Mental health helpline services for students during matriculation exam results: A unique psychosocial intervention model

ABSTRACT

Background:

During and after the matriculation exam results, students face a lot of pressure, anxiety, stress, and depression, and this is associated with deliberate self-harm and even suicide. Hence, the government of Karnataka launched a helpline service in collaboration with National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. This helpline provided psychosocial support to 10^th standard students before, during, and after their exam results.

Aim:

To understand the major stressors associated with the matriculation (SSLC) exam results and to provide psychosocial support.

Materials and Methods:

A qualitative research design was used, and the study was conducted in Karnataka state, India. The helpline was accessible to all Karnataka 10^th standard students and their family members. The helpline number was publicized widely on state news media platforms, including government websites. The data used for this study included all the calls received on this helpline during May 2022.

Results:

About 532 students called the helpline. The average age of the caller is 15.5 years. There were more male students (62%) than female students (38%). The callers reported psychosocial issues such as informational concerns (238%), emotional and behavioral disturbances (36%), family issues (13%), and subject-related issues (12%). These issues were addressed by professionals with primary, secondary, and tertiary level interventions.

Conclusion:

Students are worried about their exam results. It may have short-term and long-term impacts on their mental health. Therefore, this unique model suggests remedial measures such as psychosocial care for students.

Introduction

Education is empowerment and essential in one’s life. It is the key to success in the future and to having many opportunities in our lives. It is the right of every child, and it fosters academic skills and skills required to lead a successful career. It is an essential element in every child’s life. While studying, children are exposed to large-scale constructive opportunities that make their future life easier.[1]

Students in secondary and tertiary education settings face various ongoing stressors related to academic demands. Research indicates that academic-related stress can reduce academic achievement, decrease motivation, and increase the risk of school dropout. The longer-term impacts, which include reduced likelihood of sustainable employment, cost governments billions of dollars each year.[2,3]

Academic stress is a main source of stress for many students. Academic stress relates to mental distress associated with some anticipated frustration because of academic failure or even realizing the possibility of such a failure.[3]

The causes of academic stress can be classified mainly into seven categories, i.e., the stress due to exam results, peer pressure, anticipation of failure in an exam, societal status, parental pressure, bad results, writing exams, deadlines, and academic difficulties. These can arise from different school-based sources of stress, such as school work, discipline and classroom management procedures, extracurricular activities, and public performance.[4]

The concept of academic stress is known to everyone, but is often neglected by teachers and parents, as they play a major part in the causative role. Strict parenting styles, academic pressures from schools, and parental pressure are some of the most noticeable stressors that cause mental distress among matriculation (10^th standard) students.[3]

Studies show that helplines are generally a population-level resource for providing accessible, timely, easy-to-access, and anonymous counseling and information.[5] The various helpline services intend to provide free emotional support in a confidential, accessible format via telephone, and with more recent technological advancements, via SMS/text messaging or online “chat.” Helpline services aim to serve large-scale community populations.[6,7]

Research describing therapeutic approaches such as phone-based cognitive behavior therapy (CBT) has successfully helped callers in Israel who were worried about a threat of a military attack on their country.[8,9] For many people needing mental health, emotional support, and substance abuse services, crisis hotlines provide services to many people. Over 300,000 crisis calls were answered by the national hotline over five years and provided support to males and females between the ages of 10 and 89.[6] Telephonic helplines are the first step to breaking the barriers for people to reach out for help, moving forward from the planning to the action stage.[8]

Students are loaded with various pressures, and peer and parental pressure add to their problems. Anxiety, stress, and depression due to results and excessive force are associated with deliberate self-harm and even suicide.[10,11] Hence, the government of Karnataka launched a helpline service in collaboration with the Department of Psychosocial Support in Disaster Management (DPSSDM), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. This helpline provided psychosocial support to matriculation (10^th standard) students before, during, and after their results were announced. Literature on help-seeking behaviors among students has shown that whenever they have such psychological issues owing to failures in examinations or study-related challenges, they approach a nearby primary health care center rather than a mental health facility. They complain of headache, stomach ache, sleep disturbance, or vague body pain, which are considered to be psychosomatic responses when there is no demonstrable physical disease. This may lead to a wrong diagnosis and treatment, which will result in poor outcomes if primary health care physicians are not trained in mental health. Therefore, such health care professionals, especially primary care providers, need to be aware of common psychological problems faced by students during stressful times like examinations. In addition, primary health care must provide a spectrum of care, including mental health services, which are being integrated at all levels of health care. This is happening all over the world, including India.

Materials and Methods

Study design

A qualitative research design was used in the study to assess psychosocial issues and provide psychosocial support to matriculation (10^th standard) students during their results. The study was conducted in Karnataka state, India.

Study participants

The data for this study were taken from the database of recorded audio calls received for psychosocial and mental health services on the national helpline deployed for the matriculation students of Karnataka in response to their exam results. The MHPs from the state handled the helpline calls. These professionals included practicing psychiatric social workers, Master’s in social work, clinical psychologists, psychiatrists, and psychiatric nurses. The helpline was accessible to all Karnataka matriculation students, their family members, teachers, and school authorities. The helpline number was publicized widely on state news media platforms, including state government websites. All the callers who approached the helpline during this period were considered as the study sample. Five hundred and thirty-two (532) calls were made during this period. The calls were received from 30 districts from across the state.

Eligibility criteria

The helpline calls from May 18^th to 21^st, 2022, were included. Matriculation students who were awaiting and/or had received their results, and matriculation students’ parents who were under stress due to their children’s results, were included in the study.

Development of national helpline

Over the last four decades, the NIMHANS, Bengaluru, India, has provided psychosocial support and mental health services for disaster survivors. To further expand and strengthen these services, the Ministry of Health and Family Welfare (MoHFW), Government of India (GoI), sanctioned the Center for Psychosocial Support in Disaster Management (CPSSDM) in August 2019. On January 1, 2022, it became an independent department.[12]

NIMHANS is one of the first institutes in India to start a national helpline for psychosocial support and mental health services. This helpline attempted to combat the psychosocial crisis that people in the country went through during the nationwide lockdown. It is a 24 × 7 toll-free helpline (080-4611 0007). The helpline was handled by mental health professionals (MHPs)—initially from the institute and later by volunteers from across the country. More than 600 MHPs from various states are connected to the helpline.[13,14]

Development of state helpline

In the history of Karnataka, for the first time, the state opened a mental health helpline for students who are in distress as they await their matriculation (10^th) exam results on May 18, 2022. In discussion with the NIMHANS Director, the government of Karnataka circulated the national helpline number (080-46110007) on social media and websites two days before the exam results were announced. The matriculation students who felt low, distressed, anxious, depressed, or scared were encouraged to call the helpline. This helpline attempted to combat the psychosocial crisis/distress that matriculation students were going through in the Karnataka state during their exam results. It is the MHPs who handle the calls received at this 24 × 7 toll-free helpline. MHPs working in the DPSSDM, NIMHANS, and the Karnataka District Mental Health Program (DMHP) team started receiving calls from various districts of Karnataka from May 18, 2022, onwards.

Ethics

At every stage of the coding process, the caller’s mobile number was masked. All calls were recorded for review and to improve the quality of services while ensuring the anonymity and confidentiality of the callers. This study was approved by the Institute’s Ethics Committee of the NIMHANS, Bengaluru.

Statistical analysis

Descriptive statistics such as frequencies, mean, and percentages were employed to analyze participants’ demographic characteristics. Qualitative answers to the psychosocial issues were analyzed using thematic analysis,[12,13] similar to the deductive coding steps in the grounded theory method.[14]

Results

Table 1 presents the socio-demographic characteristics of the callers. Demographics documented through the Interactive Visual Response System (IVRS) system included age and gender. Around 532 matriculation students called the Karnataka helpline. The average age of the caller is 15.5 (SD.57) years, and the majority of the participants were 16 years old (51.5%) and 15 years old (45.5%); some were in the age group 17 years old (2.4%) and 18 years old (0.6%).

Table 1.

Socio-demographic characteristics

Variable	Participants (n=532)
Age
15 years	242 (45.5%)	Mean, (SD) 15.5 (.57)
16 years	274 (51.5%)
17 years	13 (2.4%)
18 years	3 (0.6%)
Gender
Male	331 (62.2%)
Female	201 (37.8%)

Figure 1 shows that the helpline received over 532 phone calls during the matriculation exam results in Karnataka state. Fifteen MHP team members received the calls and provided psychosocial intervention to the individual, family, and community. Around 49 calls were received on the previous day of the results. On the day of the result, the number of calls from students increased to 452; on the second day, it decreased to 25.

Figure 1.

No. of students approached the helpline

Table 2 presents the populations that contacted the helpline. The helpline received calls from diverse groups. Each group had different issues and concerns. While the students had questions about the website, percentages, stress, and worries, parents were concerned about their children’s scores, re-evaluation, behavioral issues, and suicidality. The siblings of students also had inquiries regarding their results, behaviors, and concerns.

Table 2.

Details of the callers

Callers	Percentage
Students	419 (78.7%)
Parents	76 (14.2%)
Siblings	21 (3.9%)
Relatives	13 (2.4%)
Friends	2 (0.3%)
Community volunteer	1 (0.1%)
Total	532 (100%)

Table 3 presents the calls received from the Karnataka tele helpline in 30 districts of the state. Among them, the highest number of calls was from Bengaluru (127, 23.9%), and the lowest number of calls was from three districts, namely, Chamarajanagar (2, 0.4%), Uttarakannada (2, 0.4%), and Yadgiri (2, 0.4%).

Table 3.

District-wise distribution of calls

Name of the district	Percentage	Name of the district	Percentage
Bagalkot	16 (3%)	Kalaburgi	25 (4.7%)
Bellary	19 (3.6%)	Kodagu	8 (1.5%)
Belagavi	19 (3.6%)	Kolar	16 (3.0%)
Bengaluru (Rural and Urban)	127 (23.9%)	Koppala	23 (4.3%)
Bidar	12 (2.3%)	Mandya	10 (1.9%)
Chamrajnagara	2 (0.4%)	Mysore	5 (0.9%)
Chikkaballapura	15 (2.8%)	Raichur	10 (1.9%)
Chikkamagaluru	4 (0.8%)	Ramnagar	4 (0.8%)
Chitradurga	8 (1.5%)	Shimoga	13 (2.4%)
Dakshina Kannada	17 (3.2%)	Tumkur	21 (3.9%)
Davangere	24 (4.5%)	Udupi	4 (0.8%)
Dharwad	15 (2.8%)	Uttara Kannada	2 (0.4%)
Gadag	17 (3.2%)	Vijayapura	28 (5.3%)
Hassan	37 (7.0%)	Vijayanagara	6 (1.1%)
Haveri	23 (4.3%)	Yadgiri	2 (0.4)

Table 4 presents the issues and concerns of the callers: They had different concerns before, during, and after the results. The call rate was lower before the results (18.7%), but after the results announcement, calls increased significantly (84.9%). The review of the calls received at the helpline on the first two days revealed that most students were distressed and anxious about their results. After two days, the calls were related to re-evaluation, supplementary exams, availability of tuition centers, inquiries on good pre-university colleges, etc., The callers reported psychosocial issues such as informational concerns (n = 203), emotional and behavioral disturbances (n = 191), family issues (n = 71), and subject-related issues (n = 67).

Table 4.

Issues and concerns of callers

Domains	Issues and concerns
	Pre results	On the day of the results	Post results
Informational concerns n=203	Inquiry about the results (20%). Whether they can know the results before 12.30 pm (14%). Website inquiry (18%). Offline results checking queries (4%).	The process of checking results online (89%). Clarification of grade system (44%). Inquiry on re-evaluation (20%). Supplementary exams (14%). Mark card (9%).	College inquiry for admission (9%). Information on higher education (11%). Inquiry on various courses (9%), such as a good college, coaching for NEET (10%). Process of re-evaluation (5%), availability of coaching/tuition (4%).
Emotional and behavioral disturbances n=191	Worried about status in society (20%). Stress waiting for an exam result (8%).	Not accepting the result (62%), expected a higher percentage (33%). Failure in the exam (25%).	Some children did not reach their expectations, so they were angry for getting less marks (15%), crying (16%), locking themselves in their room (9%), not talking to others (7%), sleeplessness (5%), fearful (11%).
Familial issues n=71	Parents worrying about their children’s exam results (68%). Stress before getting the results (32%).	IPR issues (55%) include parents scolding their children for lower marks. Fights between parents (26%).	Parents worried about their children’s behavior (19%), such as not talking, running away from family and relatives. Parents feeling helpless about the current situation of children (39%).
Subject-related issues n=67	Worry about getting failed in particular subjects (33%) like English, Maths, Science, etc.	Upset about getting a low grade in a few subjects (39%). Difficulty in accepting the results (79%), as failed in a few subjects.	Students and parents are having difficulty accepting the subject-wise marks (48%) as they expected (100%) in a few subjects, like Maths. Parents expected (23%) out of our results from their children.

Psychosocial intervention provided

Each of the above concerns was dealt with by MHPs. Students who required follow-up or emergency evaluation were directed to local psychiatric facilities and the DMHP team. This is another advantage of helplines, which creates a network of resources and helps link individuals to the local resources they need. The helpline is not just a one-time contact; as and when needed, students were followed up to check if their issues have been resolved or are still persisting.[14]

Discussion

The secondary school stage is the most important phase of life, where students face physical, social, mental, family, educational, and personal problems due to their academic stress and exams.[15] Exam stress is a feeling of pressure that many young people feel during exams. It usually occurs during the revision period before exams and immediately before the exams. Exams and their result stress are crucial in matriculation (10^th) student life.[1]

Our findings suggest that most matriculation students go through difficult times before, during, and after the results. They are vulnerable to developing abnormal reactions like being overwhelmed, exhaustion, extreme avoidance, flooded states, psychosomatic responses, and character disorder.[16] As psychological reactions change over time, it is essential to understand their different reactions in a phase before, during, and after the results. The reactions could be following a normal or an abnormal mode of occurrence. For example, some children took it normally, but some were negatively affected. It is crucial to identify an individual leaning towards the abnormal mode and help them recover through the technique of acceptance; it provides young people with a way of looking at the world and, in particular, how they consider their value and self-worth, and leads to their emotional regulation and resilience.[17] The helpline was a 24 × 7 service facilitated through an IVRS. This helped students to understand that they were going through a stressful situation, and it provided them with psychosocial support to overcome it effectively.

In this unique psychosocial intervention model, MHPs helped matriculation students of Karnataka state overcome their stressful situation during the exam results by providing psychological first aid.[18,19,20] Principles of Psychological First Aid, WHO[21] include three components such as: (1) Look out for individuals who seek help: The initiation of a helpline to provide those matriculation students who are in distress with psychosocial support, (2) Listen to their concerns: This was done through empathetic, active listening and allowing ventilation, and (3) Link, to facilitate linking with available resources: Link them to their school teachers for further support, local DMHP team.

The current study revealed that the mental health statuses of matriculation students are deteriorating due to various issues and challenges. In terms of academic stress, learning difficulties and exam result pressure can lead to a high level of fear, anxiety, insomnia, depression, and adjustment disorders as a long-term impact. It was also found that proper orientation and awareness about mental health issues and challenges at the secondary school level will be conducive for students to cope with the tense situation and help them be well-adjusted in school, family, and society. When stress is perceived negatively or excessively, it leads to anxiety before and during examinations. It ultimately affects their academic achievement, and there is a high chance that they may develop common mental disorders like anxiety.[22,23]

Thus, the findings of the present study are beneficial for students, teachers, and parents to make necessary arrangements to provide a conducive environment at home and school so that the mental health of matriculation students can be improved.

Students are the wealth and future of our country. The national mental health helpline for matriculation students in Karnataka helped us understand that matriculation students have more stress during their results. This unique psychosocial intervention model recommends that it is necessary to provide a healthy environment to students to reduce stress. The Karnataka unique psychosocial intervention model can be implemented all over India so that matriculation students can benefit from it during stressful situations.

Limitations

The helpline calls were for a short duration, and the counselors were unable to see distressed students and their parents face-to-face, as it is an online communication. MHPs could not gauge facial expressions and body language and had to rely on their skills to pick up the same over a phone call. Whenever students required more intense psychosocial interventions for serious mental health problems such as depressive thoughts, suicidality, and severe interpersonal relationship (IPR) issues, they had to be linked to local mental health resources. Another major limitation of the work is the unavailability of any data regarding the perceived/actual utility/efficacy of the interventions. Since this is a service-based research activity, the researchers focused on reporting the psychosocial issues and concerns expressed by the students before, during, and after the matriculation exam results. There was not much scope to go further into their issues and find out whether they were perceived or actual.

Conclusion

As per the national helpline call records, most students are worried about their matriculation exam results and are distressed. It may have short-term and long-term impacts on their mental health. Therefore, this unique model suggests remedial measures for future improvements, like psychosocial care for students and their parents, which is a need of the hour.

Author contributions

SKM, KAT, KVS: Study concepts and design, definition of intellectual content, literature search, statistical analysis, manuscript preparation, manuscript editing, and manuscript review.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.