High-stakes national examinations are an important part of the education system. GCSE examinations at the end of secondary school are not only used to measure the skills of pupils, but also play a key role in measuring and monitoring the quality of schools. Yet there is growing concern amongst parents, teachers and government officials about the examination stress that young people suffer, and how this may be linked to the development of serious mental health issues. This concern has increased in recent years, particularly amongst secondary school pupils, with the recent reforms made to GCSE examinations (with much more emphasis now placed upon the end-of-Year 11 assessments).
The aim of this project is to provide new insight into the link between GCSE examinations and young peoples mental health. It will investigate how indicators of pupils mental health (e.g. prescription of anti-depressants) change during childrens progress through secondary school, and if spikes in mental health problems can be observed at key timepoints (e.g. in the build-up to GCSE exams, during GCSE results week). The project will also explore whether this varies by childrens background characteristics (e.g. gender, family background, season of birth). This will provide important new evidence about young peoples mental health, whether these are linked to GCSE examinations and if there are key mental health flash-points at certain points during the school year.
This project will investigate the incidence and prevalence of anxiety / depression amongst young people as they progress through secondary school. The primary interest is in when such mental health issues start to emerge and whether there are spikes at certain points in the academic year (particularly around the time that teenagers take their GCSE examinations). The primary outcome of interest is occurrences of anxiety/depression, with secondary outcomes including incidence of eating disorders and self-harm. Academic year group is the main exposure of interest, defined using month and year of birth, which in turn allows us to establish the date when individuals will have sat their GCSE examinations.
The project will begin with a descriptive analysis, illustrating how the risk of suffering anxiety/depression changes as young people progress through secondary school, potentially finding particular academic year groups most at risk of developing such problems. This will include differences between key sub-groups such as girls and young people from advantaged / disadvantaged socio-economic backgrounds. Logistic regression and difference-in-difference analysis will then follow to investigate how diagnoses and treatment of anxiety/depression is related to the timing of national examinations.
Together, the results from the project will provide important new evidence on how mental health is related to young peoples journey through secondary school, and particularly the relationship between anxiety/depression and GCSE examinations.
Primary outcome
Our primary outcome of interest is diagnoses or treatment of anxiety/depression (and the time that this occurred). We have defined this outcome drawing upon previous use of the CPRD by other research groups, who have published their READ codes (see below for further details). Precise details on how we intend to define this outcome are provided in the code lists supplied.
Secondary outcomes
Examination stress has previously been linked to eating disorders (Costarelli and Patsai 2012), and often co-occur with anxiety. The same is true of the link between stress and self-harm (Menon et al 2018). We are hence also interested in how stress, eating disorders and self-harm develop across school year groups, and whether such problems are likely to emerge (or re-emerge) around the time that GCSE examinations occur. Likewise, we are also interested in exploring healthcare utilisation amongst young people with anxiety/depression, in order to get some idea about how severity of conditions changes across academic year groups.
John Jerrim - Chief Investigator - University College London ( UCL )
John Jerrim - Corresponding Applicant - University College London ( UCL )
Arturo Gonzalez-Izquierdo - Collaborator - University College London ( UCL )
Muhammad Qummer ul Arfeen - Collaborator - University College London ( UCL )
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation