Adolescence is a key period for the onset of mental health difficulties, particularly anxiety and depression, with 1 in 5 young people experiencing a probable mental health disorder (NHS England, 2023). At the same time, educational systems are placing increasing value on academic achievement, resulting in young people reporting higher levels of academic pressure (Armitage et al., 2025). The Educational Stressors Hypothesis (West & Sweeting, 2003) proposed that increasing academic pressure may be partly responsible for rising mental health challenges, making understanding this association an important research objective.
A recent systematic review concluded that academic pressure is consistently associated with mental health problems, including depressive symptoms, although causality could not be established (Steare et al, 2023). Existing studies are mostly cross-sectional and therefore have not looked at changes in academic pressure and mental health problems over time, making it difficult to determine if academic pressure precedes observed increases in depression and self-harm among young people. Moreover, much of the research fails to consider the impact of academic pressure on self-harm in particular.
To bridge the gap, a team of researchers based across UK universities investigated whether the amount of academic pressure young people experienced during adolescence was linked to depressive symptoms and self-harm in early adulthood (Guo et al., 2026). Looking at data over several years, they hypothesised that higher levels of academic pressure would be associated with higher levels of both depressive symptoms and self-harm.
Methods
The researchers in this study examined whether academic pressure at age 15 was associated with depressive symptoms and self-harm across a 7-year follow-up period, from adolescence into early adulthood, using data collected by the Avon Longitudinal Study of Parents and Children (ALSPAC). ALSPAC followed approximately 14,000 children from birth into adulthood, collecting lots of different data.
Academic pressure was measured using three items from the ALSPAC questionnaires based on a definition of academic pressure that was developed with input from young people. Topics covered by the measure included worrying over schoolwork, feeling pressure from home to succeed and the importance of achieving good GCSE grades.
Depressive symptoms were measured repeatedly between ages 16 and 22 using the Short Mood and Feelings Questionnaire, a common measure of depressive symptoms in young people. Self-harm was assessed at approximately ages 16.5, 17.5, 21 and 24, including self-harm regardless of suicidal intent.
Multilevel regression models were used to examine whether associations between academic pressure and mental health difficulties persisted over time. They adjusted for other factors that could also influence mental health or academic pressure, such as parents’ education, depressive symptoms at age 13 and experiences of bullying, to name a few. The researchers used multiple imputation to address missing data, under the assumption that missingness was dependent on observed data.
Results
Despite estimating missing outcome data, the researchers only included participants who had complete data for the exposure: academic pressure. This resulted in an overall sample of 4,714 adolescents (2,725, 57.8% female).
Higher academic pressure was associated with increased depressive symptom scores across follow-up points. For each 1-point increase in academic pressure, depressive symptom scores increased by 0.43 (95% CI 0.36 to 0.51).
Although the association was smaller, higher academic pressure was also associated with 8% higher odds of self-harm (Odds Ratio 1.08, 95% CI 1.01 to 1.16). This self-harm association was observed across the follow-up time-points. An interesting finding to note is that the opposite effect was seen when looking at the individual measure on “the importance of achieving good GCSE grades”, whereby viewing grades as being more important was associated with slightly lower odds of self-harm.
Conclusions
This study adds to evidence that academic pressure may be relevant to mental health beyond adolescence. The association with depressive symptoms was strongest when symptoms were measured at age 16, but remained detectable at age 22. The self-harm finding was weaker and less consistent than the finding for depressive symptoms, although there was no evidence that the association varied across follow-up timepoints. Together, the findings suggest that academic pressure may be a potential modifiable risk factor, but the observational design means that causation cannot be established.
Strengths and limitations
The study’s biggest strength was its longitudinal design, building on previous research by measuring outcomes at multiple points into early adulthood. Using a large sample that was followed up repeatedly meant the researchers could track change over time rather than relying on a single snapshot.
While the involvement of young people in developing the academic pressure measure was a strength, it was measured using just three questions that had not been validated elsewhere. This could help explain why the individual academic pressure questions produced different results, as each item may be measuring a different aspect of academic pressure. The researchers also mixed pressure from home, school and internal worry into one score, so it is unclear which matters most for potential interventions. Importantly, because the study was observational, residual confounding cannot be ruled out, i.e., factors such as perfectionism, personality, family mental health, self-esteem or vulnerability to stress could influence both perceived academic pressure and mental health.
The sample was also overwhelmingly White, from one part of England, and participants were assessed in the mid-2000s exams. This may not fully reflect experiences of young people today who are growing up in a more diverse, post-pandemic world, shaped by social media and changes to the education system (i.e., GCSE reform). The authors also note that more recent data are needed because educational policy has changed and academic pressure may have continued to rise.
Another limitation is the overlap between academic pressure and symptoms of anxiety and depression, particularly because one item concerned worry about schoolwork. The researchers note that this could mean the exposure measure partly reflects perceptual biases associated with mental health symptoms, although the correlation with depressive symptoms was small and baseline depressive symptoms were adjusted for. Future research should examine anxiety alongside depression to clarify whether anxiety is a confounder, a co-occurring outcome, or part of the pathway linking academic pressure to later mental health.
Implications for practice
With a well-validated measure of academic pressure, future research should try to unpick which areas of academic pressure (home, school or individual) matter most for mental health. This would provide better targets for interventions. Research should then evaluate whether reducing specific forms of academic pressure actually improves mental health outcomes, rather than assuming that an observed association is causal.
Schools could evaluate whole-school approaches such as reducing or delaying unnecessary high-stakes assessments, placing more emphasis on learning rather than grades alone, and building in opportunities for social and emotional learning and relaxation. For example, in Finland there is no compulsory standardised testing throughout education (TechClass, 2025). At policy level, education systems could consider the mental health implications of assessment structures and high-stakes testing.
Statement of interests
As MSc Clinical Mental Health Sciences students at UCL, we want to clarify that although some individuals involved in the research discussed are UCL faculty, we have no direct involvement in the study, its review, or its publication. This blog was created independently for our coursework and reflects our interpretation. We have no conflicts of interest beyond our academic relationship with the study. We acknowledge the use of ChatGPT for language refinement and proofreading of the final draft.
Contributors
Thanks to the UCL Mental Health MSc students who wrote this blog from the Merrit Student Group: Shahad Asfary, Jenna Buller, Callum Hamilton, Anoushka Malik, Naomi Shacham.
UCL MSc in Mental Health Studies
This blog has been written by a group of students on the Clinical Mental Health Sciences MSc at University College London. A full list of blogs by UCL MSc students can be found here.
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Edited by
Dr Dafni Katsampa.
Links
Primary paper
Xuchen Guo, Marie Mueller, Jessica Armitage, Chris Bonell, Tamsin Ford, Ann John, Glyn Lewis, Simon Murphy, George Ploubidis, Frances Rice, Alice Sullivan & Gemma Lewis (2026). The association between academic pressure and adolescent depressive symptoms and self-harm: a longitudinal, prospective study in England. The Lancet Child & Adolescent Health, 10(4), 265–272. https://doi.org/10.1016/s2352-4642(25)00342-6
Other references
Armitage JM, Lewis G, Page N, et al. Change over time in perceived schoolwork pressure and associations with emotional problems among 11–16-year-olds: a repeat cross-sectional study in Wales, UK. JCPP Adv 2025; 5: e70005. https://doi.org/10.1002/jcv2.70005
NHS England. (2023). Mental health of children and young people in England, 2023: Wave 4 follow up to the 2017 survey. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2023-wave-4-follow-up (Accessed: 14 July 2026)
Steare T, Gutiérrez Muñoz C, Sullivan A, Lewis G. The association between academic pressure and adolescent mental health problems: a systematic review. J Affect Disord 2023; 339: 302–17. https://doi.org/10.1016/j.jad.2023.07.028
TechClass. (2025, March 12). Finland’s approach to student assessment: What we can learn. https://www.techclass.com/resources/education-insights/finlands-approach-to-student-assessment-what-we-can-learn
West P, Sweeting H. Fifteen, female and stressed: changing patterns of psychological distress over time. J Child Psychol Psychiatry 2003; 44: 399–411. https://doi.org/10.1111/1469-7610.00130