reflink idref="bib4" id="ref123">4</reflink>]), and another with higher levels in teachers from special/specialised schools (Ervasti et al., [<reflink idref="bib15" id="ref124">15</reflink>]) compared to teachers from general/regular schools. Also, there were three studies indicating that there were no significant differences in the stress scores between these groups (Kebbi & Al-Hroub, [<reflink idref="bib22" id="ref125">22</reflink>]; Pepe & Addimando, [<reflink idref="bib34" id="ref126">34</reflink>]; Platsidou & Agaliotis, [<reflink idref="bib36" id="ref127">36</reflink>]). Although the inconclusive evidence from these studies, there is a general indication that working with students with disabilities exposes teachers to high levels of job-related stress, regardless of whether they are from general/regular or special/specialised schools. Also, there were many heterogeneous methodological issues in all the studies, and thus we were cautious with the interpretation of these results. As with the syntheses for research on burnout, we need more studies to assure evidence regarding levels of stress in teachers who work with students with disabilities in general/regular schools versus those who work in special/specialised school. So far, our findings strengthen the argument that teachers working with students with disabilities are at risk of high levels of stress, and that these levels are not determined by the type of school environment.</p> <p>Additionally, according to current literature (Desouky & Allam, [<reflink idref="bib11" id="ref128">11</reflink>]; von der Embse et al., [<reflink idref="bib46" id="ref129">46</reflink>]; von Haaren-Mack et al., [<reflink idref="bib47" id="ref130">47</reflink>]; Wettstein et al., [<reflink idref="bib50" id="ref131">50</reflink>]) teaching, in general, is a higher risk duty to increase stress and mental health problems because personal factors, motivation, and support systems in schools play a major role in the development of the symptoms related to mental health problems in this population. Those symptoms amongst teachers are generally high, regardless of whether they are teaching students with or without disabilities in their classes. So, the relationship between reported high levels of mental health problems (Burnout and stress) and teaching children, including those with disabilities, found in this systematic review might be better explained considering the burden of contextual factors along with the students' needs than the disability per si.</p> <hd id="AN0181776759-14">Considerations and Scientific Evidence Synthesis</hd> <p>Although purposes of the present were different from previous studies, similar results were found on mental health of special education teachers. High levels of burnout and stress in special education teachers were found (Brunsting et al., [<reflink idref="bib5" id="ref132">5</reflink>]; Park & Shin, [<reflink idref="bib33" id="ref133">33</reflink>]; Wisniewski & Gargiulo, [<reflink idref="bib51" id="ref134">51</reflink>]); however, one review included only studies conducted in the USA (Brunsting et al., [<reflink idref="bib5" id="ref135">5</reflink>]), whereas two (Brunsting et al., [<reflink idref="bib5" id="ref136">5</reflink>]; Wisniewski & Gargiulo, [<reflink idref="bib51" id="ref137">51</reflink>]) did not specify risk of bias assessment. Thus, this systematic review outstands when it demonstrates burnout and stress between teachers from regular <emph>versus</emph> special schools because most previous studies compromised methodological quality and presented heterogeneous findings.</p> <p>The quality of the studies was low, and they failed in not reporting the non-response rates (selection item in the NOS) and not controlling the groups for potential confounding factors (comparability items in NOS), such as age, gender, or teachers' experience. Since confounding factors can mask the actual results and indicate a false interpretation of the findings, studies that did not control for at least a main potential confounding factor (age in our systematic review) may have resulted in a distortion of the comparability of the primary outcome, which in this case would be the levels of burnout or stress in teachers. In addition, describing information about the non-response rates is essential for the recruitment process to be clear and minimise bias (Cheung et al., [<reflink idref="bib8" id="ref138">8</reflink>]). We selected studies with at least two comparison groups of teachers, and this helped us to achieve the purpose of this systematic review. However, the selection process of the participants was not clearly described in all the studies, with the majority of them leaving out this important information.</p> <p>We tried calculating the effect sizes of the studies, but the majority of them did not present the means and standard deviations of the teachers' groups. Therefore, we based our interpretations on the differences between the groups of the studies according to the reported <emph>p</emph>-values.</p> <p>Along with policies ensuring the better education of students with disabilities, provisions at the level of public healthcare should be enacted by taking into consideration the teachers, who according to this systematic review are most likely to exhibit high levels of mental health problems, particularly the job-related symptoms of stress and burnout. Also, further studies should focus on learning from what has worked to prevent mental health problems in teachers. Despite the benefits observed from specific interventions, like mindfulness for teachers (von der Embse et al., [<reflink idref="bib46" id="ref139">46</reflink>]), those who receive adequate salaries, have more psychosocial support and work through better work conditions (Desouky & Allam, [<reflink idref="bib11" id="ref140">11</reflink>]) reported less mental health problems. Specific interventions for improving teachers' mental health and well-being have been reported (Kidger et al., [<reflink idref="bib23" id="ref141">23</reflink>], [<reflink idref="bib24" id="ref142">24</reflink>]), but no significant effects were observed. According to the authors (Kidger et al., [<reflink idref="bib23" id="ref143">23</reflink>], [<reflink idref="bib24" id="ref144">24</reflink>]), the interventions did not succeed because had no focus on structural and cultural aspects of the school environment, which should be crucial for improvements on teachers mental health and well-being. So far, as we know those teachers with less job demands and more job control and social support have significantly more psychological well-being (Ibrahim et al., [<reflink idref="bib20" id="ref145">20</reflink>]).</p> <hd id="AN0181776759-15">Limitations and Practical Implications</hd> <p>This study is not free of limitations. Practical interpretation of results can not be estimated due to lack of mean and standard deviation of mental health scores. Practical implications are also limited because effect sizes were not calculated. Furthermore, most studies presented low methodological quality and risk of bias, justifying cautious interpretations. A wide range of countries of origin and methods for data analysis was observed among studies. Further studies should be conducted in low income countries as well, using culturally appropriate methods to see how teachers from those countries in comparison to their peers from high income countries are dealing with inclusion and teaching students with and without disabilities. So, it can make a proper recommendation on a global level. Thus, we recommend that mental health policies at primary care level compose more regular and special school settings to support teachers of students with disabilities. This systematic review shows that teachers are at great risk of burnout symptoms and alert authorities to preserve mental health of teachers, mainly prioritising their psychological well-being. Lastly, adding the COVID-19 pandemic issues into consideration to the teachers' practices would be relevant as teaching situation has changed globally for many teachers. So, further studies should also include the impact of the pandemic and remote teaching on teachers' mental health problems, as burnout and stress.</p> <hd id="AN0181776759-16">Conclusion</hd> <p>Teachers who worked with students with disabilities reported high levels of stress and burnout, regardless of the school setting. There is no clear evidence attesting to significant differences between teachers from regular/general school and those from special/specialised schools. More high-quality studies are needed to provide clear evidence that facilitates understanding of the possible differences between these school settings. Future studies could not only focus on comparing mental health problems in different systems, but learning from what has worked to prevent these problems, mainly teachers' psychological well-being by offering better working conditions to them.</p> <hd id="AN0181776759-17">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <ref id="AN0181776759-18"> <title> References </title> <blist> <bibl id="bib1" idref="ref16" type="bt">1</bibl> <bibtext> Ainscow, M., Booth, T., Dyson, A., Farrell, P., Frankham, J., Gallannaugh, F., Howes, A., & Smith, R. (2006). Improving schools, developing inclusion. In Improving schools, developing inclusion. Routledge Taylor & Francis Group. https://doi.org/10.4324/9780203967157.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref17" type="bt">2</bibl> <bibtext> American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. https://doi.org/10.1176/appi.books.9780890425596</bibtext> </blist> <blist> <bibl id="bib3" idref="ref8" type="bt">3</bibl> <bibtext> Billingsley, B., Bettini, E., Mathews, H. M., & McLeskey, J. (2020). Improving working conditions to support special educators' effectiveness: A call for leadership. Teacher Education and Special Education: The Journal of the Teacher Education Division of the Council for Exceptional Children, 43 (1), 7 – 27. https://doi.org/10.1177/0888406419880353</bibtext> </blist> <blist> <bibl id="bib4" idref="ref42" type="bt">4</bibl> <bibtext> Boujut, E., Dean, A., Grouselle, A., & Cappe, E. (2016). Comparative study of teachers in regular schools and teachers in specialized schools in France, working with students with an autism spectrum disorder: Stress, social support, coping strategies and burnout. Journal of Autism and Developmental Disorders, 46 (9), 2874 – 2889. https://doi.org/10.1007/s10803-016-2833-2</bibtext> </blist> <blist> <bibl id="bib5" idref="ref21" type="bt">5</bibl> <bibtext> Brunsting, N. C., Sreckovic, M. A., & Lane, K. L. (2014). Special education teacher burnout: A synthesis of research from 1979 to 2013. Education and Treatment of Children, 37 (4), 681 – 711. https://doi.org/10.1353/etc.2014.0032</bibtext> </blist> <blist> <bibl id="bib6" idref="ref9" type="bt">6</bibl> <bibtext> Bryant, D. P., Bryant, B. R., & Smith, D. D. (2019). Teaching students with special needs in inclusive classrooms. In SAGE Publications Ltd (CA). SAGE Publications. Advance online publication.; <ulink href="http://www.uk.sagepub.com">http://www.uk.sagepub.com</ulink>.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref112" type="bt">7</bibl> <bibtext> Campisi, L., Imran, N., Nazeer, A., Skokauskas, N., & Azeem, M. W. (2018). Autism spectrum disorder. British Medical Bulletin, 127 (1), 91 – 100). Oxford University Press. https://doi.org/10.1093/bmb/ldy026</bibtext> </blist> <blist> <bibl id="bib8" idref="ref138" type="bt">8</bibl> <bibtext> Cheung, K. L., Ten Klooster, P. M., Smit, C., De Vries, H., & Pieterse, M. E. (2017). The impact of non-response bias due to sampling in public health studies: A comparison of voluntary versus mandatory recruitment in a Dutch national survey on adolescent health. BMC Public Health, 17 (1), 276. https://doi.org/10.1186/s12889-017-4189-8</bibtext> </blist> <blist> <bibl id="bib9" idref="ref40" type="bt">9</bibl> <bibtext> Coman, D., Alessandri, M., Gutierrez, A., Novotny, S., Boyd, B., Hume, K., Sperry, L., & Odom, S. (2013). Commitment to classroom model philosophy and burnout symptoms among high fidelity teachers implementing preschool programs for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43 (2), 345 – 360. https://doi.org/10.1007/s10803-012-1573-1</bibtext> </blist> <blist> <bibtext> Cooc, N. (2019). Do teachers spend less time teaching in classrooms with students with special needs? Trends from international data. Educational Researcher, 48 (5), 273 – 286. https://doi.org/10.3102/0013189X19852306</bibtext> </blist> <blist> <bibtext> Desouky, D., & Allam, H. (2017). Occupational stress, anxiety and depression among Egyptian teachers. Journal of Epidemiology and Global Health, 7 (3), 191 – 198. https://doi.org/10.1016/J.JEGH.2017.06.002</bibtext> </blist> <blist> <bibtext> Dinapoli, E. A., Cully, J. A., Wayde, E., Sansgiry, S., Yu, H. J., & Kunik, M. E. (2016). Age as a predictive factor of mental health service use among adults with depression and/or anxiety disorder receiving care through the Veterans health Administration. International Journal of Geriatric Psychiatry, 31 (6), 575 – 582. https://doi.org/10.1002/gps.4362</bibtext> </blist> <blist> <bibtext> Dukes, C., & Berlingo, L. (2020). Fissuring barriers to inclusive education for students with severe disabilities. Research and Practice for Persons with Severe Disabilities, 45 (1), 14 – 17. https://doi.org/10.1177/1540796919895968</bibtext> </blist> <blist> <bibtext> Efthymiou, E., Kington, A., & Lee, J. (2017). The development of inclusive learning relationships in mainstream settings: A multimodal perspective. Cogent Education, 4 (1), 1304015. https://doi.org/10.1080/2331186X.2017.1304015</bibtext> </blist> <blist> <bibtext> Ervasti, J., Kivimäki, M., Pentti, J., Salmi, V., Suominen, S., Vahtera, J., & Virtanen, M. (2012). Work-Related violence, lifestyle, and health among special education teachers working in Finnish basic education. Journal of School Health, 82 (7), 336 – 343. https://doi.org/10.1111/j.1746-1561.2012.00707.x</bibtext> </blist> <blist> <bibtext> Garwood, J. D., Werts, M. G., Varghese, C., & Gosey, L. (2018). Mixed-methods analysis of rural special educators' role stressors, behavior management, and burnout. Rural Special Education Quarterly, 37 (1), 30 – 43. https://doi.org/10.1177/8756870517745270</bibtext> </blist> <blist> <bibtext> Hayes, A. M., & Bulat, J. (2017). Disabilities Inclusive Education Systems and Policies Guide for Low- and Middle-Income Countries. RTI Press. https://doi.org/10.3768/rtipress.2017.op.0043.1707</bibtext> </blist> <blist> <bibtext> Hirschle, A. L. T., & Gondim, S. M. G. (2020). Stress and well-being at work: A literature review. Ciencia e Saude Coletiva, 25 (7), 2721 – 2736. https://doi.org/10.1590/1413-81232020257.27902017</bibtext> </blist> <blist> <bibtext> Hurrell, J. J. J., Nelson, D. L., & Simmons, B. L. (1998). Measuring job stressors and strains: Where we have been, where we are, and where we need to go. Journal of Occupational Health Psychology, 3 (4), 368 – 389. https://doi.org/10.1037/1076-8998.3.4.368</bibtext> </blist> <blist> <bibtext> Ibrahim, R. Z. A. R., Zalam, W. Z. M., Foster, B., Afrizal, T., Johansyah, M. D., Saputra, J., Bakar, A. A., Dagang, M. M., & Ali, S. N. M. (2021). Psychosocial Work Environment and teachers' psychological well-being: The moderating role of job control and social support. International Journal of Environmental Research and Public Health, 18 (14), 7308. https://doi.org/10.3390/IJERPH18147308</bibtext> </blist> <blist> <bibtext> Karagiannis, A., Stainback, S., & Stainback, W. (1996). Rationale for inclusive schooling. In S. Stainback & W. Stainback (Eds.), Inclusion: A guide for educators (pp. 3 – 15). Paul H Brookes Publishing.</bibtext> </blist> <blist> <bibtext> Kebbi, M., & Al-Hroub, A. (2018). Stress and coping strategies used by special education and general classroom teachers. International Journal of Special Education, 33 (1), 34 – 61.</bibtext> </blist> <blist> <bibtext> Kidger, J., Turner, N., Fisher, H., Evans, R., & Bell, S. (2019). An intervention to improve mental health support and training available to secondary school teachers (the WISE study): A cluster-randomised controlled trial. The Lancet, 394, S63. https://doi.org/10.1016/S0140-6736(19)32860-0</bibtext> </blist> <blist> <bibtext> Kidger, J., Turner, N., Hollingworth, W., Evans, R., Bell, S., Brockman, R., Copeland, L., Fisher, H., Harding, S., Powell, J., Araya, R., Campbell1, R., Ford, T., Gunnell, D., Murphy, S., Morris, R., & Tomlinson, M. (2021). An intervention to improve teacher well-being support and training to support students in UK high schools (the WISE study): A cluster randomised controlled trial. PLOS Medicine, 18 (11), e1003847. https://doi.org/10.1371/JOURNAL.PMED.1003847</bibtext> </blist> <blist> <bibtext> Küçüksüleymanoğlu, R. (2011). Burnout syndrome levels of teachers in special education schools in Turkey. International Journal of Special Education, 26 (1), 53 – 63.</bibtext> </blist> <blist> <bibtext> Luchini, C., Stubbs, B., Solmi, M., & Veronese, N. (2017). Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale. World Journal of Meta-Analysis, 5 (4), 80. https://doi.org/10.13105/wjma.v5.i4.80</bibtext> </blist> <blist> <bibtext> Maslach, C., & Jackson, S. E. (1986). Maslach burnout inventory manual (2nd ed.). Consulting Psychologists Press.</bibtext> </blist> <blist> <bibtext> Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L. A., & PRISMA-P Group. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Review, 4 (1), 1 – 9. https://doi.org/10.1186/2046-4053-4-1</bibtext> </blist> <blist> <bibtext> Nazife, K., & Umit, S. (2015). Comparing levels of professional satisfaction in preschool teachers whose classes ınclude or do not ınclude a special-needs student. Educational Research & Reviews, 10 (10), 1396 – 1402. https://doi.org/10.5897/err2015.2190</bibtext> </blist> <blist> <bibtext> Nind, M. (2014). Inclusive research and inclusive education: Why connecting them makes sense for teachers' and learners' democratic development of education. Cambridge Journal of Education, 44 (4), 525 – 540. https://doi.org/10.1080/0305764X.2014.936825</bibtext> </blist> <blist> <bibtext> Oliva, D. V. (2016). Barriers and resources to learning and participation of inclusive students. Psicologia USP, 27 (3), 492 – 502. https://doi.org/10.1590/0103-656420140099</bibtext> </blist> <blist> <bibtext> Papalia-Berardi, A., Hughes, C. A., & Papalia, A. S. (2002). Teacher education students with disabilities: participation and achievement factors. Teacher Education and Special Education: The Journal of the Teacher Education Division of the Council for Exceptional Children, 25 (1), 23 – 31. https://doi.org/10.1177/088840640202500104</bibtext> </blist> <blist> <bibtext> Park, E.-Y., & Shin, M. (2020). A meta-analysis of special education teachers' burnout. SAGE Open, 10 (2), 215824402091829. https://doi.org/10.1177/2158244020918297</bibtext> </blist> <blist> <bibtext> Pepe, A., & Addimando, L. (2013). Comparison of occupational stress in response to challenging behaviours between general and special education primary teachers in Northern Italy. International Journal of Special Education, 28 (1), 14 – 26.</bibtext> </blist> <blist> <bibtext> Platsidou, M., & Agaliotis, I. (2008). Burnout, job satisfaction and instructional assignment-related sources of stress in Greek special education teachers. International Journal of Disability, Development and Education, 55 (1), 61 – 76. https://doi.org/10.1080/10349120701654613</bibtext> </blist> <blist> <bibtext> Platsidou, M., & Agaliotis, I. (2017). Does empathy predict instructional assignment-related stress? A study in special and general education teachers. International Journal of Disability, Development and Education, 64 (1), 57 – 75. https://doi.org/10.1080/1034912X.2016.1174191</bibtext> </blist> <blist> <bibtext> Pülschen, S., & Pülschen, D. (2015). Preparation for teacher collaboration in inclusive classrooms – stress reduction for special education students via acceptance and commitment training: A controlled study. Journal of Molecular Psychiatry, 3 (1), 8. https://doi.org/10.1186/s40303-015-0015-3</bibtext> </blist> <blist> <bibtext> Sant'ana, I. M. (2005). Educação inclusiva: concepções de professores e diretores. Psicologia em Estudo, 10 (2), 227 – 234. https://doi.org/10.1590/s1413-73722005000200009</bibtext> </blist> <blist> <bibtext> Schaufeli, W. B., Leiter, M. P., & Maslach, C. (2009). Burnout: 35 years of research and practice. Career Development International, 14 (3), 204 – 220. https://doi.org/10.1108/13620430910966406</bibtext> </blist> <blist> <bibtext> Sharp Donahoo, L. M., Siegrist, B., & Garrett-Wright, D. (2018). Addressing compassion fatigue and stress of special education teachers and professional staff using mindfulness and prayer. The Journal of School Nursing, 34 (6), 442 – 448. https://doi.org/10.1177/1059840517725789</bibtext> </blist> <blist> <bibtext> Stainback, S. B., & Stainback, W. C. (1996). Inclusion: A guide for educators. Paul H Brookes.</bibtext> </blist> <blist> <bibtext> Stempien, L. R., & Loeb, R. C. (2002). Differences in job satisfaction between general education and special education teachers. Remedial and Special Education, 23 (5), 258 – 267. https://doi.org/10.1177/07419325020230050101</bibtext> </blist> <blist> <bibtext> Ugwoke, S. C., Eseadi, C., Onuigbo, L. N., Aye, E. N., Akaneme, I. N., Oboegbulem, A. I., Ezenwaji, I. O., Nwobi, A. U., Nwaubani, O. O., Ezegbe, B. N., Ede, M. O., Orji, C. T., Onuoha, J. C., Onu, E. U., Okeke, F., Agu, P., Omeje, J. C., Omeke, F., Ugwu, R., Arumede, F., & Eneh, A. (2018). A rational-emotive stress management intervention for reducing job burnout and dysfunctional distress among special education teachers. Medicine (United States), 97 (17), e0475. https://doi.org/10.1097/MD.0000000000010475</bibtext> </blist> <blist> <bibtext> UNESCO. (1994). The Salamanca statement and framework for action on special needs education. https://unesdoc.unesco.org/ark:/48223/pf0000098427</bibtext> </blist> <blist> <bibtext> United Nations Development Group. (2017). Building more inclusive, sustainable and prosperous societies in Europe and Central Asia. <ulink href="http://europeandcis.undp.org">http://europeandcis.undp.org</ulink></bibtext> </blist> <blist> <bibtext> von der Embse, N., Ryan, S. V., Gibbs, T., & Mankin, A. (2019). Teacher stress interventions: A systematic review. Psychology in the Schools, 56 (8), 1328 – 1343. https://doi.org/10.1002/PITS.22279</bibtext> </blist> <blist> <bibtext> von Haaren-Mack, B., Schaefer, A., Pels, F., & Kleinert, J. (2020). Stress in physical education teachers: A systematic review of sources, consequences, and moderators of stress. Research Quarterly for Exercise and Sport, 91 (2), 279 – 297. https://doi.org/10.1080/02701367.2019.1662878</bibtext> </blist> <blist> <bibtext> Wang, J., Su, H., Xie, W., & Yu, S. (2017). Mobile phone use and the risk of headache: A systematic review and meta-analysis of cross-sectional studies. Scientific Reports, 7 (1), 1 – 7. https://doi.org/10.1038/s41598-017-12802-9</bibtext> </blist> <blist> <bibtext> Wang, L., Wang, M., & Wen, H. (2015). Teaching practice of physical education teachers for students with special needs: An application of the theory of planned behaviour. International Journal of Disability, Development and Education, 62 (6), 590 – 607. https://doi.org/10.1080/1034912X.2015.1077931</bibtext> </blist> <blist> <bibtext> Wettstein, A., Schneider, S., Grosse Holtforth, M., & La Marca, R. (2021). Teacher Stress: A psychobiological approach to stressful interactions in the classroom. Frontiers in Education, 6, 344. https://doi.org/10.3389/feduc.2021.681258</bibtext> </blist> <blist> <bibtext> Wisniewski, L., & Gargiulo, R. M. (1997). Occupational stress and burnout among special educators: A review of the literature. The Journal of Special Education, 31 (3), 325 – 346. https://doi.org/10.1177/002246699703100303</bibtext> </blist> <blist> <bibtext> World Health Organization (WHO). (2011). World report on disability. <ulink href="http://www.who.int/about/licensing/copyright%5fform/en/index.html">www.who.int/about/licensing/copyright%5fform/en/index.html</ulink></bibtext> </blist> <blist> <bibtext> Xing, D., Xu, Y., Liu, Q., Ke, Y., Wang, B., Li, Z., & Lin, J. (2016). Osteoarthritis and all-cause mortality in worldwide populations: Grading the evidence from a meta-analysis. Scientific Reports, 6 (1). https://doi.org/10.1038/srep24393</bibtext> </blist> </ref> <aug> <p>By Jorge Lopes Cavalcante Neto; Soraya Dayanna Guimarães Santos and David dos Santos Calheiros</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib52" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib44" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib31" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib13" firstref="ref6"></nolink> <nolink nlid="nl5" bibid="bib32" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib10" firstref="ref10"></nolink> <nolink nlid="nl7" bibid="bib29" firstref="ref11"></nolink> <nolink nlid="nl8" bibid="bib49" firstref="ref12"></nolink> <nolink nlid="nl9" bibid="bib37" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib40" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib43" firstref="ref15"></nolink> <nolink nlid="nl12" bibid="bib21" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib17" firstref="ref19"></nolink> <nolink nlid="nl14" bibid="bib42" firstref="ref22"></nolink> <nolink nlid="nl15" bibid="bib35" firstref="ref25"></nolink> <nolink nlid="nl16" bibid="bib18" firstref="ref26"></nolink> <nolink nlid="nl17" bibid="bib19" firstref="ref27"></nolink> <nolink nlid="nl18" bibid="bib39" firstref="ref28"></nolink> <nolink nlid="nl19" bibid="bib51" firstref="ref30"></nolink> <nolink nlid="nl20" bibid="bib33" firstref="ref33"></nolink> <nolink nlid="nl21" bibid="bib28" firstref="ref35"></nolink> <nolink nlid="nl22" bibid="bib26" firstref="ref36"></nolink> <nolink nlid="nl23" bibid="bib53" firstref="ref37"></nolink> <nolink nlid="nl24" bibid="bib48" firstref="ref38"></nolink> <nolink nlid="nl25" bibid="bib12" firstref="ref39"></nolink> <nolink nlid="nl26" bibid="bib16" firstref="ref41"></nolink> <nolink nlid="nl27" bibid="bib15" firstref="ref43"></nolink> <nolink nlid="nl28" bibid="bib34" firstref="ref44"></nolink> <nolink nlid="nl29" bibid="bib36" firstref="ref45"></nolink> <nolink nlid="nl30" bibid="bib25" firstref="ref46"></nolink> <nolink nlid="nl31" bibid="bib22" firstref="ref47"></nolink> <nolink nlid="nl32" bibid="bib14" firstref="ref115"></nolink> <nolink nlid="nl33" bibid="bib30" firstref="ref116"></nolink> <nolink nlid="nl34" bibid="bib38" firstref="ref117"></nolink> <nolink nlid="nl35" bibid="bib41" firstref="ref118"></nolink> <nolink nlid="nl36" bibid="bib45" firstref="ref119"></nolink> <nolink nlid="nl37" bibid="bib11" firstref="ref128"></nolink> <nolink nlid="nl38" bibid="bib46" firstref="ref129"></nolink> <nolink nlid="nl39" bibid="bib47" firstref="ref130"></nolink> <nolink nlid="nl40" bibid="bib50" firstref="ref131"></nolink> <nolink nlid="nl41" bibid="bib23" firstref="ref141"></nolink> <nolink nlid="nl42" bibid="bib24" firstref="ref142"></nolink> <nolink nlid="nl43" bibid="bib20" firstref="ref145"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1454593
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Mental Health Outcomes in Teachers of Students with Disabilities: A Systematic Review
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Jorge+Lopes+Cavalcante+Neto%22">Jorge Lopes Cavalcante Neto</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-8396-2410">0000-0002-8396-2410</externalLink>)<br /><searchLink fieldCode="AR" term="%22Soraya+Dayanna+Guimarães+Santos%22">Soraya Dayanna Guimarães Santos</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-2623-4430">0000-0003-2623-4430</externalLink>)<br /><searchLink fieldCode="AR" term="%22David+dos+Santos+Calheiros%22">David dos Santos Calheiros</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4761-5569">0000-0002-4761-5569</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22International+Journal+of+Disability%2C+Development+and+Education%22"><i>International Journal of Disability, Development and Education</i></searchLink>. 2025 72(1):149-166.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 18
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Information Analyses<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Teacher+Welfare%22">Teacher Welfare</searchLink><br /><searchLink fieldCode="DE" term="%22Work+Environment%22">Work Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Teacher+Burnout%22">Teacher Burnout</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Teacher+Attitudes%22">Teacher Attitudes</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/1034912X.2024.2344013
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1034-912X<br />1465-346X
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Teachers who work with students with disabilities may have high levels of mental health problems, such as burnout or stress. The aim of this systematic review was to summarise the evidence on mental health outcome assessments among teachers of students with disabilities in different work spaces and to compare the levels of burnout and stress among teachers from general/regular versus special schools. The results reveal high levels of symptoms of burnout or stress in teachers of students with disabilities, regardless of the type of school. Due to the heterogeneity and low quality observed across the studies, evidence remains unclear.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1454593
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1454593
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/1034912X.2024.2344013
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 18
        StartPage: 149
    Subjects:
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Teacher Welfare
        Type: general
      – SubjectFull: Work Environment
        Type: general
      – SubjectFull: Stress Variables
        Type: general
      – SubjectFull: Teacher Burnout
        Type: general
      – SubjectFull: Students with Disabilities
        Type: general
      – SubjectFull: Teacher Attitudes
        Type: general
    Titles:
      – TitleFull: Mental Health Outcomes in Teachers of Students with Disabilities: A Systematic Review
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Jorge Lopes Cavalcante Neto
      – PersonEntity:
          Name:
            NameFull: Soraya Dayanna Guimarães Santos
      – PersonEntity:
          Name:
            NameFull: David dos Santos Calheiros
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1034-912X
            – Type: issn-electronic
              Value: 1465-346X
          Numbering:
            – Type: volume
              Value: 72
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: International Journal of Disability, Development and Education
              Type: main
ResultId 1