The association between academic pressure and adolescent depressive symptoms and self-harm: a prospective longitudinal study in the UK

Guo, Xuchen, Mueller, Marie A. E., Armitage, Jessica M., Bonell, Chris, Ford, Tamsin J., John, Ann, Lewis, Glyn, Murphy, Simon, Ploubidis, George, Rice, Frances ORCID: https://orcid.org/0000-0002-9484-1729, Sullivan, Alice and Lewis, Gemma 2025. The association between academic pressure and adolescent depressive symptoms and self-harm: a prospective longitudinal study in the UK. The Lancet Child & Adolescent Health Item availability restricted.

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Abstract

Background. Academic pressure could increase the risk of adolescent depression and self-harm. However, there are few longitudinal studies of this association, and those that exist have limitations. We used a large prospective cohort in England to investigate associations between academic pressure and subsequent depressive symptoms and self-harm. Methods: We included adolescents born 1991-1992 from the Avon Longitudinal Study of Parents and Children. Our main exposure was academic pressure measured at age 15, using items from a school experiences questionnaire (total scores 0-9). Outcomes were depressive symptoms assessed with the short Mood and Feelings Questionnaire at five time-points between ages 16 and 22 (total scores 0-26), and a self-harm questionnaire at four time-points between ages 16 and 24. Analyses were linear (depressive symptoms) and logistic (self-harm in the previous year) multilevel models in samples with multiply imputed data, before and after adjustments. Findings: We included 4714 adolescents (58.1% female, ; n= 2,725; 42.2% male, n=1989). In fully adjusted models, a 1-point increase in academic pressure at age 15 was associated with a 0.43 (95% CI 0.36, 0.51) point increase in depressive symptoms. This association was largest when depressive symptoms were assessed at age 16 (0.53, 95% CI 0.42, 0.64), but remained at age 22 (0.35, 95% CI 0.23, 0.47). For self-harm, in fully adjusted models, each 1-point increase in academic pressure was associated with an 8% higher odds of self-harm (OR 1.08, 95% CI 1.01, 1.16) (no differences over time). Interpretation: Our findings support the hypothesis that academic pressure is a potential modifiable risk factor for adolescent depressive symptoms, and possibly self-harm. Interventions to reduce academic pressure could be developed and evaluated.

Item Type:	Article
Status:	In Press
Schools:	Schools > Medicine
Publisher:	Elsevier
ISSN:	2352-4642
Date of First Compliant Deposit:	28 November 2025
Date of Acceptance:	13 November 2025
Last Modified:	28 Nov 2025 12:00
URI:	https://orca.cardiff.ac.uk/id/eprint/182739

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