The association between academic pressure and adolescent mental health problems: A systematic review

Abstract

Background: Academic pressure is a potential contributor to adolescent mental health problems, but international evidence on this association has never been synthesised. Methods: We conducted the first systematic review on the association between academic pressure and adolescent depression, anxiety, self-harm, suicidality, suicide attempts and suicide. We searched MEDLINE, PsycINFO, ERIC and Web of Science (core collection) up to November 24, 2022, for studies of school-going children or adolescents, which measured academic pressure or timing within the school year as the exposure and depression, anxiety, self-harm, or suicidal ideation, attempts or suicide as outcomes. Risk of bias was assessed using the Mixed Methods Appraisal Tool. We used narrative synthesis to summarise the evidence. The review was prospectively registered with PROSPERO (CRD42021232702). Results: We included 52 studies primarily from Asia (n=26) and Europe (n=20). Most studies assessed mixed anxiety and depressive symptoms (n=20) or depressive symptoms (n=19). Forty-eight studies found evidence of a positive association between academic pressure or timing within the school year and at least one mental health outcome. Limitations: Most studies were cross-sectional (n=39), adjusted for a narrow range of confounders or had other limitations which limited the strength of causal inferences. Conclusions: We found evidence that academic pressure is a potential candidate for public health interventions which could prevent adolescent mental health problems. Large population-based cohort studies are needed to investigate whether academic pressure is a causal risk factor that should be targeted in school- and policy-based interventions.

Current evidence and opportunities in child and adolescent public mental health: a research review

“…These 'modern matters' (Boxes 1-4), ranging from climate uncertainty to rapidly-evolving virtual environments, might have an impact on child and adolescent mental health. Not Box 4 Modern matters in the school system: academic pressure Despite an absence of any recent reviews on interventions targeting academic stress and pressure, many children and adolescents report stressors from the education system including 'fear of failure, concerns about the future, chronic stress about workload and exams, worries about parental expectations, and competition with peers for grades' (Steare et al, 2023). Furthermore, there is evidence that academic pressure, a complex construct that is influenced by individual and family perspectives but also invokes school leadership, policy directives and the school inspection system, might be on the rise (L€ ofstedt et al, 2020).…”

“…In many countries the emphasis is on a 'one-size-fits-all' focus on individuals achieving top marks in public examinations rather than encouraging student accomplishment in areas best aligned with their interests and skill set, be that in academic, athletic, creative, community engagement or other arenas. Although further evidence is required to understand whether there is a causal relationship between school-based pressure and mental health difficulties (Steare et al, 2023), it is reasonable to suggest that these academic pressures could be an important target for public mental health approaches. Schools may be a natural place to address this, including through policies and approaches that emphasise, in addition to academic attainment, the importance of domains such as school climate, interpersonal relationships and extracurricular activities.…”

“…For many, the school also provides a link to the broader community, including other families at school as well as groups for sporting, arts, community engagement and other opportunities for self-expression and connection. There are many school-based risks for poor mental health outcomes that either result from or are exacerbated by interpersonal experiences (such as bullying or peer violence (Arseneault, 2018;Patalay & Fitzsimons, 2018)), school requirements (including start time (Ziporyn et al, 2022) and assessments (Steare, Gutierrez Munoz, Sullivan, and Lewis, 2023)), and wider school climate and environment (Ford et al, 2021;Troy et al, 2022), all of which can exert complex, pervasive and multi-level influences which can best be elucidated through systematic and indepth measurement.…”

Changes in internalizing and externalizing problems in Dutch children and adolescents receiving youth care before and during the COVID-19 pandemic

“…Olfson, Druss, & Marcus, 2015; Patalay & Gage, 2019). Societal changes such as increased social media use (Abi-Jaoude, Naylor, & Pignatiello, 2020; Kelly, Zilanawala, Booker, & Sacker, 2018), increased mental health awareness efforts (Foulkes & Andrews, 2023), increasing rates of parental mental health problems (Mark Olfson, Blanco, Wang, Laje, & Correll, 2014; Thapar, Collishaw, Pine, & Thapar, 2012), increased long-term poverty (Chaudry & Wimer, 2016; Ridley, Rao, Schilbach, & Patel, 2020), increased school pressure (Steare, Gutiérrez Muñoz, Sullivan, & Lewis, 2023), and earlier puberty onset (Golub et al, 2008; Lee & Styne, 2013) have previously been linked to these trends of poorer child mental health over the past decades. The increased internalizing and externalizing problems in children who entered care during the pandemic in our sample may therefore be a continuation of changes already occurring at a larger societal scale, rather than only being a result of the pandemic on child mental health.…”

Adolescent psychotic experiences before and during the COVID‐19 pandemic: a prospective cohort study

“…On the other hand, gender difference in the effects of the pandemic was not significant in the mid-pandemic period. In this period, schoolwork-related stress/ pressure, which are the major factors of mental health problems (Steare, Gutierrez Munoz, Sullivan, & Lewis, 2023), may be more prevalent compared to other periods, because school works were increased in this period to compensate for decreasing amount of works due to school closure, with 60% decrease in summer vacation (Tokyo Metropolitan Board of Education, 2020). Considering that schoolwork-related stress/pressure was originally more prevalent in girls compared to boys (OECD, 2017), these stress/pressure may affect especially girls in the mid-pandemic period.…”