NEW DELHI // It is exam season in India, a time when stress levels among students rise so high that hotlines have been set up to help them cope.
An estimated 1.2 million students in grades 10 and 12 will sit this month for public exams whose scores will determine their professional futures.
With so much at stake, the pressure to succeed creates an annual spike in stress-induced health problems. It also contributes to India having one of the world's highest rates of suicides among young people, according to a report by The Lancet medical journal.
To address this, more hospitals are launching hotlines to offer students and parents advice on dealing with issues such as anxiety created by parents' expectations, lack of concentration, loss of appetite, and helping boost self-esteem.
"We have created a monster out of these exams," said Samir Parikh, the director of mental health and behavioural sciences at Fortis Healthcare, an Indian chain of private hospitals and clinics that has run a mental-health hotline during the exams for the past five years.
"Exams should help you learn, grow and they happen everywhere in the world. But for years in India, marks have become a big deal," Dr Parikh said.
"The problem is not with the students, but the Indian adult. It is how parents reacted and made a big deal out of it. There is the pressure teachers face to get better results. We created this issue."
Students who call the hotline report a host of pressures to succeed: fears of disappointing their family, of losing friends, and of being made fun of. They also report symptoms of mental stress, including blackouts, lack of concentration and loss of appetite.
For those in grade 10, the exams determine which "stream" of study they can enrol in. The science stream is a first step to becoming a doctor or an engineer, and is the most competitive. The arts stream, which would lead to, say, a liberal arts programme, is the least.
The grade 12 exam is even more stressful, particularly in the science stream, in which the best schools for medicine or engineering often require scores of 90 per cent or higher for admission.
While top-scoring students can choose from the best medical, engineering or business schools in the country, those who fail to make the grade face further stress, coping with the idea of not having been good enough.
The intense competition is created by the shortage of quality higher education in India. For example, there are just 362 medical schools (168 government, 194 private), offering only 45,000 places each year. The Central Board of Secondary Education, which most schools in the country are affiliated, also conducts an annual all-India premedical/pre-dental test in April. Last year, 2.21 million candidates sat the exam, of whom only 26,064 qualified for a spot in a government-recognised medical or dental school.
Aadya Swaroop Naik, 17, from New Delhi, is appearing for the grade 12 exams in the arts stream this month, described how students put themselves under stress.
"It starts out with harmless college talk - where are you applying? Slowly it changes into more intense talk about what marks they will get, how they will get into those colleges. They get anxious about how their parents will receive their grades," she said.
"For some, especially those applying to medical or engineering schools, the marks are the centrepoint of their lives."
"I am stressed because I am not good with exams," Aadya said. "I get very nervous to the point where I cannot study. Some people are able to use their stress as motivation to study, not me."
Aadya is lucky, in that her mother helps her cope. They study in cafes, where Aadya feels she is able to learn better. She has heard about the hotlines for students and believes they would be "very valuable" for her friends whose parents were not as understanding as hers.
She said these friends have issues "where they don't want to appear weak in front of their parents, who are not empathetic to the stress generated from the exams".
A study published in The Lancet last year said suicide rates in India were highest among the 15-29 age group. Although the report did not examine the motives behind the suicides, Indian authorities say it is quite common to read about students taking their lives because of unhappiness over their exam results.
Sameer Malhotra, the head of the department of mental health and behavioural sciences at Max Healthcare, helped set up the student hotline offered by his hospital for the first time this year.
"Children go through a lot of stress these days. The kind of competition that they have to face, with respect to opportunities at hand, they get into phases of depression and anxiety, and sleeplessness," Dr Malhotra said.
Adolescents are especially vulnerable to high stress, he said. The biological and hormonal changes that mark this period of life only add to stress arising from the need to prove oneself to parents and friends.
"They get into their heads to pursue a particular college or course, but given the population of the country and the number of children sitting for these exams, versus the number of seats available, one has to be realistic about one's reach," Dr Malhotra said.
"We want them not to feel disheartened, that they are a failure, that they can't do anything. Self-esteem is critical at this point."