Introduction

Mental disorders never once entered my mind until my teenage years. Although it was not significant or sudden, there was a gradual increase in the appearance of mental disorders when I entered seventh grade; my peers began to show symptoms of depression, eating disorders, insomnia and more. The first time I was hit with reality was when I was informed that a high school student from my school had committed suicide. I was in eighth grade.

I didn’t understand what possibly could have pushed someone over the edge and end with such fatal consequences, but in the next few years I witnessed first-hand the pressures that teenagers endure on a daily basis. Slowly, I began to empathize more and more with those who have suffered or are still suffering from intrusive and overwhelming thoughts.

After watching a series of shows, eating disorder on Skins and Tiny Pretty Things, depression in Euphoria and The End of the F***ing World, and schizophrenia in 13 Reasons Why and Words on Bathroom Walls, I realized, though there has been a growing amount of representation of mental illnesses in media in recent years, many focused on the consequences and not how to alleviate them. Certain disorders are almost never portrayed and when they were (dissociative identity disorder in Split), there was often backlash for the misrepresentation and negative connotations involved, causing misconceptions and audience members to be offended.

It is after watching reality and fiction unfold did I see a difference between the two. Hence, it did not come as a surprise that there are often huge misconceptions of mental disorders. As teenagers, it is important for us to learn how to cope with these issues and how to reach out for help and there is no better place to learn about this than at school. School should be a safe place for students and they should have the responsibility of checking in with the mental wellbeing of their students.

To learn more about the mental health of students, specifically a comparison between those in international or private, public US, and local Chinese schools a survey was created.

Methodology

Most questions on the survey are the ones that I have been pondering on for quite some time. As a student, my best resources are my classmates. This survey was sent out to all high school students in my school as well as posted on all forms of social media.

To maintain the engagement and receive the most honest responses, I decided to have the most important questions in multiple choice or ranking form to collect numerical data quickly. (Special thanks to Kalin for helping me translate the survey and for sending it out in her community as well).

Most schools have counselors or therapists, most likely because it is a requirement for many regions. What is concerning is that many students do not feel comfortable with them. In fact, the average rating of how comfortable they feel with them is only 3.02/5. Hence, while the facilities are there, many students will only ever trust these counselors and therapists with issues that are less personal. Student led organizations, on the other hand, are less common in all schools, with around half of international, private, local Chinese, and public US schools having them. Interestingly, students don’t find their peers more trustworthy either, and, instead, gave 2.50/5, a much lower score compared to counselors and therapists. According to ScienceDaily, a study conducted in 2017 by Michigan State University suggested that students often trust peers more for academic feedback rather than teachers. The results of our survey suggest that this trust does not extend to more personal issues and the bond between classmates and peers is lacking today, especially in international and private schools. Additionally, it should be noted that more students of international, private, or local Chinese schools have a trusted adult outside of school than inside. This may have been caused partly by some sort of barrier between faculty and students, possibly a clear hierarchy in schools.

“Peers, More than Teachers, Inspire Us to Learn.” ScienceDaily, ScienceDaily, 21 Mar. 2017, www.sciencedaily.com/releases/2017/03/170321110341.htm

Students in international, private, and US public schools talk more about mental health amongst themselves than local Chinese schools. Though it’s great that these students talk about mental health quite often, with a rating of 3.43/5 on frequency (see table for measurement), what is concerning is the comparison between this and how frequent the school addresses these issues. It is equally, if not more important for schools to talk about mental health as it is their responsibility to ensure students’ wellbeing under academic pressure and to provide a safe space for students. With a rating of 2.63/5, international, private, and US public schools are not addressing mental health nearly enough. Quite the opposite, students in local Chinese schools talk less about mental health amongst themselves than school addresses them, and this is backed up with the data of significantly more local Chinese schools providing mental checkups than others.

While no homework weekends, school ending early, full day of study hall, group meditations, and more are provided in certain schools, only 44.7% of all practices occur every week or more frequently. For those who talk to their counselors, students in private and international schools do so the most frequently and not many students talk to counselors in local Chinese schools. While the reason behind this is not clear, it can be implied that students from international and private schools are either given the most chances or feel the most comfortable with their counselors or they may have more mental health issues that need to be discussed.

Depression and anxiety disorder are the most professionally diagnosed mental health issue, followed by eating disorder, ADHD, and finally insomnia. Anxiety and depression also occur as a pair quite often, providing evidence that one may lead to another. Anxiety disorder is the most self-diagnosed mental health issue, followed by depression, ADHD, panic disorder and insomnia, then bipolar disorder, OCD, and eating disorder. Again, anxiety and depression are leading the list of diagnostics. This trend should be noted; schools and communities can target these two illnesses and provide support and education on how to manage or prevent them. Based on the survey, out of all students, local Chinese students have the least mental disorders, whether that is those professionally diagnosed or self-diagnosed. This set of data implies that either students do not have enough opportunities to be properly diagnosed or they do not have the education to properly diagnose themselves. Anyhow, not enough attention to mental illnesses in adolescents is given. Communities should provide diagnostic tests annually for high school students, especially as mental distress and illnesses are increasing in adolescents (AJMC)

Rosenberg, Jaime. “Mental Health Issues on the Rise Among Adolescents, Young Adults.” AJMC, AJMC, 30 July 2020, www.ajmc.com/view/mental-health-issues-on-the-rise-among-adolescents-young-adults.

In response to the biggest stressors, students open up and generally find the most positive support in family and friends. At first glance, this is somewhat confusing as family relationship was in the top three stressors for all three types of schools in data table 5. However, it is said that the ones who love you the most hurt you the most; students may have complicated relationships with their family.

While diary/vlog/etc is a good first step, students should be encouraged to speak to others. More attention should be brought to the number of students who engage in unhealthy habits or avoidance. Out of the three types of schools, international, private, and public US students are more likely to engage in unhealthy habits, the youngest of whom is merely 13. This should be extremely alarming as this coping method often does not solve problems and may even worsen them. With 32% using diary/vlog/etc, 22% using unhealthy habits, and 49% using avoidance, it is clear that while around 78% of these students stated that they have a trusted adult inside or outside of school, not all are able to open up to them as they are resorting to other measures.

While COVID itself did not cause an uprise in mental health issues, quarantine and lockdown have taken a huge toll on everyone. Students lack the common social activities and a sudden decrease in physical activity; adults face job loss and financial instability. According to the survey, COVID impacted international, private, and public US students the most. Two possible correlations may be the reason behind this data: the length of quarantine (as students in China were able to resume to on campus classes sooner), and the amount of social and physical activities students previously had before quarantine.

To deal with isolation, International, private, and public US students found the most comfort in online activities, namely talking to friends and social media (spend more time on social media than local) whereas local Chinese students found the most comfort with finding new hobbies and talking to friends.

Surprisingly, only 43.9% of the schools actually helped students transition from on campus learning to online learning and back. Rather than telling students how to deal with stressful times, schools generally passively aided these transitions by being less strict and giving less pressure.

A very large number of students believe that mental health is not addressed enough or could be addressed more in their community. While many schools provide advertisements, orientations, etc, they don’t take direct action, giving the impression that they do not actually care about the wellbeing of their students. Another example is how schools tell students to simply speak to adults, without taking into account that many students don’t feel comfortable enough to follow through with such stereotypical instructions.

Many students don’t want to express their concerns as a fear of burdening others. Communities should come together and reassure each other that they are there for one another. Surprisingly, it is noted that some students are not aware of their school having an emotional therapist and not just a counselor, preventing many from using all of their resources.

Evaluation

Most analysis are drawn from the data collected by a survey created by me with the help of Kalin. Because of this, there are a few limitations to this paper. The most obvious one being the unequal distribution of participants who completed this survey. As Kalin and I both come from international and private schools, it became the largest audience that we were able to attain; local Chinese and US public schools were difficult to reach. With only six and two surveyors respectively in those two fields, most international and private school students coming from an Asian background, and most surveyors from middle to high social classes, the results of the survey cannot be generalized to the entire population of adolescents.

Another significant disadvantage to surveys is the accuracy of both the data and the analysis. It is important to note that for such research methods, it is impossible to control whether the participants are taking the survey seriously and speaking the truth, with confirmation bias being an existing factor. Moreover, I tried to make as much use of quantifiable data as they are much more direct and easier to interpret. Because of this, I was able to draw conclusions but did not have much information on why these trends occur.

It is important for studies to be ethical. Mental health can be a very sensitive topic and to prevent myself from asking uncomfortable questions or triggering disorders, I made sure that all survey results were anonymous and stated in the instructions that no question in the survey was mandatory.

Conclusion

General trends across the entire survey that can be noticed is that local Chinese schools tend to provide the most mental health checkups in schools and most students believe that they do not have any mental health issues. For the most, international, private, and public US schools are grouped together and students there tend to have more struggles with mental health problems.

To start, education on symptoms of common mental health issues should be given to prevent misconceptions on mental health and so that students are able to identify and reach out for help when they notice symptoms of specific illnesses. To create a stronger bond within a school, students and staff should break certain barriers between them and create more trust. For instance, schools could have a mandatory one to one therapist session for all students beginning of the year so that students are able to experience and trust them more when they are in need. Another action that can be taken is for student led organizations on mental wellbeing to be promoted and for them to reach out to their peers more often. Awareness on mental health wellbeing should be raised in communities outside of school as well. It is important for everyone to realize how important it is to promote this as mental health problems that are not addressed correctly will prevent adolescents from focusing on academics and experience things they love. If not enough attention is to be given to mental health issues, the rate of suicides or suicide attempts will continue to increase among adolescents.