Prevalence and link of academic stress and depressive symptoms among school-going adolescents in Manipur, India

ABSTRACT

Objectives:

Academic stress and depressive symptoms are major mental health concerns among adolescents globally and in India. However, limited research has examined their association in Manipur, a northeastern state of India. This study assessed the prevalence of academic stress and depressive symptoms, their association, and group differences by sociodemographic variables among school-going adolescents in Manipur.

Methods:

A cross-sectional survey was conducted among 861 students in grades 9–12 from six private schools in Manipur. Data were collected via self-administered questionnaires between August and October 2024. Analyses included descriptive statistics, Pearson’s correlation, multiple linear regression, t-tests, and ANOVA.

Results:

All participants reported moderate to high academic stress, and a majority experienced mild to severe depressive symptoms. Academic stress was positively correlated with depressive symptoms and significantly predicted them (β =0.37, P < 0.001), indicating that higher stress levels were associated with higher depressive symptom scores. Female students and those with the lowest academic results (3^rd division: 33%–45%) reported significantly higher depressive symptoms (β =1.90, P < 0.001; β =2.33, P < 0.05). The model showed moderate explanatory power (R = 0.571, R² = 0.326, F = 45.81, P < 0.001). Significant group differences were found across gender (P < 0.01), hometown (P < 0.01), and grade (P < 0.05).

Conclusion:

Academic stress levels were alarmingly high and significantly associated with depressive symptoms among adolescents. Future studies should explore school-based interventions to address academic stress and promote mental health.

Introduction

Academic stress is a significant issue for students across the globe, and particularly in Asian countries.[1] Academic stress is characterized as a student’s psychological condition arising from persistent social and self-imposed pressures inside an educational setting that exhausts the student’s mental resources.[2] Academic stress may stem from the substantial weight of homework and adverse attitudes toward studying, including diminished motivation and learning problems.[3]

India is a part of the Asian continent and is with a population of around 1.43 billion,[4] which is the world’s most populous country and has the largest adolescent demographic, totalling 253 million individuals aged 10 to 19.[5] Previous study in Kolkata revealed that more than two-thirds (63.5%) of Indian students encountered stress with academic pressure as a cause.[6] The competitive nature of India’s education system leads to competitive pressure from final evaluations, particularly at the upper secondary level (Grades 11 and 12), where admission to prestigious universities depends on qualifying examinations.[7] With this number, the National Mental Health Survey (NMHS 2015–2016) found that 7.3% of this population experiences mental health problems (MHPs).[8]

Academic stress is a considerable concern for adolescents in India and may contribute to mental health issues such as depression. Emerging stressors are from academic work, including coursework, examinations, and research initiatives, as well as expectations from teachers and parents, and interactions with classmates.[9] Severe stress adversely affects students’ mental health, perhaps resulting in different psychological disorders such as depression, which is a mood disorder, where one faces depressive symptoms such as feeling of persistent sadness and loss of interest.[10] In the Indian context, the southern state of Tamil Nadu, adolescents in higher secondary schools were evaluated using the Beck Depression Inventory; 45.7% exhibited moderate depression, 25.4% mild depression, 19.6% severe depression, and 9.3% minimum depression; students with elevated scores had further examination by a psychiatrist, who validated their depressed state. The prevalence of depressive episodes and recurrent depressive disorder among adolescents was 2.6%, whereas that of phobic anxiety disorder in India was found to be 1.3%.[8] Another recent study (2025) conducted in the capital city of India, New Delhi, suggested that the prevalence of depression and anxiety among school-going adolescents was 25.92% and 13.70%, respectively.[11] It indicates that prevalence of depression was more than anxiety.

Previous study in other parts of India found a moderate to strong positive relationship between academic stress and depression, where adolescents experiencing academic stress had 2.4 times (95% confidence interval [CI] = 0.9–2.4) (P < 0.01) increased risk of depression compared to those without academic stress.[12] Emerging stressors are from academic work, including coursework, examinations, and research initiatives, as well as expectations from teachers and parents, and interactions with classmates. In another Indian study conducted in Udupi, Karnataka, among late adolescents (aged 17–19 years) enrolled in Pre-University Colleges (PUCs or grade 11–12), it was found that academic stress has a modest influence on mental health, shown by a correlation coefficient (R) of 0.513, signifying that as academic stress escalates, mental health concerns also escalate. Approximately 26% of the variance in mental health (Depression, Anxiety, Stress or DASS) is attributable to academic stress, as shown by an R² value of 0.263.[9] Comparable findings have been shown indicating the prevalence of depression or depressive symptoms increased as academic stress increased among the study population.[12,13,14,15,16,17,18]

To exacerbate this already troubling situation, according to the National Crime Records Bureau[19] (2022), India had 170,924 suicides, reflecting a 4.2% rise compared to 2021, with the suicide rate increasing by 3.3% during 2022 relative to 2021. Of these, 7.6% were by students, and 2248 suicide fatalities were attributable to academic failure. The Lancet (2018) identified the 15–29 age group in India as having the highest global incidence of suicide, with academic stress being a primary contributing factor.[20,21] There is a growing concern about academic pressure and its association with mental health issues among school-going adolescents in India. In 2024, WHO stated that suicide ranks as the third greatest cause of mortality among adolescents,[22] with undiagnosed depression being a significant contributing factor. Academic stress may be a contributing cause to depression.[12]

However, no documentation of studies on the similar context of academic stress and depression has taken place in any of the northeastern states to the best of knowledge. India is a diverse country with various races, ethnicity, and culture, and Manipur, a part of the northeastern region, is burdened with widespread mental health challenges, rooted in chronic political volatility, interethnic conflict, economic hardship, and a lack of adequate mental healthcare infrastructure.[23] Moreover, Manipur was found to be the first worst state in terms of mental disorders in India in the National Mental Health Survey 2015–2016.[8] A study conducted among adolescents in higher secondary schools in Imphal, Manipur, India, indicated that 81.6% of participants had at least one MHP, namely, depression, anxiety, or stress (DASS), with levels respectively found to be 19.5%, 24.4% for anxiety, and 21.1% for stress.[24] Moreover, a study in Manipur (2023) found that adolescents in private schools experience higher levels of stress compared to those in government schools, possibly due to parental pressure and a competitive atmosphere.[25] A similar study in Delhi also found that high-school students in private schools experienced higher academic stress.[26]

The 2015–2016 National Mental Health Survey revealed that the prevalence of mental disorders is markedly greater in urban metropolitan areas (10.6%) than in rural regions (5.2%). Mood disorders, including depression and stress-related, are observed at rates approximately two to three times greater in urban populations compared to rural counterparts.[8] The disparities highlight the increased mental health burden in urban environments. Therefore, this study was conducted in urban areas of Imphal, Manipur, to investigate the prevalence and association of academic stress and depressive symptoms in adolescents, particularly in a context associated with increased mental health risks.

Various results were found, but it is to be concluded that there was significant prevalence of academic stress and depressive symptoms among these school-going adolescents in India. This highlights the need for further research into the academic environment and its impact on the growing Indian adolescent population. The competitive academic landscape in India intensifies this stress, and to the best of knowledge, there is no prior documentation on the level and correlation of academic stress and depressive symptoms in private schools of urban Manipur, in Imphal.[8,25,26] It was hypothesized that academic stress was significantly associated with depressive symptoms among students of Manipur, as was found among students in the state of Tamil Nadu.[12]

Methods

The study design was a cross-sectional survey-based observational study.

Setting

This study was conducted in private schools from urban areas in Imphal, India, among adolescents aged between 13 and 18 years. Data were collected between August 2024 and October 2024.

Sample and procedure

While using a two-stage sampling, three private schools were randomly selected from respective two districts (Imphal East and West). Therefore, the survey was conducted among six private schools. The students from grade 9 to 12 were selected for the study. Then, about 35–50 students from each grade were selected based on systematic random sampling. Data were collected from grade 9–12 students during the 2024–2025 academic year. 902 eligible students were recruited from all six schools, out of which 861 students were considered as the final sample after data cleaning.

The participants were included in the study if they met the following criteria: (a) aged between 13 and 18 years, (b) grade between 9 and 12, (c) full-time students from schools of Imphal East and West districts, and (d) willing to participate and provide assent, with parental/guardian consent obtained. The participants were excluded if: students with known psychiatric diagnoses, currently unwell and currently under treatment, absent on the day of data collection, incomplete or invalid responses in the Patient Health Questionnaire for Adolescents (PHQ-A) or Educational Stress Scale for Adolescents (ESSA) questionnaires (>20% missing data), and students who refuse participation or withdraw consent/assent at any stage.

Sample size calculation was performed using Epi Info ver. 7.2.6.0 (Centers of Disease Control and Prevention, Atlanta, GA, USA). software. The total population of Grade 9–12 students in private schools in Imphal (East and West district) was 30,690, according to the 2023–2024 census.[27,28] The estimated prevalence of MHPs (DASS) among Higher Secondary School students in Manipur, as reported in a previous study conducted in 2014, was 34.7% (35% approximately).[24] The sample size of 594 was estimated in a study conducted in Imphal, Manipur, based on this. Considering the possibility of discontinuing participation in the study, 20% loss of participation is considered, and the final sample size was 743. However, about 902 students showed voluntary participation in total from all the six schools. After data cleaning, a total of 861 students were considered for the final analysis of the data.

Measures

Participants completed the self-administered questionnaire of ESSA, PHQ-A, and sociodemographic details. Prior to administering the surveys to research participants, the instruments were pretested in a comparable environment (n = 30) for appropriateness and were found to be reasonably highly reliable scales for adolescents in Manipur, India (Cronbach’s α = 0.89 for ESSA and 0.74 for PHQ-A).

ESSA comprised 16 items aimed at assessing educational stress across five components: study pressure (4 items), workload (3 items), worry on grades (3 items), self-expectation (3 items), and despondency (3 items). Responses are rated on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree), with higher scores signifying increased educational stress. Scores vary from 16 to 80. The total score of ESSA range was classified as low stress levels (0–21), medium (22–42), and high (43–64), similar to a study conducted in Malaysia among school-going adolescents in 2022.[29] Besides that, there were a total of individual 5 components of ESSA to quantify study pressure, workload, worry on grades (3 items), self-expectation (3 items), and despondency as continuous variables. Permission to utilize this tool was obtained from one of the developers and authors, Michael Dunne. The Cronbach’s alpha of ESSA in the East Asian adolescents was 0.81, indicating good internal consistency.[30] Additionally, the Cronbach’s alpha for ESSA in this study (n = 861) was 0.818, which is the same as found earlier in a study by Sun et al. in 2013.[30]

This study specifically used the adapted version of PHQ-9,[31,32] that is, PHQ-A, a four-point Likert-type assessed the severity of depressive symptoms. It is a freely available tool. Responses are ranged on a 4-point scale from 0 (not at all) to 3 (nearly every day). The cutoff scores for depression are 5–9 for mild, 10–14 for moderate-to-severe, 15–19 for moderately severe levels, and 20–27 for severe depression.[33] PHQ-9 was found to have a good internal consistency for the Indian adolescents (Cronbach’s α = 0.835). The Cronbach’s alpha for PHQ-A in this study was 0.823. A threshold score of ≥10 (PHQ-9) demonstrated substantial agreement with the diagnosis based on the International Classification of Diseases, 10^th Revision (Cohen’s κ = 0.62);[20] moreover, with PHQ-A, a score of ≥10 was considered elevated.[34]

Before conducting the analysis, the assumptions of linear regression, namely, linearity, independence, normality of residuals, and homoscedasticity, were scrutinized for both simple and multiple regression models, with residual plots being visually assessed to determine the constancy of variance across predicted values.

Statistical methods

IBM SPSS Statistics for Windows, ver. 18.0 (IBM Corp., Armonk, NY, USA). was used to analyze the data where descriptive statistics, Pearson’s correlation, linear and multiple regression, and ANOVA and t-tests were used. Prior to administering the surveys to research participants, the instruments were pretested in a comparable environment for appropriateness.

Results

Participants

The sample for the study comprised 861 students from grade 9 to 12. Out of this, 43% (n = 370) were male students, whereas 57% (n = 491) were female students. The mean age was 15.56, with a standard deviation (SD) of ± 1.23 for the age range between 13 and 18.

Prevalence and severity of academic stress

Every student faced academic stress (100%), where students experienced moderate to high levels of academic stress. In specific, around 88% of students experienced high levels of academic stress. The overall mean of academic stress was found to be 53.23, SD ± 9.088 [Figure 1 and Table 1]. As for the dimensions of academic stress, the mean and SD are: study pressure 13.2, SD ± 3.281; workload 8.6, SD ± 2.466; worry on grades 11.31, SD ± 2.448; self-expectations 10.4, SD ± 2.588; despondency 9.72, SD ± 2.275 [Table 1].

Figure 1.

Prevalence and severity of academic stress

Table 1.

Prevalence and severity of academic stress and its subdimensions among the study participants

Variable	Frequency (n)	Percentage	Mean	SD
Overall academic stress (ESSA)	861	100	53.23	9.09
Low stress	0	0.0	-	-
Moderate stress	101	11.7	-	-
High stress	760	88.3	-	-
ESSA dimensions
Study pressure	861	100	13.20	3.28
Workload	861	100	8.60	2.47
Worry on grades	861	100	11.31	2.45
Self-expectations	861	100	10.40	2.59
Despondency	861	100	9.72	2.28

The categorical classification (low/moderate/high) is based on ESSA total score. SD=Standard deviation, ESSA=Educational Stress Scale for Adolescents

Prevalence and severity of depressive symptoms

Around 76% of students had mild to severe levels of depressive symptoms, where 24% of students experienced moderate-severe depressive symptoms. The overall mean of depression was found to be 9.69, SD ± 6.39 [Figure 2 and Table 2].

Figure 2.

Prevalence and severity of depressive symptoms

Table 2.

Prevalence and severity of depressive symptoms among the study participants

Depressive symptoms (severity level)	Frequency (n)	Percentage
Normal (0–4)	210	24.4
Mild (5–9)	253	29.4
Moderate (10–14)	191	22.2
Moderately Severe (15–19)	134	15.6
Severe (20–27)	73	8.5
Total	861	100

Depressive symptoms summary: Mean score=9.69, Standard deviation=6.40

While considering a score of ≥10 for elevated presence and absence of depressive symptoms, 46% (n = 398) had depressive symptoms.

Relationship between academic stress and depressive symptoms

Correlation

The correlation coefficient of overall academic stress (total) and depressive symptoms was determined to be r = 0.544, indicating a moderate to strong positive relationship between the two variables (P < 0.01) [Table 3].

Table 3.

Descriptive statistics and correlations between (g) depressive symptoms and academic stress domains: (a) academic stress, (b) despondency, (c) self-expectations, (d) study pressure, (e) worry about grades, and (f) workload

Variable	Mean	SD	r with depressive symptoms	P
a. Academic stress (total)	53.23	9.09	0.544	<0.001***
b. Despondency	9.72	2.28	0.510	<0.001***
c. Self-expectations	50.40	2.59	0.451	<0.001***
d. Study pressure	13.20	3.28	0.430	<0.001***
e. Worry on grades	11.31	2.45	0.283	<0.001***
f. Workload	8.60	2.47	0.209	<0.001***
g. Depressive symptoms (PHQ-A)	9.69	6.40	-	-

P<0.001 indicates statistically significant correlation, ***Correlation is significant at the 0.001 level (2-tailed). r=Pearson correlation coefficient, SD=Standard deviation, PHQ-A=Patient Health Questionnaire for Adolescents

As for the dimensions of academic stress [Table 3]:

The study found a weak to moderate positive relationship between despondency, self-expectations, study pressure, worry on grades, and workload with depressive symptoms (r = 0.510, r = 0.451, r = 0.430, r = 0.209, and r = 0.283, respectively).

Regression

In both simple and multiple linear regression analyses, the examination of residuals against fitted values revealed a satisfactory adherence to the homoscedasticity assumption as the residuals were randomly dispersed without discernible patterns, indicating constant variance.

Simple linear regression

Overall academic stress (total) and depressive symptoms had moderate to strong positive regression relationship (R = 0.544) (P < 0.01), indicating that as academic stress increases, depressive symptoms tend to increase as well. About 29.6% of the variance in depressive symptoms scores is explained by academic stress (R² = 0.296) [Table 4].

Table 4.

Simple linear regression analyses predicting depressive symptoms from (a) academic stress total, and its subdomains: (b) despondency, (c) self-expectations, (d) study pressure, (e) worry about grades, and (f) workload

Predictor variable	r	R2	B	95% CI for B	t	P
Equation 1 a. Academic stress	0.544	0.296	−10.69	−12.83, −8.56	−9.83	<0.001***
			0.383	0.343, 0.423	19.01	<0.001***
Equation 2 b. Despondency	0.430	0.185	−1.37	−2.97, −0.24	−1.67	0.095
			0.838	0.720, 0.955	13.95	<0.001***
Equation 3 c. Self-expectations	0.451	0.202	−1.91	−3.49, −0.32	−2.36	0.018*
			1.115	0.968, 1.263	14.82	<0.001***
Equation 4 d. Study pressure	0.510	0.259	−4.24	−5.86, −2.63	−5.15	<0.001***
			1.434	1.272, 1.596	17.38	<0.001***
Equation 5	0.283	0.080	1.33	−0.62, 3.27	1.34	0.181
e. Worry on grades			0.740	0.572, 0.908	8.65	<0.001***
Equation 6 f. Workload	0.209	0.044	5.04	3.52, 6.56	6.52	<0.001***
			0.541	0.371, 0.711	6.26	<0.001***

The equations labeled 1 (total ESSA), 2-6 represent the effect of each specific ESSA subdomain, modeled separately. R=Pearson correlation between predictor and depressive symptoms, R²=Proportion of variance in PHQ-A scores explained by each predictor, B=Unstandardized regression coefficient. CI=Confidence interval, ESSA=Educational Stress Scale for Adolescents, PHQ-A=Patient Health Questionnaire for Adolescents. *P<0.05, **P<0.01, ***P<0.001

As for the dimensions of academic stress [Table 4]:

The study found a weak to moderate positive regression relationship between despondency, self-expectations, study pressure, worry on grades, and workload on depressive symptoms. Despondency was the strongest determinant among the dimensions that explained 26% of the variance (R = 0.51, P < 0.01) (R² = 0.260).

Multiple linear regression analysis

A multiple linear regression analysis was executed to investigate the correlation between academic stress and depressive manifestations, while controlling for age, gender, grade level, and academic performance [Table 5]. Academic stress surfaced as a significant predictor of depressive symptoms (B = 0.37, P < 0.001), signifying that elevated levels of academic stress are correlated with increased depressive symptoms. The model elucidated approximately 32.6% of the variance in depressive symptom scores (R² = 0.326; adjusted R² = 0.319).

Table 5.

Multiple linear regression analysis examining the association between academic stress and depressive symptoms, controlling for age, gender, grade/standard, and academic result

Variable	Coefficient (B)	Standard error	95% CI	t	P
Intercept	−9.68	3.59	−16.72, −2.64	−2.70	0.007**
Academic stress (ESSA total)	0.37	0.02	0.33, 0.40	18.09	<0.001***
Age	−0.14	0.24	−0.61, 0.33	−0.58	0.564
Gender	1.90	0.37	1.17, 2.63	5.10	<0.001***
Grade (standard)
10	0.38	0.54	−0.67, 1.43	0.71	0.480
11	1.00	0.63	−0.23, 2.23	1.60	0.110
12	1.11	0.87	−0.60, 2.82	1.27	0.203
Academic result: 1st division	0.60	0.44	−0.26, 1.47	1.37	0.170
Academic result: 2nd Division	0.06	0.58	−1.08, 1.20	0.10	0.918
Academic result: 3rd Division	2.33	1.01	0.35, 4.31	2.31	0.021*

Reference categories: Gender=male; Grade=9; Academic result=distinction. R²= 0.326; adjusted R²=0.319, F (9, 851)=45.81; ESSA=Educational Stress Scale for Adolescents, *P<0.05, P<0.01, ***P<0.001

Among the covariates, gender was a significant predictor, with females indicating higher depressive symptoms than males (B = 1.90, P < 0.001). Students who attained a 3^rd division in academic performance also indicated significantly higher depressive symptoms in comparison to those with distinction (B = 2.33, P = 0.021). Other variables, including age, grade level, and additional academic performance categories, were not statistically significant predictors of depressive symptoms (F (9, 851) =45.81, P < 0.001).

Sociodemographic determinants of depressive symptoms

Gender

Out of the entire sample, females (n = 491) significantly also had more incidence of depressive symptoms with mean 11.01, SD ± 6.676 (95% CI = 10.42–11.60) than the males (n = 370), 7.95, SD ± 5.546 (95% CI = 7.38–8.52) (P < 0.01) [Table 6].

Table 6.

Group differences in depressive symptoms by sociodemographic determinants

Variable	Group	Mean PHQ-A	SD	95% CI	P
Sex	Male	7.95	5.55	7.38, 8.52	<0.001***
	Female	11.01	6.68	10.42, 11.60
Age group	13–15 years	9.64	6.81	8.99, 10.29	0.792
	16–18 years	9.75	5.97	9.19, 10.31
Grade/standard	Grades 9–10	9.24	6.55	8.64, 9.85	0.030*
	Grades 11–12	10.19	6.19	9.59, 10.79
Hometown	Urban	10.20	6.55	9.64, 10.76	0.002**
	Rural	8.81	6.19	8.16, 9.45
Residence	Day Scholar	9.69	6.49	9.23, 10.16	0.989
	Boarder	9.70	5.76	8.62, 10.79
SES	Low	9.70	6.40	9.26, 10.14	0.921
	Middle	9.59	6.42	7.35, 11.83
	High	-	-

P-values reflect the significance of group differences (independent t-tests or ANOVA). CI=Confidence interval for the mean PHQ-A score, SD=Standard deviation, SES=Socioeconomic status, PHQ-A=Patient Health Questionnaire for Adolescents, *P<0.05, P<0.01, ***P<0.001

Hometown

Urban hometown students significantly had more depressive symptoms, 10.2, SD ± 6.549 (95% CI = 9.64–10.76) than rural hometown students, mean 8.81, SD ± 6.192 (95% CI = 8.16–9.45) (P < 0.01) [Table 6].

Grade

Grade was found as a significant determinant of depressive symptoms, where grade 11–12 students, with mean 10.19, SD ± 6.192 (95% CI = 9.59–10.79) had more depressive symptoms than grade 9–10 students, 9.24, SD ± 6.549 (95% CI = 8.64–9.85) (P < 0.05) [Table 6].

Other sociodemographic determinants

Age (P = 0.792), residence (0.989), and socioeconomic status (P = 0.921) were not found as a significant determinant of depressive symptoms among the students [Table 6].

Discussion

Academic stress among adolescents in Manipur was very high, with everyone experiencing moderate to severe academic stress, while 88% experience high levels of academic stress. This result is similar to previous studies; more than two-thirds (63.5%)[6] of Indian students encountered stress with academic pressure as a cause and 64% students had moderate to high academic stress in another study.[35] In fact, the results in this study show higher incidence of academic stress in comparison to earlier studies, which is crucial. Evidence indicated that academic pressure levels have escalated among adolescents,[16] coinciding with a rise in depression rates throughout the same timeframe.

Alongside, this study found around 76% students had mild to severe levels of depressive symptoms, where 24% students experienced moderate-severe to severe depressive symptoms. A significant incidence of depression (65.32%) was identified among school-attending adolescents in Chandigarh.[36] In previous studies conducted in Manipur among adolescents, levels of depression were found to be 19.5%[24]; 33.7% showed signs of considerable depression or depressive symptoms[25]; the total prevalence of depressed symptoms among the examined among the school-going adolescents was 68%. These previous studies and the current study were found to have quite similar results.

Academic stress and depressive symptoms had a moderate to strong positive correlation regression even after controlling gender and hometown as sociodemographic variables, indicating that as academic stress increases, depressive symptoms tend to increase as well. A study conducted in another Asian country, in China, among adolescents found academic stress had a positive correlation with depression (r = 0.56).[37] The outcome of this study also corresponds with a separate research involving school-going adolescents in India, which revealed a moderate positive correlation between depression and the level of academic stress (r = 0.52 at P < 0.01), where adolescents experiencing academic stress had a 2.4 times (95% CI = 0.9–2.4) (P < 0.01) increased risk of depression compared to those without academic stress.[12] In another Indian study[9] conducted in Udupi, Karnataka, late adolescents (PUCs or grade 11–12) had a moderate influence on mental health (R = 0.513), signifying that as academic stress escalates, mental health concerns also escalate. With this, approximately 26% of the variance in mental health (DASS) was attributable to academic stress (R² = 0.263). Comparable findings have been shown indicating the prevalence of depression increased as academic stress increased among the study population.[12,13,14,15,16,17,18]

A study in Kolkata, India, shows that over 50% of parents engage multiple private tutors for their children, leading to increased anxiety and stress due to the pressure of exams.[6] This trend is similar in Manipur, India. Private tuition often dominates students’ lives, encroaching on their leisure time. In a case study, 49% of students attended up to 3 private tutoring sessions daily, while 51% participated in 4–6 sessions daily.[38] To add to this, a recent study conducted in Manipur[39] found that the majority of the school-going adolescents who had depressive symptoms (69.6%) attended tuitions. Given the high prevalence, correlation and regression of academic stress, and depressive symptoms found in this study, the prediction model of academic stress on depressive symptoms was found to be well justified.

The dimensions of ESSA were found to be correlated with depressive symptoms, with despondency having the strongest correlation. A moderate positive regression relationship showed that as despondency increases, depressive symptoms also increase. About 26% of the variance in depressive symptoms scores is explained by despondency, usually known as hopelessness, which is a gloomy outlook on future outcomes and the belief that results are irreparable.[40] These symptoms are all aligned with depressive symptoms. Moreover, the origin stems not only from the encountered difficulties but also from the persistent inability to attain desired objectives, compounded by a deficiency in stress management skills, which exacerbates this situation.[41,42] Factors like dissatisfaction and hopelessness can lead to severe mental illnesses like depression, which is characterized by symptoms like diminished motivation, sadness, suicidal ideation, reduced energy, sleep disturbances, impaired concentration, and negative cognition.[41]

Although the other dimensions, self-expectations, study pressure, worry on grades, and workload, showed weaker regression relation with depressive symptoms, some previous studies also showed supportive results. Self-expectations in the academic context are often shaped by adolescent parents’ expectations of them. In China, research shows that parents’ expectations about their children’s future academic and career achievements also lead to increased expectations among the children.[43] Furthermore, parental expectations were associated with heightened levels of depression among students.[44] In certain studies, it revealed that students see test scores and academic performance (worry on grades) as very significant, leading to competition among them to get satisfying outcomes.[45] As a predictor of depression, it was also found that there was lack of self-satisfaction with academic performance (odds ratio = 5.1) among school-going adolescents in India.[46]

Out of the entire sample in this study, females had more incidence of depressive symptoms as academic stress increased than males. Supporting this, in a meta-analysis done, it was found that prevalence of depression was higher in females, 57%, than male adolescents, 50%.[47] A recent study in Manipur also revealed the prevalence of depression among school-going adolescents girls exhibiting a greater likelihood of experiencing depression than boys,[39] and the study in Tamil Nadu also found girls with more academic stress and depression.[12] Research showed that female adolescents face greater challenges during the adolescent transitional phase due to puberty-related alterations, including morphological development, physiological changes, and physical manifestations.[48] In Asian civilizations, social taboos and gender expectations can make females vulnerable to depression due to societal limitations, pressures, and discrimination.[49] The lower prevalence of depressive symptoms among males may be due to a combination of factors.

The study revealed that urban hometown students had higher depressive symptoms than rural adolescents, consistent with a 2015–2016 national report on mental health in India, where depression prevalence was higher in urban areas (13.5%) compared to rural areas (6.9%).[8] A recent study in India had noted that the heightened maximizing, which is the inclination to persistently seek superior alternatives in the metropolitan area, may be ascribed to a more competitive capitalist market orientation inherent in urban India compared to rural India.[50] Along with this is the competitive nature of India’s education system that leads to competitive pressure from final evaluations, where admission to prestigious universities depends on qualifying examinations[7] and leading to severe academic stress.[51] This is particularly evident among urban-based adolescents, who may experience higher levels of stress and depressive symptoms due to the pressure from final evaluations.

Moreover, this study revealed that grade 11–12 (higher secondary) significantly had more prevalence of depressive symptoms than grade 9–10 (secondary) students, although grade level was not a significant predictor of academic stress when controlling for sociodemographic factors. Higher secondary school is a critical era in a student’s life since their performance and grades at this level significantly influence their subsequent academic opportunities and likely job selection as well.[52] A meta-analysis in an Indian context revealed that the frequency of depressive symptoms escalated with higher grades,[47] highlighting the competitive nature of the education system particularly at the higher secondary level (Grades 11 and 12 or preuniversity), and the importance of qualifying examinations for prestigious universities.[7] This could be a potential explanation to the prevalence of significant depressive symptoms as an outcome due to academic stress among higher-grade students.

Other sociodemographic details such as age, residence, and socioeconomic status were not found significantly related to depressive symptoms in this study unlike previous studies in India.[53,54,55,56] This could be due to differences in the cultural setting or lack of representation of the data.

Overall, the results correspond with some of the prior research demonstrating elevated academic stress among Indian school-going adolescents and as a major predictor for depressive symptoms among the same population. Significant moderate to strong correlation and moderate positive regression were found to exist between academic stress and depressive symptoms, aligning with previous studies.[12,13,14,15,16,17,18] With the increase in academic stress, the incidence of depressive symptoms also increased. In fact, this study reveals a greater frequency of academic stress compared to previous research, which is noteworthy. Out of the dimensions of academic stress, despondency had the strongest correlation that significantly predicted depressive symptoms with moderate positive regression. Gender and hometown are significantly associated with depressive symptoms, and academic stress remains significant after controlling these sociodemographic factors. Therefore, females exhibit elevated levels of academic stress compared to males and urban adolescent students experience more academic stress than their rural counterparts. These results highlight the critical need to mitigate academic stress due to its significant effects on mental health such as depressive symptoms.

Limitations

The present research has various advantages, such as using a reasonably high sample size in an underexplored geographic region of Imphal, Manipur. However, the sample might not be truly representative of the entire state and only private schools were included for the study, although results found were similar to those conducted in other parts of the country. Furthermore, it is essential to do analogous research on bigger samples from other schools across broader geographic regions to facilitate the generalization of the findings. Although an anonymous approach was used, offline, pen-paper self-administered instruments pose biases where students may feel conscious to provide socially acceptable responses in the presence of the survey administrator. Last, a cross-sectional survey only offers a temporary view of a population, which may not accurately represent the dynamics or changes over time. Depressive symptoms were only assessed with a screening tool, and future studies should add diagnostic validations.

Generalizability

While the study particularly focused on the private schools, the educational system within the state and across the Northeast region of India share some similarities. As India is situated inside the Asian continent, this research may have broader implications for the educational landscape throughout Asia. The instruments used were well validated in the Asian context. Subsequent research with bigger and more heterogeneous samples in other parts of India and globally may enhance the understanding of generalizability and work for a common cause together.

Conclusion

In conclusion, the results are an alarming signal for prompt detection and implementation of potential intervention for adolescents experiencing academic stress. This is crucial to reduce the incidence and intensity of depressive symptoms. Despite the critical importance of adolescent mental health for any nation, it has not garnered much attention in India, and specifically in Manipur as proven by this study. The current research indicated that a significant percentage of Indian adolescents are experiencing academic stress and depressive symptoms. Therefore, with an alarmingly high number of students facing academic stress and its correlation with depressive symptoms, it is urged that all key stakeholders collaborate to identify potential interventions aimed at enhancing adolescents’ overall mental health and wellbeing. This is particularly significant given the fact that Indian adolescents are the largest adolescent demographic of the world, who represent the future foundation of the country. Altering overall academic pressure or stress might reduce or prevent mental health issues such as depressive symptoms or depression if they have a causal relationship.

Awareness of mental health and academic stress should be enhanced among adolescents, along with instruction on techniques that improve adolescent’s resilience and self-management or coping mechanisms. The integration of health and education policy may foster a comprehensive approach to adolescent wellbeing. Institutions that adopt holistic health initiatives, including mental health services, enhance educational achievement and mental health outcomes, so concurrently meeting Sustainable Development Goals 3 (Good Health and Well-being) and 4 (Quality Education).[57] When adolescents have the necessary resources, they develop into productive members of society.

Ethics approvals

Ethical approval for the study were obtained from the Mahidol University Institutional Review Board (IRB)(COA. No. MUPH 2024-063) and the Research Ethics Board (REB), Regional Institute of Medical Sciences, Imphal (Registration No. A/206/REB/Prop(Sp)226/202/18/202. Informed parents’ consent and assent were obtained. To guarantee that participant privacy was maintained, we employed an anonymous approach. After the survey, if any students seemed to be in urgent need of help for mental health or severe depressive symptoms, immediate attention was brought and recommended for immediate professional help or counseling.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.