Adolescence is a transitional stage from childhood
to adulthood and is a time of major changes in all areas of functioning.
Children and adolescents can experience various life stresses ranging
from catastrophic or traumatic life events, persistent strain and daily
hassles. Academic matters are the most important sources of chronic and
sporadic stress for young people in both Western and Asian countries,
and has significant associations with mental health problems, such as
depression, anxiety and suicidal ideation [1,2].
There is an increasing concern regarding study
pressure and its relationships with mental health problems among school
children and adolescents in India. Suicide is the third leading cause of
death among adolescents, and unrevealed depression is a major cause.
Academic stress may be contributing factor in depression. This study
aimed to explore the relationship between depression and academic
A case-control study was conducted at selected higher
secondary schools in Tamil Nadu, between July 2013 and January 2014.
Ethical approval was obtained from the Institutional Ethics Review Board
and formal permission was obtained from the Chief Education Officer,
Thiruvallur District and the Principals of the selected private schools.
The samples were recruited from three private and one government higher
A total of 2432 school-going adolescents studying in
class 9th to 12th were screened using MINI-Kid [3,4], which is a
screening tool for depression. 640 students who scored highly in the
MINI-kid were subjected to further assessment by the Psychiatrist, who
confirmed their depressive status. 612 students from this high-scoring
group were enrolled as cases whereas 612 students who had a low score in
MINI-kid were enrolled into the control group. Prior to data collection
informed consent form was handed over to these 1224 students; 1198
parents gave their written informed consent. Finally 1120 adolescents
(560-cases and 560-control group) were confirmed as the study sample.
Beck Depression Inventory (BDI)  a
psychometrically sound measure for screening depression among
adolescents , was administered to the Case group. BDI was used
specifically to classify the these adolescents into minimal, mild,
moderate and severe depression. Modified Educational Stress Scale for
Adolescents  was administered to both the Case and Control groups.
The scale is based on the Ziandong Sun’s educational stress scale for
adolescents, which includes 6 dimensions and 30 items. This scale had 20
items and 6 dimensions. The Educational Stress Scale for Adolescents is
considered a suitable measure for school-based mental health research in
Asia . In the present study, reliability score for Beck Depression
Inventory was 0.85, and for Modified Educational Stress Scale was 0.81.
Statistical analysis: Statistical analysis was
performed using the Statistical Package for Social Sciences Programme
(SPSS) version 17.0. Descriptive statistics and inferential statistics
such as Student’s independent t-test, Karl Pearson correlation
coefficient, Chi square test, Odds Ratio, and Multivariate logistic
regression was used for analysis.
Of the 612 adolescents diagnosed with depression
during the study period, 45.7% had moderate, 25.4% had mild, 19.6% had
severe, and 9.3% had minimal depression as per BDI.
In Case group, the mean (SD) academic stress score
was 78.4 (4.67) whereas in Control group it was 41.9 (5.61). The
percentage difference (95% CI) score between case and control was 36.5%
A moderate positive relationship was found between
the level of depression and the level of academic stress. The r value
was 0.52 at P<0.001 level (Fig. 1).
Fig. 1 Scatter plot shows the positive
correlation between depression score and stressful life events
Adolescents with academic stress were found to have
2.4 times (95% CI=0.9-2.4) (P<0.001) more risk of having
depression than the adolescents without academic stress. Demographic
variables such as late adolescents, girls, XII standard, Tamil medium,
and government school students had significant association with academic
stress in Case group.
The study findings revealed that the overall mean
academic stress score difference between case and control group was
36.5. In case group 75% of the adolescents experienced severe academic
stress whereas in control group 87% of the adolescents experienced mild
These findings were consistent with previous studies
, which found academic achievement to be significantly correlated
with depression and Self- expectations. Parent and teachers expectations
were the main sources of academic stress among adolescents. Adolescent
girls had higher academic stress than boys, similar to a previous Indian
The current study is limited because of adolescents
sickness, absenteeism, unwillingness, incomplete questionnaires, and
lack of matching. The findings implied that academic stress is
associated with depression among adolescents. Adolescents with severe
academic stress have to be identified early, and prompt interventions
will likely prevent or ameliorate depression. Students should be
counselled for stress factor by school counsellor or school heath nurse.
Teachers should try to remove academic stress generating factors from
learning environment by taking appropriate steps.
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