Do we take the stress associated with academic pressures seriously enough? A recent editorial in the Lancet (2023) argues strongly that we do not. Although we think we know about such pressures, there is actually remarkably little data in this area. It is generally assumed that academic pressure is a factor in school absenteeism, in mental health issues such as depression and anxiety in the young, and even suicide – but data specifying the reality of such problems is remarkably lacking. Consequently, efforts to reduce the burden of such stress are poor.
The Good Childhood Report
The Children's Society performs regular surveys of happiness with children and their parents or carers, and their reports (The Good Childhood Report) are often cited as evidence for problems with school. Recent results are depressing (The Children's Society, 2023). Almost a quarter of children (24.3%) were unhappy with at least one aspect of life. Mean level of overall happiness with life has fallen steadily in 10–15-year-olds over the last 12 years. Mean happiness with school and schoolwork has shown a marked decline over that period. This is certainly suggestive of issues with academic pressures – but is not definitive: mean level of happiness has consistently fallen in every area assessed, including friendship and appearance, the one exception being happiness with family, which has been fairly static.
‘… we need a new, more holistic approach to understanding what academic pressure actually is, if we are to properly understand the issues.’
Detailed breakdowns of the data (The Children's Society, 2023) suggest that nearly 10% of children are currently unhappy with school and schoolwork. So far as understanding the impact of academic pressures goes, this result is hard to unpack. For example, ‘unhappiness’ is defined in this survey as scoring below the median on a happiness scale. What does that mean, in terms of mental health issues – particularly in a situation where the median is consistently falling? How many children above the current median score have mental health issues? And what are those issues?
More specific research
As implied in the lancet editorial, research on the impact of academic pressures is remarkably limited, convoluted, and complex. One problem is that ‘academic pressure’ is a poorly defined concept. It encompasses factors as diverse as peer competition, worries about parental expectations, the chronic worries about coping with workload and continuous assessment, the acute stresses of preparing for and taking exams – and in older teens, the worries about what their performance will mean for their future. This diversity complicates research. Different studies measure different things, and using different methods, so that collating results across studies to draw general conclusions can be hard. The Lancet editorial argues that we need a new, more holistic approach to understanding what academic pressure actually is, if we are to properly understand the issues.
An important new study (Steare et al, 2023) presents a very helpful meta-analysis of research directly addressing the impact of academic pressure on adolescent mental health. Steare and his colleagues identified 52 studies fit to be included in this meta-analysis (though they remained critical of some aspects of over 40% of these). These studies come from a range of different cultures, mainly from high income settings in Europe, North America and Asia. Four of the studies were done in the UK, and a fifth includes data from the UK, Australia and Spain. Since different studies used different measures of academic pressure and assessed different outcomes, the general themes emerging across the 52 studies are of more interest than individual studies and variation between studies.
‘Mixed anxiety and depression is the most commonly reported outcome of academic pressure, with 19 of the 20 studies measuring this outcome reporting a positive association…’
Academic pressure and mental health
Of the 52 studies analysed by Steare, 48 found clear evidence of an association between academic pressure and mental health outcomes.
Psychological distress
The majority of studies measuring depression found that academic pressure was associated with increased depression (Steare et al, 2023). One UK study that found no association looked at depression only in the 6 to 8 weeks before exams (Locker and Cropley, 2004) which might have been too small a timespan to detect an effect – surely most students anticipate exams far earlier than this, and worry longer? A German study (Kaman et al, 2021) found that academic pressure was positively associated with depression across a five year follow-up, though only in boys.
Anxiety: The majority of studies measuring anxiety found a positive relationship between academic pressure and anxiety. The exception is again Locker and Cropley (2004) – but as noted above, this study only looked at the few weeks before exams, finding no rise in anxiety. It seems likely that student anxiety rises way earlier than this, so that the baseline ‘start’ measure in Locker and Cropley was too late, limiting the value of this result.
Mixed anxiety and depression is the most commonly reported outcome of academic pressure, with 19 of the 20 studies measuring this outcome reporting a positive association. The 20th study, in Australia, found that academic pressure was associated with psychological distress (anxiety and depression) for some demographic groups more than others, as well as reflecting personality (Hodge et al, 1997). Interestingly, a study in Sweden compared the scale of the association between academic pressure and psychological symptoms across time, finding that there was a stronger impact in 2017 than in 1993 (Högberg et al, 2020).
Hospital admissions for mental health issues may offer a proxy for more direct measures of the level of distress the young suffer through academic pressures. Studies in UK (Blackburn et al, 2021) and Canada (Slaunwhite et al, 2019) found that such hospital admissions rise through school term time and are lower in vacation time. While suggestive, this result needs caution. Academic pressure is not the only thing that may reduce in vacations: for example, out of school, a child may be less accessible to bullies.
Suicide and self-harm
A study in the UK found that hospital admissions for self-harm increase in school term time and reduce in vacations (Hawton et al, 2003). Again, while suggesting that school-related stressors play a role in self-harm, there are other school stressors besides academic pressure. Studies in Pakistan (Masood et al, 2018) and China (Shang et al, 2014; Zhang et al, 2019) found an association between academic pressure and suicidal thoughts. Two studies in the USA (Carbone et al, 2019; Spiller et al, 2020) found that hospital admissions for suicide attempts were lower in vacation months than term time. Likewise, suicide rates were found to be lowest during school holidays in the USA (Hansen and Lang, 2011) and Japan (Matsubayashi et al, 2016), though no such association was found in a study in Finland (Lahti et al, 2007).
Conclusions
Reading the detail of the meta-analysis presented by Steare et al (2023) the strongest conclusion one comes away with is that the Lancet editorial is right. Plainly, there is already some evidence that academic pressure is indeed associated with mental health problems, and possibly suicide and self-harm in adolescents across the world. That should surely be enough to support the call that we should take academic pressure on our young more seriously.
Importantly, the data we have so far do not provide what we need, to know how best to reduce the toll of academic pressure on the young. For example: what is it, exactly, that defines and creates academic pressure? What is it that makes some individuals, some demographic groups more vulnerable or more robust in the face of such pressures? What interventions work in protecting the vulnerable, at an individual, a family, a school level? As the Lancet argues, these issues need to be taken more seriously.