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
2026.
The association between academic pressure and adolescent depressive symptoms and self-harm: a prospective longitudinal study in the UK.
The Lancet Child & Adolescent Health
10.1016/S2352-4642(25)00342-6
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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 |
|---|---|
| Date Type: | Published Online |
| 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: | 10 Mar 2026 12:20 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/182739 |
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