Academic pressure during adolescence is linked to depression and self-harm into early adulthood

Is the study of good quality?

“The study demonstrates high methodological quality. One of its main strengths is its longitudinal design with a large sample (nearly 5,000 participants). It follows participants from age 15 to 24. It examines the relationship between academic pressure and self-harm behaviours, an area that has been scarcely studied using longitudinal approaches. The researchers employ validated instruments such as the Short Mood and Feelings Questionnaire (SMFQ) to assess depressive symptoms, while also controlling for several relevant confounding factors and applying robust statistical analyses. Although it is more appropriate to speak of association rather than causation, the study provides well-grounded evidence on the potential impact of academic pressure on young people’s mental health.”

What are the implications, and how does it fit with existing evidence?

“The findings reinforce the idea that adolescents’ perceived academic pressure may be a significant risk factor for the development of depressive symptoms and self-harm behaviours, with effects that extend into early adulthood. The study suggests that reducing academic pressure—either through changes in the education system or through school-based interventions focused on emotional well-being—could improve child and adolescent mental health.

The results expand and strengthen previous evidence pointing to a link between academic stress and psychological distress, which until now has largely been based on cross-sectional studies of lower methodological quality (with small samples or without adequate control for confounding factors). The longitudinal design, with repeated measures over time, provides more robust data on how this association evolves. Above all, it highlights the need to consider the academic environment as part of preventive mental health strategies.”

Are there any important limitations to bear in mind?

“All studies have limitations that should be considered when interpreting their findings, and this one is no exception. First, it is not possible to establish causality between the variables studied. Although trends are observed, it is more appropriate to speak of association, as the authors rightly do. In other words, while the longitudinal design strengthens the evidence, the associations identified do not allow us to conclude that academic pressure is the direct cause of depressive symptoms or self-harm behaviours.

Second, the data come from a cohort born in 1991–1992, whose adolescence took place in a different social and technological context from today’s. Although these adolescents had access to the internet—particularly through cybercafés, chat rooms, or the digital platforms available at the time—their digital ecosystem was not the same as the one we have today. For example, smartphones were not yet widely used, nor were highly influential social media platforms such as TikTok, Snapchat, or Instagram. Therefore, while adolescents born in the 1990s were exposed to digital technologies, the level of social pressure, forms of interaction, and constant stimuli experienced by today’s adolescents are different. This limits the direct applicability of the findings to contemporary youth.

Third, the use of self-report measures as the sole assessment tool may also be considered a limitation. Adolescents’ emotional states and factors such as social desirability may influence their responses. Despite these limitations, the study is well designed and provides solid evidence of a potential risk factor that deserves attention.”

The study participants were born more than 30 years ago. Can the findings be applied to today’s adolescents?

“Demands evolve and change according to social, economic, and historical contexts. Although academic pressure remains a relevant factor, today’s adolescents are exposed to a broader and more complex combination of demands, many of them stemming from their digital and social environment. Social media exposes them to constant comparison, the need to project an idealised image, and the pursuit of external validation. All of this can create fertile ground for emotional difficulties such as anxiety, as well as feelings of insecurity or inadequacy.

We are likely facing a context of greater uncertainty: a labour market perceived as unstable, the climate crisis as a real concern, and the emotional aftermath of the COVID-19 pandemic, well documented in the scientific literature. For this reason, while academic pressure is important, it should be understood as part of a broader set of factors influencing young people’s mental health.”

Is social media use among adolescents overshadowing other variables that affect their mental health? Or does it occupy such a prominent place because it truly deserves it?

“Social media use occupies a central place in the current debate on young people’s mental health. Intensive—or even passive—use (based on social comparison) has been associated with symptoms of anxiety, low self-esteem, and sleep disturbances. However, mental health is a multifactorial phenomenon. The impact of social media depends on the content consumed, the type of interaction, the family and school context, and the adolescent’s prior emotional state.

The scientific literature also identifies both risk and protective factors for mental health, including academic pressure, socioeconomic environment, family support, experiences of bullying, and sleep quality.

Therefore, although the prominence of social media in young people’s daily lives today is undeniable, it should not be considered in isolation. Mental health results from the interaction of individual, family, school, and sociocultural factors. Addressing it requires a comprehensive approach that acknowledges this complexity and allows for the identification of both risks and protective factors.”

This study analyzes the relationship between perceived academic pressure in adolescence (age 15) and the onset of depressive symptoms and self-harm, with or without suicidal intent, at different times between the ages of 16 and 22. The results show that greater academic pressure at age 15 predicts greater intensity of depressive symptoms and a higher probability of self-harm in subsequent assessments. In the case of depression, this relationship weakens over time, although it does not disappear. In contrast, the association with self-harm appears to remain stable regardless of the time of assessment.

Limitations:

1. Academic pressure was measured using a self-report consisting of several items. Although these items appear to constitute a measure with sufficient psychometric reliability, it is important to remember that perceived academic pressure does not necessarily equate to objective academic pressure. The experience of school demands depends as much on the educational environment as on personal and family expectations, as well as on individual and personality characteristics (e.g., the tendency toward perfectionism). Since these components cannot be separated in this measure, it is premature to assert that school pressure is a risk that can be modified solely through changes in the educational environment, as the article suggests.
2. The participants belong to a non-representative cohort born in 1991-1992, assessed for school pressure at age 15 (approximately in 2006) and subsequently at ages 16, 17, 18, 21, and 22. The follow-up, therefore, extended until around 2014. Although there are no clear reasons to believe that the impact of academic pressure on mental health has changed since then, it is true that significant social transformations have taken place during this period, such as digitalization, equality movements, and the COVID-19 pandemic. These changes could have altered the relative weight of academic pressure within the set of factors that influence mental health. This possibility is not considered in the study's limitations.
3. The size of the effects is difficult to interpret. It is indicated that a one-point increase in academic pressure predicts approximately a half-point increase on the depression scale, but no standardized coefficients or sufficient information on the scale are provided to adequately interpret the meaning of these scores and their increases. In the case of self-harm, the dependent variable is dichotomous, so the increase in risk is objectively interpretable, although we still do not know what an additional point of academic pressure represents qualitatively. In general, odds ratios below 1.5 are usually considered small effects, but this interpretation adds little in this context. In short, it is not advisable to limit oneself to reporting statistical significance without offering a qualitative interpretation of the effect size that allows it to be contextualized.

Strengths:

1. This is a longitudinal study with a large sample and a long follow-up period, which is an improvement over most previous studies, which tend to be cross-sectional and with small samples.
2. The control of possible confounding variables is comprehensive and detailed. In this type of research, it is particularly important to control baseline scores on mental health measures, i.e., to check whether academic pressure predicts subsequent development beyond the initial state of each participant. Failure to control these measures would prevent an estimation of whether academic pressure in adolescence really has predictive value for subsequent changes in mental health.
3. The results are consistent with previous literature, which suggests that perceived academic pressure is a relevant factor in explaining changes in mental health in adolescents and young adults. The study overcomes some of the methodological limitations common in this field, although not all.