Emotional Labor, Social Support, and Posttraumatic Growth as Factors Associated with Depression and Anxiety in Elementary School Teachers: A Cross-Sectional Study

Article information

J Korean Acad Psychiatr Ment Health Nurs. 2025;34(3):320-329

Publication date (electronic) : 2025 September 30

doi : https://doi.org/10.12934/jkpmhn.2025.34.3.320

Seon-Jeong Im¹, Hee-Joo Oh², Suk-Sun Kim^,3

¹Graduate Student, College of Nursing, Ewha Womans University, Seoul, Korea

²Ph.D. Candidate, College of Nursing, Ewha Womans University, Seoul, Korea

³Professor, College of Nursing, Ewha Womans University, Seoul, Korea

Corresponding author: Kim, Suk-Sun College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-2885, Fax: +82-2-3277-2850, E-mail: suksunkim@ewha.ac.kr

- This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (No. NRF 2022R1A2C2004867 & RS2025-00513687)

Received 2025 June 23; Revised 2025 August 25; Accepted 2025 September 18.

Abstract

INTRODUCTION

Mental health issues among elementary school teachers in South Korea have been increasingly prominent, especially after several teacher suicides drew national attention [1]. According to the National Health Insurance Service [2], 9,446 elementary school teachers received treatment for depression in 2024, representing 2.5 times increase from 3,744 in 2018. Similarly, 7,104 teachers were treated for anxiety in 2024, nearly twice the 3,728 cases reported in 2018[2]. Depression and anxiety, which are known precursors to suicidal behavior [1], are especially concerning among elementary school teachers due to their high-stress work environment. Given the rising prevalence and their potential link to suicide, understanding the factors associated with depression and anxiety is essential for developing effective preventive strategies.

To better understand the underlying factors contributing to depression and anxiety among teachers, the Job Demands-Resources (JD-R) model [3] provides a comprehensive framework for examining how job demands, job resources, and personal resources impact mental health. According to this model, job demands are physical and psychological pressure that arise from social or organizational environments. These demands, when excessive, can negatively affect both physical and mental health. In contrast, job resources include social or organizational supports that help individuals achieve work goals and promote professional growth. Personal resources are internal beliefs and capacities that allow individuals to manage and influence their environment. Both resources help protect against the harmful effects of stress and play a critical role in maintaining and promoting mental health [3]. The extended JD-R theory further expands these concepts by emphasizing that demands and resources arise from multiple domains, including job, home, personal, and organizational spheres, and that their interaction influences the health impairment process [3].

Guided by the JD-R model [3], this study investigates how diverse work-related and personal factors affect teachers' depression and anxiety. Emotional labor, which involves suppressing genuine emotions and displaying those expected by others at work [4], acts as a major job demand that can adversely affect mental health [3]. For elementary school teachers, it is a significant source of stress that has been strongly associated with exhaustion, depression, and anxiety [1,5,6]. Elementary school teachers reported higher levels of emotional labor than other teachers, largely due to the specific characteristics of their occupational role [5]. Most elementary school teachers, as homeroom teachers, spend most of their working hours with students in the same classroom and supervise them even during breaks [1]. They also interact more frequently with parents, since younger children's education requires greater parental involvement [1]. Moreover, societal expectations demand that teachers maintain professionalism by suppressing negative emotions [1,5,6]. These prolonged emotional labor in high-intensity interpersonal contexts increases their susceptibility to mental health difficulties [1,4-6].

Furthermore, emotional labor is not a single behavior, but a multidimensional concept which can affect mental health in different ways. Morris and Feldman [4] describe four main dimensions: how often teachers have to show emotions, how strong or long their efforts last, how many different emotions they need to express, and emotional dissonance, which means the difference between what they really feel and what they show. Previous studies have emphasized the importance of examining these dimensions separately to capture the complexity of emotional labor and its mental health implications [6]. However, few studies have examined how these specific subdimensions relate to mental health among elementary school teachers. Addressing this gap, the present study investigates which aspects of emotional labor are most strongly associated with depression and anxiety for elementary school teachers in South Korea, with the goal of informing targeted mental health interventions for them.

In contrast, social support as a job resource that can alleviate the adverse consequences of work-related stress such as emotional labor [3]. Previous studies reported that teachers who perceive greater social support tend to demonstrate better psychological well-being [7,8]. However, prior research suggests that the psychological benefits of social support may vary by source, as support from family often differs in meaning and effect from that provided by friends or others [7,8]. Despite this, most research treats social support as a single factor, overlooking these differences. To address this gap, this study categorized social support into three subdimensions such as family, friends, and significant others to determine its unique contribution to teachers' mental health.

Psychological trauma among teachers may result from student misbehavior, verbal abuse, and malicious complaints from parents [9]. Previous studies indicate that emotional labor is associated with trauma-related symptoms, including posttraumatic stress disorder (PTSD) [10], suggesting that elementary school teachers who frequently engage in such labor may be particularly at risk. Posttraumatic growth (PTG) has been conceptualized as constructive psychological development that emerges through challenging life experiences [11]. It may involve discovering personal strengths, improving relationships, or rethinking life values [11]. Although traditionally studied in trauma-exposed groups like soldiers or healthcare workers, PTG has also been observed in people facing intense job-related stress [12]. The development of PTG is facilitated through meaning making as a central mechanism, in which individuals reinterpret traumatic experiences and reframe their outlook on the future [9,11,12]. In addition, social support provides the relational and emotional resources necessary for this transformation [9,11,12]. In this study, PTG was conceptualized not merely as an outcome but as a facilitator of personal resources, strengthening individuals' capacity to buffer against job demands [3,13]. PTG has also been associated with fewer depressive symptoms [14] as well as enhanced resilience and optimism [13].

Taken together, these findings suggest that the complex interplay of work-related demands, social resources, and personal resources shapes depression and anxiety among elementary school teachers. While emotional labor, social support, and posttraumatic growth have each been linked to mental health outcomes, few studies have comprehensively examined their combined influence-particularly within the unique cultural and educational context of South Korea. Accordingly, the present study aimed to examine the relationships among emotional labor, social support, posttraumatic growth, depression, and anxiety, and to identify key predictors of depression and anxiety in elementary school teachers. By exploring both risk and protective factors within the JD-R model framework, this descriptive correlational study seeks to provide empirical evidence that may inform more targeted and effective mental health interventions that are both theoretically sound and contextually relevant (Figure 1).

Fig. 1.

Revised JD-R model in the present study.

METHODS

RESULTS

1. Differences in Depression and Anxiety by Sample Characteristics

The 155 samples consisted of 40 men (25.8%) and 115 women (74.2%). Participants' mean age was 34.81±7.23 years, ranging from 23 to 56 years. The mean of teaching experience was 10.33±6.43 years, ranging from 0.17 to 30 years. Table 1 shows that most participants were in their 30s (48.4%), married (52.9%), had no religion (68.4%), and held a bachelor's degree (68.4%). In addition, a third had 5~10 years of teaching experience, and nearly 90% were currently working as homeroom teachers.

Table 1.

Participant Characteristics and Comparisons of Depression and Anxiety (N=155)

Depression scores differed significantly according to religion (t=2.97, p=.004), while anxiety levels showed significant differences by both gender (t=-2.38, p=.018) and religion (t=2.09, p=.038).

2. Descriptive Statistics of Study Variables

Tables 1 and Table 2 present descriptive statistics for depression, anxiety, emotional labor, social support, and PTG. The mean score for depression was 17.06±13.12. Based on the CES-D cutoff score [22], 20.0% of participants were classified as probable depression and 27.7% as definite depression. The mean anxiety score was 44.92±13.61, with 69.0% scoring above the anxiety cutoff score of 38.5 [25].

Table 2.

Descriptive Statistics and Correlations among Study Variables (N=155)

4. Multiple Regression Results for Predictors of Depression

In Table 3, the regression model predicting depression was statistically significant (F=13.05, p<.001) and explained 39% of the variability (adjusted R²=.39). All assumptions of regression analysis were met, including no multicollinearity (tolerance=0.396~0.876; VIF=1.142~2.522), and independence of residuals (Durbin-Watson=2.101). Also, visual inspections of residual and P-P plots confirmed the assumptions of linearity, homoscedasticity, and normality. Religion (0=no, 1=yes) was dummy-coded and entered as a control variable.

Table 3.

The Result of Multiple Regression for Depression (N=155)

The results of the multiple regression analysis indicated that emotional dissonance (β=.39, p<.001) as a subscale of emotional labor and religion (β=.21, p=.002) were significant risk factors for depression. In contrast, family support (β=-.21, p=.014), and posttraumatic growth (β=-.17, p=.019) were identified as protective factors for depression. Other variables were not statistically significant.

5. Multiple Regression Results for Predictors of Anxiety

The predictors of anxiety identified through multiple regression analysis are summarized in Table 4. The model was statistically significant (F=15.69, p<.001) and explained 46% of the variability in anxiety. All assumptions for regression analysis were met, including no multicollinearity (tolerance=0.390~0.877; VIF=1.141~2.565), and independence of residuals (Durbin-Watson=2.120). Residual and normal probability plots confirmed the assumptions of linearity, homoscedasticity, and normality. Gender (0=male, 1=female) and religion (0=no, 1=yes) were dummy-coded and included as control variables.

Table 4.

The Result of Multiple Regression for Anxiety (N=155)

Multiple regression analysis indicated that emotional dissonance (β=.45, p<.001), a subscale of emotional labor, was a significant risk factor for anxiety, while family support (β=-.31, p<.001) and posttraumatic growth (β=-.25, p<.001) were protective factors. Other variables were not significant.

DISCUSSION

Grounded in the JD-R model, this study identified emotional labor, social support, and PTG as independent variables, serving as job demands, job resources, and personal resources, respectively, and examined their effects on depression and anxiety in elementary school teachers.

The average depression score was 17.06±13.12, which is higher than the 15.45±9.56 reported among teachers in Brazil [15]. According to the CES-D cutoff point, this score indicates probable depression, and nearly half of participants were classified as experiencing depressive symptoms [21]. The average anxiety score was 44.92±13.61, which is also higher than the 39.60±8.78 reported among Indian teachers [26]. These findings suggest that South Korean elementary school teachers may face a heightened risk of depression and anxiety, potentially due to high emotional labor. Such risk may be understood within collectivist cultural contexts, particularly in Eastern societies (e.g., China), where the emphasis on social harmony and culturally prescribed emotional display rules structurally increases teachers' daily emotional labor, thereby intensifying the risk of emotional dissonance and its psychological consequences (e.g., depression and anxiety) [4,6]. The regression analysis revealed that among the subscales of emotional labor, emotional dissonance significantly predicted increased levels of depression and anxiety among elementary school teachers. This finding aligns with previous research on call center employees, which demonstrated that the suppression of authentic emotions to meet organizational expectations induces emotional dissonance and, in turn, leads to mental health difficulties, including depression and anxiety [3,27]. Emotional dissonance arises from suppressing one's genuine emotions to conform to social expectations, and the resulting psychological exhaustion may increase depression and anxiety [3,27]. This is especially relevant for teachers, whose high role demands and frequent interpersonal interactions make them more susceptible to emotional dissonance and its negative impact on mental health [1]. Interestingly, among the subscales of emotional labor, frequency of emotional display (FE) and attentiveness to display rules (AR) were not significant predictors of depression and anxiety. This finding supports prior research suggesting that emotional dissonance-stemming from a mismatch between genuine and expressed emotions-has a greater impact on mental health than quantitative aspects of emotional labor, such as its frequency or attentiveness to display rules [28]. Emotional dissonance may represent the most psychologically detrimental aspect of emotional labor for teachers. These findings underscore the importance of implementing mental health interventions that alleviate teachers' internal emotional conflicts arising from the expression of inauthentic emotions, rather than solely reducing the frequency of emotional labor. Therefore, implementing emotional regulation programs or psychoeducational interventions is warranted to help teachers recognize and effectively manage emotional dissonance. In addition, further studies should investigate the effect of emotional dissonance on depression and anxiety across diverse teaching populations.

Conversely, within the three subscales of perceived social support, only family support emerged as a significant mitigating factor for depression and anxiety, whereas support from friends and significant others was not significantly associated with depression or anxiety. The present findings are partially consistent with previous studies conducted among teachers. While the protective role of family support aligns with prior research [7,8], international studies have also demonstrated that support from school administrators serves as a mitigating factor for depression and anxiety [7]. In addition, support from colleagues has been shown to improve mental health by enhancing work engagement [8]. These findings contrast with the current results. As Korean elementary school teachers typically work independently in their classrooms, opportunities for emotional interaction with colleagues are structurally limited [1], which may partly explain why support from significant others was not statistically significant. Nevertheless, emotional support from other sources may still play an important role in teachers' mental health. The warmth and emotional support provided by family help individuals overcome psychological crises and serve as important resources for mental health [8]. Given these characteristics, such stable and enduring emotional support systems may have been particularly important in alleviating depression and anxiety among elementary school teachers in Korea. Furthermore, in Korean culture, emotional connectedness and psychological stability are often fostered through family time and participation in family rituals [29]. These cultural factors may also account for the lack of significant effects of support from friends and significant others in this study. Therefore, it is necessary to develop and systematically implement family counseling and intervention programs for elementary school teachers who lack sufficient family support or experience familial conflict. In addition, family-friendly policies-such as the adoption of flexible work arrangements-should be strengthened to ensure that teachers can spend adequate time with their families and experience emotional stability.

Posttraumatic growth (PTG) was also identified as a significant factor in reducing depression and anxiety among elementary school teachers. Previous research on patients has shown that individuals with high PTG tend to cope with negative experiences rather than engaging in self-blame or pessimism [14], which may contribute to reduced depression and anxiety. Most previous studies have examined trauma-exposed groups, including patients, military personnel, and disaster survivors [12], with few investigating PTG as an independent predictor of depression and anxiety. Therefore, the findings of this study warrant cautious interpretation. Despite certain limitations, this study contributes empirical evidence of an association between PTG and lower levels of depression and anxiety in everyday occupational settings. Future research should further explore this relationship across diverse occupational groups, including middle and high school teachers.

Meanwhile, religious affiliation was identified as a risk factor for increased depression among elementary school teachers. This finding corresponds with prior research showing that religious individuals may experience spiritual struggles-including doubts about their faith, moral conflicts, and confusion regarding the ultimate meaning of life-when exposed to stress, thereby increasing depression [30]. In this regard, elementary school teachers, whose professional roles emphasize moral integrity and dedication, may be particularly susceptible to spiritual struggles when their religious values conflict with the emotional labor or occupational stressors inherent in their work. Thus, spiritual assessment and intervention should be considered for teachers experiencing depressive symptoms [30]. Faith-based psychological interventions may offer effective support for teachers facing spiritual conflict between religious beliefs and work-related demands. Further studies are recommended to clarify the role of spiritual struggle in the mental health of teachers, particularly within the Korean educational context.

This study makes a significant theoretical contribution by applying the Job Demands-Resources (JD-R) model as a framework for analyzing the impact of emotional labor, posttraumatic growth, and social support on depression and anxiety among elementary school teachers. Emotional labor was analyzed in terms of three subscales-frequency of emotional display, attentiveness to display rules, and emotional dissonance-while social support was categorized into support from family, friends, and significant others. By examining the effects of each subcomponent, the study identified emotional dissonance and family support as salient predictors of depression and anxiety, thereby offering concrete guidance for the development of more targeted psychological interventions.

However, this study has limitations in generalizability, as it employed convenience sampling of elementary school teachers who voluntarily participated through an online survey. In addition, the cross-sectional design restricts the assessment of how the variables evolve and interact over time. As prior research on emotional dissonance and posttraumatic growth in elementary school teachers remains limited, the findings should be interpreted with appropriate caution. Nevertheless, these results may serve as a valuable foundation for future research. Future research should conduct more in-depth analyses of the various components of emotional labor and posttraumatic growth in relation to teacher mental health, and adopt longitudinal designs to clarify developmental changes and causal relationships. In particular, qualitative studies grounded in the Korean cultural context are needed to better capture the unique experiences of elementary school teachers.

CONCLUSION

To gain deeper insight into the psychological risk and protective factors among elementary school teachers, this study used the Job Demands-Resources (JD-R) model to examine the roles of emotional labor, social support, and posttraumatic growth. Findings indicate that internal conflict caused by the gap between teachers' genuine emotions and the emotions expected in their professional roles significantly increased levels of depression and anxiety. Therefore, it is important to provide teachers with emotional regulation training and psychological support to help them recognize and manage emotional dissonance effectively. Conversely, family support and PTG were identified as protective factors that mitigate depression and anxiety. These findings highlight the importance of fostering emotional stability through family support and promoting PTG in teachers facing adversity. To this end, family-centered counseling programs should be implemented alongside institutional measures such as flexible work arrangements and extended parental leave. Additionally, interventions that facilitate PTG in the context of occupational stress should be prioritized. Lastly, religious affiliation emerged as a risk factor for depression. This may reflect spiritual struggles stemming from conflicts between personal religious beliefs and occupational demands. Accordingly, faith-based psychological interventions should be considered for teachers experiencing such distress. Overall, these findings provide foundational evidence for the development of targeted, theory-driven mental health interventions and policy strategies aimed at improving the psychological well-being of elementary school teachers.

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