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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 38  |  Issue : 1  |  Page : 52-57

Academic difficulties among young persons with mental disorders


1 Psychologist, Department of Psychiatry, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
2 Psychiatrist, Department of Psychiatry, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India

Date of Submission09-Jun-2020
Date of Decision04-Jul-2020
Date of Acceptance26-Jul-2020
Date of Web Publication04-Aug-2021

Correspondence Address:
Dr. Vijaya Raghavan
Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai - 600 101, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 0.4103/ijsp.ijsp_156_20

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  Abstract 


Background: Various factors contribute the poor academic performance and discontinuation from schools among young people with mental disorders. The present study aimed to identify the difficulties and barriers posed by mental disorders; coping strategies to overcome them, and consolidate the recommendations made by students with mental illness and their parents to make education friendlier for students with mental illness. Materials and Methods: Semi-qualitative study was conducted in the outpatient department of the Schizophrenia Research Foundation, a mental health center and nonprofit organization based in Chennai. All patients between 13 and 23 years with an International Classification of Diseases, Tenth Revision diagnosis of any psychiatric disorder, pursuing or discontinued studies within the last 2 years were included in the study. A qualitative interview pro forma was developed and used for interviewing the patients and their family members. Results: 60.3% of the individuals interviewed had a disruption in their academic endeavor lasting for a minimum period of 2 weeks wherein they could not attend class and 1–4 such disruptions per individual in the last 2 years. Major difficulties cited by the participants were the interference of illness symptoms in academic performance, stress caused by difficulties in meeting academic requirements, and interpersonal stressors. Recommendations proposed by the participants were directed toward strategies for compensating the cognitive deficits caused by mental illness and special provisions in the examinations and evaluation. Conclusion: Acknowledging the difficulties faced by the students with mental illness and providing feasible provisions and concessions can go a long way in ensuring the students with mental illness receive a complete education.

Keywords: Academic discontinuation, challenges, mental illness, young people


How to cite this article:
Akshaya A, Gopal S, Pavithra R, Raghavan V. Academic difficulties among young persons with mental disorders. Indian J Soc Psychiatry 2022;38:52-7

How to cite this URL:
Akshaya A, Gopal S, Pavithra R, Raghavan V. Academic difficulties among young persons with mental disorders. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Jun 30];38:52-7. Available from: https://www.indjsp.org/text.asp?2022/38/1/52/323112




  Introduction Top


Recent evidence from the World Health Organization indicates that mental illness affects nearly one in four people in the world at some point in their lives. Around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.[1] This prevalence of mental illness is associated with considerable disablement, with the combination of affective and anxiety disorders being the most predictive of disability and service utilization.[2] Symptoms of mental illness and the concomitant stigma are a major cause of discrimination and exclusion, which in turn negatively affects self-esteem of persons with mental illness, disrupts relationships, and limits their ability to obtain an education.[3]

Students are often unwilling to seek help because of the perceived stigma associated with mental illness and experience a sense of social isolation.[4],[5] After a certain threshold, the distress pushes them to either act in ways that disrupt their education or discontinue academics. Studies undertaken in different parts of the world reveal that academic discontinuation and mental illness are more closely related.[6],[7],[8]

In the Indian context, the literature on the impact of mental illness on education is limited. Such information on the status of the impact of the mental illness on education among students with mental illness will help educators and policy-makers to devise appropriate interventions to reduce discontinuation and improve academic performance. Hence, the aim of this study was to understand the impact of mental illness on the academic performances among young people with mental illness, the barriers faced by them in academic performance, coping strategies used by them to overcome these barriers, and their recommendations to make education more friendly for those with mental illness.


  Materials and Methods Top


Study site

The present study was conducted in the outpatient department of the Schizophrenia Research Foundation, a mental health center and nonprofit organization based in Chennai. Prior ethics clearance was obtained before the start of the study from the Institutional Ethical Committee (IEC) of SCARF.

Study participants

All patients between 13 and 23 years with International Classification of Diseases, Tenth Revision diagnosis of any psychiatric disorder, who were then pursuing or had discontinued studies within the last 2 years, were included in the study after obtaining their consent or assent along with their parental consent, whichever is appropriate. Parents of young patients with mental health disorders who are currently pursuing or discontinued studies were also included. Those with a diagnosis of mental retardation or with a learning disability were excluded. The recruitment methodology of the study participants is depicted in [Figure 1].
Figure 1: Flow chart describing the methodology of the study population recruitment

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Study procedure

A semistructured qualitative interview pro forma pertaining to the research question of this study was developed based on previous research findings and discussions with mental health experts and education professionals about academic difficulties faced by students with mental illness. This pro forma was pilot tested with the patients and parents, and their recommendations were incorporated to modify the pro forma. The final version of the pro forma was approved by all the members of the research team. The patients and their family members were interviewed using the pro forma and their responses were recorded verbatim. The pro forma comprised sociodemographic details, illness information, and current academic status. It also included questions on (1) difficulties and problems faced by the patients while pursuing academics because of their mental illness, (2) the efforts made by them and their parents to overcome these problems, and (3) suggestions from patients and parents regarding the changes they would like to be implemented which would facilitate the patients in being able to continue with their studies.

Data analysis

The sociodemographic variables of the study participants were analyzed using the descriptive statistics, including mean with standard deviation and frequency with percentages. The semiqualitative data recorded including the detailed comments from the study participants for the questions on the academic difficulties were analyzed using thematic analysis. Thematic analysis was done by two independent researchers to categorize the comments into different groups, and any discrepancies were resolved by discussion. Most of the viewpoints articulated by the study participants distinctly fell into one of the groups. Within each group, the responses were classified and categorized into subthemes and tabulated accordingly.


  Results Top


Study participants' characteristics

Of the 43 individuals interviewed, 32 (74.4%) were currently studying or had completed their studies recently. Most of those who discontinued have done so in college rather than in school (4:1). It was also seen that 24 (60.3%) of the 43 individuals had a disruption in their academic endeavor lasting for a minimum period of 2 weeks wherein they could not attend class within the past 2 years. These disruptions have ranged from 1 to 4 such instances per individual in the past 2 years. The age and gender distribution of the patients and their mental illness diagnoses are presented in [Table 1].
Table 1: Demographic, illness, and academics-related variables of the study patients (n=43)

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Qualitative interview findings

The focus of the discussions with patients was on the difficulties and problems faced by them in pursuing academics. The family members were interviewed about the attempts and steps they have taken to assist their wards in their academic pursuits. Both the groups were asked about the suggestions and recommendations they have that will help them cope better with academics.

Difficulties faced by the patients in pursuing academics

The difficulties pointed out by patients have been broadly categorized into themes for better understanding. Each category was provided with the statements made by patients or their parents in verbatim along with their age and duration of illness (DOI).

Symptoms

Cognitive symptoms: Severe mental illness potentially affects the cognitive ability and functioning of the patient. Poor attention, inability to concentrate for extended periods of time, and impaired memory were the major problems that have significantly affected their academic performance.

“After this illness I am not able to pay attention in class even with the interested subject. I was very good at maths, now I am not able to solve simple calculations also which distress me a lot.”

(17 years, DOI-1 year)

Positive symptoms: Patients who experienced pronounced positive symptoms found those symptoms to be highly disabling. Auditory hallucinations were reported to have been a significant disturbance, especially during examinations leading to poor performance. Obsessive and intrusive thoughts also caused difficulties in concentrating and sustaining work. Symptoms caused by chronic pain syndrome, somatization, and dissociation disorders also affected the patients' academics.

Depression and anxiety symptoms: Apart from cognitive impairment and positive symptoms, patients also had to put up with depressive and anxiety symptoms. Most patients cited poor interest, lack of motivation, repeated thoughts of failure, and low self-confidence, which can considerably impact studies. Some of them also expressed how they are often too anxious and fearful to commit mistakes and consequently spend a long time writing answers and repeatedly checking their responses, eventually running out of time. All of this furthers their frustrations.

Now I am feeling much better with medicines, voices have reduced. But I just don't feel like taking my book and study. It's very hard to push myself to study. I don't feel confident about my abilities.”

(21 years, DOI-2 Years)

Treatment side effects

Apart from the symptoms, the medication taken for symptom management itself posed interference in academics. Many patients reported feeling drowsy as a side effect of the medication, and in turn, it affected their ability to focus.

“It is so difficult for me to stay awake in class with these medicines. I feel drowsy and sometimes I take permission from lectures and sleep in the back row. I miss on the class also I feel very embarrassed in such situation.”

(20 years, DOI-1 year and 4 months)

Meeting academic requirements

The demands of academia increase with each stage and those who have mental illness find it harder to meet those requirements. Basic requirements such as attendance, being on time, completion of classwork and homework, staying back for special classes are also stressful for those with mental illness to handle. The participants stated that they struggle when there are frequent tests, and there is a heavy syllabus to cover. While few reported difficulties with theoretical concepts, most patients found mathematics very difficult since it involves rote learning of formulas and applying them to problems. Parents to ease the academic load shift their children to different boards or mediums of instruction, which inadvertently becomes a stressor for the patient. Even if the parent doesn't pressure the patient with high expectations, the patients set high expectations for themselves, which can be extremely stressful.

“I was always the first person to complete the assignments, My friends used to copy it from me, but now I copy from them. The thought that I am not like how I used to be is very frustrating. My school has everyday class test and other assignments which I don't complete most of the time.”

(16 years, DOI-10 months)

Interpersonal relationship stressors

Interpersonal relationship stressors were quoted very often among the list of difficulties during the discussions. The stigma associated with mental illness alienates the patients from their peer group and teachers, which brings down the patients' morale. They face adjustment issues with their classmates and find it difficult to get academic help from them. Parents also end up discouraging the patient from coping with the academic stress by underestimating their ability to handle the pressure.

Attempts made by the families

While difficulties have been abundant for the patients, the families have also made several attempts to deal with them. Most parents approached teachers to request them to give more individual attention to their wards, and in addition, resorted to hiring personal tutors to come home and teach. The parents who could afford to spend more time with their children and assist them with their academic work tried that as well. Changing the patient's environment in terms of the school they studied in, or place of residence was also among the efforts made by the families. However, when all else failed, parents chose to shift to less stressful or demanding academic options for their children, like shifting from mainstream education to studying in correspondence as their last resort.

“Before he used to travel 12 km to his school, now we thought that might stress her too much and hence we shifted to a house very near to her school, she can go by cycle. We stayed in our own house, now it is a rented apartment. It is too expensive for us, but we thought it would help her to cope with her studies.”

(Parent of 14 years old, DOI-1 year 3 months)

Suggestions and recommendations made by patients and families

Classroom practices

Simple changes that can be incorporated in classroom practices such as employing more visual aids, providing more examples to simplify concepts, giving notes and pointers can go a long way in helping students with mental illness cope effectively with academics. Apart from this, the existing ban on corporal punishment should be strictly adhered to.

Special provisions

While there are special provisions in place for students with intellectual disability, patients and their families opine that such provisions be extended to those suffering from other mental illnesses as well. Psychologists or counselors can be of great help in an educational setting and considerably lower the stress caused by academics for the patients.

“In my school, teachers take special class for below - average students, similarly if they can help us with assignments, give us extra time it would be of great help. With this illness I find it very difficult to work with time pressure.”

(17 years, DOI-1 year)

Examinations

Examinations and tests seemed to be one of the most important precipitators of stress, and there were a lot of recommendations put forward during the discussion. Emphasizing practical knowledge than theory during examinations was a major recommendation. Reducing the syllabus or breaking them into smaller chunks for those with mental illness could potentially help them perform better. Patients also preferred objective type questions over long essays as it is easier for them to focus on multiple-choice questions. Many patients struggled to attempt class regularly, and due to lack of the mandated minimum attendance, they could not give examinations or continue with the academic year. Relaxation in the minimum requirement of attendance to undertake examinations would immensely help the patients. The patients also recommended a spaced out examination schedule, extra time during the examination, and special consideration while evaluating their answers.

“All parents wish their children to study and have a degree, now that has become a standard. If my son doesn't have a degree in hand the society won't respect him. He has only 55% attendance, with some help from us he submitted his records, but without 75% he can't take up his exams. If some concession can be given to students like him it would be of great help.”

(Parent of 22 years, DOI-3 years)

The subjects suggested that patients could be provided a course certificate for the completed years of education. For instance, a bachelor in engineering student who has discontinued after having passed 3rd-year examinations can be given a diploma, those who have completed 2 years of the degree program can be issued a certificate.


  Discussion Top


The aim of the study was to understand the reasons behind academic difficulties among students with mental illness comprehensively and make appropriate recommendations to policymakers in the education sector.

Nearly 60.3% of the people interviewed in the study reported that they had a disruption in their academic endeavor, and the disruption lasted a minimum of 2 weeks, with 1–4 such instances in the past 2 years. Research conducted in the United States on the impact of anxiety disorders on educational achievement showed in the past decade, nearly 300,000–500,000 students per year left high school without completing a high-school program.[9] The Canadian statistics are quite similar, with approximately 18% of students not completing high school.[10] While the current study does not provide a picture of the actual number of students with mental illness whose academic pursuit has been disrupted, the results indicate a trend similar to the West that many students with mental disorders face school disruptions or discontinuation.[11],[12],[13]

In this study, 37.8% of the participants had schizophrenia and related psychosis, followed by 18.6% of participants with mood disorders. According to Eisenberg et al.,[14] conduct disorders were the most important psychiatric determinant of dropping out for males, whereas anxiety disorders were the most important psychiatric determinant of dropping out for females. A study using U.S. data finds that adolescent depression is positively correlated with high school dropout and negatively correlated with college enrolment.[2] In a study from India, symptoms of anxiety were present in 10.8% of the students screened with older students (12–15 year olds) having greater odds of having overall anxiety symptoms.[15]

While the current study shows that most of those who discontinued have done so in college rather than in school (4:1), a majority of the literature reveals that the proportion of school terminations attributable to mental disorders was most significant for high-school graduation (10.2%).[16] The vast cultural difference in terms of high-school set up in the West, in comparison to India, could be a reason for the difference in trend in dropout.

In this study, cognitive deficits resulting from mental illness were a huge detrimental factor in academic pursuit. Besides that, it was observed that the presence of positive symptoms, difficulties in meeting basic academic requirements, and interpersonal stressors are also huge contributing factors for academic discontinuation. Similar results were observed in other studies. For example, individuals with high levels of psychopathology are also found to have impaired information-processing skills, which are a critical component of academic performance and success.[17] Furthermore, they have higher levels of psychological distress characterized by higher test anxiety, lower academic self-efficacy, less effective time management, use of study resources, and less likely to persist when faced with distraction or difficulties.[18]

While many of the recommendations suggested by the participants in this study mainly related to examinations, which are very similar to the existing practice for students with learning disabilities, other recommendations include modifications in the classroom teaching strategies. Recommendations from a study conducted in Queensland, Australia include, providing better links between the university and external mental health providers, and increasing students' awareness of existing support services within and external to the university.[2]

The major limitations of this study are: (1) this is a single center-based study from Chennai. Hence, the results cannot be generalized to all the students with mental illness all over India; (2) only the young people and their parents who visited the facility were included in the study. Since the psychopathology of these participants could be severe, the results cannot be translated to students with minor psychopathology or mental distress but not disorders; (3) since the study is a semi-qualitative one, some valuable information might not be captured.


  Conclusion Top


The results suggest that in terms of difficulties faced by students, it largely revolves around symptom management. Acknowledging the difficulties faced by the students with mental illness and providing feasible special provisions and concessions can go a long way in ensuring that the students with mental illness receive a complete education.

Acknowledgment

We would like to thank the participants for their time and for actively taking part in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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World Health Organization. Mental Disorders Affect One in Four People. World Health Report. World Health Organization; 2001.  Back to cited text no. 1
    
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Storrie K, Ahern K, Tuckett A. A systematic review: Students with mental health problems--a growing problem. Int J Nurs Pract 2010;16:1-6.  Back to cited text no. 2
    
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Baumann AE. Stigmatization, social distance and exclusion because of mental illness: The individual with mental illness as a 'stranger'. Int Rev Psychiatry 2007;19:131-5.  Back to cited text no. 3
    
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Barney LJ, Griffiths KM, Christensen H, Jorm AF. Exploring the nature of stigmatising beliefs about depression and help-seeking: Implications for reducing stigma. BMC Public Health 2009;9:61.  Back to cited text no. 4
    
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Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry 2002;1:16-20.  Back to cited text no. 5
    
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Fletcher JM, Tokmouline M. The Effects of Academic Probation on College Success: Regression Discontinuity Evidence from Four Texas Universities; 2017.  Back to cited text no. 6
    
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Lee Y, Choi J. A review of online course dropout research: Implications for practice and future research. Educ Technol Res Dev 2011;59:593-618.  Back to cited text no. 7
    
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McLeod JD, Uemura R, Rohrman S. Adolescent mental health, behavior problems, and academic achievement. J Health Soc Behav 2012;53:482-97.  Back to cited text no. 8
    
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Van Ameringen M, Mancini C, Farvolden P. The impact of anxiety disorders on educational achievement. J Anxiety Disord 2003;17:561-71.  Back to cited text no. 9
    
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Dassanayake W, Springett J, Shewring T. The impact on anxiety and depression of a whole school approach to health promotion: Evidence from a Canadian comprehensive school health (CSH) initiative. Adv Sch Ment Health Promot 2017;10:221-34.  Back to cited text no. 10
    
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Esch P, Bocquet V, Pull C, Couffignal S, Lehnert T, Graas M, et al. The downward spiral of mental disorders and educational attainment: A systematic review on early school leaving. BMC Psychiatry 2014;14:237.  Back to cited text no. 11
    
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Kishore AN, Shaji KS. School dropouts: Examining the space of reasons. Indian J Psychol Med 2012;34:318-23.  Back to cited text no. 12
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Pascoe MC, Hetrick SE, Parker AG. The impact of stress on students in secondary school and higher education. Int J Adolesc Youth 2020;25:104-12.  Back to cited text no. 13
    
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Eisenberg D, Golberstein E, Hunt JB. Mental health and academic success in college. BE J Econ Anal Polic 2009;9:1.  Back to cited text no. 14
    
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Karande S, Gogtay NJ, Bala N, Sant H, Thakkar A, Sholapurwala R. Anxiety symptoms in regular school students in Mumbai City, India. J Postgrad Med 2018;64:92-7.  Back to cited text no. 15
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Breslau J, Lane M, Sampson N, Kessler RC. Mental disorders and subsequent educational attainment in a US national sample. J Psychiatr Res 2008;42:708-16.  Back to cited text no. 16
    
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Martinez YJ, Ercikan K. Chronic illnesses in Canadian children: What is the effect of illness on academic achievement, and anxiety and emotional disorders? Child Care Health Dev 2009;35:391-401.  Back to cited text no. 17
    
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Ergene T. The relationships among test anxiety study habits achievement motivation and academic performance among Turkish secondary school students. Egitim ve Bilim 2011;36:320.  Back to cited text no. 18
    


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