Academic stress at age 15 linked to increased risk of later self-harm, study finds.
For each one-point increase in academic pressure at age 15, UK researchers found an 8% increase in the odds of self-harm at four follow-up timepoints between ages 16-24.
The study, published in The Lancet Child & Adolescent Health, looked at a cohort of 4714 adolescents (57.8% female). In fully adjusted models, a one-point increase in academic pressure at age 15 was also associated with a 0.43-point increase in depressive symptoms. This association was largest when depressive symptoms were assessed at 16 years of age (0.53) but persisted at age 22 (0.35).
Participants were part of the Avon Longitudinal Study of Parents and Children, which included around 14,000 children born in 1991 and 1992 who were followed up to age 24 years.
At 15 years of age, composite academic pressure scores ranged from 0 to 9, with females scoring higher than males (mean 6.05 and 5.90, respectively). At this age, each one-point increase in academic pressure scores was associated with 16% higher odds of self-harm in unadjusted models and 8% higher odds in fully adjusted models.
“This is an important and interesting study that draws attention to a topic that deserves much more focus,” said Dr Louise Birrell, senior research fellow and program lead of Young People’s Mental Health & Wellbeing at the Matilda Centre for Research in Mental Health and Substance Use (part of the National Health and Medical Research Council).
“Most past studies were cross-sectional, so this study is a helpful step forward,” she told The Medical Republic.
“That said, it is important to interpret the findings carefully. The study relied on a single, subjective measure of overall academic pressure and could not distinguish between different sources of pressure, for example pressure from parents, teachers or internal expectations.”
Given the lack of standardised measures of academic pressure available for longitudinal analyses in UK cohorts, researchers provided the children with questionnaires which queried school-related experiences consistent with their definition of academic pressure. These were completed at age 11, 14 and 15 years, correlating with schooling in 2002–03, 2005–06 and 2006–07.
Three items were highlighted as being particularly heightened at age 15 – “I worry a lot about getting my school work done”, “I feel under a lot of pressure from home to do well at school” and “how important is it to you that you get 5 GCSEs at level A*–C (or equivalent) this summer”?
Depressive symptoms were measured between ages 10 and 22 years using the 13-item Short Mood and Feelings Questionnaire (SMFQ). At age 16.5, 17.5, 21 and 24 years, the questionnaires included whether they had harmed themselves on purpose in any way and how often this had occurred in the previous year.
Researchers found no evidence that the associations they found varied by sex, social class or baseline depressive symptoms.
“The effect sizes, as the authors highlight, were small. And while the increase in odds is statistically meaningful, self-harm remains a relatively rare behaviour. The study shows an 8% increase in odds, not an 8% increase in actual self-harm behaviours in the cohort,” Dr Birrell explained.
“Another consideration is that the cohort was born in the early 1990s. Young people now face a very different educational and digital landscape. We don’t yet know whether this association holds for more recent generations or within the Australian context.
“At present, we simply don’t have comparable longitudinal data in Australia to answer that question [but] generating that evidence would be incredibly valuable.”
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She cited a large review of literature in 2023 which concluded that academic pressure was a potential candidate for intervention to prevent issues in adolescent mental health.
She also highlighted the 2025 Mission Australia Youth Survey, which showed that school or study problems was selected most often as a source of personal stress over the previous year, affecting 58% of respondents.
“We do know that adolescents frequently cite academic and study stress as a top concern, but this is a concern for all adolescents, not just those with depression and we need to understand the causal links and pathways between academic stress and mental health better.”
“It’s understandable that people want a single explanation for rising rates of youth mental ill-health. But the reality is far more complex. Depression and self-harm arise from an interplay of individual vulnerabilities, family and peer environments, social pressures, and school contexts. Academic pressure is one factor within that broader picture.”
“The broader challenge remains distinguishing between healthy, expected levels of academic stress—which can support motivation and learning—and the kinds of sustained, overwhelming pressure that may put young people at risk. We need more contemporary, high-quality research to understand where that line sits for today’s adolescents and how best to intervene.”
