As the country approaches exam season, school children, especially matriculants, need support to lessen the impact this high-pressure season has on their mental health.

Key to this is addressing mental health struggles as early as possible to prevent students’ conditions from worsening by the time they get to university.

Professor Jason Bantjes, a researcher specialising in mental health and injury at the South African Medical Research Council (SAMRC) said younger students experience higher levels of psychological distress, probably because they are adjusting to university. 

“We can’t begin to talk about the mental health of university students without talking about the mental health of high school students. What we find between 2015, 2017 and 2020 is that more students were arriving at university with pre-existing conditions”, said Bantjes.

Academic stress among causes of mental health

Banjies is part of HELM Engage, a national project where experts work to promote the mental health of university students across the globe. It is an online platform hosted and managed by Universities South Africa’s  Higher Education Leadership and Management (HELM) programme.

It is funded by the SAMRC, and 26 publicly funded South African universities were invited to participate. In the end, only 19 took part, with a total of 29 000 students fully completing the survey.

Among numerous possible causes of psychological disorders, 75.8% of students said the academic performance was a recent stressful life event.

More education on mental health needed

Yolisa, is one of many students whose mental health was affected by exams. The second-year nursing student at the University of the Western Cape (UWC) had a panic attack in Grade 11 and is still dealing with the fear of having another one.

“In Grade 11, I had a panic attack 2 weeks before final exams started. It happened in the afternoon when I got back from school. I was taking a nap, and it started out of nowhere. I remember feeling like I couldn’t breathe, gasping for air and like my throat was closing.”

“Tears were coming out of my eyes, I was shaking, and the more I tried to breathe, the more it felt like I was running out of air. I honestly thought that I was going to die.”

Yolisa said her mother did not know what to do and went to their neighbours for help. But the neighbours were also at a loss. In the end, an ambulance was called to take her to a clinic for treatment.

When she arrived, a nurse asked her a few questions to try and figure out what triggered the panic attack and gave her a pill to help her calm down.

“I told the nurse that I was about to start exams and felt under pressure to get good marks. My parents were so used to me getting good marks that I didn’t want to disappoint them.”

Yolisa said that the nurse told her all the stress and pressure of the exams could be what triggered the panic attack.

“When I got home, I felt slightly embarrassed by what happened. I don’t know why. A few months later, I had another panic attack, but I wasn’t stressed about anything. 

My family and siblings did support me, but we never really spoke about the idea of counselling; it was more through prayer”, she said.

Almost three years later, Yolisa said she still fears having panic attacks, especially when she goes to sleep. “Almost every night after that, I would go to sleep hoping that I wouldn’t have another panic attack.

Yolisa said she still gets stressed about assessments and exams, but her fear of panic attacks is not as debilitating anymore. But she wishes she had gotten professional help at that time.

Screen students to ensure they get help

Bantjies suggested that South Africa adopt an approach used by Belgium.

“It may be possible to screen students on registration or early in their first year for those with histories of psychiatric conditions and target them for particular interventions.”

In Belgium, for example, on registration, students are prompted to do a mental health survey, and they’re given feedback immediately. They can opt-out immediately or receive information on services that may help them. There is no stigma and no profiling”, he said.

A cross-sectional study – conducted among students from four universities in the Eastern Cape – revealed that the prevalence of mental distress among students was reported to be 53.3%. 58.2% of female and 41.8% of male students had mental distress.

The data was collected from 844 students using an online self-reporting questionnaire-20 to assess the mental distress of students. 

Field of study, year of study, academic workload, using cannabis, gender and poor sleep quality were strong factors associated with mental distress among students. The study also showed that the field of science, in which the majority of the students are medical students, reported a higher mental distress level than students from non-science fields. 

The possible explanation for this finding is that science students include students from the faculties of medicine who are reported by studies to experience higher distress than other students.

Female students face higher risks

Female students also had a higher risk of having mental distress than male students. Some studies attribute the finding to structural determinants of mental health, such as social roles and income of women. 

Some recommendations from the study for these findings included the need for mental distress intervention programmes to target female students, students in the field of science, students in the first year level of study and students reporting heavy academic workload.

The study also recommends that government and non-government organisations devise evidence-driven interventions and strategies to prevent and reduce the problem of mental distress among students. 

The South African College of Applied Psychology  (SACAP) has five strategies designed to assist parents to support the mental well-being of their children when they write exams.

These include prioritising emotional well-being, discussing proactive ways to relieve stress, and ensuring that your child gets enough restorative sleep, exercises and eats properly. Parents must also ensure that their expectations do not contribute unnecessarily to the child’s stress levels.

Universities must do more

Professor Bantjes said if mental health is to become a priority, South African universities have to work closer together, with less bureaucracy. 

“If we plan interventions across three or four campuses, we can have various interventions.  We can have a web-based intervention, we can have a virtual group, we can have app-based interventions, and we can have a mood monitoring intervention. 

It’s only possible if funding is earmarked, the research is prioritised and support groups and facilities are put in place”, said Bantjes. – Health-e News