Pushing children to breaking point

19th April 2013 at 01:00
Exam stress is contributing to an increase in suicide rates among teenagers, Adi Bloom discovers

High-stakes, test-driven schooling has contributed to a rise in suicides and suicidal behaviour among young people, new research says.

While suicide has many contributory factors, Alastair Sharp, deputy director of Samaritans, Hong Kong, and associate professor in the department of English at Hong Kong's Lingnan University, believes that test-focused education "must take some of the blame for inducing behavioural and psychological problems".

In an article published in the current edition of the Education and Health journal, Sharp points out that suicide is the most common cause of death among 15- to 19-year-old girls worldwide. It is the third most common cause of death among boys of the same age.

An estimated 4 million young people attempt suicide every year around the world; at least 164,000 are successful, according to World Health Organisation figures. Suicide is increasing at a greater rate among young people than in any other age group.

In the UK it is the second most common cause of death among 15- to 19-year-olds after road-traffic accidents. The number of children and teenagers who called ChildLine in order to talk about suicide more than doubled between 2004 and 2008.

"The risk factors which may lead to suicide are many," Sharp says. "They include mental disorders (particularly depression), substance use, stressful life events, social isolation (and) a family history of suicide."

He adds: "Understanding the causes of suicidal behaviour in young people and children remains a major challenge."

But, while there is no single cause of suicide, there are contributing factors. Sharp points out that there appears to be a correlation between school-related stress and teen suicide.

He cites a survey commissioned by the Samaritans, which revealed that almost three-quarters of the 6,020 students in English schools questioned in 2000-01 who self-harmed and had suicidal thoughts referred to worries about school work and exams. This figure was much higher than other problems cited by the students, such as bullying or parental and relationship problems. Similarly, a survey of teachers conducted in 2008 by the Association of Teachers and Lecturers revealed that 89 per cent of respondents felt that tests and exams were the main cause of student stress.

"School-performance stress (is) having a profound effect on mental health, particularly among girls in the UK," Sharp says.

But, he adds, there are similar rises in depression, suicide and self-harm in other countries with strongly exam-focused education systems. A 2009 survey of 3,383 students in Hong Kong found a strong correlation between suicidal thoughts and the pressure of exams. And, in mainland China, 24 per cent of 2,500 Shanghai students interviewed in 2004 by academics said they had contemplated killing themselves. Many added that this was a response to exam stress.

"Indications are that the pressure from a developing exam culture appears to be putting increasing stresses on the young: stresses not felt to the same degree by the previous generation," Sharp says. "The mental health of the world's children has worsened."

England, he adds, may be the international leader in exam-driven education. And, while suicidal behaviour and depression have biological, psychological and environmental causes, "the suggestion that the pressure of high-stakes exams is a contributing factor has to be given greater credibility", he says. "Test-driven education must take some of the blame for inducing behavioural and psychological problems."

This, Sharp believes, is a powerful argument for moving away from a model of education that focuses on league tables and quantifiable progress. "Moving away from measurement-driven instruction to a more humanistic view of education ideals would help," he says.

"In this view, teaching the young to live happier and healthier lives, while promoting intellectual and emotional development, are what matters."


Various school-based programmes have been introduced around the world in an effort to combat depression, exam stress and suicidal behaviour.

But the effectiveness of such programmes is often debatable, says Alastair Sharp, deputy director of Samaritans, Hong Kong, and associate professor in the department of English at Hong Kong's Lingnan University.

In some cases, while students' awareness of suicidal behaviour is increased, there is no concomitant drop in suicide rates. There have also been suggestions that suicide programmes mistakenly suggest that such behaviour occurs simply as a result of stress, ignoring broader mental-health issues.

Other critics have attacked the brevity of many programmes: some take up only two hours of a student's entire school career.

But Sharp cites some that provide effective intervention. Students in the US-based Signs of Suicide programme, for example, are taught about depression and the warning signs of suicide, as well as about where to go for help. The scheme makes it clear depression is treatable.

Another US study combined a suicide-prevention curriculum with a home-based scheme involving teenagers and parents. This produced "significantly greater reductions in suicide risk factors", Sharp says.

And peer-support programmes in the UK have been effective: students are often more willing to talk to one another about problems than to a teacher.

Indeed, fears over confidentiality often mean that students are unwilling to seek help from staff. But Sharp believes that talking more openly about suicidal behaviour may help to remove the stigma surrounding mental health problems.

"School programmes which offer help should identify exams and school performance as contributory indicators of stress and suicidal behaviour," he says. "Advising students on coping skills, as part of these programmes, is becoming increasingly necessary."


Sharp, A. (2013) "Exam culture and suicidal behaviour among young people", Education and Health, 311: 7-11.


Education and Health.


Alastair Sharp, deputy director of Samaritans, Hong Kong and associate professor, Lingnan University, Hong Kong.


Samaritans UK.


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