The impact of stress on students in secondary school

and higher education

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The impact of stress on students in secondary

school and higher education

Michaela C. Pascoe, Sarah E. Hetrick & Alexandra G. Parker

To cite this article: Michaela C. Pascoe, Sarah E. Hetrick & Alexandra G. Parker (2019): The
impact of stress on students in secondary school and higher education, International Journal of
Adolescence and Youth, DOI: 10.1080/02673843.2019.1596823

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INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH
https://doi.org/10.1080/02673843.2019.1596823

The impact of stress on students in secondary school and higher

education
a,b
Michaela C. Pascoe , Sarah E. Hetrickc,d and Alexandra G. Parkera,c
a
Institute for Health and Sport, Victoria University, Melborne, Australia; bDepartment of Cancer
Experiences, Peter MacCallum Cancer Centre, Melbourne, Australia; cOrygen, the National Centre of
Excellence in Youth Mental Health (Centre for Youth Mental Health, University of Melbourne) University
of Melbourne, Australia; dDepartment of Psychological Medicine, Faculty of Medical and Health Sciences,
University of Auckland, Auckland, New Zealand

ABSTRACT ARTICLE HISTORY

Students in secondary and tertiary education settings face a wide Received 29 January 2019
range of ongoing stressors related to academic demands. Previous Accepted 14 March 2019
research indicates that academic-related stress can reduce academic KEYWORDS
achievement, decrease motivation and increase the risk of school Academic; adolescent
dropout. The longer-term impacts, which include reduced likelihood health; education; mental
of sustainable employment, cost Governments billions of dollars health and well-being; stress
each year. This narrative review presents the most recent research
concerning the impact of academic-related stress, including discus-
sion of the impact on students’ learning capacity and academic per-
formance, mental health problems, such as depression and anxiety,
sleep disturbances and substance use.

Young people report high levels of stress

Students in secondary and tertiary education settings face a wide range of ongoing normative
stressors, which can be defined as normal day to day hassles such as ongoing academic
demands. Accordingly, secondary/high school (defined here as junior/lower secondary educa-
tion and senior/upper secondary education)] (UNESCO, 2012) and tertiary (defined here as
post-secondary education) (UNESCO, 2012) students commonly self-report experiencing
ongoing stress relating to their education, which we refer to as academic-related stress, such
as pressure to achieve high marks and concerns about receiving poor grades. For example, the
Organisation for Economic Co-operation and Development (OECD) recently conducted a survey
involving 72 countries and consisting of 540,000 student respondents aged 15–16 years. On
average across OECD countries, 66% of students reported feeling stressed about poor grades
and 59% reported that they often worry that taking a test will be difficult. The OECD further
found that 55% of students feel very anxious about school testing, even when they are well
prepared. As many 37% of students reported feeling very tense when studying, with girls
consistently reporting greater anxiety relating to schoolwork compared to boys (OECD, 2017).
This data demonstrates that education and academic performance are a significant source of
stress to students. The impact of this ongoing academic-related stress to student outcomes and
well-being has not been comprehensibly explored. Therefore, the current narrative review
explores the impact of academic-related stress on students’ academic performance, mental
health and well-being.

CONTACT Michaela C. Pascoe Michaela.pascoe@vu.edu.au

© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/
4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
2 M. C. PASCOE ET AL.

Methods
A single author (MP) searched PubMed and Google Scholar for peer-reviewed articles published
at any time in English. Search terms included academic, school, university, stress, mental health,
depression, anxiety, youth, young people, resilience, stress management, stress education, sub-
stance use, sleep, drop-out, physical health with a combination of any and/or all of the preceding
terms. A snowball strategy allowed for examination of references in identified articles, and
inclusion of additional articles as appropriate. The author reviewed all potential articles for
inclusion. Articles from all countries were included in this narrative review, if a school based
(secondary [as defined at grade 7 or higher] or university) population was included and the study
assessed the impact of stress on student mental health, substance use, sleep, dropout rates,
physical activity or academic outcomes. Articles were included regardless of study design.

Academic-related stress and mental health

Previous research indicates that self-reported stress is associated with the presentation of anxious
states and lower well-being (Carter, Garber, Ciesla, & Cole, 2006; Kessler, 1997; Robotham & Julian,
2006). The recent above-mentioned OECD survey reports that secondary students who self-report
higher levels of academic-related stress also report lower well-being, measured using psychologi-
cal, social, cognitive and physical components (OECD, 2015). A systematic review of 13 studies
showed that in individuals undertaking higher education, self-reported levels of stress are asso-
ciated with poorer quality of life and well-being (Ribeiro et al., 2017). Ongoing stress also pre-
cipitates the development of more serious mental health issues such as anxiety and depression
(Kessler, 1997; Moylan, Maes, Wray, & Berk, 2013). The prevalence of anxiety is as high as 35% in
tertiary students (Bayram & Bilgel, 2008; Eisenberg, Gollust, Golberstein, & Hefner, 2007; Ozen,
Ercan, Irgil, & Sigirli, 2010) and the prevalence of depression is 30% (Ibrahim, Kelly, Adams, &
Glazebrook, 2013). The reciprocal relationship between stress and depression and anxiety is well
established (Dantzer, 2012; Dantzer, O’Connor, Lawson, & Kelley, 2011; Maes, 2008). Indeed, major
stressful life events are one of the best predictors of the onset of depression (Kendler et al., 1995;
Kessler, 1997). Accordingly, in young people the first onset of depression is often preceded by
major life stressors (Lewinsohn, Allen, Seeley, & Gotlib, 1999).
Aside from impairing overall health and well-being, depression and anxiety symptoms can
further adversely affect academic achievement (Bernal-Morales, Rodríguez-Landa, & Pulido-
Criollo, 2015). In undergraduate university students from the United States, those with higher
self-reported anxiety and depression symptoms were found to achieve poorer grades on exam-
inations (Chapell et al., 2005; Hysenbegasi, Hass, & Rowland, 2005). A longitudinal study of
Hawaiian secondary school students showed that self-reported depressive symptoms resulted
in subsequent poor academic achievement (Kessler, 2012; McArdle, Hamagami, Chang, &
Hishinuma, 2014). This is consistent with the findings of Humensky et al. (2010) who found
that self-reported depressive symptoms were associated with concentration difficulties and
trouble with completing school tasks, in 83 students from the United States between the ages
of 14–21, and at-risk for major depression (Humensky et al., 2010). In a sample of Finnish students
aged 13–17, self-reported depression severity was associated with concentration difficulties, and
poorer social relationships, self-learning, poorer academic performance, and worse reading and
writing outcomes (Fröjd et al., 2008). Therefore, it is not surprising that young people with
depression, particularly males, are less likely to undertake higher education, as shown in a 15-
year longitudinal study of Swedish adolescents (Jonsson et al., 2010). Importantly, adolescent
depression can also result in longer-term poor employment outcomes, as demonstrated by a 25-
year longitudinal study of New Zealand children (n = 982). This study found that people who had
depression at ages 16–21 had greater rates of welfare dependence and unemployment, demon-
strating that the impact of poor mental health in adolescence can have long-lasting impacts
 INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 3

(Fergusson, Boden, & Horwood, 2007). Enhancing support in the education setting may improve
the mental health of young people. A national telephone survey of United States households
showed that the incidence of depression in college students decreases if students have positive
adjustments to academic life as well as adequate social support (Ross & Mirowsky, 2006). Indeed,
an Australian randomised control trial reported that a gamified online cognitive behaviour
therapy intervention was effective in reducing depressive symptoms in 540 final year secondary
students (Perry et al., 2017). This study demonstrates the potential of education settings in
mediating the impacts of academic-related stress on young people’s mental health.

Academic-related stress and substance use

The health and risk behaviours of young people, including substance use and abuse, are all important
determinants of their current and future health and well-being status (Tountas & Dimitrakaki, 2006;
World Health Organisation, 2004). Academic-related stress can increase substance use among young
people. In a survey study of 128 Grade 11 students attending competitive private schools in the
United States, students who reported experiencing high ongoing stress, particularly in relation to
academic achievement and the tertiary education admissions process, also reported high rates of
drug and alcohol use (Leonard et al., 2015). The authors report that substance use was associated
with a greater desire for academic achievement, higher perceived stress, less effective coping
strategies, and less closeness with parents (Leonard et al., 2015). In 7th and 8th Grade students
from the United States, self-perceived stress has similarly been reported to be related to substance
use. In these students, coping strategies that included information gathering, problem solving and
having a positive outlook, as well as adult social support and relaxation were inversely related to
substance use (Wills, 1986). This study demonstrates the importance of protective social factors in
mediating the effects of academic-related stress. In a cross-sectional study of tertiary nursing
students from the United States, those with higher self-reported stress had higher incidence of
substance use. Students who had higher perceptions of faculty support used fewer stimulants to
assist them while studying, further demonstrating the proactive role of social factors (Boulton &
O’Connell, 2017). Finally, The Canadian Institute for Health reports that young people aged 12–19
who feel connected to their school report less anxiety and less risky behaviours, such as smoking and
drinking alcohol, compared to those who do not feel connected to their schools (Canadian Institute
for Health, 2005). Collectively, the above discussed findings indicate that increased stress is asso-
ciated with substance use among students and that perceived social support, including from within
the education environment, may positively mediate this relationship.

Academic-related stress and sleep

Insufficient sleep in adolescents is recognised as a serious health risk by the American Medical
Association and the American Academy of Sleep Medicine, who report that many young people
do not get enough hours of sleep (Owens, 2014). Stress is a contributing factor to poor sleep in
young people (Bernert, Merrill, Braithwaite, Van Orden, & Joiner, 2007; Curcio, Ferrara, & De,
2006). Noland et al., found that 42% of 9–12th Grade students report that stress is an impediment
to good sleep, in 384 students surveyed (Noland, Price, Dake, & Telljohann, 2009). Self-perceived
stress has been shown to result in poorer sleep in female university students from the United
States (Lee, Wuertz, Rogers, & Chen, 2013; Wallace, Boynton, & Lytle, 2017), medical students
from Saudi Arabia (Almojali, Almalki, Alothman, Masuadi, & Alaqeel, 2017), university students
from Portugal (Amaral et al., 2017) and Pakistani medical school students (Waqas, Khan, Sharif,
Khalid, & Ali, 2015), demonstrating the cross cultural impacts of stress on sleep quality and
quantity tertiary education students. In a study from the United States, over 90% of 9–12th Grade
students reported that they have an inadequate number of hours of sleep on most school nights.
These young people report that the impact of the loss of sleep is difficulty paying attention,
4 M. C. PASCOE ET AL.

lower grades, higher stress, and trouble getting along with other people. Some students reported
problematic coping strategies such as taking sleeping pills, smoking cigarettes and drinking
alcohol to help them sleep (Noland et al., 2009). Sleep quality and quantity has been shown to be
closely related to student learning capability and academic performance (Curcio et al., 2006). Loss
of sleep is frequently associated with poor learning (Curcio et al., 2006). Therefore, stress-related
disruption to sleep quality and quantity is an important factor contributing to poor learning and
well-being among students.

Academic-related stress and physical health

The experience of high levels of academic-related stress increases the risk of young people developing
preventable physical health problems later in life. A systematic review of prospective studies found that
people who were stressed, such as during examination periods, were less likely to be physically active,
the impact of which is associated with a plethora of potentially inter-related poor physical health
outcomes (Stults-Kolehmainen & Sinha, 2014). Stress may also lead to the development of non-
communicable diseases, including metabolic syndrome, obesity and reduced insulin sensitivity, result-
ing from unhealthy lifestyle habits and stress system dysregulation (Pervanidou & Chrousos, 2012).
Similarly, stress has been shown to be associated with increased appetite (Dallman et al., 1993) and
higher body weight (Stephens et al., 1995). Therefore, academic-related stress can contribute to the
development of health issues, including chronic non-communicable diseases, due to decreases in
physical activity and increases in unhealthy lifestyle habits.

Academic-related stress and achievement

The World Health Organisation (1996) states that students must be healthy and emotionally
secure to fully participate in education (World Health Organisation, 1996). Indeed, the above-
mentioned OECD survey reports that anxiety about schoolwork, homework and tests has
a negative impact on students’ academic performance in science, mathematics and reading.
The survey highlights that top-performing girls report that the fear of making mistakes often
disrupts their test performance (OECD, 2015). Students in the bottom quarter of academic
performance report feeling far more stressed compared to those in the top quarter of academic
performance. As many as 63% of students in the bottom quarter of science performance report
feeling anxious about tests no matter how well prepared they are, while 46% of students in the
top quarter report feeling anxious (OECD, 2015). This demonstrates that higher perceived stress
levels are associated with poorer academic performance.
Previous research shows that the experience of positive and negative emotions are directly
related to levels of student engagement (Reschly, Huebner, Appleton, & Antaramian, 2008). In
293 students in Grades 7–10 from the United States, the frequency of positive emotions during
classes was associated with higher student engagement. Conversely, the frequency of negative
emotions was associated with lower engagement (Reschly et al., 2008). This finding is important
as engagement in learning is necessary for achievement, as illustrated by the findings of a survey
conducted by the National Union of Students. This survey reported that the main factors
affecting the tertiary studies of Australian university students aged 17–25 was stress (Rickwood,
Telford, O’Sullivan, Crisp, & Magyar, 2016). In an observational study of 456 German under-
graduate medical students, higher perceived academic-related stress was found to predict poor
academic performance (Kotter, Wagner, Bruheim, & Voltmer, 2017). In another study of 121
medical students from Hong Kong, high self-reported stress levels were similarly related to
poorer academic performance (Stewart, Lam, Betson, Wong, & Wong, 1999). The above findings
demonstrate that the academic-related stress that secondary and tertiary students experience
constitutes a major factor affecting their academic achievement. Students with higher perceived
stress are likely to have lower academic achievement.
 INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 5

Academic-related stress and dropout

Academic-related stress and burnout includes exhaustion, depersonalization, cynicism and ineffi-
cacy or reduced accomplishment (Walburg, 2014). Academic-related stress is strongly related to
decreased student academic motivation (Liu, 2015; Liu & Lu, 2011; Shinto, 1998) and academic
disengagement (National Centre on Addiction and Substance Abuse at Columbia University (CASA)
United States of America, 2003). The relationship between academic-related stress, motivation and
dropout does not appear to be culturally specific, with similar findings shown from a number of
international studies (Liu, 2015; Liu & Lu, 2011; Shinto, 1998; Walburg, 2014). In 298 Chinese
secondary school students, academic-related stress in Grade 10 negatively predicted intrinsic
academic motivation and positively predicted lack of motivation in Grade 12. This indicates that
decreasing academic-related stress might preserve students’ ongoing intrinsic academic motivation
(Liu, 2015; Liu & Lu, 2011). Similarly, in 495 Japanese students in junior secondary school, self-
reported academic-related stress was found to negatively relate to feelings of self-growth and
academic motivation (Shinto, 1998). A recent literature review highlights how stress and burnout
can also affect academic achievement by increasing the risk for school dropout (Walburg, 2014).
This was particularly true for students who experience more stressful life events of a more severe
nature, as well as students who do not seek support from their parents or other family members as
well as students from ethnically diverse groups (Hess & Copeland, 2001).
School dropout is associated with a lifelong reduction in earning capacity and secure employ-
ment (Lamb & Huo, 2017). Individuals with lower education levels report having poorer mental
health and more illness than those with higher levels of education (Turrell, Stanley, de Looper, &
Oldenburg, 2006). Early dropout from school has also been reported to contribute to inter-
generational issues including unemployment, poverty and less academic achievement (Black,
2007; Lamb & Huo, 2017; Muir, Family, Maguire, Slack-Smith, & Murray, 2003). Academic achieve-
ment and completion of secondary school leads to greater employability, less reliance on social
welfare support and a higher likelihood of participation in further education (Noble, Wyatt,
McGrath, Roffey, & Rowling, 2008). These outcomes in turn increase the likelihood of sustainable
employment, adequate income and self-sufficiency (Noble et al., 2008), which can save
Governments hundreds of millions of dollars every year (Lamb & Huo, 2017).

Discussion
The current narrative review highlights that students commonly report high levels of academic-
related stress, cross-culturally. The academic-related stress experienced by secondary and tertiary
students’ impacts their mental and physical health and leads to a range of academic problems.
Good stress-management skills have the potential to benefit young people in an ongoing
manner throughout their lives, given that many long-term health-related behaviours and pat-
terns, both positive and negative, are established during adolescence and early adulthood
(Sawyer et al., 2012). Therefore, providing opportunities to improve young people’s academic
stress-related coping abilities during this highly stressful, crucial period of development is an
important target (OECD, 2015).
The OECD highlights that education settings are places where young people develop many of the
social and emotional skills needed to become resilient and thrive (OECD, 2015). Therefore, education
settings can work to improve student academic related stress through the provision of
programmes shown to decrease stress and increase stress management and coping. Discussion regarding
the efficacy of particular school based stress management programmes to teach students to cope with
stress is beyond the scope of the current review. It worth noting, however, that education-based initiatives
that focus on increasing students skills and ability to cope with stress have been previously demonstrated
to directly and positively influence educational achievement and decrease health risks (Hanson & Austin,
2002; Perry et al., 2017; Weare & Gray, 2003). For example, a meta-analysis of 19 randomised controlled
6 M. C. PASCOE ET AL.

trials or quasi-experimental studies found that school programmes targeting stress management or
coping skills reduced stress symptoms and improved coping skills among students (Kraag, Zeegers,
Kok, Hosman, & Abu-Saad, 2006). Schools provide access to a large number of young people, across
a diverse range of backgrounds, during a formative developmental period (Sawyer et al., 2012). As such,
even if modestly effective, the population level implementation of stress management and coping skills
programmes would help young people to develop healthy coping strategies in order to deal with the
inevitable stressors of life. Understanding and addressing the barriers and enablers to implementation of
stress management programmes in schools would support the development of effective implementation
strategies (Albers & Pattuwage, 2017; Domitrovich et al., 2008), resulting in significant health, economic
and social benefits for large numbers of young people, their families and the community.
A strength of the current review is that we have discussed studies from many countries,
indicating that the academic-related stress experienced by students in education is cross-cultural
and wide spread and is of international concern. We reviewed studies that demonstrated a range of
negative effects of academic-related stress, highlighting the potential broad spectrum of benefits
that may result from the implementation of stress-management interventions. A limitation of the
current study is that we have not delineated between studies that have assessed the impact of
academic-related stress during different phases of secondary and tertiary education. It is more than
likely that the needs and therefore the most beneficial coping strategies may vary throughout the
life span. Therefore, the most appropriate stress-management education approaches may differ
between the early high school and tertiary education years.

Conclusion
This narrative review highlights that academic-related stress is a major concern for secondary and
tertiary students. The ongoing stress relating to education has demonstrated negative impact on
students’ learning capacity, academic performance, education and employment attainment, sleep
quality and quantity, physical health, mental health and substance use outcomes. Increasing
students’ stress-management skills and abilities is an important target for change.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
The authors received no financial support for the research, authorship and/or publication of this article.

ORCID
Michaela C. Pascoe http://orcid.org/0000-0002-3831-5660

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