Academic burden and emotional problems among adolescents in China: a longitudinal mediation analysis

Abstract

Background There is a high prevalence of depression and anxiety in adolescents, and emotional problems are more likely to occur for students with high academic burden. The reasons underlying the educational impact are not well understood. This study aimed to explore loneliness, physical activity, and sleep as potential mediating pathways between academic burden and emotional problems in adolescents. Methods A longitudinal cohort study was conducted among middle and high school students in Taizhou City, Zhejiang Province, China with data collected at three time points (T1: April-May 2022, T2: September-October 2022, T3: February-May 2023). Depressive and anxiety symptoms were assessed using the Children’s Depression Inventory and the Generalized Anxiety Disorder-7, respectively. Structural equation modeling was employed to analyze the direct effect of academic burden (measured by study time and academic stress) on depressive and anxiety symptoms, and the indirect effects of academic burden via three mediators: loneliness, physical activity, and sleep. Results Using data from 2965 adolescents who completed all the three assessments, we found that higher academic stress at T1 was directly associated with more severe depressive symptoms at T3. Sleep (indirect effect 0.08, 95% CI 0.07 to 0.10), loneliness (0.07, 0.06 to 0.08) and physical activity (0.01, 0.002 to 0.01) mediated the association, accounting for 30.8%, 26.7% and 1.9% of the total effect of academic stress respectively. For anxiety symptoms, sleep (0.04, 0.03 to 0.05) and loneliness (0.03, 0.02 to 0.03) mediated the effect of academic stress with longitudinal mediation effect sizes of 34.4% and 20.8%, respectively. Study time was only associated with the outcomes indirectly via academic stress. Conclusions Our findings suggest that sleep, loneliness and physical activity could partly explain why adolescents with higher academic stress had more severe emotional problems, highlighting the importance of behavior and psychosocial differences driven by academic burden in explaining severity of mental health problems. The findings should raise awareness about the related risk factors of academic burden for adolescents, and strengthen calls for comprehensive strategies to improve adolescent mental health.