Systematic review on stress, insomnia, and burnout syndrome in secondary school teachers

This systemic review article aimed to analyze the symptoms of stress, insomnia, and burnout syndrome in secondary school teachers. The PICO methodology was adapted for the research question and the PRISMA methodology for the article review and selection process. As a result, it was found that professional stress occurs when there is dissatisfaction or restrictions in the environment in which it is exercised; when the preparation of the person has ceased before an elaboration of organizations, as well as the deterioration of the teacher’s vitality because of the stress produced. Burnout syndrome is a reaction to chronic professional stress; the amplitudes that stand out in burnout syndrome are related to stress levels and insomnia. In conclusion, burnout syndrome tends to be more pronounced in teachers because they have direct contact with people; also, the current economic and political factors directly influence the development of their daily activity; in this way, when all these factors come together, it is possible to suffer from burnout.


Introduction
Work-related stress is associated with overwhelming events in the work environment, with obligations that exceed the worker's capabilities, means, and needs.This syndrome can be caused by various situations, such as pressure to increase productivity or lack of training.In this sense, it can be said that the work environment is one of the main sources of work-related stress risks.Many surveys have emphasized that work can be a source of satisfaction for various human needs, such as self-realization, maintaining interpersonal relationships or making decisions, and an indispensable resource for workers (Seijas, 2019).
It is important to note that among the most frequent mental illnesses in the educational group is work stress; this is the imbalance between the demands of a job and the human intellect for its performance, where this precision leads to a basic point, activated by professional stress and related functions of cognitive effects (Párraga and Escobar, 2020).

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The burnout syndrome is a response to professional stress; it is an ability made up of cognitions, sensations, and attitudes that deny the duty and the people with whom they are related through their work (Rivera-Porras et al., 2019).This condition has been identified as a threat to tasks related to working with individuals, such as education, vitality, and human interests.
Teaching is recognized as a task that is prone to triggering this phenomenon, as it involves carrying out different actions inside and outside the classroom, such as going with classmates and students, transforming curriculum planning and evaluation, and participating in organizational activities (Rodríguez, 2017).
Various variables have been identified that may be involved in the individual's protective mechanisms against stressors.In the risk of burnout syndrome, the cause is considered multifactorial, given the dimension of antecedents that are directly or indirectly related to coping with work or teacher stress; however, the factors could be classified into personal and social variables.Personal variables are catalogued as those that determine a type of attitude to stress: gender, family organization, previous optimism before work and perhaps the predominant type of personality (Sabio et al., 2019).
Insomnia is the most common sleep disorder in general and one of the most pressing reasons for seeing a therapist during a psychiatric consultation.The assessment and treatment of insomnia are very challenging; the arousal often goes unnoticed or unheard, which contributes to the aggravation of the therapeutic and psychological levels of those who suffer from it (Martínez, 2019).
It is estimated that about one third of the population suffers from insomnia (difficulty falling asleep or staying asleep).If only nocturnal symptoms are considered, this figure drops to 10% when daytime consequences are considered, so that the clinical syndrome can be considered complete.Chronic insomnia affects between 6% and 10% of the population (Martínez, 2019).
The inefficiency in the development and/or maintenance of sleep, as well as the aid to recovery or photo stimulation, has a significant impact on the subsequent sexual abstinence of the patient and can be the cause of various damages in the physical and partial state.This disorder is associated with mild cognitive impairment, particularly in attention to complex tasks, consolidation of sleep memory, and some aspects of executive function (Martínez, 2019).
Stress and anxiety are the body's natural response or awareness of imminent danger.They can create the alerts and triggers needed to deal with these risks or threats and find solutions (Ramos-Narváez et al., 2020).However, it becomes a problem when it is too intense or disproportionate to the stimulus, for too long (when the danger or challenge has passed or is no longer manageable), or too often.
Arousal and the stimuli it triggers whose main purpose is to mobilize resources for survival, are incompatible with sleep.Therefore, when these feelings persist over time, they cause psychophysiological problems such as insomnia (Colorado Sleep Institute, n.d.).
To sleep well, you need good sleep hygiene and the right psychology.Stress or anxiety, even in its mildest form, can make it difficult to sleep.
There is a physiological explanation for this: during periods of stress and anxiety, various hormones are produced to prepare the body to respond to the threat.Among other things, this altered state alters our circadian rhythms, which control various aspects of our daily metabolism.Lack of melatonin production, lack of adrenaline, and a busy mental state combine to make it impossible for our bodies and minds to relax (Campillo, 2020).
Similarly, sleep deprivation can lead to increased fatigue the next day, which leads to a deterioration in mood and attitude; over time, this leads to a variety of physiological problems that exacerbate these problems, so that insomnia can worsen and lead to more severe episodes of anxiety (Rivera-Porras et al., 2018).

Method
It is important to note that there are several research methods, but for this systematic review article the qualitative method was chosen because it is used to study how people observe, understand, and analyze a particular issue.In this sense, it is known that qualitative research is the science and art of describing a group or culture, that it is a particularly valuable approach because it problematizes how citizens constitute and interpret societies.In the same way, it is a means that facilitates the learning of cultures because it provides the researcher with forms of organizing knowledge, behavior, and skills, also using and interpreting their experiences (Hernández et al., 2014), in terms of sources of information.A selection of key DECS (Descriptors in Health Sciences) and MESH (Medical Subject Titles) terms was made (see Table 1).  1 were used, considering the publication base from 2015 to 2021.It should also be added that the languages found were English and Spanish.Some terms were included in the review because they could be translated.On the other hand, it is important to mention that for this review the PRISMA methodology was used, implementing thesauruses in the information search process, where the selection of the different studies was made by applying inclusion and exclusion criteria, which allowed the evaluation of the reliability and quality of the investigation, answering the research question (Beltrán, 2005;González and Balaguer, 2021) (see Table 2).("Stress Disorders, Post-Traumatic" OR "Tension" OR "Anxiety" OR "Anguish" OR "Fatigue" OR "Exhaustion") ("Burnout, Professional") DNA ("Absenteeism") ("Insomnia" OR "Wakefulness" OR "Worry" OR "Restlessness" OR "Nervousness") AND ("Sleep Initiation") ("Tiredness" OR "Wasting" OR "Exhaustion" OR "Weakness" OR "Debilitation" OR "Reluctance" OR "Fatigue") ("Mental Fatigue") AND ("Exhaustion") ("Behaviour" OR "Pattern" OR "Proceed" OR "Performance" OR "Tactics" OR "Custom" OR "Habit") ("Conduct") AND ("Adaptation, Psychological") ("Antisocial Personality Disorder") ("Rejoicing" OR "Complacency" OR "Delight") AND ("Job Satisfaction") AND ("Personal Satisfaction") ("Solitude" OR "Abandonment" OR "Withdrawal") AND ("Social Isolation") ("Restlessness" OR "Anxiety" OR "Anguish" OR "Uneasiness" OR "Concern") AND ("Performance Anxiety") ("Occupation" OR "Position" OR "Exercise" OR" Execution" OR "Practice" OR "Fulfillment" OR "Function") DNA ("Physical Functional Performance") ("Identity OR "Character" OR "Temperament" OR "Genius" OR "Style") ("Dissociative Identity Disorder") Source: authors.
According to what is indicated in Table 2, it is possible to observe the different equations that have been used to obtain the necessary information to carry out this systematic review article, which was oriented in an English language and in Spanish, finding the databases mentioned above and considering the categories selected for the development of this article.
On the other hand, it was necessary to formulate the research question; for this purpose, the PICO tool was added, as it is very useful to improve the specificity and conceptual clarity of the clinical problems to be studied, as well as to improve the quality of the searches and the accuracy, which allows to address adequate and precise data to answer the problem question (Landa- Ramírez and Arredondo-Pantaleón, 2014).Considering the research question posed, the different components that make up the PICO strategy were identified, as can be seen in Table 3, which led to the following research question: What are the symptoms of stress and sleeplessness that influence burnout syndrome in secondary basic education teachers?
Table 3 Question PICO

Data extraction process
To this end, an Excel spreadsheet was created by the authors, in which the key elements of each of the selected studies were listed.

Study characteristics
First of all, the behaviours, strategies and situations related to the identified research are associated, considering the characteristics assigned to the variables studied.

Information sources
The information used was obtained from the review of research published in high-impact journals in the following databases: PubMed, Science Direct, REDALYC, SCIELO, Dialnet, Proquest, and Scopus.

Eligibility criteria
Within the criteria of eligibility of information are the scientific evidence in a range of temporality of the last five years, considering the selection of variables related to stress and insomnia and burnout syndrome, sleep disorders, among others.

Search
The entire search was conducted in English and Spanish for SCIELO, REDALY, SCOPUS, PROQUEST, and PUMD, based on the mining of titles and abstracts using the search engines available in the databases used (see Table 4).

Table 4
Search equations according to the database

Selection of studies
The studies were selected by searching the databases using the specific variables of the study, to obtain an overall result of articles of different types of research.

Inclusion criteria
Articles related to the functioning and development of stress insomnia and burnout syndrome guide the characteristics of the bad habit faced by teachers exposed to a period of intensity that prevents performance, compliance, and satisfaction of daily life, mismanagement of stress viralizes various factors, generating depersonalization, emotional exhaustion, and lack of personal fulfillment both in the mental and physical health of the teacher.

Exclusion criteria
Articles on stress, insomnia, and burnout syndrome; articles that are conducted in contexts other than the intervention process; studies in the population of the health care environment and caregivers; descriptive studies.

Selection and analysis
First, we considered the preliminary selection of studies based on the review by inclusion criteria, population characteristics, study type, and year.Subsequently, an Excel registration table prepared by the authors was independently completed, specifying the key elements of each of the selected studies (see Tables 5, 6, and 7).Finally, the process of identification, screening, eligibility, and inclusion of articles was described in summary form, following the structure suggested by the PRISMA statement (Urrútia and Bonfill, 2010).

Table 5
Filters applied Source: Authors.

Database
Table 5 shows the results obtained in the five databases used, where a total of 11645 documents were found, while in PUBMED the total number of articles found was 2341.These 15 articles were selected by applying the appropriate filter.In addition, PROQUEST yielded data from 1235 articles, from which three documents were selected, and SCIELO yielded 3585 documents.In REDALYC, 1626 manuscripts were found, and only two documents were selected after the filters.Finally, in SCOPUS 2858 manuscripts were found from which nine articles were selected, making a total of 30 documents taken as samples.

Figure 1
Flowchart of the study selection process Source: Authors.
The selected studies are presented below.

Stress and insomnia
A link has been found between stress and insomnia, and as this affects people, sleep reactivation is associated with the disposition to stress that interrupts sleep, which translates into difficulty falling asleep and staying asleep (Spiller et al., 2021;Ouellette et al., 2018).High sleep reactivity is also associated with the risk of shift work disorder, depression, and anxiety.It is important to emphasize that worry and work are related to stress, which can exploit sensitive sleep systems, increasing the pathogenicity of sleep reactivity.Now we can identify those people at risk of insomnia in the future; the aim is to identify a population to intervene and promote this problem caused by overwork and long shifts (Kalmbach et al. 2018).

Stress and burnout
Stress can be defined as an unpleasant experience associated with a particular environment and can include feelings of anger, tension, frustration, and anxiety.Stress can have a negative effect on people's lives in relation to work or the environment in which they live; it develops in excessive work demands with low and little emotional support; job satisfaction has been associated with a high level of stress because the long hours of work and the work and cognitive load that the human being can maintain in his daily life generate excessive stress.Several factors have been identified that influence good job satisfaction and are able to generate personal coping strategies and social support, although most of the identified predictors of stress and satisfaction can be classified as predictors at the individual level (age, experience, selfefficacy) or at the organizational level (culture and work environment, workload, principal's leadership style and role management).Workrelated stress and burnout continue to increase as teachers are faced with increasingly difficult student behaviors to manage (Ouellette et al., 2018;Schonfeld et al. 2019;Zhang et al. 2021).

Insomnia and burnout
In recent years there has been an increase in mental health problems related to insomnia, worry, environmental strategies, and academic engagement due to levels of worry and cognitive avoidance strategies.Job burnout can lead to sleep problems.The prevalence of insomnia is due to the high hours of overwork that a person can observe in his or her job; therefore, insomnia and burnout have a certain relationship; one predicts the other and can cause a loss of sleep due to the work exploitation acquired by the teacher.Insomnia, one of the most common sleep disorders, is the inability to initiate or maintain sleep or to achieve sufficient sleep duration and quality to restore normal energy and alertness (García-Campayo et al., 2016;Matsuyama et al., 2021;Kuriyama et al., 2022).Worry is a cognitive component of the anxiety response that processes and organizes information to cope with future-threatening situations.In addition, insomnia and worry have been associated with reduced work and academic engagement, which is a positive, sustained, emotional, and cognitive state related to a specific task.Stressful situations can affect teachers psychologically, putting their cognitive, emotional, and physical parts at risk (Imran et al., 2020;Campillo, 2020).

Discussion
In this sense, it is known that professional stress occurs when there are dissatisfactions or restrictions in the environment where the person carries out his/her work; his/her preparation faces ineffective situations, with the effect of stress reserve; but the deterioration of the teacher's vitality as a consequence of this produces the burnout syndrome, which is a response to chronic professional stress.
The amplitudes that stand out in the burnout syndrome are related to episodes of stress and alertness, which in turn cause emotional exhaustion, depersonalization, and failures in personal performance at work (Putwain et al., 2020;Sousa et al., 2021;Galanis et al., 2021).
People with burnout syndrome have similar cognitions, sensations, and prohibitions, such as feelings of failure, disappointment, nervousness, and work inefficiency, among others.The dysfunctions presented by the syndrome are physical and psychological.A teacher suffering from burnout syndrome presents at maximum frequency according to his/her official time strength, because of the attention and contributions he/she presents between the students and the educational committee.Depending on the negative actions presented, it will be the level of the developed syndrome.It should be noted that it is important to admit stress to indicate the progress of emotional commitments so that a negative reaction to burnout syndrome does not develop.Educational institutions should organize plans for the promotion and prevention of the vitality of their staff (Torres, 2021).
The concept of burnout has caused much debate due to the confusion it causes when distinguished from other concepts, but Van Someren (2021), Kalmbach et al. (2018), andSalvagioni et al. (2017) state that burnout does not overlap with other psychological constructs.
It is also necessary to mention how burnout differs from other psychological concepts; it can be pointed out that this syndrome is different from general stress, work stress, physical fatigue, depression, sadness, boredom, or depression with job dissatisfaction and significant events and crises in the East.Long life, although some similar symptoms or developmental processes are involved (Lee et al., 2019).
Work stress is understood as the interaction between the high psychological demand, under control (decision) on work, and under social support that the individual receives from other workers and headquarters; that is, an unpleasant, tense environment and conflictive relationships.Stress can infer the relationship between satisfaction and pleasure that the individual has with work and the quality of life of this same; sometimes high levels of stress tend to reduce the quality of life of the individual, creating risk factors it associated with their work environment.The lack of mechanisms to adapt to work situations can become a problem product of chronic wear and tear on the person (Vidotti et al., 2019;Theorell et al., 2015;Brownlow et al., 2020).
Burnout syndrome is characterized by a set of symptoms that indicate the worker's burnout, manifested by a lack of physical and mental energy (mental exhaustion), loss of interest in work (reduced personality), and feelings of weakness and self-esteem (low professional accomplishment).The consequences of the syndrome are detrimental to individuals and organizations due to reduced psychosocial wellbeing, absenteeism, and job dissatisfaction, as well as putting the safety of staff and patients at risk (Vidotti et al., 2019;Párraga and Escobar, 2020;Sparks et al., 2021).

Conclusions
Sleep deprivation and insomnia are very common disorders due to a variety of causes, including stress, environmental, and emotional factors.Anxiety, on the other hand, is usually restlessness or agitation associated with an acute illness.Insomnia is the subjective feeling that you can't sleep when you want or as much as you want.It is the most common sleep disorder and has many causes.The duration of insomnia is the most important guide to its assessment and treatment.Temporary insomnia (within a few nights) or short-term insomnia (within three weeks) can be associated with a variety of medical conditions (Lozano, 2020).
Work-related stress has been studied and different explanatory models have been proposed because different social conditions can act as stressors and change people's health (Pereiro and Rodríguez, 2008), as well as the impact of stress triggers, including socio-demographic variables such as age, income level and gender, and other everyday variables in which workers have negative stress-related experiences.
Repeated periods of stress often precede burnout and are interpreted as burnout at work.It results from the interaction of variables in the work and personal environment, involving a variety of symptoms and emotions associated with work stress.These symptoms are characterized by emotional distress, lack of energy, detachment and ridicule, incompetence, poor professional self-image and hostile attitudes towards work, various psychological symptoms such as nervousness, anxiety, sadness, low self-esteem and job dissatisfaction, and physical symptoms such as respiratory diseases and allergies (Aguirre et al., 2018).Burnout syndrome is a major problem among teachers of formative use, which has become very popular in our country in recent years.In the course of this study, it was found that professional stress increases the number of events at the physical and psychological level for teachers and workers who are involved in long periods of work.In addition to this, their way of life and the way they carry out their daily tasks are reduced, and there is also a prevalence of disturbed sleep, commonly referred to as wakefulness, which leads to an imbalance in the physical and cognitive functioning of the individual.
In terms of socio-demographic characteristics, we have a young population with an average age of 34.83 years, which varies as 71.1% are men and only 28.9% are women.However, although burnout syndrome is more common in women than in men, due to the double burden of work and family, no relationship was found between the presence of burnout syndrome and gender.Schools should apply the MBI as a strategy to control the possible appearance of the syndrome, periodically and for teachers who have been in the exercise of their work for many years; that is, where you can diagnose and seek solutions if you are suffering, thus improving the quality of life of teachers (Aguirre et al., 2018;Torres, 2021;Merchán-Galvis et al., 2018).
In conclusion, it can be said that burnout syndrome tends to be more pronounced among teachers since they have direct contact with people, and the economic and political factors of today have a direct influence on the development of their daily activities.In this way, when all these factors come together, one can suffer from burnout.For this reason, preventive measures should be taken in educational institutions to avoid more burnt-out and stressed professionals (Torres, 2021).
Description Q: Patient or problem of interest (Population) Teachers of secondary basic education I The bibliographical review of the research articles was carried out by searching various academic electronic databases, among which the scientific material search engines Scielo, Scopus, Redalyc, PubMed, and ProQuest are mentioned to carry out the research.The categories established for this research are stress, insomnia, and burnout syndrome, through a systematic review that allows orientation from psychology.It should be noted that to search for this information, a series of keywords mentioned in Table

Table 6
Selected studies Source: authors.