［Original Article］

Relationship between Burnout, Mental Health, and Assertivenessamong Nursery school teachers of Children with Special Needs
Mami Shiratori

Graduate School of Comprehensive Human Sciences, University of Tsukuba/
Department of Child Education, Teikyo Junior College

Michio Kojima

Faculty of Human Sciences, University of Tsukuba

Motoko Igarashi

Department of Child Studies, Shiraume Gakuen University

Abstract
Background: It has been suggested that caring for children with special needs in the generalclassroom is a dangerous stressor that can lead to poor mental health among nursery school teachers.
Another problem in Japan is the existence of nursery school teachers who hold certiﬁcations but do
not work as nursery school teachers, or who leave their jobs because of workplace relationships.
Objective: To investigate the mental health of nursery school teachers when caring for children
with special needs, we will identify the relationship between stressors, mental health, and burnout
measures. Additionally, to examine the relationship between assertiveness and the mental health ofnursery school teachers because it is expected to reduce relationship stress.
Method: A questionnaire was administered to nursery school teachers. Covariance structure
analysis was used to determine the stressors scale in Inclusive Education (SSIE), burnout (J‑MBI),
mental health (J‑WHO‑5), and self‑assertion (J‑RAS) in an inclusive childcare environment forJapanese nursery school teachers.
Results: Approximately 60% of nursery school teachers were found to be in the mental healthdisorder group. Furthermore, it was veriﬁed that an increase in J‑RAS not only decreases SSIE but
also increases J‑WHO‑5 and may decrease burnout tendency. Nursery school teachers who currently
care for children with medical care needs argued that they are more likely to experience stressors.
Conclusion: Nursery school teachers who care for children who need medical care are expected
to experience worsening mental health, and immediate support is needed. Since nursery school
teachers with high levels of assertiveness also have high values of mental health, we hope that
assertiveness training for nursery school teachers will be developed.
Keywords: Japanese nursery school teachers, children with special needs, stressors and psychologicalresponse

1.

Introduction

In Japan, preschool facilities are divided into three categories: kindergartens for educational
purposes for children aged 3 to pre‑elementary school, under the jurisdiction of the Ministry of
Education, Culture, Sports, Science and Technology (MEXT); nursery schools and child welfare─ 18 ─

Journal of Developmental Disabilities Research No. 1

facilities for children aged 0 to pre‑elementary school, under the jurisdiction of the Ministry of
Health, Labor and Welfare (MHLW); and certiﬁed childcare facilities that combine the functions ofboth kindergarten and nursery school, under the jurisdiction of the Cabinet Oﬃce (CAO). According
to the survey conducted from 2021 to 2022, the number of children in nursery schools isapproximately 2.6 million (MHLW, 2022), whereas the number of children in kindergartens is nearly
0.92 million (MEXT, 2022). Meanwhile, the number of children in certiﬁed childcare facilities is 1.06
million (Cabinet Office, 2021). According to Ikeda and Okawa (2012), kindergarten teachers andchildcare workers are similar in several aspects, but they have diﬀerent stressors and stress‑related
factors. Thus, the present study examines a sample of nursery school teachers in day‑care centers,
representing the largest group of subjects among those working in preschool facilities in Japan.
In recent years, the demand for childcare facilities has been rapidly increasing due to theincrease in number of dual‑earner families, and the “Plan for Securing Nursery School Teachers”(launched by the Ministry of Health, Labor and Welfare in 2015) made the securing of nursery school
teachers an important issue in Japan. However, there is still an acute shortage of nursery school
teachers, and the deteriorating mental health of such teachers has been indicated as the main reason
for this shortage. A survey using the Japanese version of the Kessler Screening Scale for
Psychological Distress (K6) has been conducted to clarify the mental health of nursery school
teachers. The results indicated that 60.0% of nursery school teachers showed a prevalence of
psychological distress (K6 score ≥ 5) (Yaginuma‑Sakurai et al., 2020). In addition, according to
Akagawa and Kimura (2019), up to 20% of nursery school teachers are already in a state of burnout(Akagawa and Kimura, 2019).Given this situation, investigating the mental health of nursery school
teachers would be helpful in preventing early job turnover. The high prevalence of burnout has also
been noted in many countries (Aboagye et al., 2018; Tasic et al., 2020). The poor mental health ofnursery school teachers can be considered an issue in many countries around the world.
Further, the number of children with special needs is increasing in Japan. According to a survey
conducted in 2018, the percentage of the number of nursery schools that reported having children
with special needs was as high as 83.2% (MHLW, 2017). With the Salamanca Declaration, the idea andpractice of inclusive education have become a global principle and are becoming more widespread in
the country. The United Nations Educational, Scientiﬁc and Cultural Organization (UNESCO) deﬁnes“special educational needs” to include not only children with disabilities but also gifted children,
street children, working children, children from remote areas, nomadic children, and other children
living in disadvantaged or remote areas. Children living in remote areas, nomadic children, and otherdisadvantaged or marginalized children are all in need of support (UNESCO, 1994). In response tothis trend, the core curriculum for teaching in Japan, which clariﬁes the qualities and abilities thatshould be commonly acquired in teaching programs, has been revised since 2017 to include children
with special needs, such as those who have problems with their mother tongue and poverty andhave learning and living difficulties and those who need systematic support. In the curriculum,children with special needs include those who have problems with their native language and poverty,
learning or living diﬃculties, or organizational needs (MEXT, 2017).
It has been suggested that caring for children with special needs is a dangerous stressor thatcan lead to poor mental health in nursery school teachers. Faulkner et al. (2016) explored the workstress of childcare providers through semi‑structured interviews. Among the stresses of childcare
providers, dedication to the impact of factors, such as poverty and domestic violence on children, wascited. It was also elucidated that identifying problems faced by children and providing support toparents, especially single parents, also contribute to the stress of childcare workers (Faulkner et al.,─ 19 ─

Journal of Developmental Disabilities Research No. 1

2016). However, deﬁning children with special needs is very diﬃcult (Japan Council for Childcare
Issues, 2021). Hence, previous studies have limited the scope of children with special needs tochildren with disabilities (Štemberger and Kiswarday, 2018) or categorized them by the presence orabsence of a disability label (Kiso, 2016). Most of the scales employed in previous studies to identify
concerns about inclusive education have also been developed with the assumption that children withdisabilities would be integrated into general classes (Jobe et al., 1996; Sharma and Desai, 2002).
Against this background, stress among nursery school teachers must be investigated considering thediverse and changing perceptions of children with special needs.
It has also been reported that the stress of nursery school teachers is largely inﬂuenced by theirperceptions and personal characteristics. Finding a relationship between cognitive appraisals andstress in nursery school teachers, Friedman‑Krauss et al. (2014) reported that teachers who
perceived higher levels of childrenʼs behavioral problems also felt higher levels of stress from theirwork and that this relationship was statistically significant (Friedman‑Krauss et al., 2014). An
American study on early childhood teachers who teach children from infants to third grade has
noted that the impact of inclusive education on their concerns is mediated by their conﬁdence inteaching children with disabilities (Park et al., 2018). In addition, the study has also examined thepersonal characteristics of caregivers, such as self‑eﬃcacy, past childcare experience, whether they
have had contact with children with disabilities, gender, age, grade level taught, academic status, andtraining.
Therefore, the present study focused on assertiveness, which has never been investigated as apersonal factor aﬀecting stress. Assertiveness is a method of self‑expression that started in the 1970sin the U.S. It refers to communicating appropriately while respecting the other person, rather thanstating oneʼs point of view one way or the other. The concept of assertiveness was popularized inJapan by Hiraki (1993). A related study on nurses reported that developing assertive communication
allows them to communicate their feelings in an honest and appropriate manner, leading to stress
reduction and improved mental health (Daigo et al., 2010). Furthermore, According to Jovanović et al.
(2019), teachers who are in charge of children with developmental disabilities have less work‑relatedburnout than teachers with higher levels of assertiveness (Jovanović et al., 2019). According to asurvey by the Tokyo Metropolitan Governmentʼs Bureau of Social Welfare and Public Health (2018),
workplace relationship is the principal reason why nursery school teachers leave their jobs. Sincesuch teachers are expected to communicate with several people, including parents and colleagues,
they must have the ability to manage stress related to workplace relationships. Thus, learning
assertive communication is expected to help nursery school teachers effectively build healthy
workplace relationships and reduce overall stress.
In the current research, the relationship between stressors, mental health, and burnout scales
will be clariﬁed to investigate the mental health of nursery school teachers when caring for children
with special needs. Yoshikane and Hayashi (2010) explored the relationship between the presence or
the absence of a child with developmental characteristics in the classroom and the burnout index. In
this study, nursery school teachers were more likely to experience burnout than kindergarten
teachers, highlighting that nursery school teachers spend more time with children as a factor(Yoshikane and Hayashi, 2010). Additionally, according to Kiso (2013), as the number of undiagnosed
developmentally disabled children increases, nursery school teachers are more likely to suﬀer fromburnout(Kiso, 2013). A study in Turkey also aﬃrmed that having integration students enrolled or notin the current class did not aﬀect the burnout index of preschool teachers (Sahbaz and Kocer, 2017).
Comparing these studies is diﬃcult simply because they were conducted in diﬀerent countries, and─ 20 ─

Journal of Developmental Disabilities Research No. 1

the instruments utilized were distinct from each other. In addition, there have been no studies
conducted on nursery school teachers or on whether children with special needs are enrolled in the
program, which made us feel the need to investigate this issue.
Furthermore, this study will clarify the relationship between assertiveness and mental healthburnout among nursery school teachers. Given that nursery school teachers interact with many
people, including children, colleagues, and parents, they must learn how to communicate assertively.

2.

Research Methods

In this study, we conducted a questionnaire survey of nursery school teachers. The survey
examines whether the stressors of caring for children with special needs aﬀect mental health andburnout and their relationship with assertiveness as a personal factor. An online survey was chosen
as the method of data collection because it is more eﬃcient to survey nursery school teachers in awide range of communities.
2.1

Procedure
The survey was commissioned to an Internet research company (Rakuten Insight) that has
roughly 2.2 million registered monitors. According to the 2018 survey, of the 1.54 million registerednursery school teachers, 590,000 are working as nursery school teachers (MHLW, 2020a). The numberof registered nursery school teachers is 590,000 out of 1.54 million. We conducted a screening andselected 300 nursery school teachers who are certiﬁed as nursery school teachers and are currently
working as classroom teachers in childcare centers to complete this survey. Care was taken to makethe bias due to region and age as even as possible to prevent bias due to regional diﬀerences andage. The survey was sent out on March 12, 2021 and the collection of 300 respondents was completed
on March 15, 2021. The valid response rate was 100% as the system was designed so that responses
could not be completed in case of incompleteness.
As an ethical consideration, this study was conducted after obtaining approval from the ****
Ethical Review Committee (approved November 1, 2020; No. 21). The survey system was initiatedonly after the research subjects reviewed and agreed to the privacy policy of the Internet ResearchCompany Survey (https://member.insight.rakuten.co.jp/explanation/privacy/). It is clearly stated in
the terms of use that the information obtained from the survey and the individual will only bepresented in a form that cannot be identiﬁed and will not be used for any purpose other than that of
the survey.
2.2

Participant
The subjects were 300 nursery school teachers who were qualiﬁed and currently working asclassroom teachers. As for gender, 14(4.70%) were males, 286(95.3%) were females, 65(21.7%) were in
their 20s, 129(43.0%) were in their 30s, 66(22.0%) were in their 40s, and 29(13.3%) were in their 50s orolder. As for the type of employment, 222(74.0%) were in standard employment, 18(6.0%) in non‑standard employment, and 59(20.0%) in part‑time employment, and 1(0.3%) were others. The lasteducational background of 43(14.4%) students was vocational school, 180(60.0%) were junior college,
75(25.0%) were university, and 2(0.70%) were other. As for the classes they oversaw, 186(62.0%) werein the infant class, 100(33.3%) were in the toddler class, 11(3.7%) were in free charge, and 3(1.0%) werein other classes. With regard to the establishment entities, 88(29.3%) were public, 167(55.7%) weresocial welfare corporations, 32(10.7%) were stock companies, and 13(4.3%) were others.
─ 21 ─

Journal of Developmental Disabilities Research No. 1

In Japan, the Core Curriculum for the Teaching Profession, which clarifies the qualities andabilities that should be commonly acquired in teaching programs, has clearly indicated theunderstanding and support for children who need special support, such as those who have problems
with their mother tongue or poverty, learning or living difficulties, or need systematic support(MEXT, 2017). In the present research, children with special needs were classiﬁed into the following
seven categories: (1) children diagnosed as having disabilities, (2) children without a diagnosis buthaving special developmental needs, (3) children experiencing poverty, (4) children having needs forsupport due to their family environment, (5) children having been abused, (6) children requiring
language support due to foreign nationality, and (7) children calling for medical care. For each item,
the respondents were asked to answer in three ways: “currently in caring,” “have experience incaring,” or “have no experience in caring” (Table 1). Regarding whether they have looked afterchildren diagnosed as having disabilities, 62(20.7%) were currently in caring, and 162(54.0%) had
experience in caring. In terms of whether they have overseen children without a diagnosis buthaving special developmental needs, 129(43.0%) are currently in caring of such children, and133(44.3%) have overseen such children. In regard to whether they have had experience in caring forchildren who require medical care, 19(6.3%) are currently in charge, and 198(66.0%) had no experiencein taking charge, with the largest number of the respondents having no experience in taking caring.
2.3 Measurement method
2.3.1 The Stressor Scale in Inclusive Education
We employed the Scale in Inclusive Education (SSIE), which was developed by the authors. The
scale comprises ﬁve questions ranging from “I do not feel stress at all” to “I feel very stressed” whenassuming stressful situations in inclusive education. The questionnaire consists of 21 items, including“diﬃculty in dealing with children” (eight items), “human relations with parents and other children in
the class” (seven items), “insuﬃcient self‑expertise” (two items), “burden of keeping childcare records”(two items), and “insufficient support from colleagues” (two items). This scale has Cronbachʼsreliability coeﬃcients of α = .84 to .93, which ensures internal consistency, based on a survey of 211
nursery school teachers. On the basis of the results of conﬁrmatory factor analysis, the goodness ofTable 1

Experience in caring for children with special needs

Experience in caring for children with special needs

Currently inchargeHaveexperiencein caringNoexperiencein caring

N

%

N

%

N

%

(1)

Children diagnosed as having disabilities

62

20. 7

162

54. 0

76

25. 3

(2)

Children without a diagnosis but having special
developmental needs

129

43. 0

133

44. 3

38

12. 7

(3)

Children experiencing poverty

32

10. 7

99

33. 0

169

56. 3

(4)

Children with needs for support due to their family
environment

72

24. 0

149

49. 7

79

26. 3

(5)

Children having been abused

31

10. 3

99

33. 0

170

56. 7

(6)

Children requiring language support due to foreign
nationality

40

13. 3

110

36. 7

150

50. 0

(7)

Children requiring medical care

19

6. 3

83

27. 7

198

66. 0

─ 22 ─

Journal of Developmental Disabilities Research No. 1

ﬁt of the model is X²=384.144, df = 197, GFI = .869, AGFI = .832, CFI = .919, RMSEA = .067, and AIC= 469.144, and the validity can be veriﬁed (Shiratori & Kojima, 2022). Nonetheless, as this scale wasdesigned for nursery school teachers in ﬁve prefectures, mainly in the Kanto region, out of the 47
prefectures in Japan, it must be veriﬁed whether the factor structure can be replicated for nurseryschool teachers in a wider range of regions.
2.3.2 Burnout scale
The Maslach Burnout Inventory, which was translated into Japanese by Tao and Kubo wasutilized (Kubo and Tao, 1992; Maslach and Jackson, 1981). J‑MBI has also been studied with nurseryschool teachers, and its reliability and validity have been veriﬁed (Akagawa and Kimura, 2019; Kiso,
2016). The questionnaire consists of 17 items, with three subscales, namely, “emotional exhaustion”(five items), which includes feeling mentally fatigued at work and wanting to quit work,“depersonalization” (six items), which includes avoiding contact with colleagues and children andfeeling less meaningful at work, and “decreased sense of personal accomplishment” (six items), which
includes feeling joyful, enthusiastic, and satisﬁed at work. The survey also comprises three subscales.
The responses were based on a ﬁve‑point scale (1‒5) ranging from “always” to “never.” The total
score for “personal accomplishment” was reversed to “decreased personal accomplishment,” with ahigher total score indicating higher burnout symptoms.
2.3.3 Mental health level
The “WHO‑ﬁve Well‑Being Index Japanese Version (J‑WHO‑5)” developed by the World HealthOrganization (WHO) was employed. The responses were based on a six‑point scale (0‒5) ranging
from “never” to “always.” A total score of 13 or more points indicates good mental health, and a scoreof 13 or less indicates poor mental health (Awata et al., 2007). A total score of 13 or higher indicatesgood mental health, while a score of 13 or lower indicates poor mental health to create a stress scale
for nursery school teachers and to examine its reliability and validity.
2.3.4 Assertiveness scale
J‑RAS, translated by Suzuki et al. (2004) and completed after a review by several researchers,
including a translator from the U.S., was used (Rathus, 1973; Suzuki et al., 2004). Seventeen of the 30
items are reversed items, and the higher the total score after processing the reversed items, themore assertive the respondents. After processing the reversed items, the higher the total score, themore assertive the respondents. The minimum and maximum score ranges are from −90 to +90. In
the current study, the nursing students were surveyed, and the mean of the J‑RAS total score was−12.0 (±20.2) (Suzuki et al., 2004).
2.4

Analysis method
For SSIE and J‑MBI, the appropriateness of the factor structure was confirmed, andconfirmatory factor analysis was conducted with each item as the observed variable and themeasurement of each item as the latent variable.
For J‑MBI, we conducted conﬁrmatory factor analysis with each item as the observed variable
and each item as the latent variable. Multiple comparisons (Games‒Howell method) were performed.
The results of these comparisons were shown only if diﬀerences were found.
An analysis of covariance structure was conducted with the factors of SSIE, J‑WHO‑5, J‑MBI,
and J‑RAS as latent variables and the subscales of each scale as observed variables. Among thepaths between the assumed latent variables, those for which no signiﬁcant path coeﬃcients wereobtained were sequentially deleted one by one, starting with those with the smallest path coeﬃcients(standard estimates). Thereafter, the deletion was repeated while checking the signiﬁcance level of─ 23 ─

Journal of Developmental Disabilities Research No. 1

the other path coefficients, and the process was terminated when all the paths between latentvariables became signiﬁcant. The appropriateness of the model was judged comprehensively fromthe three indices of goodness of ﬁt index (GFI), comparative ﬁt index (CFI), and root mean squareerror of approximation (RMSEA).
Statistical analysis was performed using SPSS 27.0 and AMOS 26.0.

3.

Results

3.1

Factor structure and total score of SSIE and J‑MBI
Table 2 presents the mean values and standard deviations of SSIE and J‑MBI. The Cronbachalpha coeﬃcients were calculated to be high, ranging from α = .870 to .917 for SSIE and α = .789 to.879 for J‑MBI. The GFI (.823‒.859), CFI (.881‒.896), and RMSEA (.088‒.089). On the basis of acomprehensive review of the results, the factor structure of each scale was judged to be generally
appropriate.
3.2 Relationship between the personal attributes of nursery school teachers and SSIE, J‑MBI, andJ‑WHO‑5
A t‑test, one‑way analysis of variance, and multiple comparisons using the Tukey method wereconducted to clarify the relationship between the basic attributes of nursery school teachers and
SSIE, J‑MBI, and J‑WHO‑5.
Table 3 exhibits the relationship between basic attributes and SSIE. Signiﬁcant diﬀerences were
found in the age of nursery school teachers and “insuﬃcient self‑expertise” ( = .006‒.027). There wasa signiﬁcant diﬀerence between SSIE and the two subscales of “human relations with parents andother children in the class” and “burden of keeping childcare records” in terms of the relationshipwith the establishment of the childcare center ( = .002‒.024).
I would like to examine the relationship between J‑MBI. There was a significant difference
between the age of the nursery school teachers and “emotional exhaustion” and “depersonalization” (= .004‒.048). In “depersonalization,” there was a signiﬁcant diﬀerence in the relationship between thetype of employment and the establishment entity ( = .006‒.013) (Table 4).
For J‑WHO‑5, the maximum value was 25, the minimum value was 1, and the overall meanvalue was 12.8 (SD = 5.28). The mental health of the nursery school teachers was below the 13 points
that are in good mental health. This value is lower than the results of the study by Akada (2010),
Table 2 Results of the conﬁrmatory factor analysis of SSIE and J‑MBI and the mean values of subscales
Scale
SSIE

J‑MBI

Fitness Index

Subscale

GFI=. 823

Diﬃculty in dealing with children (8 items)

25. 85

6. 53

CFI=. 896

Human relations with parents and other children in
the class (7 items)

20. 78

5. 55

RMSEA=. 089

Insuﬃcient self expertise (2 items)

6. 59

1. 80

Burden of keeping childcare records (2 items)

6. 72

2. 05

Insuﬃcient support from colleagues (2 items)

5. 53

2. 05

GFI=. 859

Emotional exhaustion (5 itemes)

13. 48

4. 54

CFI=. 881

Depersonalization (6 itemes)

21. 35

5. 76

RMSEA=. 088

Decreased sense of personal accomplishment (6 itemes)

17. 35

4. 51

─ 24 ─

─ 25 ─Female
20s

30s
40s

50s and older
Full‑time
employment

2
1

2
3

4

Junior college
University

Other
Infant class

Toddler classFree charge

Other
Public

2
3

4
1

2
3

4
1

4

3

2

1

Other

Social welfare
service
corporation
Joint‑stockcompanies

Other
Vocational
school4

3

Part‑time
employment
Part‑time job

2

1

Male

1

‑

6. 54
6. 64

6. 28

‑

6. 15

5. 36

6. 69

6. 49

6. 84
6. 19

6. 59
6. 14

6. 53
4. 54

13(4. 3) 23. 8532(10. 7) 26. 78

167(55. 7) 25. 643(1. 0) 21. 00
88(29. 3) 26. 19100(33. 3) 25. 92
11(3. 7) 25. 09

6. 16

5. 88

6. 44

6. 24
6. 97

6. 30
8. 85

2(0. 7) 26. 00 12. 73
186(62. 0) 25. 93 6. 52

180(60. 0) 25. 93
75(25. 0) 25. 87

43(14. 3) 25. 470(0. 0)59(20. 0) 24. 53

18(6. 0) 25. 56

222(74. 0) 26. 1940(13. 3) 24. 98

129(43. 0) 25. 46
66(22. 0) 25. 64286(95. 3) 25. 96
65(21. 7) 27. 37300(100)
25. 8
14(4. 7) 23. 50

Factor Ⅰ

n. s.

n. s.

n. s.

n. s.

n. s.

n. s.

16. 15

19. 5920. 78

18. 33
21. 91

21. 51
20. 1815. 0020. 47

20. 83
21. 15

20. 21‑

19. 44

19. 3921. 22

19. 4020. 57
21. 27

20. 76
21. 57

20. 78
21. 21

5. 06

5. 78

5. 81

4. 93
4. 57

5. 42
5. 81

1. 41
5. 60

5. 64
5. 71

4. 87

‑

4. 76

4. 13

5. 77

6. 36

5. 61
5. 32

5. 65
5. 03

5. 55
2. 89

Factor Ⅱ

1‑4**
2‑4*

n. s.

n. s.

n. s.

n. s.

1‑2*

6. 15

6. 53

6. 48

6. 33
6. 88

6. 87
6. 18

5. 00
6. 46

6. 52
7. 07

6. 12

‑

6. 20

6. 56

6. 69

6. 00

6. 41
6. 71

6. 58
7. 17

6. 59
6. 64

1. 86

1. 76

1. 77

0. 58
1. 86

1. 80
1. 40

1. 41
1. 83

1. 73
1. 93

1. 73

‑

1. 60

1. 50

1. 87

1. 81

1. 82
1. 51

1. 80
1. 91

1. 80
1. 95

Factor Ⅲ

n. s.

n. s.

3‑1*

n. s.

1‑2*
1‑4**

n. s.

5. 38

6. 91

6. 59

4. 67
7. 10

7. 30
5. 82

5. 00
6. 49

6. 69
6. 92

6. 58

‑

6. 10

5. 94

6. 95

6. 05

6. 92
6. 47

6. 68
6. 98

6. 72
7. 50

1. 89

2. 19

2. 02

1. 15
2. 01

1. 87
2. 04

1. 41
2. 09

1. 99
2. 15

2. 17

‑

1. 84

2. 46

2. 03

1. 84

2. 17
2. 00

2. 03
1. 90

2. 05
2. 35

Factor Ⅳ

Relationship between the basic attributes of nursery school teachers and J‑MBI

1‑4*

1‑2**

n. s.

1‑2*

n. s.

n. s.

4. 54

5. 88

5. 67

4. 33
5. 30

5. 59
5. 27

4. 00
5. 54

5. 52
5. 64

5. 49

‑

5. 17

5. 11

5. 66

5. 50

5. 57
5. 26

5. 54
5. 77

5. 53
5. 36

2. 11

2. 24

2. 11

2. 08
1. 80

1. 85
2. 37

2. 83
2. 14

1. 96
2. 12

2. 28

‑

1. 65

1. 81

2. 15

2. 11

2. 05
2. 06

2. 04
2. 01

2
2. 21

Factor Ⅴ

n. s.

n. s.

n. s.

n. s.

n. s.

n. s.

Note:Factor Ⅰ Diﬃculty in dealing with children，Factor Ⅱ Human relations with parents and other children in the class，Factor Ⅲ Insuﬃcient self
expertise，Factor Ⅳ Burden of keeping childcare records，Factor Ⅴ Insuﬃcient support from colleagues. Gender was subjected to t‑test. Other items
were subjected to one‑way analysis of variance followed by the Tukey method as a subsequent test. * <. 05，** <. 01.

EstablishedClass inchargeFinal
educational
background

Employment
statusAge

GenderOverallN(%)

Table 3

Journal of Developmental Disabilities Research No. 1

Journal of Developmental Disabilities Research No. 1

Table 4

Basic attributes of nursery school teachers and their relationship to SSIE
Factor Ⅰ

Overall
Gender

Age

Employment
statusFinaleducational
background

Class inchargeFactor Ⅱ

Factor Ⅲ

13. 50

4. 54

21. 35

5. 76

17. 35

4. 51

1

Male

13. 00

3. 04

20. 50

4. 07

18. 36

3. 32

2Female13. 51

4. 60

21. 395. 83

17. 30

4. 56

1

20s

12. 32

4. 20

19. 85

5. 12

17. 06

4. 11

2

30s

12. 95

4. 65

21. 14

5. 95

17. 19

4. 71

3

40s

14. 52

4. 14

22. 35

5. 89

17. 704. 59

450s and older

15. 38

4. 56

22. 83

5. 42

17. 80

4. 44

1Full‑time
employment

12. 96

4. 53

20. 75

5. 88

17. 21

4. 63

2Part‑time
employment

14. 33

4. 77

22. 94

6. 01

18. 56

3. 93

3Part‑time job

15. 31

4. 00

23. 25

4. 69

17. 59

4. 22

4

Other

‑

‑

‑

‑

‑

‑

1

Vocational
school14. 445. 06

23. 07

5. 61

17. 19

4. 57

2Junior college

13. 36

4. 49

3University

13. 13

4. 15

n. s.
3‑1*
4‑2*
4‑1**

3‑1**

n. s.

21. 41

5. 82

20. 27

5. 40

n. s.

3‑1*
4‑1*

3‑1*

n. s.

17. 094. 35

18. 13

4. 77

4

Other

17. 5010. 61

20. 0012. 73

15. 00

8. 49

1Infant class

13. 394. 72

21. 40

5. 99

17. 43

4. 82

2Toddler class

13. 44

4. 20

3Free charge

15. 09

4. 83

4

Other

15. 001

Public2Social welfare
service
corporation

3

Joint‑stockcompanies

13. 28

3. 70

22. 25

5. 96

16. 66

4. 79

4

Other

15. 92

5. 14

26. 31

3. 43

18. 38

4. 11

Established

21. 18

5. 37

22. 18

5. 62

3. 00

20. 67

13. 33

4. 72

13. 41

4. 53

n. s.

16. 90

3. 86

18. 91

3. 67

7. 02

22. 00

5. 29

21. 17

5. 59

16. 82

4. 69

20. 89

5. 79

17. 69

4. 38

n. s.

n. s.

4‑1*
4‑2**

n. s.

n. s.

n. s.

n. s.

n. s.

n. s.

Note:Factor Ⅰ emotional exhaustion, Factor Ⅱ depersonalization, Factor Ⅲ Decreased sense of personal
accomplishment. Gender was subjected to t‑test. Other items were subjected to one‑way analysis ofvariance followed by the Tukey method as a subsequent test. * <. 05，** <. 01.

which revealed that the mental health status of nursery school teachers is deteriorating. The best
mental health status was found in the free charge category, with a score of 17.64. By contrast, theworst mental health status was 11.71 for male nursery school teachers. Although there was asigniﬁcant diﬀerence in mental health status depending on the class they were in charge of ( =.009‒.023), there was no signiﬁcant diﬀerence between the other basic attributes and J‑WHO‑5.
Finally, the relationship between J‑RAS and the basic attributes: the maximum total score of
J‑RAS was 42, and the minimum was −63, with an overall mean of −3.49 (SD = 16.41). Comparedwith a study conducted on nurses in Japan, −6.6 (SD = 19.7) for managerial nurses and −12.4 (SD =─ 26 ─

─ 27 ─12. 56
13. 21
11. 84
12. 08Junior college

University

Other

Infant class

Toddler classFree charge

Other

PublicSocial welfare service
corporation

Joint‑stock companies

Other

4

1

2

3

4

1

2

3

12. 67

17. 64

12. 8912. 51

11. 0012. 65

13. 01

12. 44‑

14. 32

13. 003Part‑time job

3

2

Part‑time employment2

12. 41

13. 50Other

Full‑time employment

1

Vocational school

50s and older

4

13. 02

440s

3

12. 74

12. 38

12. 88

11. 71

1

20s

30s

1

Female

2

2

Male

1

12. 82

6. 40

4. 95

5. 22

5. 35

3. 51

3. 91

5. 15

5. 33

11. 31

4. 93

5. 28

5. 75

‑

5. 63

4. 89

5. 16

5. 60

5. 30

5. 51

4. 60

5. 32

4. 25

5. 28

J‑WHO‑5

n. s.

3‑1**
3‑2*

n. s.

3‑1*

n. s.

n. s.

56. 15

48. 9448. 9048. 1952. 33

51. 55

48. 5249. 0850. 0048. 3948. 68

51. 47‑

52. 33

51. 94

47. 88

52. 43

50. 8648. 2846. 4949. 03

48. 5749. 01

8. 40

9. 48

9. 22

10. 25

13. 01

8. 66

8. 69

10. 11

25. 46

8. 95

9. 77

9. 30

‑

7. 72

10. 26

9. 80

9. 19

8. 87

10. 54

7. 71

9. 74

6. 80

9. 61

J‑MBI

n. s.

n. s.

n. s.

3‑1**

3‑1*
4‑1*

n. s.

‑3. 77‑5. 09‑2. 71‑4. 36

13. 50‑5. 79‑2. 57‑4. 14

13. 50‑5. 79‑2. 57‑4. 14‑‑0. 09‑3. 71‑3. 58

1. 53‑3. 18‑3. 01‑7. 86‑3. 690. 50‑3. 4915. 6015. 25

15. 5018. 66

13. 44

16. 05

15. 3920. 56

13. 44

16. 05

15. 3920. 56‑

17. 14

16. 13

16. 71

17. 01

12. 18

17. 36

17. 13

16. 25

19. 65

16. 41

J‑RAS

Relationship between the basic attributes of nursery school teachers and J‑WHO‑5 and J‑RAS

n. s.

n. s.

n. s.

n. s.

n. s.

n. s.

Gender was subjected to t‑test. Other items were subjected to one‑way analysis of variance followed by the Tukey method as asubsequent test. * <. 05，** <. 01.

EstablishedClass inchargeFinal
educational
background

Employment
statusAge

GenderOverall

Table 5

Journal of Developmental Disabilities Research No. 1

Journal of Developmental Disabilities Research No. 1

20.8) for new nurses (Suzuki et al., 2017), the assertiveness level of nursery school teachers was foundto be higher than that of nurses (Table 5).
Finally, all the groups with very low J‑RAS scores were in the J‑WHO‑5 low group. There wasalso a signiﬁcant diﬀerence in J‑WHO‑5 high and low groups with low or slightly low J‑RAS scores( < .001) (Figure 1).
3.3 Relationship between experience in caring for children with special needs and SSIE, J‑MBI,
and J‑WHO‑5
A one‑way analysis of variance was conducted to determine if there was a diﬀerence between
SSIE and SSIE according to experience in caring for children with special needs. After the analysis
of variance, the Tukey method was used for the multiple comparisons of equal variances, the Games‒
Howell method was employed for unequal variances, and significant differences were found only
between those with and without experiences in caring for children with medical care needs andSSIE. For the SSIE subscale “human relations with parents and other children in the class,” there
was a signiﬁcant diﬀerence ( = .010) between the SSIE subscale “human relations with parents andother children in the class” and SSIE. For the SSIE subscale “insuﬃcient self‑expertise,” there was asignificant difference between “have experience in caring childcare teachers” compared with “noexperience as a caring childcare teacher” ( = .031) (Table 6).
Subsequently, a one‑way analysis of variance was conducted to determine if there was adiﬀerence between J‑BMI and experience in caring for children with special needs. As there wereTable 6 Relationship between SCIE and the childcare experiences of children requiring medical care
Multiplecomparison

SSIE

Factor Ⅰ

Factor Ⅱ
Childrenrequiring
medicalcare

Factor Ⅲ

Factor Ⅳ

Factor Ⅴ

1

Currently in caring

3. 3

0. 9

2

Have experience in caring

3. 1

0. 8

3

No experience in caring

3. 2

0. 8

1

Currently in caring

3. 3

0. 5

2

Have experience in caring

2. 9

0. 9

3

No experience in caring

3. 0

0. 7

1

Currently in caring

3. 5

1. 0

2

Have experience in caring

3. 1

0. 9

3

No experience in caring

3. 4

0. 9

1

Currently in caring

3. 7

0. 7

2

Have experience in caring

3. 2

1. 0

3

No experience in caring

3. 4

1. 1

1

Currently in caring

2. 9

0. 8

2

Have experience in caring

2. 7

1. 0

3

No experience in caring

2. 8

1. 1

2. 0

0. 25

0. 818

n. s.

2. 0

3. 01

0. 011

1‑2**
1‑3*

2. 0

3. 61

0. 034

2‑3*

2. 0

1. 89

0. 070

n. s.

2. 0

0. 12

0. 829n. s.

Note:Factor Ⅰ Difficulty in dealing with children，Factor Ⅱ Human relations with parents and otherchildren in the class，Factor Ⅲ Insuﬃcient self expertise，Factor Ⅳ Burden of keeping childcare records，
Factor Ⅴ Insuﬃcient support from colleagues.
After one‑way analysis of variance, multiple comparison (Games‑Howell) was used. * <. 05，** <. 01.
─ 28 ─

Journal of Developmental Disabilities Research No. 1

Table 7 Relationship between J‑MBI and children requiring language support due to foreign nationality
J‑BMI
FactorChildrenrequiringlanguagesupportdue toforeignnationality

Ⅰ

Ⅱ

Ⅲ

Multiplecomparison

1

Currently in caring

13. 3

4. 9

2

Have experience in caring

13. 8

4. 7

3

No experience in caring

13. 3

4. 4

1

Currently in caring

13. 8

4. 7

2

Have experience in caring

21. 2

5. 8

3

No experience in caring

17. 6

4. 7

1

Currently in caring

13. 5

4. 5

2

Have experience in caring

21. 4

5. 8

3

No experience in caring

17. 4

4. 5

2. 0

0. 31

0. 734

n. s.

2. 0

0. 05

0. 949

n. s.

2. 0

3. 78

0. 024

1‑3*

Note:Factor Ⅰ Emotional exhaustion ，Factor Ⅱ Depersonalization ，Factor Ⅲ Decreased sense of personal
accomplishment. After one‑way analysis of variance, multiple comparison (Tukey) was used. * <. 05，** <. 01.

Figure 1 Distribution of J‑RAS score in J‑WHO‑5 high and low groups

equal variances, the analysis of variance was followed by multiple comparisons (Tukey), and theresults confirmed that nursery school teachers who had experience with “children requiring
language support due to foreign nationality” were more likely to have “decreased sense of personal
accomplishment” than their current counterparts ( = .026) (Table 7).
Finally, a t‑test was conducted to determine if there was a diﬀerence between the 181(60.3%)
children with good mental health status and the 119(39.7%) ones with poor mental health status in
J‑WHO‑5 and experience in caring for children with special needs. Consequently, no significant
diﬀerences were found in any of the items.
3.4

Examination of the model by covariance structure analysis
The SSIE, J‑MBI, J‑WHO‑5, and J‑RAS factors were used as latent variables, and the subscalesof each factor were employed as observables. For J‑RAS, the total score was calculated and utilized─ 29 ─

Journal of Developmental Disabilities Research No. 1

Figure 2 Model diagram of SSIE, J‑MBI, J‑WHO‑5, and J‑RAS

as an observational variable. According to previous studies, a model with a GFI of .94 or higher, an
AGFI of .90 or higher, and an RMSEA of less than .01 is considered to have a good ﬁt (Takagi andTanaka, 2003). During the creation of the model, the corrections were made repeatedly byintroducing error correlations based on correction indices. Consequently, the goodness of ﬁt indicesof the model that speciﬁed the interrelationships among the four scales showed acceptable ﬁt values(X² = 184.973, df = 72, GFI = .919, AGFI = .882, CFI = .937, RMSEA = .072, and AIC = 250.973).
Figure 2 illustrates that the path coeﬃcients of the model demonstrated a direct eﬀect from SSIE to
J‑MBI, but no path from SSIE to J‑WHO‑5. The J‑RAS total score was significant for the SSIE
subscale, insuﬃcient self‑expertise, and the direct eﬀect to J‑WHO‑5.

4.

Discussion

4.1 Relationship between the childcare experience of children with special needs and the SSIE,
J‑MBI, and J‑WHO‑5 of nursery school teachers
Children with special needs were categorized into seven items, and the relationship between
their childcare experience and stress‑related factors was clariﬁed. The results validated that there
was no significant difference between SSIE, J‑MBI, and J‑WHO‑5 for the items other than (6)children requiring language support due to foreign nationality and (7) children requiring medicalcare. There was no significant difference between SSIE, J‑MBI, and J‑WHO‑5. This result waspartially directed by the results of Sahbaz and Kocer (2017), who affirmed that the presence ofchildren with special needs did not aﬀect the burnout level of caregivers. Conversely, the results
were different from those of Kiso (2013) and Yoshikane and Hayashi (2010) and other studies
conducted in Japan, which argued that burnout was affected when caring for developmentallydisabled children or children with developmental tendencies (Kiso, 2013; Yoshikane and Hayashi,2010). In Japan, it has been reported that approximately 80% of nursery schools have children withspecial needs (MHLW, 2019b), and it is expected that children with disabilities and developmental
disabilities, even among those with special needs, are now expected to spend time together in regularclasses. Since the Salamanca Declaration, there has been a change in the awareness of nursery school─ 30 ─

Journal of Developmental Disabilities Research No. 1

teachers toward inclusive education and research on the practice in Japan (Hori, 2017). We believethat this may be because nursery school teachers have accumulated knowledge about disabilities andchildcare practices that are no longer directly connected to SSIE and J‑MBI.
Contrarily, there was a signiﬁcant diﬀerence between the SSIE subscales “human relations withparents and other children in the class” and “insuﬃcient self‑expertise” and the experience of caring
for children with medical care needs. In Japan, since Act for Eliminating Discrimination against
Persons with Disabilities in 2016, the Child Welfare Law has been amended, and the number ofchildren requiring medical care in nursery schools has increased dramatically (MHLW, 2020b).
According to a case study on children with medical care who use nursery schools, the inclusion ofchildren with medical care needs, children with disabilities, and healthy children in a class brings out
diverse needs and increases the number of diﬃcult situations for day‑care practices (Ueda et al.,2020). In addition, according to a questionnaire survey of nurses at nursery school caring for children
who require medical care, training for nursery school teachers is necessary because nursery school
teachers are currently providing medical care together with nurses (Sorata, 2014). The burden andrisk of providing safe and secure medical care in a non‑medical nursery school is great, and theimportance of supporting nursery school teachers in dealing with tension and accidents is required(Ueda et al., 2020). As revealed in the results of the present research, there are many nursery school
teachers who have no experience with the need for medical care in nursery schools, and childcare
practices and issues involving children with medical care have not been sufficiently accumulated(Matsumoto et al., 2019). Thus, the entire preschool must establish a system to prevent the burden
from becoming too great only on the nursery school teachers who oversee children with medicalcare, to accumulate childcare practices, and to improve the skills of nursery school teachers byenhancing training. It has also been elucidated that there is a chronic shortage of nurses in nurseryschools and that they do not adequately accept children who require medical care (Sorata, 2014).
Deciding for the placement of not only nursery school teachers but also nurses is crucial.
Similarly, there was a significant difference between the childcare experience of children
requiring language support due to foreign nationality and J‑MBIʼs “decreased sense of personal
accomplishment.” Hayashi (2021) aﬃrmed that in caring for children who need language support due
to their foreign nationality, understanding the diﬃculties of communication with children and parents
and their culture is necessary. This is not a problem that can be solved by simply communicating in
the language, but it is expected that the inability to communicate due to diﬀerences in the mothertongue leads to a decrease in the sense of personal accomplishment of the nursery school teachers.
There are some reports that translation and dissemination applications are used to supplement
linguistic communication with parents, but there is a large disparity in the dispatch of interpreters
among local governments, and the actual situation is that it is left to the eﬀorts of the nursery school
teachers to respond (Hayashi, 2021). In a national survey report, the following issues were also
identiﬁed as challenges in caring for children with foreign nationality: “It is diﬃcult to communicate
the detailed nuances of concerns to parents” and “It is diﬃcult to understand the speciﬁc problems
and needs of children with foreign roots and their parents” (MHLW, 2019a). This suggests that it is
not a problem that can be solved simply by being able to communicate in a language, but that theinability to communicate due to diﬀerences in native languages leads to a decline in the personalsense of accomplishment of nursery school teachers. In the future, utilizing foreign nursery school
teachers who understand multicultural childcare, accumulating practical experience in the childcare
ﬁeld, and training nursery school teachers in multicultural understanding and communication will beessential.
─ 31 ─

Journal of Developmental Disabilities Research No. 1

According to Fukushima and Shimizu (2017), who examined knowledge about developmental
disabilities and the factors that inﬂuence burnout among nursery school teachers, it was noted thatthe level of knowledge about developmental disabilities depends on whether nursery school teachers
are aware of it or not. In this study, the importance of the balance between personal knowledge andsocial support is highlighted as stress is higher when nursery school teachersʼ knowledge of inclusive
education is high but social support from colleagues in the workplace is low(Fukushima and Shimizu,2017). The importance of balancing personal knowledge and social support is aﬃrmed. In addition,
Friedman‑Krauss et al. (2014) asserted that teachers who reported higher levels of child behavior
problems also reported higher levels of stress from their work and that this relationship was
statistically significant. This relationship is statistically significant (Friedman‑Krauss et al, 2014).
Therefore, future research should focus on nursery school teachers who feel strongly about SSIE andadditionally investigate the reasons for this and their working environment.
4.2

Related models of SSIE, J‑MBI, J‑WHO‑5, and J‑RAS
The relationship between SSIE, which is a stressor in caring for children with special needs,
J‑MBI and J‑WHO‑5, which are stress responses, and J‑RAS, which is a personal factor, wasanalyzed by covariance structure analysis. Additionally, the relationship between SSIE, a stressor incaring for children with special needs, the stress responses, J‑MBI and J‑WHO‑5, and the personal
factor, J‑RAS, was analyzed by covariance structure analysis. The results conﬁrmed that although
SSIE directly aﬀected burnout, there was no direct path between SSIE and J‑WHO‑5. In addition, a
direct path was found from J‑RAS to the stressors insuﬃcient self‑expertise and mental health. Thissuggests that an increase in the assertiveness total score may reduce the stressor, increase mental
health, and reduce burnout tendencies. This result supported a study by Jovanović et al. (2019),
which examined the special needs of teachers working with children with developmental disabilities,
and the assertiveness level is a stressor and stress response to burnout and mental health. It was
found to be one of the personal factors that inﬂuence (Jovanović et al, 2019).
4.3

Mental health and assertiveness of nursery school teachers
It is worth noting that 181(60.33%) of the nursery school teachers were considered to have poor
mental health, with an overall mean of 12.82 (SD = 5.28) in J‑WHO‑5. In Japan, there is a serious
problem of early turnover and shortage of nursery school teachers (Kiso, 2018). Stress and burnout
among nursery school teachers are problems in many countries (Grant et al., 2019; Lim and Kim,
2014), and eﬀorts to reduce the burden on nursery school teachers and create a comfortable work
environment are required. In addition, according to a study conducted by the OECD in 2020, nurseryschool teachers are more likely to feel stressed when the percentage of children with special needs
exceeds 11% of the class (OECD, 2020). The results of the present study corroborated that
employment condition part‑time employees are more likely to suﬀer from emotional exhaustion on
the burnout scale compared with full‑time employees. These hard aspects, such as the number ofchildren, working conditions, and environment, cannot be improved by individual nursery school
teachers. Efforts to improve mental health should not be left to the efforts of individual nurseryschool teachers but should include a preschool‑wide support system, training initiatives, working
conditions, and class sizes.
I would also like to discuss the assertiveness scores of nursery school teachers. The mean
assertiveness score of the nursery school teachers was −3.49 (SD: 0.97). The higher the J‑RAS score,
the higher was the value of mental health. Conversely, a study of nurses indicated that a J‑RAS
─ 32 ─

Journal of Developmental Disabilities Research No. 1

score of −10 to +10 was unlikely to lead to burnout, and that too high a score can also lead toburnout (Suzuki et al., 2006). Suzuki et al. (2007), who investigated the relationship between
assertiveness and burnout among new nurses, argued that a J‑RAS score of 10 to +10 was less likely
to lead to burnout (Suzuki et al., 2007). Nevertheless, it has been highlighted that nurses have very
low assertiveness scores because they are required to act as a mediator between doctors andpatients and because they are in a profession where medical accidents directly aﬀect human lives(Suzuki et al., 2017). Accordingly, comparing the assertiveness scores of nurses and nursery school
teachers is diﬃcult. As there have been very few studies on assertiveness in nursery school teachers(Shiratori et al., 2021), a comparative study on mental health and burnout is an area for future
investigation.
4.4

Limitations of this study and future issues
It is good to note that by using an online questionnaire, we were able to obtain responses fromall 47 prefectures, covering all nursery school teachers. However, a certain amount of bias must be
considered as the target audience was users registered as monitors with the research company.
Since it has been pointed out that it is very diﬃcult to accurately grasp the concerns in promoting
inclusive childcare (Park et al., 2018), cross‑sectional surveys have their limitations. It is important to
conduct additional research, such as interviews, on the relationship between stress among nurseryschool teachers and caring for children with special needs and stress among nursery school teachers.
Let us talk about future issues. Assertiveness is strongly associated with self‑trust, self‑
disclosure, etc., and is deeply related to stress in interpersonal relationships (Hiraki, 1993). According
to Park et al. (2018), early childhood teachersʼ concerns about inclusive education are mediated byteachersʼ background variable “confidence,” and training to improve confidence is of paramountimportance(Park et al., 2018). This is the most important factor. The acquisition of assertive
communication is expected to lead to self‑belief and self‑conﬁdence, which, in turn, will improve themental health of nursery school teachers. Assertion training for nursery school teachers in the future
must be developed as there have been no research reports on assertion training for nursery school
teachers in Japan.
Statements and declarations
Competing interests
The authors have no relevant ﬁnancial or nonﬁnancial interests to disclose.
Funding
Funding was provided by the Mitsubishi Foundation.

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