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

Xuchen Guo, Marie A E Mueller, Jessica M Armitage, Chris Bonell, Tamsin J Ford, Ann John Orcid Logo, Glyn Lewis, Simon Murphy, George Ploubidis, Frances Rice, Alice Sullivan, Gemma Lewis

The Lancet Child & Adolescent Health

Swansea University Author: Ann John Orcid Logo

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DOI (Published version): 10.1016/s2352-4642(25)00342-6

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BackgroundAcademic 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 aimed to investigate associations between perceived levels of academic pressure and subsequent depres...

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Published in: The Lancet Child & Adolescent Health
ISSN: 2352-4642
Published: Elsevier BV 2026
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URI: https://cronfa.swan.ac.uk/Record/cronfa70901
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Our hypothesis was that higher levels of academic pressure would be associated with higher levels of depressive symptoms and self-harm.MethodsIn this longitudinal study, we used data from the Avon Longitudinal Study of Parents and Children (Avon, UK) that includes adolescents born in 1991&#x2013;92. Our primary exposure of interest was academic pressure measured at age 15 years, using items from a school experiences questionnaire (total scores 0&#x2013;9). Outcomes were depressive symptoms assessed with the Short Mood and Feelings Questionnaire at five timepoints between age 16 years and 22 years (total scores 0&#x2013;26), and a self-harm questionnaire at four timepoints between age 16 years and 24 years. 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.FindingsWe included 4714 adolescents (2725 [57&#xB7;8%] female, 1989 [42&#xB7;2%] male). In fully adjusted models, a 1-point increase in academic pressure at age 15 years was associated with a 0&#xB7;43 (95% CI 0&#xB7;36&#x2013;0&#xB7;51) point increase in depressive symptoms. This association was largest when depressive symptoms were assessed at age 16 years (0&#xB7;53, 0&#xB7;42&#x2013;0&#xB7;64), but remained at age 22 years (0&#xB7;35, 0&#xB7;23&#x2013;0&#xB7;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 (adjusted odds ratio 1&#xB7;08, 1&#xB7;01&#x2013;1&#xB7;16), with no differences over time.InterpretationOur findings support the hypothesis that academic pressure is a potential modifiable risk factor for adolescent depressive symptoms, and possibly self-harm. 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spelling 2026-02-18T13:33:25.5688142 v2 70901 2025-11-14 The association between academic pressure and adolescent depressive symptoms and self-harm: a longitudinal, prospective study in England ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2025-11-14 MEDS BackgroundAcademic 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 aimed to investigate associations between perceived levels of academic pressure and subsequent depressive symptoms and self-harm from adolescence to early adulthood. Our hypothesis was that higher levels of academic pressure would be associated with higher levels of depressive symptoms and self-harm.MethodsIn this longitudinal study, we used data from the Avon Longitudinal Study of Parents and Children (Avon, UK) that includes adolescents born in 1991–92. Our primary exposure of interest was academic pressure measured at age 15 years, 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 timepoints between age 16 years and 22 years (total scores 0–26), and a self-harm questionnaire at four timepoints between age 16 years and 24 years. 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.FindingsWe included 4714 adolescents (2725 [57·8%] female, 1989 [42·2%] male). In fully adjusted models, a 1-point increase in academic pressure at age 15 years 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 years (0·53, 0·42–0·64), but remained at age 22 years (0·35, 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 (adjusted odds ratio 1·08, 1·01–1·16), with no differences over time.InterpretationOur 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. Journal Article The Lancet Child &amp; Adolescent Health 0 Elsevier BV 2352-4642 12 2 2026 2026-02-12 10.1016/s2352-4642(25)00342-6 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee Funding: Sir Henry Dale Fellowship awarded to Dr Gemma Lewis; Wellcome Trust and Royal Society (223248/Z/21/Z). 2026-02-18T13:33:25.5688142 2025-11-14T09:56:23.4383365 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Xuchen Guo 1 Marie A E Mueller 2 Jessica M Armitage 3 Chris Bonell 4 Tamsin J Ford 5 Ann John 0000-0002-5657-6995 6 Glyn Lewis 7 Simon Murphy 8 George Ploubidis 9 Frances Rice 10 Alice Sullivan 11 Gemma Lewis 12 70901__36262__c721f3ffb524438782b358b533a8fd2d.pdf 70901.VoR.pdf 2026-02-18T13:30:15.6795185 Output 344847 application/pdf Version of Record true © 2026 The Author(s). This is an Open Access article under the CC BY 4.0 license. true eng https://creativecommons.org/licenses/by/4.0/
title The association between academic pressure and adolescent depressive symptoms and self-harm: a longitudinal, prospective study in England
spellingShingle The association between academic pressure and adolescent depressive symptoms and self-harm: a longitudinal, prospective study in England
Ann John
title_short The association between academic pressure and adolescent depressive symptoms and self-harm: a longitudinal, prospective study in England
title_full The association between academic pressure and adolescent depressive symptoms and self-harm: a longitudinal, prospective study in England
title_fullStr The association between academic pressure and adolescent depressive symptoms and self-harm: a longitudinal, prospective study in England
title_full_unstemmed The association between academic pressure and adolescent depressive symptoms and self-harm: a longitudinal, prospective study in England
title_sort The association between academic pressure and adolescent depressive symptoms and self-harm: a longitudinal, prospective study in England
author_id_str_mv ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Ann John
author2 Xuchen Guo
Marie A E Mueller
Jessica M Armitage
Chris Bonell
Tamsin J Ford
Ann John
Glyn Lewis
Simon Murphy
George Ploubidis
Frances Rice
Alice Sullivan
Gemma Lewis
format Journal article
container_title The Lancet Child &amp; Adolescent Health
container_volume 0
publishDate 2026
institution Swansea University
issn 2352-4642
doi_str_mv 10.1016/s2352-4642(25)00342-6
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
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description BackgroundAcademic 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 aimed to investigate associations between perceived levels of academic pressure and subsequent depressive symptoms and self-harm from adolescence to early adulthood. Our hypothesis was that higher levels of academic pressure would be associated with higher levels of depressive symptoms and self-harm.MethodsIn this longitudinal study, we used data from the Avon Longitudinal Study of Parents and Children (Avon, UK) that includes adolescents born in 1991–92. Our primary exposure of interest was academic pressure measured at age 15 years, 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 timepoints between age 16 years and 22 years (total scores 0–26), and a self-harm questionnaire at four timepoints between age 16 years and 24 years. 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.FindingsWe included 4714 adolescents (2725 [57·8%] female, 1989 [42·2%] male). In fully adjusted models, a 1-point increase in academic pressure at age 15 years 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 years (0·53, 0·42–0·64), but remained at age 22 years (0·35, 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 (adjusted odds ratio 1·08, 1·01–1·16), with no differences over time.InterpretationOur 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.
published_date 2026-02-12T05:31:26Z
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