Association between academic pressure, NR3C1 gene methylation, and anxiety symptoms among Chinese adolescents: a nested case-control study.

BACKGROUND: Academic pressure is a prevalent stressor among Chinese adolescents and is often linked to anxiety symptoms, although the underlying mechanism remains unclear. This study aimed to investigate the association between NR3C1 gene methylation, academic pressure, and anxiety symptoms among Chinese adolescents. METHODS: This nested-case control study included 150 adolescents (boys: 38.7%; baseline age: 12-17 years) from a school-based longitudinal study of Chinese adolescents. Cases (n = 50) were defined as those with anxiety symptoms at both baseline and follow-up, while controls (n = 100) were randomly selected from those without anxiety symptoms at both timepoints. The cases and controls were 1:2 matched by age. Academic pressure, anxiety symptoms, and potential covariates were measured using a self-report questionnaire. Peripheral whole blood samples were collected from each participant for the detection of cortisol level (i.e., morning serum cortisol level) and DNA methylation. The methylation analysis included a total of 27 CpG units at the NR3C1 promoter region. RESULTS: The final adjusted models showed that students with heavy academic pressure at baseline were at a higher risk of anxiety symptoms at follow-up compared to those with mild academic pressure (ß estimate: 6.24 [95% CI: 3.48 ~ 9.01]). After adjusting for covariates, the methylation level of one CpG unit (NR3C1-16 CpG10) in NR3C1 differed significantly between cases and controls (F = 6.188, P = 0.014), and the difference remained significant after correction for multiple testing (P < 0.025). The adjusted regression models showed that moderate (ß estimate = 0.010 [95% CI: 0.000 ~ 0.020], P = 0.046) and heavy (ß estimate = 0.011 [95% CI: 0.001 ~ 0.020], P = 0.030) academic pressure were significantly associated with the methylation level of NR3C1-16 CpG 10. Further mediation analysis demonstrated that the association of academic pressure and anxiety symptoms was significantly mediated by the methylation of NR3C1-16 CpG 10 (ß estimate for indirect effect = 0.11 [95% CI: 0.005 ~ 0.32]; indirect/total effect = 8.3%). CONCLUSION: The present study suggests that NR3C1-16 CpG 10 DNA methylation might be a potential mechanism that partially explains the lasting effects of academic pressure on subsequent anxiety symptoms among adolescents. Further studies with larger sample sizes are recommended to replicate this finding.

The association between academic stress, social support, and self-regulatory fatigue among nursing students: a cross-sectional study based on a structural equation modelling approach.

BACKGROUND: Emphasizes the state of academic stress, social support, and self-regulatory fatigue on the physical and mental development of Chinese nursing students, the purpose of this study was to investigate the relationship between these variables and the mediating role of social support in academic stress and self-regulatory fatigue among a group of undergraduate nursing students in Heilongjiang Province, China, in order to provide a theoretical basis for working to reduce nursing students' self-regulatory fatigue. METHODS: In this cross-sectional study, 1703 nursing students from various academic years completed the scales of social support, academic stress, and self-regulatory fatigue. In the end, there were 797 valid questionnaires, for a recovery rate of 46.80%. For statistical analysis, the independent t-test, Kruskal Wallis test, and Pearson correlation coefficient were used. In addition, we undertake analyses using structural equation modeling. RESULTS: The bulk of nursing students, or 81.4%, are between the ages of 19 and 21. Eighty percent were females. The bulk (93.0%) was comprised of freshmen. Academic stress, social support, and self-regulatory fatigue had total scores of 111.28 ± 29.38, 37.87 ± 6.70, and 45.53 ± 5.55,respectively. Academic stress was correlated with social support and self-regulatory fatigue (all p < 0.001). Social support was an intermediate variable (p < 0.001), with an intermediate effect value of 0.122, representing 32.35% of the total effect. CONCLUSION: Academic pressure is associated with an increase in self-regulatory fatigue, mediated by social support. Educational administrators should pay attention to the social support and resource supplement of nursing students, the adjustment and compensatory development of nursing students' physical and mental resources, the advancement of nursing students' internal resource adjustment, and the reduction of their self-regulatory fatigue.

Association of stress and emotional well-being in non-medical college students: A systematic review and meta-analysis.

Stress among college students is a well-explored area with profound implications for their emotional well-being. Despite extensive research, the literature presents inconsistent and mixed findings regarding its relationship with emotional well-being, particularly focusing on medical students. Moreover, there is no meta-analytic study to address this inconsistency. To bridge these gaps, this study conducts a systematic review and meta-analysis to explore the nuanced association between stress among non-medical college students and their emotional well-being. The systematic review utilized databases: PubMed, Scopus, and Web of Science, search engine: Google Scholar, and gray literature sources: ProQuest and Research Gate. The dataset consisted of 46 eligible studies (k), comprising 26,214 participants across 20 countries. The mean age was 21.86 (k = 32), with females constituting 60 % (k = 45). The majority of studies employed a cross-sectional/correlational design. The estimated pooled correlation is found to be -0.27 (95 % CI: -0.33, -0.21, p < .01; I2 = 97.5 %, k = 46). Subgroup analysis revealed significant influences of the type of stress (p < .01), emotional well-being (p < .01), tools (p < .01) used, significance status of findings (p < .001), and demographic factors - country (p < .001) and income level (p < .05). The study found an inversely significant and moderate association between stress and emotional well-being in non-medical college students, consistent with existing literature. Significant moderation by study and demographic variables suggests substantial heterogeneity among studies, highlighting potential influences from demographics, methodologies, and populations.

Effect of teacher-student relationship on academic engagement: the mediating roles of perceived social support and academic pressure.

Although previous research has established that a strong teacher-student relationship can enhance students' academic engagement, the mechanisms underlying this effect remain less explored. Therefore, this study examined the mediating roles of perceived social support and academic pressure in the association between teacher-student relationship and academic engagement. A survey involving 1,058 Chinese university students was conducted, with teacher-student relationship, perceived social support, academic pressure, and academic engagement being the evaluated factors. The results of structural equation modeling revealed that (a) teacher-student relationship directly and positively associated academic engagement, (b) teacher-student relationship indirectly and positively associated academic engagement through perceived social support, and (c) teacher-student relationship indirectly and positively associated academic engagement through both perceived social support and academic pressure. These results indicate that perceived social support and academic pressure are the primary factors mediating the effect of teacher-student relationship on academic engagement among university students.

Using shanghai municipal data to examine whether student sacrifice exercise in response to academic pressure.

The competitive education environment in Mainland China pressure many students to take up after-school lessons, cutting into their leisure time and exercise less, setting a path towards a more sedentary lifestyle. We use a survey on sports consumption for Shanghainese adolescent ages 6 to 17 to examine whether they sacrifice sports activity as they advance through the grade. We found that students a year older exercise 16.2 fewer minutes per week, 1.38 percent less likely to spend on sports training, 1.42 percent more likely to watch sports events, 1.90 percent more likely to buy more sports related goods. Our result shows that students substitute sports activities with more expenditure on sports products and events. When older adolescent exercise less, we are concerned that it may contribute to rising obesity and a more sedentary lifestyle.

The association between academic pressure and adolescent mental health problems: A systematic review.

BACKGROUND: Academic pressure is a potential contributor to adolescent mental health problems, but international evidence on this association has never been synthesised. METHODS: We conducted the first systematic review of the association between academic pressure and adolescent depression, anxiety, self-harm, suicidality, suicide attempts and suicide. We searched MEDLINE, PsycINFO, ERIC and Web of Science (core collection) up to November 24, 2022, for studies of school-going children or adolescents, which measured academic pressure or timing within the school year as the exposure and depression, anxiety, self-harm, or suicidal ideation, attempts or suicide as outcomes. Risk of bias was assessed using the Mixed Methods Appraisal Tool. We used narrative synthesis to summarise the evidence. The review was prospectively registered with PROSPERO (CRD42021232702). RESULTS: We included 52 studies. Most studies assessed mixed anxiety and depressive symptoms (n = 20) or depressive symptoms (n = 19). Forty-eight studies found evidence of a positive association between academic pressure or timing within the school year and at least one mental health outcome. LIMITATIONS: Most studies were cross-sectional (n = 39), adjusted for a narrow range of confounders or had other limitations which limited the strength of causal inferences. CONCLUSIONS: We found evidence that academic pressure is a potential candidate for public health interventions which could prevent adolescent mental health problems. Large population-based cohort studies are needed to investigate whether academic pressure is a causal risk factor that should be targeted in school- and policy-based interventions. FUNDING: UCL Health of the Public; Wellcome Institutional Strategic Support Fund.

Factors Associated with Increased or Decreased Stress Level in French Children during the First COVID-19 Lockdown.

In spring 2020, governments of many countries implemented lockdown measures to prevent the spread of the COVID-19 pandemic. Worldwide, the pandemic forced about 1.5 billion children to stay at home for several weeks and to experience homeschooling. The objective of this study was to assess the variation in stress levels and associated factors in school-aged children in France during the first COVID-19 lockdown. A cross-sectional study using an online questionnaire was designed by an interdisciplinary team involving hospital child psychiatrists and school doctors. Between 15 June and 15 July 2020, Educational Academy of Lyon (France) invited the parents of school-aged children to participate in this survey. The first part of the questionnaire concerned the children with data on lockdown conditions, socio-demographic data, daily rhythms (eating and sleeping), perceived stress variations, and feelings. The second part assessed parental perspectives on their child's psychological state and use of the mental health care system. Multivariate logistic regression was performed to identify factors associated with stress variation (increased or decreased). A total of 7218 questionnaires were fully completed by children from elementary school to high school with a balanced sex ratio. In summary, 29% of children reported a higher stress level during the lockdown, 34% reported a lower stress level, and 37% reported no stress variation in the usual situation prior to COVID-19. Parents were most often able to identify signs of increased stress levels in their children. The most influential factors in the variation of stress for children were academic pressure, family relationships, and fear of being infected or infecting a family member with SARS-CoV-2. Our study underlines the high impact of school attendance stressors on children in usual conditions and encourages vigilance for children whose stress levels have decreased during the lockdown but who may have increased difficulty re-exposing themselves upon deconfinement.

The Structural Relationships among Academic Pressure, Independent Learning Ability, and Academic Self-Efficacy.

Background: The coronavirus disease pandemic has caused significant disruption in the field of education, resulting in the need for more online classes and a blended offline and online teaching model. Therefore, understanding what makes this model effective is important. Accordingly, this study explored the structural relationships among academic pressure, independent learning ability, and academic self-efficacy in a blended teaching environment during the pandemic and independent learning ability's mediating effect on the relationship between academic pressure and academic self-efficacy. Methods: Adopting a random sampling method, this study surveyed 761 Chinese college, Shaanxi Province, China in 2022 and university students. Factor analysis, correlation analysis, structural equation modeling, and path analysis were used to analyze the data. Results: The results show that the academic pressure faced by Chinese English majors had a significant negative impact on academic self-efficacy (P<0.001). However, academic pressure had no statistical effect on students' independent learning ability (P=0.317). Moreover, independent learning ability had a significant positive effect on academic self-efficacy (P<0.001) and a mediating effect on the relationship between academic pressure and academic self-efficacy (P=0.032). Conclusion: Independent learning ability can directly and indirectly affect academic self-efficacy. Thus, in an online and offline blended teaching model, teachers should guide students regarding self-exploration, communication, and cooperation based on existing knowledge and experience. They should also enable students to improve their learning process and independent learning ability. Various language learning situations should be established for learning English so that by experiencing success and failure, students can ultimately improve their academic self-efficacy.

The Impact of Academic Pressure and Peer Support on Adolescents' Loneliness: A Polynomial Regression and Response Surface Analysis.

Purpose: To explore the impact of the match between academic pressure and peer support on adolescents' sense of loneliness and examine whether social connectedness played a mediating role, using a polynomial regression and response surface analysis. Methods: A questionnaire survey was conducted with 1277 adolescents from two cities in Sichuan Province, China, to investigate their academic pressure, peer support, social connectedness, and sense of loneliness. Results: (1) Adolescents' sense of loneliness positively correlated with their level of academic pressure and negatively correlated with their degree of peer support. (2) Social connectedness played a mediating role in the relationship between academic pressure, peer support, and sense of loneliness. (3) Adolescents with high academic pressure and low peer support had weaker social connectedness than those with low academic pressure and high peer support. (4) Adolescents with high academic pressure and high peer support had stronger social connectedness than those with low academic pressure and low peer support. Discussion: The study revealed the mechanism through which a match (or mismatch) between academic pressure and peer support influenced adolescents' sense of loneliness and validated the mediating role of social connectedness. The study enriches the developmental theory of adolescent loneliness and provides research experience for future interventions targeting adolescent loneliness.

Experiencing Childhood in the Context of Societal Academic Expectations.

The present paper discusses in part the findings from the first author's master's dissertation exploring the experience of childhood in the context of increased academic expectations in society, with special reference to Kerala, India. The objectives were to understand how academic expectations on children shape their childhoods and to document children's time use and daily lives. A mixed research design was chosen: in-depth interviews were supplemented by a quantitative study on the time allocations of children for different activities. Triangulation of data was done by interviewing three groups of participants: children (n = 10), parents (n = 8), and key informants (n = 3) selected through convenience and purposive sampling. The qualitative data and time-use data are from separate samples. The latter study was conducted on fifth and sixth graders (N = 320) from the Kozhikode district of Kerala. Children's voices indicated an over-emphasis on academic achievement from different quarters: parents, teachers, and peers. This is reflected in their day-to-day conversations, peer cultures, and daily pursuits. Findings from the time-use study supported the qualitative data: routines of children predominantly revolved around academic activities (35% of 24 hours, including time at school), and little time was devoted to physical play (5.67%). Parents' voices corroborated these findings and gave insights into the children's internalization of societal beliefs regarding academic achievement. Inputs from the key informants helped understand the development of the societal beliefs and practices that perpetuate a preoccupation with educational attainment in the community, and the adverse psycho-social impact it has on the children in this context.

The impact of agricultural disasters on child development in rural China.

Background: China's uneven development under the urban-rural dichotomy has led to the discouraging development of children in rural areas. China is a large agricultural country and agricultural disasters are relatively common. Rural children aged 10-15 whose families depend on the agricultural economy may experience far-reaching negative effects from these disasters. Objective: This study explored the effects of agricultural disasters on rural children's development, including cognitive and noncognitive skills, and academic pressure. Methods: Survey data from the China Family Panel Survey and the National Meteorological Administration for 2010-2018 and a fixed-effect panel model with difference-in-differences regressions were used in the study. Results: The fixed effects model results showed evidence that agricultural disasters have a negative impact on rural children's cognitive and noncognitive skills and a positive impact on academic pressure. The statistically significant coefficients are -0.092, -0.938, and 0.223, respectively. School and family environments also explain children's development. Robustness tests confirmed these results. Conclusions: Evidence shows that agricultural disasters have a significant negative impact on rural child development. It may be inferred that these will increase the difficulty of narrowing the urban-rural development gap. China is committed to promoting prosperity for all its people. Special attention should be paid to the consequences of disasters at the child level and appropriate measures should be taken to mitigate possible negative impacts.

The influence of academic pressure on adolescents' problem behavior: Chain mediating effects of self-control, parent-child conflict, and subjective well-being.

As a negative social issue, teenagers' problem behavior not only affects individuals' physical and mental health and social function development but is also not conducive to social harmony and stability. This study mainly discusses the influence of academic pressure on adolescents' problem behavior, and the potential relationship between these and academic pressure, examining issues such as self-control, parent-child conflict, and subjective well-being. The data were collected from the fifth wave of the China Family Panel Studies (2017-2018). The data of 2,465 teenagers aged 10-15 were analyzed by LISREL8.8 software. The results show that academic pressure positively affects adolescents' deviant behavior. The mediation model finds that parent-child conflict and self-control play a direct mediating role between academic pressure and adolescents' behavioral problems. Parent-child conflict, self-control, and subjective well-being have important chain mediation effects between academic pressure and adolescents' problem behavior. Therefore, in order to reduce the risk of such problems, it is necessary to further strengthen individuals' ability to maintain self-control, promote or cultivate adolescents' character strengths, create a harmonious family atmosphere, reduce the probability of parent-child conflict, and increase the subjective well-being of teenagers.

The Associations between Sleep Duration, Academic Pressure, and Depressive Symptoms among Chinese Adolescents: Results from China Family Panel Studies.

Depressive symptoms are a common mental health problem among adolescents, which may affect their physical and mental health development and impose heavy burdens on individual families and society. This study aimed to examine the associations between sleep duration, academic pressure, and depressive symptoms among Chinese adolescents and to construct the mediation model to explore the mediating effect of sleep duration. The data are from the China Family Panel Studies (CFPS). Methodologically, the aforementioned associations were explored by constructing a structural equation model and applying multivariate multilevel logistic regression. In this study, we found that approximately 6.49% of the 3724 Chinese adolescents had depressive symptoms. Sleep duration of <6 h/night (OR = 2.39, 95%CI = 1.33-4.32) and high/maximum academic pressure (high: OR = 1.43, 95%CI = 1.02-1.99; maximum: OR = 2.43, 95%CI = 1.58-3.73) were both associated with an increased risk of depressive symptoms in adolescents. Meanwhile, the multiplicative interaction between sleep duration and academic pressure was significantly associated with depressive symptoms in adolescents (p < 0.001). The sleep duration played a partial mediating role in the relationship between academic pressure and depressive symptoms (a*b = 0.006, 95%BootCI = 0.001-0.012). Our study highlights that it is essential to mitigate the academic pressure of adolescents to increase their sleep duration and further reduce the occurrence of depressive symptoms by adopting corresponding preventive measures.

What stresses adolescents? A qualitative study on perceptions of stress, stressors and coping mechanisms among urban adolescents in India.

Background: In India, stress levels are increasing steadily among youth. We aimed to explore the factors that contribute to psychological stress and coping strategies among adolescents in Mysore, India to inform the development of an intervention. Methods: We recruited 16 volunteers in Mysore, India including 6 younger (12-15 years; 3 girls) and 10 older adolescents/ young adults (17-25 years; 5 girls) using a purposive sampling technique. Older adolescents were recruited from ongoing birth cohort study, and the younger adolescents by word-of-mouth from the community. Individual in-depth interviews were carried out based on a semi-structured interview guide comprising open-ended questions. The interviews were analysed to derive themes and emerging constructs related to stress and coping strategies.  Results: Adolescents generally perceived stress in their daily lives. Family conflicts and academic pressures were the main triggers for increased stress. Issues around peer relationships, and social position were also important contributors. Adolescents reported that they had robust coping strategies. These included stress release through rationalising and acceptance of the situation, distraction activities, spirituality, and self-comforting methods. However, they felt the need for further support from their family, and the society in general. In particular they expressed the need for a space to share their concerns and obtain guidance through healthy discussions with adults.      Conclusions: Our study indicates that adolescents in India are exposed to a wide range of stressors in their daily lives. The conflict between 'traditional' society's opinions of what adolescents should do and the new age adolescents' aspirations for autonomy to find 'informed' solutions for their issues may hinder the stress management efforts. Moving forward, we propose to develop a culturally acceptable intervention tool that accommodates adolescents' perspectives and psychosocial context.

The Effect of Filial Piety and Cognitive Development on the Development of Adolescents' Depressive Symptoms: A Longitudinal Study.

The present study aims to investigate the pathways through which filial piety and cognitive development work on the development of depressive symptoms in adolescents as well as the trigger of adolescents' depressive symptoms (e.g., academic pressure). Two hundred fifty-seven Chinese adolescents (128 females and 129 males) participated in the study from Grade 7 to Grade 9. Results showed that both filial piety and cognitive autonomy significantly contribute to the development of adolescents' depressive symptoms and academic pressure. But reciprocal filial piety (RFP) and authoritarian filial piety (AFP) as two coexisting aspects of filial piety contribute to depressive symptoms in opposite directions. RFP provides significant protection against adolescents' depressive symptoms directly and indirectly through promoting the development of adolescents' cognitive autonomy and alleviating adolescents' academic pressure. In contrast, AFP positively contributes to adolescents' depressive symptoms by hindering the development of cognitive autonomy and intensifying academic pressure.

Suicide in Chinese Graduate Students: A Review From 2000 to 2019.

Suicide is an important public problem in China. The characteristics of Chinese graduate students' suicides and the reasons they occur have never been reported systematically. We conducted a systematic search of public reports on local media and medical websites in this review to gain a basic understanding of these questions. A total of 150 cases of graduate students' suicides were reported from 2000 to 2019. Among the 150 students, 65.8% were male, nearly half between 26 and 30 years old, most (83.3%) never married, and 43.4% of graduation students committed suicide in graduation year and postponed years. The top three suicide methods were jumping, hanging, and drowning. Graduation pressure, depression, and academic pressure were the three leading suicidal causes. There is an urgent need for the Chinese government and universities to pay more attention to prevent suicides among graduate students.

A Latent Profile Analysis of Anxiety among Junior High School Students in Less Developed Rural Regions of China.

The purpose of this study is to understand the potential types of anxiety among middle school students by analyzing the current situation of middle school students' anxiety and its influencing factor. This study used a multistage stratified cluster random sampling to investigate students in grades 9 to 12. Mplus 7.4 was used for latent profile analysis. A total of 900 junior high school students were investigated. The junior high school students were divided into three subgroups by latent profile analysis. A total of 223 junior high school students experienced severe anxiety, accounting for 24.78%. Multivariate logistic regression analysis revealed that males are more likely to develop moderate and severe anxiety. The development of severe anxiety (OR = 0.562, p < 0.05) is less likely for students in schools with adequate mental health support. Students who were confident with their academic performances were less likely to develop moderate anxiety (OR = 0.377, p < 0.05). Students with extreme academic pressure are more likely to develop moderate anxiety (OR = 6.523, p < 0.05) and severe anxiety (OR = 11.579, p < 0.05). It is recommended that mental health counseling be set up in schools and to provide professional counselors to prevent serious anxiety for students. This paper also demonstrates a need to reduce students' academic pressure.

Relationship between academic pressure and mobile game addiction among middle school students： mediating role of self-control / 四川精神卫生

ObjectiveTo explore the current status of academic stress， self-control and mobile game addiction among middle school students， and to test the mediating role of self-control. MethodsA total of 750 middle school students were enrolled by convenient sampling method， and were assessed using Academic Pressure Questionnaire， Self-Control Scale （SCS） and Mobile Game Addiction Scale. Thereafter， the mediating effect of self-control on the association between academic stress and mobile game addiction was analyzed with PROCESS mediating effect test. ResultsA total of 682 middle school students completed the survey. The scores of Academic Pressure Questionnaire， SCS and Mobile Game Addiction Scale of the selected middle school students were （58.56±11.34）， （38.42±6.94） and （34.23±12.14）， respectively. The total score and each dimension score of Academic Pressure Questionnaire were positively correlated with the total score of Mobile Game Addiction Scale （r=0.189~0.259， P<0.01）， and negatively correlated with the SCS score （r=-0.348~-0.196， P<0.01）. The total score and each dimension score of Mobile Game Addiction Scale were negatively correlated with SCS score （r=-0.336~-0.252， P<0.01）. Academic stress could predict self-control negatively （β=-0.205， t=-9.288， P<0.01） and predict mobile game addiction positively （β=0.281， t=7.084， P<0.01）. Meantime， self-control could predict mobile game addiction negatively （β=-0.480， t=-7.238， P<0.01）. With self-control as a mediator variable， academic stress still significantly predicted the mobile game addiction （β=0.182， t=4.492， P<0.01）. ConclusionThe academic pressure， self-control and mobile game addiction of middle school students are all at the lower middle level， moreover， self-control has a partial mediating effect between academic pressure and mobile game addiction.

Academic Pressure and Research Ethics at the Crossroads.

Healthcare professionals become research scientists to improve the health and well-being of humankind. Often stemming from clinical observations, the process of writing a proposal to investigate the problem, obtaining funding, conducting the study, and disseminating findings takes considerably longer than the expectations of productivity in grant funding and publishing manuscripts for faculty on a tenure track in academia. Application back into practice, which is the goal of research, and evaluation of improving patient care and outcomes take even longer. 
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