The association between academic pressure and adolescent mental health problems.

Steare, T., Gutiérrez Muñoz, C., Sullivan, A., & Lewis, G. (2023). The association between academic pressure and adolescent mental health problems: A systematic review. Journal of affective disorders, 339, 302–317. https://doi.org/10.1016/j.jad.2023.07.028

From first-hand experience, academic pressure is an issue close to my heart. I often see kids, during what is meant to be a time of growth and exploration, instead becoming swamped with the academic and socio-academic pressures of school. As humans become increasingly cerebrally competitive (we aren't the strongest animal, but arguably can be the cleverest), and companies are looking to maximize cerebral productivity from each employee, it is no wonder that kids today are struggling.

I often wish I could tell kids that years 11 and 12 are actually not the be-all and end-all, and there is actually a huge amount of flexibility in career and life. Sure, life means sacrifices, but not over-sacrificing our health for grades is doomed to have long-term negative effects and sabotage any long-term happiness or contentment.

The other thing I often wished someone had explained to me is that IQ, memory, and mathematical skills are a small set of the unique strengths of the human mind. Being good at maths or memory is like your skin color—highly genetic and not much you can do about it. Sure, just like tanning, there is some brain training and study, and of course, if we don't study, we won't have a chance. But the genetic IQ spectrum means that some kids will learn easier and others will struggle to remember and apply things—through no fault of their own. It DOES NOT mean that they are lazy, careless, and stupid. It does NOT necessarily mean that they do less than their friends or peers. Conversely, I often meet young students who have been having a breezy time at school due to their IQ (which is really a very small part of intelligence).

So let's get into the study first. This article by Steare et al was published recently in the Journal of Affective Disorders. Now, this is a pretty good journal with some really landmark papers in the past. It is highly respected and has a good amount of healthy criticism prior to any publication. The authors are all from the UK; we won't hold this against them.

The article starts by stating that they have conducted the first-ever systematic review and meta-analysis on the association between academic pressure and adolescent mental health. And what an achievement by the authors! The article starts by discussing depression, anxiety, self-harm, and the statistics behind this. They then describe modifiable risk factors—a big word meaning something that we can change in the person or in their environment so that it can improve their well-being. They then go on to talk about the concerns from teachers, students, parents, and healthcare workers about the rising academic pressures.

The article then describes its methods, which basically involve looking through lots and lots of studies and publications in various journals, using keywords, to help collect and collate information. They identified a huge number—13,020 studies! From there, they came to a total of 52 studies that have something to say about this topic. Countries range from Singapore, Iran, Sweden, Australia, India, Canada, Pakistan, and China—truly international, though no countries from the African or South American continents were represented.

The results are as follows:

- There is considerable international concern about the association of academic pressure at certain points of the school year and poor mental health outcomes.

- All but one study notice that hospital presentations, suicide attempts, suicide deaths, and self-injury are lowest when the schools are closed.

- It is hard currently to determine the direction of cause—meaning what comes first.

- Kids who already have MH problems are more susceptible to academic pressures.

- There are tons of variables to consider (like bullying), and it's not that easy to tease out causation.

- Findings are generally consistent—academic pressure is associated with poor mental health outcomes. It can be a modifiable risk factor, and policy-level interventions could have far-reaching benefits.

My takeaway is that I am clearly not alone in seeing adolescents struggling with academic pressures, which are astronomically increasing as our population increases, there is increasing cognitive burden in careers and companies, and there is increasing competition. Advocacy in school and educational reform, as well as individual treatment, management, and adjustment to alleviate pressures, would be one of the best options. I will familiarize myself with alternative methods to attain career and lifestyle goals, which can minimize pressures for patients and families alike.