1. 教育选择的核心矛盾：快乐与竞争的价值冲突
1.1 教育目标的二元对立现象
在当代社会，教育选择中“快乐倒数”与“抑郁第一”的说法，鲜明地折射出两种截然不同的教育理念。一方面，家长希望孩子拥有一个幸福、无压力的童年，强调培养其内在的喜悦和幸福感，这与积极心理学中提升个体幸福感的干预措施不谋而合，例如，有研究表明，某些旨在培养内心喜悦和幸福感的干预措施已被证实能有效提升大学生的幸福感并减轻负面情绪1，而积极心理学中的幸福干预措施也能够增加幸福感并减少抑郁症状2。此外，感恩干预措施，如感恩日记或反思练习，已被证实能有效提升大学生的幸福感并减轻负面情绪3。这种理念将“快乐”置于教育目标的首位，认为儿童的心理健康和情感发展是其全面成长的重要基石。
另一方面，传统观念和社会现实又驱动着家长追求孩子的学业卓越，力求在激烈的竞争中脱颖而出，即便这可能以牺牲部分快乐为代价。在这种理念下，“第一”代表着学业成就和社会认可。学业成功往往与未来的职业发展、社会地位紧密挂钩，例如，学业成绩与PCOA（药学课程成果评估）及NAPLEX（北美药剂师执照考试）成绩呈正相关，预示着未来的学术和职业成功4。这种对学业成就的强调，使得“成功”的定义在很长一段时间内被单一化为考试分数和升学率。
然而，随着社会发展和教育理念的进步，“成功”的定义正从单一的学业成就向更广阔的综合发展转变。越来越多的研究和实践表明，健康、幸福和学业成功之间存在关联5。例如，情商被认为是影响学业成就和职业表现的重要因素，对医疗专业人员的“人文关怀”至关重要，能够促进自我管理技能和人际关系，提高个人表现6。这种转变促使我们重新审视教育目标，认识到真正的成功不应仅限于智力或学业上的优越，而应包含个体身心健康、社会责任感及终身学习能力的全面提升。因此，如何在追求学业进步的同时，确保儿童的快乐和心理健康，成为了现代教育必须直面的核心矛盾。
1.2 家长决策的心理机制
家长在“保护孩子幸福感”与“适应社会竞争”之间进行教育选择时，其决策机制受到多重心理因素的驱动。首先，对孩子幸福感的保护是父母的天性，这种驱动源于对儿童福祉的深层关切，例如，当儿童出现焦虑症状时，父母会选择参与治疗和管理，以改善其症状7。然而，这种保护欲在面对社会竞争的现实时，往往需要进行复杂的权衡。
心理学研究揭示了家长决策背后的风险认知和情感驱动。一个重要的概念是“延迟满足”能力，这通常指个体为获得长远更大的回报而放弃即时较小回报的能力8。虽然这一概念主要用于描述个体的行为选择，但它也间接影响了家长的教育决策。例如，一些家长可能认为短期内的“快乐倒数”（较低的学业压力）会导致长期的“抑郁第一”（在竞争中落后），从而牺牲孩子当前的轻松，以期在未来获得更好的学业或职业发展，这可以被视为家长为孩子进行的“延迟满足”决策。然而，过度强调延迟满足，可能导致家长忽略当下对孩子心理健康的影响。此外，父母自身的延迟折扣（delay discounting）倾向，即倾向于选择较小的即时奖励而非较大的未来奖励，也可能影响他们对孩子教育投资的决策9。例如，如果父母倾向于即时满足，他们可能会更关注孩子当下的快乐，而较少关注长期学业竞争的压力。
另一方面，社会竞争的压力也是家长决策的重要驱动力。研究显示，家长承受的压力可能会投射到孩子的教育选择上，例如，养育自闭症儿童的父母通常会承受更高的养育压力1011。对“不确定性”的焦虑，可能促使他们寻求通过学业竞争为孩子争取更多的“确定性”。这种情感驱动可能导致家长在教育选择上倾向于保守和功利，即使意识到高压学业可能对孩子的心理健康造成负面影响，也难以完全放弃对竞争优势的追求。
家长的决策还受到其社会经济背景、教育观念以及文化价值观的影响。例如，有研究表明，父母在为孩子选择参与临床研究时，其受教育程度和经济状况会影响他们的决策，高学历和拥有私人保险的父母更倾向于不参与临床研究12。此外，父母对育儿责任的期望也会因性别和社会文化背景而异，例如，一项对澳大利亚牙科学生的研究显示，多数受访者计划休假专注于育儿，且过半数认为育儿应由父母双方分担，但男女受访者在育儿观念上存在差异13。这表明教育选择的复杂性不仅在于对风险的认知，还在于家长对“成功”定义的内在理解和情感归属。这种决策过程是一个动态且充满矛盾的心理博弈，家长需要在各种不确定性和期望中寻找平衡点，这使得他们的教育选择充满了主观性和个体差异。
2. 当前教育环境中的压力源解析
2.1 学业竞争的制度性强化
当前教育环境中，学业竞争的制度性强化是儿童面临显性压力的主要来源。升学评价体系，尤其是以考试分数为主导的选拔机制，是驱动学业竞争的核心动力。在许多国家和地区，中考、高考等决定性的考试成绩直接关系到学生能否进入更高层次的优质教育资源，这使得学生和家长都不得不将大量精力投入到学业成绩的提升上。
这种制度性压力导致了课外培训的“内卷化”。为了在竞争中占据优势，学生们不得不参加各种补习班、辅导课，甚至提前学习高年级课程。例如，有研究指出，在韩国，同学参加课外补习的比例越高，个体学生的抑郁症状就越严重。这不仅侵占了学生的自由时间，也使得学业负担不断加重，形成了恶性循环14。中国的一项研究也发现，尽管有减负政策，中国中学生在校外仍面临繁重的学习负担，包括家庭作业、校外辅导和额外练习，且为了追求更好的考试成绩和竞争力，他们承受着情感压力，甚至在校内外都没有休息时间15。
这种过度的学业压力具体表现在学生睡眠质量的下降和时间分配的失衡上。多项研究表明，大学生普遍存在睡眠质量差的问题，这与心理困扰和倦怠密切相关16171819。例如，一项针对德国大学生的研究发现，48.7%的学生存在睡眠质量差的问题，且这与较低的主观社会地位、较差的自评健康状况、压力、疲惫和不良学业表现显著相关17。在沙特阿拉伯，一项针对医学生的调查显示，63.2%的学生睡眠质量差，且这与更高的心理健康问题（如抑郁、焦虑和压力）显著相关，但有趣的是，该研究并未发现睡眠质量与学业表现之间存在显著关联1819。另一项针对中国大学生的研究也指出，学业拖延与较低的学业表现和心理健康呈显著负相关，而体力活动水平与学业拖延呈显著负相关，这间接说明了学习时间分配不合理可能导致的负面影响20。
此外，学习时间的分配也存在问题。一项基于PISA 2018中国数据的研究指出，中国学生的平均学习时间明显长于经合组织国家，且学习时间对学业表现的影响呈“倒U形”，存在一个最佳学习时长，超过这个时长反而可能影响学习效率和学生的幸福感及对学习活动的态度21。这意味着，一味增加学习时间并非提升学业表现的有效途径，反而可能带来负面影响。过度学习时间不仅会挤占学生的休息和娱乐时间，还可能导致压力增加，进而影响心理健康和整体发展。
综上所述，当前教育环境中的制度性强化，通过升学评价体系和课外培训内卷化，给儿童带来了沉重的学业负担，导致睡眠不足、时间分配失衡以及心理压力，这些都构成了儿童成长过程中的显性压力源。
2.2 隐性社会评价的渗透
除了显性的学业竞争压力，儿童和青少年还面临着来自隐性社会评价的渗透，这主要体现在社交媒体的影响和同伴间的比较上。社交媒体的普及，使得儿童和青少年置身于一个持续被评价和比较的环境中，这对其自我认知和心理健康构成潜在冲击。
社交媒体平台，如Facebook、Instagram、TikTok等，已成为青少年日常生活中不可或缺的一部分。儿童和青少年使用社交媒体的比例极高，这些平台为他们提供了娱乐和交流的门户2223。然而，研究表明，社交媒体对儿童和青少年的心理健康影响最大，特别是在自尊和幸福感方面23。过度使用社交媒体，尤其是在易受影响的群体中，与抑郁和其他心理健康问题相关24。有研究指出，社交媒体可能导致情绪和焦虑障碍，是网络欺凌的平台，甚至其使用本身就被视为一种“成瘾”25。
“晒娃”文化是社交媒体上一种普遍现象，家长在社交媒体上分享孩子的照片和视频，虽然初衷可能是记录成长和分享喜悦，但无形中也为孩子引入了被评价的维度。儿童可能会在潜移默化中感受到来自他人评价的压力，这可能影响他们的自我认同和价值观形成。
同伴比较在社交媒体环境下被放大。青少年倾向于将自己与社交媒体上呈现的“理想化”形象进行比较，包括同伴、名人以及社交媒体影响者的形象。这种比较行为，特别是对外貌的比较，与身体不满意度、饮食失调以及较低的自尊和抑郁症状显著相关262728。社交媒体的特征，例如量化的点赞和评论，以及对自我形象的过度关注和编辑（如“修图”），进一步加剧了这种比较和对理想化形象的内化，从而损害了青少年的身体满意度和主观幸福感262728。研究发现，女孩在社交媒体上分享自拍照的频率越高，以及对这些照片的投入和操作越多，其对体型和体重的过度看重、身体不满意度以及节食行为就越高28。
此外，“Facebook抑郁”现象也引起了研究者的关注2223。这指的是青少年在社交媒体（如Facebook）上花费大量时间后出现的抑郁症状，其原因可能是目睹朋友的“完美”生活而感到嫉妒和自卑。尽管社交媒体可以提供社区感并有助于促进心理健康29，但其负面影响，如网络欺凌、不适当内容暴露以及对心理健康的不利影响，不容忽视2223。尤其是在疫情期间，社交媒体的使用对大学生心理健康产生了负面影响，这种影响在社交孤立的学生中尤为明显，表明社会支持和韧性是重要的保护因素30。对于3至6岁的儿童而言，尽管总屏幕时间与心理健康问题持续相关，但不同类型的内容影响各异，其中社交媒体的暴露比例随着年龄增长而增加31。
综上，社交媒体和同伴比较构成了儿童和青少年隐性社会评价的重要来源，其带来的潜在心理冲击，如自尊问题、身体形象困扰、“Facebook抑郁”和网络欺凌，是当前教育环境必须重视并加以引导的关键问题。
3. 快乐成长对儿童发展的长期影响
3.1 心理健康与社会适应能力
童年时期的快乐成长对儿童未来的心理健康和社会适应能力具有深远的长期影响。研究表明，童年时期的主观幸福感并非昙花一现，而是与成年后的情绪调节、人际关系质量及整体生活满意度紧密相关3233。一个充满关爱和支持的家庭环境，尤其是在儿童时期感受到父母的温暖，被证实能有效预测成年后更好的应对策略和幸福感34。这种积极的早期经验有助于儿童形成健康的自我概念和对世界的积极预期。
纵向研究数据进一步证实了童年幸福感的重要性。例如，有研究发现，在儿童早期表现出较好自我调节能力（如行为问题和掌握动机）的儿童，其认知和社会技能发展轨迹也更为积极，且这些儿童的母亲所承受的育儿压力也相对较低35。此外，童年时期获得的社会情感技能（Social-Emotional Skills, SES）被认为是促进积极调整和降低风险的关键因素，它们与社会、行为和学业成果密切相关，并能预测成年后的重要生活结果36。
非认知技能的培养在快乐成长中占据核心地位，其中抗逆力（Resilience）和共情能力（Empathy）尤为关键。抗逆力是指个体在面对逆境、创伤、悲剧、威胁或巨大压力时，能够良好适应并恢复的能力37。多项研究强调，抗逆力并非一种罕见的特质，而是人类适应系统常态功能的结果，且可以通过有效的干预措施进行培养和强化373839。一个充满快乐和支持的环境能帮助儿童发展出健康的适应机制，从而在未来的挑战面前展现出更强的韧性。
共情能力作为另一种重要的非认知技能，是指理解并分享他人情感的能力。有研究表明，通过社会技能干预可以有效提升儿童的共情能力，例如，一项针对孤独症谱系障碍儿童的群组随机对照试验显示，乐高®积木疗法能够适度提升儿童的社会技能，包括合作、共情、沟通和自我控制40。此外，社会情感技能训练项目也证实了其能有效提高青少年的共情、合作、自信和自我控制能力41。这些技能的培养不仅有助于儿童建立良好的人际关系，也为他们成年后在社会中有效互动和协作奠定基础。
总而言之，快乐的童年不仅仅是短暂的愉悦，更是为儿童心理健康和社会适应能力打下坚实基础的关键时期。通过培养抗逆力、共情能力等非认知技能，儿童能够更好地应对生活挑战，发展出健康的情绪调节机制，并在成年后建立起积极的人际关系，从而实现更全面的发展和幸福生活。
3.2 学习内驱力的可持续性
快乐成长环境对于培养儿童可持续的学习内驱力至关重要，它能形成“快乐”与“学习动机”之间的正向循环。在非竞争性的环境中，儿童的知识探索兴趣得到更好的保护和激发。蒙台梭利教育和自然教育等模式的实证研究为此提供了有力的证据。
蒙台梭利教育法强调以儿童为中心，尊重儿童的内在发展规律和自主选择权。在这种教育模式下，儿童在充满预备好的学习材料的环境中自由探索，根据自己的兴趣和节奏进行学习。研究表明，与传统幼儿园相比，蒙台梭利教育能够显著提升儿童的学校动机、对学校的态度以及执行功能 42。另一项针对捷克五年级学生的数学成绩研究发现，蒙台梭利学校的学生在数学成绩、对数学的态度、元认知知识、自我效能感和动机等方面的表现，与传统学校、基因建构主义（Hejný方法）和道尔顿学校的学生存在差异，其中元认知监控被认为是数学成绩最重要的预测因子 43。此外，一项早期的追踪研究也显示，蒙台梭利教育对低收入黑人青年的学业成就和智商有积极影响，特别是蒙台梭利男性在阅读和数学方面能达到年级水平 44。这些研究结果共同表明，蒙台梭利教育通过提供一个支持自主探索和内在动机的环境，有效促进了儿童的学习兴趣和学业表现。
自然教育则将学习与户外环境和自然体验相结合，让儿童通过直接感知和互动来获取知识。这种模式减少了传统课堂的束缚和竞争，转而强调观察、体验和解决实际问题。例如，当儿童在自然环境中进行探索时，他们会自发地对周围世界产生好奇，并主动寻求解释，这种内在的好奇心正是学习内驱力的核心。
在非竞争性的环境中，儿童的学习兴趣能够得到更好的保护。当学习不再是为了超越他人或仅仅为了考试分数时，儿童更有可能将学习视为一种内在的满足和乐趣。这种内在动机驱动的学习，不仅效率更高，而且能培养儿童对知识的终身探索欲望 45。相反，过度竞争的环境往往将外部奖励（如高分、排名）置于首位，长此以往，儿童可能失去对学习本身的兴趣，将学习视为一种负担或达到目的的手段，从而损害了学习的内驱力。有研究指出，在学术高压下，学生的学业倦怠与学习投入之间存在负相关，而学习敏捷性可以部分缓解这种负相关关系，但毅力（grit）的调节作用并未被观察到 46。这进一步说明，仅仅依靠毅力可能不足以维持学习投入，创造一个能够激发内在动机、减少学业倦怠的环境同样重要。
因此，“快乐”不仅是儿童心理健康的基础，也是培养其学习内驱力、促进可持续学习的关键因素。蒙台梭利教育和自然教育等模式的成功案例表明，通过营造非竞争性的、支持自主探索和兴趣驱动的学习环境，能够有效保护和激发儿童对知识的渴望，从而为他们的长远发展奠定坚实基础。
4. 极端竞争对儿童心理健康的风险
4.1 心理问题的显性表现
在高竞争的教育环境中，儿童和青少年面临着巨大的心理压力，这导致抑郁、焦虑等心理障碍的显性表现日益突出。多项研究一致表明，学业压力是导致青少年心理健康问题的重要因素之一。例如，一项系统综述发现，在52项研究中，有48项研究证实学业压力与青少年抑郁、焦虑、自残、自杀意念、自杀尝试和自杀等心理健康问题之间存在正相关关系47。另一项针对印度卡纳塔克邦青少年的调查显示，86.0%的青少年承受着高学业压力，87.0%经历着高感知到的父母压力，28.5%有中度高焦虑，而57.7%的青少年普遍幸福感较低48。这些数据清晰地揭示了极端竞争环境对青少年心理健康的负面影响。
在高竞争环境中，青少年运动员群体也未能幸免。尽管运动通常被认为有益于身心健康，但在精英级别或国际竞争中，青少年运动员同样面临心理健康症状和障碍的风险。一项针对精英青少年运动员的范围审查发现，饮食失调、焦虑和抑郁是常见的问题，其中女性运动员的饮食失调和焦虑患病率可能更高。社会/关系因素（与教练/父母/同伴的关系）被认为是心理健康不佳的常见风险因素49。过度训练综合征（Overtraining Syndrome）也可能被误诊为抑郁症，这在高水平运动员中并不罕见，因为运动表现的压力会放大精神压力50。此外，疫情期间体育活动的中断也使得青少年运动员面临身体机能下降和心理健康负担增加的风险51。
从神经发育角度来看，长期的、高强度的学业压力对青少年的神经系统发展可能产生负面影响。早期生活逆境（如母婴分离）已被证明会导致啮齿动物焦虑行为增加，并改变其伤害感受性（疼痛敏感性），表现为疼痛相关行为的加剧，同时增加应激和“战斗或逃跑”反应相关基因以及炎症标志物的表达52。虽然这些研究主要集中在早期逆境，但高强度的学业压力可以被视为一种慢性心理社会应激源，可能诱导类似的神经生物学改变。例如，一项中国青少年的巢式病例对照研究发现，学业压力与焦虑症状之间存在关联，且这种关联部分通过NR3C1基因的DNA甲基化（一种表观遗传学改变）介导，这意味着学业压力可能通过改变基因表达来影响神经系统功能，从而导致焦虑等心理问题53。这些证据表明，高竞争环境造成的长期高压可能不仅仅是心理层面的困扰，还可能对儿童和青少年的生理和神经发育产生深远影响。
此外，心理压力与学业表现之间也存在复杂关联。尽管适度的压力可以作为学习的动力，但过度或长期的压力反而会损害学业表现，并加剧心理健康问题。例如，有证据表明运动员普遍存在睡眠不足和心理健康问题，这些问题会影响他们的竞技表现54。这种显性心理问题的出现，不仅损害了儿童和青少年的当下幸福感，也对其长远发展构成了严重威胁。
4.2 隐性发展的阻滞效应
过度竞争的环境不仅对儿童的心理健康造成显性问题，还会对其隐性发展产生阻滞效应，尤其体现在创造力、合作意识等关键能力的培养上。在追求“第一”的单一评价体系下，多元智能的发展空间受到限制，儿童可能被训练成为标准答案的机器，而非富有创新精神和协作能力的个体。
创造力是人类进步的核心驱动力，但过度竞争和高压环境已被证实会对其产生负面影响。一项元分析研究指出，压力总体上对创造力有负面影响（d = -0.20） 55。其中，非社会性压力源，如时间压力和身体压力，显著阻碍了创造性表现（d = -0.45） 55。值得注意的是，儿童的创造力尤其受到竞争、身体压力和挑战性任务的显著降低 55。这意味着，当儿童长期处于激烈的学业竞争、繁重的课业负担和时间限制之下时，他们的创新思维和发散性思考能力会受到抑制。教育体系中对标准答案和高分的单一追求，往往使儿童缺乏尝试错误、自由探索和想象的空间，而这些都是培养创造力不可或缺的要素。
除了创造力，过度竞争还会削弱儿童的合作意识。合作是社会性动物生存和发展的基础，在儿童的发展过程中，同伴间的游戏（peer play）是培养合作精神、分享、轮流和协商能力的重要途径 56。然而，当竞争成为主导模式时，儿童可能更倾向于将他人视为对手而非伙伴，从而减少甚至排斥合作行为。例如，在2到3岁，随着自我意识的发展，儿童的分享意愿会下降，为了争取玩具而竞争会使游戏迅速恶化 56。尽管父母的榜样作用可以促进分享，但若环境持续强调竞争，儿童将难以发展出健康的合作关系。研究表明，重复互动虽然在进化上被认为是解释人类合作行为的因素，但它本身并不能可靠地支持合作，因为模糊的互惠行为会破坏合作 57。而将重复互动与群体竞争结合起来时，可以触发强大的协同效应，因为群体竞争能限制模糊互惠的腐蚀性影响，从而促进内群体合作，但也可能导致对外群体的排斥 57。这提示我们，教育环境中的竞争设计需要审慎，应避免无益的零和竞争，而是鼓励在合作基础上的良性竞争。
“合作型学校气候”与“竞争型学校气候”的对比研究进一步揭示了单一评价体系的局限性。在一个鼓励合作的学习环境中，学生们能够更好地分享资源、互相帮助、共同解决问题，从而提升集体的学习成效和个体间的社会情感联系。相比之下，过度竞争的学校气候可能导致学生间的疏离、嫉妒和压力，甚至可能出现为了自身利益而阻碍他人成功的行为。一项关于学习偏好的研究发现，合作倾向与趋近型气质、一般自我效能感和内隐的渐进理论呈正相关，而竞争倾向则与趋近型气质、一般自我效能感、竞争性依恋 contingencies 和学业能力 contingencies 呈正相关 58。这表明，虽然一定的竞争可以激发部分学生的动力，但过强的竞争性环境可能会扭曲学生的学习目标和人际互动模式。
综上所述，极端竞争的教育环境不仅可能抑制儿童的创造力发展，降低其合作意愿，还会通过单一化的评价体系限制儿童多元智能的发挥，使其难以形成全面的综合素质。这种隐性的发展阻滞对儿童长远的成长和未来适应复杂社会的能力构成严峻挑战。
5. 多方视角下的教育选择分歧
5.1 家长群体的认知差异
家长在教育选择中对“快乐”与“竞争”的优先级排序存在显著差异，这与其社会经济背景、教育理念和文化价值观紧密相关。这种认知差异不仅反映了个体家庭的教育偏好，也折射出更深层次的“教育分层”现象及其背后的资源占有与代际传递逻辑。
社会经济背景是影响家长教育选择的重要因素。高社会经济地位（SES）的家庭，通常拥有更丰富的物质和文化资本，他们可能更倾向于为孩子提供多元化的教育体验，包括艺术、体育、国际交流等，这些活动旨在培养孩子的综合素质和个性化发展，而不仅仅是学业成绩。这类家长可能更看重孩子的快乐成长和兴趣培养，因为他们有能力为孩子未来的发展提供多种路径，而不必完全依赖传统意义上的学业竞争。例如，有研究发现，父母的教育背景会影响他们为孩子选择教育领域，高学历的父母更可能将子女引导至与自身领域相近的专业，这在专业人士家庭中尤为明显59。
相反，低社会经济地位的家庭，由于资源相对有限，可能更倾向于将教育视为实现阶层流动的重要甚至唯一途径。因此，他们可能更强调学业成绩和考试排名，希望孩子通过“硬实力”在竞争中脱颖而出，以获得更好的教育和职业机会。对于这些家庭而言，“竞争”的优先级往往高于“快乐”，因为他们认为学业成功是改变命运的关键。一项对医学生专业选择的研究也表明，父母的教育背景对学生的专业选择有影响，这提示父母的教育观念和职业路径对子女的教育选择具有潜移默化的影响60。
教育理念的差异也在家长群体中普遍存在。有些家长秉持“素质教育”的理念，认为儿童的全面发展、创新能力、批判性思维和社会情感技能的培养比单纯的学业成绩更为重要。他们可能更愿意让孩子在轻松、自由的环境中探索和学习，即使这意味着学业成绩不那么突出。而另一些家长则信奉“应试教育”或“精英教育”模式，他们认为只有通过高强度的学业训练才能在激烈的社会竞争中立足，因此会更加关注孩子的学习效率、知识储备和考试表现。这种理念差异往往与家长的个人成长经历、所受教育背景以及对社会成功的定义有关。
“教育分层”理论为理解这些差异提供了框架。它指出，教育体系并非完全公平的筛选机制，而是社会分层的再生产过程。不同社会阶层的家庭通过其所拥有的资本（经济资本、文化资本、社会资本）来为子女争取不同的教育机会和资源。高社会经济地位的家庭能够投入更多资源来塑造子女的“全面发展”形象，使其在升学和就业市场中占据优势；而低社会经济地位的家庭则可能因资源限制，不得不将重心放在提高子女的学业成绩上，以期通过教育改变命运。这种分层不仅体现在教育资源的分配上，也体现在家长教育选择背后的逻辑和价值观上。因此，家长群体的认知差异并非简单的个人选择问题，而是社会结构和教育体系深层互动的结果，它揭示了“快乐成长”与“学业竞争”两种看似对立的教育目标，在不同社会阶层家庭中被赋予了不同的权重和意义，从而影响了教育机会的代际传递。
5.2 儿童主体性的缺失与觉醒
在传统的教育选择过程中，儿童的主体性往往被忽视，他们的声音和真实体验较少被纳入决策考量。然而，从儿童自我报告数据出发，我们能够更真实地了解他们对“快乐”与“压力”的体验，这对于反思现有教育模式和赋予儿童话语权具有重要意义。
儿童对“快乐”的体验远不止于简单的玩耍或无忧无虑。研究表明，儿童对幸福感的感知与多种因素相关，包括社会关系、环境资源以及心理健康状况。例如，一项针对5-12岁儿童的研究发现，受限的社区参与与儿童较高的抑郁症状、较低的环境资源以及多子女家庭背景相关61。这意味着，当儿童无法充分参与社区活动、缺乏社会支持时，他们的幸福感会受到影响。此外，儿童的心理健康状况，如焦虑和抑郁，与他们所报告的幸福感水平呈显著负相关62。这提示我们，儿童的快乐不仅仅是表面的愉悦，更是其心理健康状况的综合体现。
另一方面，儿童对“压力”的感知同样不容忽视。学业压力、家庭环境、同伴关系等都可能成为儿童的压力源。一项针对7-11岁儿童的研究显示，头发皮质醇浓度与过去六个月的生活事件总分及负面事件分呈正相关63，这表明儿童在面对生活压力时，生理指标也会发生相应变化。而另一项关于儿童肠道微生物的研究则发现，积极情绪（如快乐）和副交感神经活动（反映压力水平）与肠道微生物组成模式显著相关，高压力通常与较低的肠道菌群多样性相关联64。这些生理层面的证据进一步印证了儿童在面对压力时的真实体验，提示我们不能简单地将儿童的压力反应归结为“不懂事”或“抗压性差”。
在教育选择中赋予儿童话语权的必要性日益凸显。让儿童参与到与自身健康和福祉相关的决策中，不仅是尊重其作为独立个体的权利，也符合儿童最佳利益的原则65。研究发现，当儿童和青少年在医疗决策中感到被倾听和被重视时，他们能够更好地理解治疗方案并积极配合66。这同样适用于教育领域。儿童是学习过程的主体，他们的学习风格、兴趣偏好以及对压力的承受能力各不相同。如果教育决策能够更多地听取儿童的意见，则更有可能制定出符合他们个体发展需求的教育路径。
实现儿童话语权的途径包括：
- 建立有效的沟通机制：家庭、学校和社会应创造开放、支持性的环境，鼓励儿童表达自己的想法和感受。家长和教师应学习积极倾听，理解儿童的语言和非语言信息。
- 开展儿童参与式研究：通过儿童友好的调查问卷、访谈、焦点小组等方法，直接收集儿童对学习体验、压力来源、快乐感知等方面的意见，并将这些数据纳入教育政策和实践的制定中。
- 教育决策的共同参与：在涉及儿童教育路径、课外活动选择、甚至学校课程设置时，应邀请儿童参与讨论，听取他们的意愿和建议。这并非意味着完全由儿童决定，而是在成人引导下，促进他们理解选择的后果，并培养其决策能力。
- 提升儿童批判性思维与自我表达能力：通过教育课程和活动，培养儿童独立思考、表达观点以及评估信息的能力，使他们能够更有效地参与到教育选择的讨论中。例如，有研究呼吁在疫苗犹豫研究中纳入儿童和青少年的观点，因为他们的认知发展和经历将影响其未来的疫苗接种行为和决策67。这表明，对儿童进行相关教育，能够帮助他们更好地参与到影响其自身健康的决策中。
赋予儿童话语权并非要将成人责任转嫁给儿童，而是要将儿童视为积极的参与者，从而使教育选择更加贴近儿童的实际需求，促进其身心健康发展和主体意识的觉醒。
6. 平衡路径：从政策到家庭的协同策略
6.1 教育评价体系的改革方向
为了在快乐成长与学业竞争之间找到平衡点，教育评价体系的改革至关重要。这需要从单一的学业成绩导向转向多元评价标准，将社会情感技能、实践能力等非认知技能纳入评价范畴。这种转变不仅能减轻学生过度的学业压力，还能促进他们全面而健康的发展。
具体而言，多元评价标准的设计应包含以下几个方面：
社会情感技能（Social-Emotional Skills, SES）评估：社会情感技能是儿童发展的重要组成部分，包括合作、同理心、责任感、抗逆力、情绪控制、创造力、乐观、毅力等 68。这些技能对于学生的学业成功和职业发展都至关重要。OECD（经济合作与发展组织）开展的社会情感技能调查项目，对10个城市（9个国家）的10岁和15岁学生进行了广泛评估，发现合作和乐观是核心技能，其中心性在不同年龄组和城市之间有所不同 68。将这些技能纳入评价体系，可以通过观察、项目评估、同伴互评、教师评语以及学生自我报告等多种方式进行。例如，可以设计评估工具来衡量学生的团队合作能力、解决冲突的能力、情绪管理能力以及对他人的同情理解。
实践能力与创新能力评估：传统的纸笔考试往往难以衡量学生的实践操作能力和解决实际问题的能力。因此，评价体系应增加项目式学习（PBL）、案例分析、实验操作、社会实践等评估方式。这不仅能激发学生的学习兴趣，也能培养他们的创新思维和动手能力。例如，可以要求学生完成一个结合学科知识的实际项目，并对其项目成果、解决问题的过程以及团队合作表现进行综合评价。
个性化发展与兴趣特长评估：尊重学生的个体差异，鼓励他们发展独特的兴趣和特长。评价体系中应设立专门的模块，用于记录学生的艺术、体育、科技、志愿服务等方面的表现和成就。这有助于学生发现和发展自己的潜能，形成积极的自我认同。
过程性评价与增值性评价：将评价重心从“结果”转向“过程”，关注学生在学习过程中的投入、努力和进步。增值性评价则关注学生在一定时期内所取得的进步，而非仅仅是起点或终点的表现，这能够更客观地反映学生的学习效果和教师的教学质量。
在政策层面，政府应发挥主导作用，推动教育评价改革。OECD社会情感技能调查等国际经验表明，通过大规模、跨文化的调查研究，可以识别不同文化背景下社会情感技能的核心要素及其与学业和生活成果的关联，为政策制定提供实证依据 68。例如，芬兰在教育改革中一直注重培养学生的非认知技能和批判性思维，其PISA测试成绩的优异表现也部分归因于这种以学生为中心的全面发展模式。美国、加拿大等国也积极推行基于能力的医学教育（Competency-Based Medical Education, CBME），通过设定明确的能力目标、提供量身定制的学习体验和形成性评估来促进学生能力的发展 6970。这种基于能力的评估方法，强调学习者通过表现出预期的能力来证明掌握程度，而非仅仅通过时间或课程完成情况。
政策的引导作用还体现在：
- 顶层设计：制定明确的教育评价改革目标和实施路径，鼓励各地和各级学校积极探索多元评价模式。
- 资源投入：为学校提供必要的资源支持，包括教师培训、评估工具开发、技术平台建设等，确保评价改革能够顺利实施。
- 宣传引导：通过媒体宣传、家长教育等多种方式，转变社会对教育成功的单一认知，引导家长和公众理解并支持多元评价的价值。
通过这些改革，教育评价体系将不再仅仅是选拔工具，更将成为促进学生全面发展的有效杠杆，从而在激烈的竞争中为儿童的快乐成长开辟更广阔的空间。
6.2 家庭与学校的支持性环境构建
在教育选择中实现快乐成长与学业竞争的平衡，需要家庭与学校的协同努力，构建支持性的环境。有效的干预案例和策略为我们提供了重要的借鉴，其中包括社会情感教育（SEL）项目、正念训练以及构建“保护型竞争”机制。
社会情感教育（Social Emotional Learning, SEL）项目
SEL旨在培养儿童和青少识别和管理情绪、设定和实现积极目标、感受和表达同情、建立和维持积极关系以及做出负责任决策的能力71。这些技能的培养对于提升学生的心理健康和学业表现都至关重要。例如，一项综述指出，SEL干预措施能够显著促进情绪调节、韧性、同理心和社会融合，这些对于个人幸福感和成功的社会适应至关重要71。在危机背景下，如COVID-19疫情，SEL对于支持受创儿童的学业和社交成果尤为关键71。学校可以采纳SEED（Social and Emotional Education Development）等成熟的SEL项目，将其融入日常课程和学校文化中。SEED项目通常包括课程教学、教师培训和家庭参与，旨在全方位提升学生、教师和家长的社会情感能力。
正念训练（Mindfulness-Based Interventions, MBIs）
正念训练已被证实是改善儿童和青少年心理健康的有效途径，尤其在注意力、冲动控制和情绪调节方面表现出积极效果72。通过引导学生关注当下、觉察自己的思想和情绪，正念能够帮助他们更好地应对压力、提高自我认知。研究表明，将正念训练融入学校课程，能够提升学生的心理健康和抗逆力7374。例如，一项针对ADHD儿童的随机对照试验显示，正念训练能显著改善他们的注意力、冲动性及情绪调节能力，且家庭参与能增强干预效果72。另一项系统综述和荟萃分析也指出，正念项目对学生的学校适应性（包括注意力、冲动性）和正念水平有中等到小幅度的积极影响73。在大学阶段，正念增强型运动训练（如结合太极或阻力训练）也被证实能改善学生的正念水平、幸福感并减轻焦虑75。
家长情绪管理与支持
家长是儿童心理健康的重要影响者。高压的教育环境不仅影响儿童，也给家长带来巨大的压力。因此，提升家长的情绪管理能力、减轻其养育压力，对构建支持性家庭环境至关重要。一些干预措施如亲子正念和同情训练（Cooperative Compassion, CoCo）已被证实能有效减轻父母的压力、焦虑和抑郁，同时改善儿童的认知处理速度76。学校可以组织家长工作坊，提供情绪管理、积极育儿和压力应对的培训。此外，鼓励家长之间的互助网络，分享育儿经验和情感支持，也能有效缓解个体家庭的焦虑。
学校压力缓冲机制
学校需要建立多层次的压力缓冲机制，以应对学生日益增长的心理健康需求。
- 心理健康团队与支持服务：学校应设立专业的心理健康团队，包括心理咨询师、社工等，为学生提供早期筛查、个体咨询和团体辅导。研究表明，学校心理健康团队在处理学生社会情感需求方面发挥着重要作用，能够积极影响学生的社会情感福祉和学业成就77。有调查显示，许多学生（包括有严重抑郁症状或自杀倾向的学生）并未获得心理健康支持，而学校工作人员也表达了对支持学生心理健康实践培训的强烈需求78。这凸显了建立和强化学校心理健康服务的必要性，特别是针对受创学生和移民学生，需要提供文化敏感和创伤知情的方法79。
- 全校参与的心理健康促进：心理健康促进不应局限于少数专业人员，而应成为全校师生的共同责任。通过培训教师识别和回应学生心理健康问题的能力，并推广积极的校园文化，营造一个尊重、包容和支持的环境80。
- 课程与评估的调整：在评价体系改革（如6.1节所述）的基础上，学校应在课程设计中融入更多实践性、体验性和跨学科的学习内容，减少纯粹的知识灌输和应试训练。
- “保护型竞争”的可行性：竞争并非总是负面的，关键在于如何设计和引导。学校可以探索“保护型竞争”模式，即在强调个人努力和进步的同时，弱化过度比较和零和博弈。例如，鼓励学生在团队项目中合作竞争，或与过去的自己竞争，设定个人成长目标而非仅仅追求排名。通过提供多样化的竞争平台（如艺术比赛、科学展览、体育赛事等），让每个学生都有机会体验成功的喜悦，并学会从失败中学习。同时，明确告知学生和家长，学业成绩只是评价体系的一部分，综合素质和心理健康同样重要。
通过家庭与学校的紧密合作，实施社会情感教育、正念训练等有效干预，并建立完善的心理健康支持体系，我们可以在学业竞争的现实压力下，为儿童构建一个既能促进快乐成长又能适应未来挑战的支持性环境。
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参考文献
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Jesus Alfonso D Datu, Frank Fincham, Jet U Buenconsejo
J Am Coll Health. 2024 Jul;72(5):1394-1400. doi: 10.1080/07448481.2022.2076562. Epub 2022 May 27.
The Caring for Bliss Scale (CBS) is a new measure that assesses an individuals' capacity to cultivate inner joy and happiness. Developed in the United States, its generalizability remains unknown in non-Western contexts. This research explored the scale's cross-national invariance among college students in the Philippines ( = 546) and the United States ( = 643). A multi-group confirmatory factor analysis using maximum likelihood estimation showed that the unidimensional model of caring for bliss exhibited configural, metric, scalar, and residual invariance across the Filipino and the U.S. samples. This scale also had good internal consistency estimates in both settings. In both contexts, caring for bliss was positively correlated with well-being and negatively correlated with different negative quality of life indicators (i.e., stress, anxiety, and depression). This study offered preliminary evidence regarding the cross-national applicability of the CBS in different cultural settings during the COVID-19 pandemic.
2Positive psychology progress: empirical validation of interventions.PubMed
Martin E P Seligman, Tracy A Steen, Nansook Park, et al.
Am Psychol. 2005 Jul-Aug;60(5):410-21. doi: 10.1037/0003-066X.60.5.410.
Positive psychology has flourished in the last 5 years. The authors review recent developments in the field, including books, meetings, courses, and conferences. They also discuss the newly created classification of character strengths and virtues, a positive complement to the various editions of the Diagnostic and Statistical Manual of Mental Disorders (e. g., American Psychiatric Association, 1994), and present some cross-cultural findings that suggest a surprising ubiquity of strengths and virtues. Finally, the authors focus on psychological interventions that increase individual happiness. In a 6-group, random-assignment, placebo-controlled Internet study, the authors tested 5 purported happiness interventions and 1 plausible control exercise. They found that 3 of the interventions lastingly increased happiness and decreased depressive symptoms. Positive interventions can supplement traditional interventions that relieve suffering and may someday be the practical legacy of positive psychology.
3Evaluating the effects of gratitude interventions on college student well-being.PubMed
Katherine Tolcher, Madalyn Cauble, Andrew Downs
J Am Coll Health. 2024 Jul;72(5):1321-1325. doi: 10.1080/07448481.2022.2076096. Epub 2022 May 27.
To evaluate the effects of three different gratitude interventions on college student well-being. Participants were 132 college students at a university in the northwest sampled between September 2019 and February 2020. Participants were randomly assigned to one of three gratitude interventions (journaling, reflection, app prompted reflection) or an activity-matched control group for 8 weeks and completed baseline and post-intervention assessments of well-being (e.g., satisfaction with life, happiness, resilience, depression, anxiety, and stress). Participants in all three gratitude intervention groups showed improvements in well-being over time, whereas the control group did not report any such improvements. Gratitude journaling appeared to have the most significant positive impact on well-being and affective functioning. Gratitude interventions are simple, easy to implement, low-cost tools that can increase overall well-being and decrease negative affect, stress, and anxiety in college students.
4Use of an in-house comprehensive exam as a predictor for academic success.PubMed
Erica L Rowe, Jasmine M Pittman, Beverly S Hamilton
Curr Pharm Teach Learn. 2021 Jun;13(6):643-651. doi: 10.1016/j.cptl.2021.01.036. Epub 2021 Feb 2.
INTRODUCTION: We created a comprehensive, internally developed, knowledge-based assessment called the Year 1 Comprehensive Abilities Assessment (Y1-CAA) in order to address the unique assessment needs of an accelerated three-year pharmacy program. This study investigated the correlation between the Y1-CAA and performance on a variety of academic factors, including, but not limited to, curricular performance, Pharmacy Curriculum Outcomes Assessment (PCOA) scores, and North American Pharmacist Licensure Examination (NAPLEX) scores. METHODS: The 120 question Y1-CAA was created and benchmarked by the faculty and given to students at the end of the first professional year. Y1-CAA scores were compared to a host of variables, including student demographics, pre-pharmacy grade point average (GPA), Pharmacy College Admission Test scores, PCOA scores, pharmacy school GPA, and NAPLEX scores using appropriate statistical methods. RESULTS: A total of 233 students were included in the study. Performance on the Y1-CAA was positively correlated with performance in the pharmacy curriculum and on the PCOA. Y1-CAA performance also showed a significant correlation with NAPLEX scaled scores (R = 0.568, P < .001). CONCLUSIONS: This study found a positive correlation between performance on the Y1-CAA and academic success, performance on the PCOA, and performance on the NAPLEX.
6Emotional intelligence and academic performance of students.PubMed
Rehana Rehman, Sundus Tariq, Saba Tariq
J Pak Med Assoc. 2021 Dec;71(12):2777-2781. doi: 10.47391/JPMA.1779.
The medical profession deals with 'humanism' which involves interactions with people, the ability to think about them, care for them, and to provide positive reinforcement in clinical follow-ups. Emotional intelligence integrates the significant features of personal relationships to promote self-management skills, like adaptability, control of temperaments and reduction of tension, which can improve performance of individuals. This has led to increasing interest in the importance of emotional intelligence for effective academic growth, professional experiences and clinical practice. There are many studies examining the correlation between emotional intelligence and academic achievement at different education levels, signifying its importance to predict students who need guided intervention. With proven relationship between emotional intelligence and academic success, the assessment of emotional intelligence can be introduced in entrance exams of medical schools to recognise students who might need directed intermediation. With the agreement of all stakeholders, emotional intelligence training workshops and awareness sessions can be introduced for educators and students.
7Involving Parents in the Management and Treatment of Youth Anxiety.PubMed
Erika S Trent, Samantha X L Tan, Jessica Szu-Chi Cheng, et al.
Curr Psychiatry Rep. 2025 Jul;27(7):441-449. doi: 10.1007/s11920-025-01614-8. Epub 2025 May 9.
PURPOSE OF REVIEW: Childhood anxiety disorders are impairing and chronic unless addressed early. While cognitive behavioral therapy with exposures has a strong evidence base, many youth continue to experience symptoms posttreatment. Enlisting parents may help improve the management and treatment of childhood anxiety. RECENT FINDINGS: Parental factors that influence childhood anxiety include family accommodation, parental emotion socialization, parental overcontrol, and parental anxiety. The merits of involving parents in childhood anxiety treatment have been debated. However, when specific, empirically- and theoretically-informed mechanisms are targeted, parental involvement in treatment appears efficacious and holds promise to increase access to care. Clinicians should consider the child's presentation, treatment barriers, and family dynamics to guide decision-making. Researchers and clinicians should also be aware of stressors that parents themselves face, considering ways to help children via supporting parents with their own mental health concerns.
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Kristen R Hamilton, Marci R Mitchell, Victoria C Wing, et al.
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Impulsivity critically relates to many psychiatric disorders. Given the multifaceted construct that impulsivity represents, defining core aspects of impulsivity is vital for the assessment and understanding of clinical conditions. Choice impulsivity (CI), involving the preferential selection of smaller sooner rewards over larger later rewards, represents one important type of impulsivity. The International Society for Research on Impulsivity (InSRI) convened to discuss the definition and assessment of CI and provide recommendations regarding measurement across species. Commonly used preclinical and clinical CI behavioral tasks are described, and considerations for each task are provided to guide CI task selection. Differences in assessment of CI (self-report, behavioral) and calculating CI indices (e.g., area-under-the-curve, indifference point, and steepness of discounting curve) are discussed along with properties of specific behavioral tasks used in preclinical and clinical settings. The InSRI group recommends inclusion of measures of CI in human studies examining impulsivity. Animal studies examining impulsivity should also include assessments of CI and these measures should be harmonized in accordance with human studies of the disorders being modeled in the preclinical investigations. The choice of specific CI measures to be included should be based on the goals of the study and existing preclinical and clinical literature using established CI measures.
9Delay discounting predicts COVID-19 vaccine booster willingness.PubMed
Julia G Halilova, Samuel Fynes-Clinton, Caitlin M Terao, et al.
Cogn Res Princ Implic. 2025 Jan 23;10(1):1. doi: 10.1186/s41235-024-00609-y.
Developing ways to predict and encourage vaccine booster uptake are necessary for durable immunity responses. In a multi-nation sample, recruited in June-August 2021, we assessed delay discounting (one's tendency to choose smaller immediate rewards over larger future rewards), COVID-19 vaccination status, demographics, and distress level. Participants who reported being vaccinated were invited back one year later (n = 2547) to report their willingness to receive a booster dose, along with reasons for their decision. After controlling for demographic variables and distress level, a greater tendency to discount future rewards was associated with reduced willingness to receive a booster dose. Thematic coding revealed that the most common reason for booster willingness was protection against COVID-19, and for unwillingness was non-necessity. The results identify delay discounting as a behavioral predictor of booster willingness that may be used to inform tailored approaches to increase booster uptake (e.g., trust in science vs. vaccine mandates).
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Stephanie A Hayes, Shelley L Watson
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Researchers commonly report that families of children with autism spectrum disorder (ASD) experience more parenting stress than families of typically developing (TD) children or those diagnosed with other disabilities [e.g., Down syndrome (DS), cerebral palsy, intellectual disability]. The authors reexamined the research using comparison groups to investigate parenting stress and conducted a meta-analysis to pool results across studies. The experience of stress in families of children with ASD versus families of TD children resulted in a large effect size. Comparisons between families of children of ASD and families with other disabilities also generated a large effect size however, this result should be interpreted with caution as it may be associated with the specific experience of parenting a child with DS.
11The Impact of Child Autistic Symptoms on Parental Marital Relationship: Parenting and Coparenting Processes as Mediating Mechanisms.PubMed
Kevin Ka Shing Chan, Donald Chi Kin Leung
Autism Res. 2020 Sep;13(9):1516-1526. doi: 10.1002/aur.2297. Epub 2020 Apr 21.
Research shows that parenting a child with autism spectrum disorder (ASD) is associated with increased marital conflicts and reduced marital love. Less is known, however, about the potential mechanism underlying these associations. The present study tested a family process model linking child autism to parental marriage. We hypothesized that child autistic symptoms would be associated with increased marital conflicts and reduced marital love among parents of children with ASD, and that these associations would be mediated by parenting stress and coparenting conflicts. A total of 382 parents of children with ASD from Hong Kong, China completed questionnaire measures of child autistic symptoms, parenting stress, coparenting conflicts, marital conflicts, and marital love. Structural equation modeling (SEM) and Bootstrap analyses were conducted to analyze the relations among the variables. SEM showed that child autistic symptoms were related to higher levels of parenting stress and coparenting conflicts, which were, in turn, related to increased marital conflicts and reduced marital love among parents of children with ASD. Bootstrap analyses further demonstrated that child autistic symptoms had significant indirect effects on marital conflicts and marital love via parenting stress and coparenting conflicts. Theoretically, this study revealed the potential pathways through which child autism symptomatology may adversely impact the family processes and compromise the marital relationships of parents of children with ASD. Practically, this study pointed to the utility of helping parents of children with ASD to manage child autistic symptoms, alleviate parenting stress, and reduce coparenting conflicts in improving their marital qualities. LAY SUMMARY: This study showed that child autistic symptoms were related to higher levels of parenting stress and coparenting conflicts, which were, in turn, related to increased marital conflicts and reduced marital love among parents of children with autism spectrum disorder (ASD). These findings pointed to the importance of helping parents of children with ASD to manage child autistic symptoms, alleviate parenting stress, and reduce coparenting conflicts in improving their marital qualities. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2020, 13: 1516-1526. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
12Factors that influence parental decisions to participate in clinical research: consenters vs nonconsenters.PubMed
Alejandro Hoberman, Nader Shaikh, Sonika Bhatnagar, et al.
JAMA Pediatr. 2013 Jun;167(6):561-6. doi: 10.1001/jamapediatrics.2013.1050.
IMPORTANCE: A child's health, positive perceptions of the research team and consent process, and altruistic motives play significant roles in the decision-making process for parents who consent for their child to enroll in clinical research. This study identified that nonconsenting parents were better educated, had private insurance, showed lower levels of altruism, and less understanding of study design. OBJECTIVE: To determine the factors associated with parental consent for their child's participation in a randomized, placebo-controlled trial. DESIGN: Cross-sectional survey conducted from July 2008 to May 2011. The survey was an ancillary study to the Randomized Intervention for Children with VesicoUreteral Reflux Study. SETTING: Seven children's hospitals participating in a randomized trial evaluating management of children with vesicoureteral reflux. PARTICIPANTS: Parents asked to provide consent for their child's participation in the randomized trial were invited to complete an anonymous online survey about factors influencing their decision. A total of 120 of the 271 (44%) invited completed the survey; 58 of 125 (46%) who had provided consent and 62 of 144 (43%) who had declined consent completed the survey. MAIN OUTCOMES AND MEASURES: A 60-question survey examining child, parent, and study characteristics; parental perception of the study; understanding of the design; external influences; and decision-making process. RESULTS Having graduated from college and private health insurance were associated with a lower likelihood of providing consent. Parents who perceived the trial as having a low degree of risk, resulting in greater benefit to their child and other children, causing little interference with standard care, or exhibiting potential for enhanced care, or who perceived the researcher as professional were significantly more likely to consent to participate. Higher levels of understanding of the randomization process, blinding, and right to withdraw were significantly positively associated with consent to participate. CONCLUSIONS AND RELEVANCE Parents who declined consent had a relatively higher socioeconomic status, had more anxiety about their decision, and found it harder to make their decision compared with consenting parents, who had higher levels of trust and altruism, perceived the potential for enhanced care, reflected better understanding of randomization, and exhibited low decisional uncertainty. Consideration of the factors included in the conceptual model should enhance the quality of the informed consent process and improve participation in pediatric clinical trials.
13Parenting responsibility expectations of senior Australian dental students: do the next generations' family responsibilities impact workforce planning?PubMed
Ala'a Alsharif, Estie Kruger, Marc Tennant
J Dent Educ. 2012 Oct;76(10):1384-8.
Over the past twenty-five years, there has been a substantial increase in work-based demands, thought to be due to an intensifying, competitive work environment. However, more recently, the question of work-life balance is increasingly attracting attention. The purpose of this study was to discover the attitudes of the next generation of dentists in Australia to parenting responsibility and work-life balance perceptions. Questionnaires on work-life balance were distributed to all fourth-year students at three dental schools in Australia. A total of 137 (76 percent) surveys were completed and returned. Most respondents indicated that they would take time off to focus on childcare, and just over half thought childcare should be shared by both parents. Thirty-seven percent felt that a child would have a considerable effect on their careers. Differences were seen in responses when compared by gender. The application of sensitivity analysis to workforce calculations based around changing societal work-life expectations can have substantial effects on predicting workforce data a decade into the future. It is not just the demographic change to a more feminized workforce in Australia that can have substantial effect, but also the change in social expectations of males in regards to parenting.
14Peers' Private Tutoring and Adolescent Depressive Symptoms: Quasi-Experimental Evidence From Secondary Schools in South Korea.PubMed
Taehoon Kim, Hayun Jang, Jinho Kim
J Adolesc Health. 2022 Apr;70(4):658-665. doi: 10.1016/j.jadohealth.2021.10.040.
PURPOSE: The aim of the study is to investigate the relationship between peers' private tutoring and an individual student's depressive symptoms. Potential mechanisms that underlie this link were also explored. METHODS: Data are from the Gyeonggi Education Panel Study of 7th and 10th graders in South Korea. The present study exploited quasi-experimental variation generated from random assignment of students to classes within schools to examine whether having peers who receive private tutoring is associated with students' self-reported depressive symptoms. The following mechanism variables were explored: hours spent doing leisure/hobby activities, test-related stress, hours spent playing with friends, and friend attachment. RESULTS: The proportion of classmates who receive private tutoring was associated with an increase in students' depressive symptoms (b = 0.326, p < .05), even after adjusting for individual- and peer-level covariates as well as school fixed effects. Results showed that exposure to a higher proportion of classmates who receive private tutoring leads to a decrease in hours spent engaging in leisure/hobby activities and an increase in test-related stress. Sobel-Goodman mediation tests suggested that test-related stress explains about 20% of the association between peers' private tutoring and students' depressive symptoms. CONCLUSIONS: As more peers receive private tutoring, academic competition intensifies among students in East Asian and Southeast Asian countries. The findings of this study suggest that emotional pressure and anxiety generated by such environments threaten the mental health of adolescents. Policymakers may consider creating school-based interventions that foster a culture of cooperation, not competition.
15Examining the after-school study burden of Chinese secondary school students following burden reduction policies: a sociological analysis.PubMed
Yunfang Ran, Xi Wu, Yitao Wang, et al.
BMC Psychol. 2025 Aug 14;13(1):918. doi: 10.1186/s40359-025-03199-6.
BACKGROUND: To address the significant issue of students' heavy after-school study burden, many countries have enacted relevant policies. However, the effects of policy implementation are not always desirable. This study is informed by an analysis of how dominant social imaginaries and discourses in China-emphasizing accountability, performativity, competitiveness, and capital accrual-contribute to students' burdens. METHODS: This case study investigated the after-school study burden of Chinese junior secondary school students following the implementation of burden reduction policies. It involved one-on-one semi-structured interviews with 15 students, 9 parents, and 3 teachers and informal individual or group discussions. Furthermore, the researchers spent nearly three months immersing themselves in the research site, during which period they observed students' learning status and extracurricular activities. They also reviewed assignments, learning and school extracurricular records, and teachers' reflexive journals. FINDINGS: This study found that burden reduction policies have brought some relief to student participants due to tailored assignments, learning support, and diversified after-school programs, although the pressure remained high. The convergence of the pragmatic social imaginary and discourses in China, along with social class dispositions, strongly intervened in the humanistic aims and practices under these policies. Student participants from families of different social classes continued to face heavy after-school study burdens, such as school assignments, private tutoring, and additional exercises, and suffered from emotional stress in their pursuit of better test performance and competitiveness, without breaks in or out of school. Compared to students from higher social class families, student participants from lower social class families focused more on thin exam-oriented learning goals and required more support due to a lack of access to various after-school resources. CONCLUSION: The study suggests that all stakeholders (policymakers, school administrators, teachers, parents, and students) collaborate in pursuing humanistic objectives in education, rather than being narrowly governed by the pragmatic social imaginary and related discourses. These stakeholders must engage in meaningful conversations and work together to create a humanistic educational environment, aiming to reduce after-school workload from school and other sources, and promote students' pressure relief, learning and well-being based on their individual interests, learning progress, and needs.
16Psychological Distress, Burnout, and Academic Performance in First Year College Students.PubMed
Jaume-Miquel March-Amengual, Irene Cambra Badii, Joan-Carles Casas-Baroy, et al.
Int J Environ Res Public Health. 2022 Mar 12;19(6):3356. doi: 10.3390/ijerph19063356.
BACKGROUND: The first years of university can be very challenging for students. Previous research has focused on the study of the prevalence of burnout and of psychological distress in medical students. The aim of this study was to investigate the prevalence of psychological symptoms and burnout reported by first-year students, the relationship between these variables and their academic performance, and the differences between health and non-health sciences students. METHODS: An observational study with a cross-sectional design was performed. Students of health sciences (medicine, nursing, physiotherapy, psychology), and non-health sciences (biology, social sciences, business management, and engineering) undergraduate programs completed the Brief Symptom Inventory (BSI-18) and the Maslach Burnout Inventory-Student Survey (MBI-SS). Students' grades for the first semester were collected. RESULTS: A sample of 506 students participated. Prevalence of psychological distress was 27.1% and burnout was 7.3%. Academic performance was unaffected in relation to either psychological distress or burnout. Non-health sciences students showed a greater risk of depression. CONCLUSIONS: This study provides evidence of the high prevalence of psychological distress in the first year of college. Even when burnout prevalence was low, the results suggest the need to introduce prevention programs to improve the psychological wellbeing of these students.
17Determinants of Sleep Quality: A Cross-Sectional Study in University Students.PubMed
Johanna Marie Schmickler, Simon Blaschke, Rebecca Robbins, et al.
Int J Environ Res Public Health. 2023 Jan 23;20(3):2019. doi: 10.3390/ijerph20032019.
When entering the university setting, poor sleep quality is reportedly prevalent among students and has been linked to a range of adverse health outcomes, including reduced academic performance. Moreover, determinants of sleep quality are not yet fully understood. This study was designed to (1) assess the prevalence of poor sleep quality and (2) identify determinants of sleep quality in German university students. In total, 1,684 undergraduate and graduate students (50.6% female, mean age 22.87 ± 3.15 years) from multiple academic disciplines completed a cross-sectional online survey assessing socio-demographic, health, and study-related indicators and sleep quality using the Pittsburgh Sleep Quality Index (PSQI). In our sample, 820 (48.7%) met the PSQI cut-off score (>5) for poor sleep quality. Multiple regression analysis showed that older age, being a business student, lower subjective social status, poorer self-rated health, stress, exhaustion, and poor academic performance significantly predicted poor sleep quality. Our findings document a high prevalence of poor sleep quality among university students and suggest that business students, especially, might be exposed to a greater risk for poor sleep quality. Furthermore, the results of this study are valuable for academic staff to develop tailored interventions to promote healthy sleep-in university students.
18A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia.PubMed
Abdullah Murhaf Al-Khani, Muhammad Ishaque Sarhandi, Mohamed Saddik Zaghloul, et al.
BMC Res Notes. 2019 Oct 21;12(1):665. doi: 10.1186/s13104-019-4713-2.
OBJECTIVE: Adequate sleep is integral to better mental health and facilitates students' learning. We aimed to assess sleep quality among medical students and to see whether it was associated with their mental health (e.g., depression, anxiety, and stress) and academic performance. RESULTS: A total of 206 responded, and 95 of them had complete data on demography, lifestyle, academic performance, sleep quality (Pittsburgh Sleep Quality Index), and mental health (Depression Anxiety Stress Scales). The prevalence of poor sleep was 63.2%; it was higher among students who were physically inactive and had more screen time. Poor sleepers demonstrated higher academic performance than sufficient sleepers (p = 0.04). The prevalence of depression, anxiety, and stress were 42%, 53%, and 31% respectively. Sleep quality was significantly associated with depression (p = 0. 03), anxiety (p = 0.007), and stress (p = 0.01).
19The relationship between sleep quality, stress, and academic performance among medical students.PubMed
Abdullah D Alotaibi, Faris M Alosaimi, Abdullah A Alajlan, et al.
J Family Community Med. 2020 Jan-Apr;27(1):23-28. doi: 10.4103/jfcm.JFCM_132_19. Epub 2020 Jan 13.
BACKGROUND: Sleep is essential for the body, mind, memory, and learning. However, the relationship between sleep quality, stress, and academic performance has not been sufficiently addressed in the literature. The aim of this study was to assess the quality of sleep and psychological stress among medical students and investigate the relationship between sleep quality, stress, and academic performance. MATERIALS AND METHODS: This cross-sectional study targeted all medical students in their preclinical years at a Saudi medical college in 2019. All students were asked to complete an electronic self-administered questionnaire comprising the Pittsburgh Sleep Quality Index (PSQI), the Kessler Psychological Distress Scale (K10), questions on the students' current overall grade point average, and other demographic and lifestyle factors. The associations between categorical variables were analyzed using Pearson's Chi-squared test at 0.05 significance level. RESULTS: The mean PSQI score was 8.13 ± 3.46; 77% of the participants reported poor quality of sleep and 63.5% reported some level of psychological stress (mean K10 score: 23.72 ± 8.55). Poor quality of sleep was significantly associated with elevated mental stress levels ( < 0.001) and daytime naps ( = 0.035). Stepwise logistic regression model showed that stress and daytime nap were associated with poor sleep quality. Whereas, poor sleep or stress did not show any significant association with academic performance. CONCLUSION: Poor sleep quality was significantly associated with elevated levels of strees. However, they did not show any statistically significant relationship with academic performance.
20Association and benefits of 24-h activity behavior and academic procrastination among Chinese college students based on the isotemporal substitution model.PubMed
Fang Kuai, Xia Wu, Xiaoming Zhou, et al.
Front Public Health. 2025 Nov 5;13:1700750. doi: 10.3389/fpubh.2025.1700750. eCollection 2025.
OBJECTIVE: This study systematically explores the association between 24-h activity behaviors and academic procrastination among college students, with a focus on analyzing the influence mechanisms of different activity types and time allocation patterns on academic procrastination. The aim is to reveal the potential role of optimizing activity behavior patterns in alleviating academic procrastination and provide a scientific basis for campus health promotion strategies. METHODS: Data on 24-h activity behaviors (physical activity, sedentary behavior, sleep) and academic procrastination were collected from 986 college students through a questionnaire survey. Compositional data analysis was used to quantify the isotemporal substitution effects of activity behaviors, and dose-response analysis was combined to explore the dynamic relationship between activity time allocation and academic procrastination. RESULTS: (1) Academic procrastination was prevalent (52.5%) and significantly negatively correlated with academic performance ( = -2.85, < 0.01) and mental health ( = -3.10, < 0.01). (2) Physical activity levels were significantly negatively correlated with academic procrastination ( = -3.21, < 0.001). Replacing sedentary behavior (SB) with moderate-to-vigorous physical activity (MVPA) was associated with a 0.79-unit reduction in the total score of academic procrastination (95%CI: -1.25 to -0.33). (3) Dose-response analysis of time substitution showed that the improvement benefit of academic procrastination was highly effective within the first 20 min of substitution; for instance, when MVPA replaced SB for 20 min, the total score decreased by 0.47 units, suggesting that 20 min may be a critical time window for behavioral intervention. CONCLUSION: Academic procrastination among college students is closely related to activity behavior patterns. Higher MVPA time and lower SB are associated with significantly lower levels of procrastination, suggesting that optimizing daily activity allocation may be a viable strategy for intervention. It is recommended to formulate targeted intervention strategies by optimizing daily activity time allocation (e.g., adding 20 min of MVPA daily to replace SB) to provide scientific guidance for promoting the physical and mental health of college students.
21How Learning Time Allocation Make Sense on Secondary School Students' Academic Performance: A Chinese Evidence Based on PISA 2018.PubMed
Ang Liu, Yuguang Wei, Qi Xiu, et al.
Behav Sci (Basel). 2023 Mar 8;13(3):237. doi: 10.3390/bs13030237.
It is well known that the proper allocation of learning time is particularly important for promoting students' academic performance. Based on the data from PISA 2018, this research used the method of threshold regression and quantile regression to explore the optimal length of learning time to promote the students' academic performance. At the same time, this research also explored the heterogeneity of the effect of learning time on different academic levels of students. The results show that for four Chinese provinces and cities, including Beijing, Shanghai, Jiangsu province and Zhejiang province, students who study in rural areas and private schools usually have longer learning time than students in cities and public schools. Moreover, it is suggested that there is no significant association between school quality and students' learning time. The average learning time of students from the four Chinese cities and provinces is obviously longer than that in OECD countries. Moreover, it is found that the impact of learning time on academic performance across subjects is inverted U-shaped, and the optimal study time can be found in the learning of mathematics, science, and reading related subjects. As for the effect of learning time, the results showed that learning time commitment is more effective for students who are academically disadvantaged. At the same time, this study found that there is a relationship between students' excessive learning time and students' subjective well-being and attitudes toward learning activities. The non-cognitive factors can influence students' academic performance gradually. According to the results of this research, it is suggested that students need to balance their learning time allocation against the appropriate learning time standards. Moreover, schools should adopt different learning time allocation schemes for students at different academic achievement levels. The teachers also should uphold a more scientific design of students' after-school homework, and teachers and parents should also focus on improving students' learning efficiency.
22The impact of social media on children, adolescents, and families.PubMed
Gwenn Schurgin O'Keeffe, Kathleen Clarke-Pearson
Pediatrics. 2011 Apr;127(4):800-4. doi: 10.1542/peds.2011-0054. Epub 2011 Mar 28.
Using social media Web sites is among the most common activity of today's children and adolescents. Any Web site that allows social interaction is considered a social media site, including social networking sites such as Facebook, MySpace, and Twitter; gaming sites and virtual worlds such as Club Penguin, Second Life, and the Sims; video sites such as YouTube; and blogs. Such sites offer today's youth a portal for entertainment and communication and have grown exponentially in recent years. For this reason, it is important that parents become aware of the nature of social media sites, given that not all of them are healthy environments for children and adolescents. Pediatricians are in a unique position to help families understand these sites and to encourage healthy use and urge parents to monitor for potential problems with cyberbullying, "Facebook depression," sexting, and exposure to inappropriate content.
23Impact of social media on the health of children and young people.PubMed
Deborah Richards, Patrina H Y Caldwell, Henry Go
J Paediatr Child Health. 2015 Dec;51(12):1152-7. doi: 10.1111/jpc.13023. Epub 2015 Nov 26.
This paper reviews the literature on the impact of social media on the health of children and young people. Relevant papers were identified from Medline, Embase and PsycINFO databases. The studies identified that the health impact of social media on children and young people was greatest on mental health and specifically in the areas of self-esteem and well-being, with related issues around cyberbullying and 'Facebook Depression', with an association between the use of social media and self-esteem and body image. However, it is difficult to determine the cause and effect, which is likely to be related to the nature of the young person. There is little work on the impact of social media on younger children. More research is needed to identify those most at risk of harm from social media and risk mitigation strategies to assist health-care professionals to provide essential education for parents and young people.
24Social Media Use and Mental Health: A Global Analysis.PubMed
Osman Ulvi, Ajlina Karamehic-Muratovic, Mahdi Baghbanzadeh, et al.
Epidemiologia (Basel). 2022 Jan 11;3(1):11-25. doi: 10.3390/epidemiologia3010002.
Research indicates that excessive use of social media can be related to depression and anxiety. This study conducted a systematic review of social media and mental health, focusing on Facebook, Twitter, and Instagram. Based on inclusion criteria from the systematic review, a meta-analysis was conducted to explore and summarize studies from the empirical literature on the relationship between social media and mental health. Using PRISMA guidelines on PubMed and Google Scholar, a literature search from January 2010 to June 2020 was conducted to identify studies addressing the relationship between social media sites and mental health. Of the 39 studies identified, 20 were included in the meta-analysis. Results indicate that while social media can create a sense of community for the user, excessive and increased use of social media, particularly among those who are vulnerable, is correlated with depression and other mental health disorders.
25Is social media bad for mental health and wellbeing? Exploring the perspectives of adolescents.PubMed
Michelle O'Reilly, Nisha Dogra, Natasha Whiteman, et al.
Clin Child Psychol Psychiatry. 2018 Oct;23(4):601-613. doi: 10.1177/1359104518775154. Epub 2018 May 20.
Despite growing evidence of the effects of social media on the mental health of adolescents, there is still a dearth of empirical research into how adolescents themselves perceive social media, especially as knowledge resource, or how they draw upon the wider social and media discourses to express a viewpoint. Accordingly, this article contributes to this scarce literature. Six focus groups took place over 3 months with 54 adolescents aged 11-18 years, recruited from schools in Leicester and London (UK). Thematic analysis suggested that adolescents perceived social media as a threat to mental wellbeing and three themes were identified: (1) it was believed to cause mood and anxiety disorders for some adolescents, (2) it was viewed as a platform for cyberbullying and (3) the use of social media itself was often framed as a kind of 'addiction'. Future research should focus on targeting and utilising social media for promoting mental wellbeing among adolescents and educating youth to manage the possible deleterious effects.
26The Perfect Storm: A Developmental-Sociocultural Framework for the Role of Social Media in Adolescent Girls' Body Image Concerns and Mental Health.PubMed
Sophia Choukas-Bradley, Savannah R Roberts, Anne J Maheux, et al.
Clin Child Fam Psychol Rev. 2022 Dec;25(4):681-701. doi: 10.1007/s10567-022-00404-5. Epub 2022 Jul 16.
In this theoretical review paper, we provide a developmental-sociocultural framework for the role of social media (SM) in adolescent girls' body image concerns, and in turn, depressive symptoms and disordered eating. We propose that the features of SM (e.g., idealized images of peers, quantifiable feedback) intersect with adolescent developmental factors (e.g., salience of peer relationships) and sociocultural gender socialization processes (e.g., societal over-emphasis on girls' and women's physical appearance) to create the "perfect storm" for exacerbating girls' body image concerns. We argue that, ultimately, body image concerns may be a key mechanism underlying associations between adolescent girls' SM use and mental health. In the context of proposing this framework, we provide empirical evidence for how SM may increase adolescent girls' body image concerns through heightening their focus on (1) other people's physical appearance (e.g., through exposure to idealized images of peers, celebrities, and SM influencers; quantifiable indicators of approval); and (2) their own appearance (e.g., through appearance-related SM consciousness; exposure to idealized self-images; encouraging over-valuing of appearance; and peer approval of photos/videos). Our framework highlights new avenues for future research on adolescent girls' SM use and mental health, which recognize the central role of body image.
27Social media, body satisfaction and well-being among adolescents: A mediation model of appearance-ideal internalization and comparison.PubMed
Hannah K Jarman, Mathew D Marques, Siân A McLean, et al.
Body Image. 2021 Mar;36:139-148. doi: 10.1016/j.bodyim.2020.11.005. Epub 2020 Dec 4.
Despite adolescents' prolific use of social media, relationships between social media and body satisfaction and well-being are not yet well understood, especially among boys. This study tested a sociocultural model of body image within the context of social media among adolescent boys and girls. Specifically, this study examined whether appearance-ideal internalization and social appearance comparisons mediated relationships between social media engagement (intensity and appearance-focused use) and body satisfaction and subjective well-being. Australian adolescents between 11 and 17 years (N = 1,579, M = 13.45 years, SD = 1.15; 55.4 % boys) completed an online survey. Structural equational modelling indicated that only higher appearance-focused social media use was directly associated with lower body satisfaction and well-being. Generally, higher appearance-ideal internalization and comparisons mediated the relationships between higher social media engagement and lower body satisfaction and well-being. Multi-group analyses indicated these relationships were equivalent across gender. Findings supported the proposed model among boys and girls and extend existing theoretical knowledge to encompass male body image and well-being. Interventions which target internalization and comparisons in the context of social media are likely to be valuable in improving body satisfaction and subjective well-being in co-educational settings.
28Photoshopping the selfie: Self photo editing and photo investment are associated with body dissatisfaction in adolescent girls.PubMed
Siân A McLean, Susan J Paxton, Eleanor H Wertheim, et al.
Int J Eat Disord. 2015 Dec;48(8):1132-40. doi: 10.1002/eat.22449. Epub 2015 Aug 27.
OBJECTIVE: Social media engagement by adolescent girls is high. Despite its appeal, there are potential negative consequences for body dissatisfaction and disordered eating from social media use. This study aimed to examine, in a cross-sectional design, the relationship between social media use in general, and social media activities related to taking "selfies" and sharing specifically, with overvaluation of shape and weight, body dissatisfaction, and dietary restraint. METHOD: Participants were 101 grade seven girls (M(age) = 13.1, SD = 0.3), who completed self-report questionnaires of social media use and body-related and eating concerns measures. RESULTS: Results showed that girls who regularly shared self-images on social media, relative to those who did not, reported significantly higher overvaluation of shape and weight, body dissatisfaction, dietary restraint, and internalization of the thin ideal. In addition, among girls who shared photos of themselves on social media, higher engagement in manipulation of and investment in these photos, but not higher media exposure, were associated with greater body-related and eating concerns, including after accounting for media use and internalization of the thin ideal. DISCUSSION: Although cross-sectional, these findings suggest the importance of social media activities for body-related and eating concerns as well as potential avenues for targeted social-media-based intervention.
29Potential of social media in promoting mental health in adolescents.PubMed
Michelle O'Reilly, Nisha Dogra, Jason Hughes, et al.
Health Promot Int. 2019 Oct 1;34(5):981-991. doi: 10.1093/heapro/day056.
The growing prevalence of adolescent mental disorders poses significant challenges for education and healthcare systems globally. Providers are therefore keen to identify effective ways of promoting positive mental health. This aim of this qualitative study was to explore perceptions that social media might be leveraged for the purposes of mental health promotion amongst adolescents aged between 11 and 18 years. Utilizing focus groups conducted with adolescents (N = 54), educational professionals (N = 16) and mental health practitioners (N = 8). We explored their views about the value of social media for this purpose. Three themes were identified. First, social media appears to have potential to promote positive mental health. Second, adolescents frequently utilize social media and the internet to seek information about mental health. Finally, there are benefits and challenges to using social media in this way. We conclude that despite challenges of using social media and the risks, social media does offer a useful way of educating and reaching adolescents to promote mental wellbeing.
30The effect of social media use on mental health of college students during the pandemic.PubMed
Jane Cooley Fruehwirth, Alex Xingbang Weng, Krista M Perreira
Health Econ. 2024 Oct;33(10):2229-2252. doi: 10.1002/hec.4871. Epub 2024 Jun 14.
Social media is viewed to be a key contributor to worsening mental health in adolescents, as most recently reflected in a public health advisory by the US Surgeon General. We provide new evidence on the causal effects of social media on mental health of college students during the Covid-19 pandemic, exploiting unique, longitudinal data collected before the Covid-19 pandemic began and at two points during the pandemic. We find small insignificant effects of social media 4 months into the pandemic during a period of social distancing, but large statistically significant negative effects 18 months into the pandemic when colleges were mostly back to normal operations. Using rich data on substance use, exercise, sleep, stress, and social support, we find some evidence of substitution away from activities that better support mental health at later stages of the pandemic but not at early stages. We find that the negative effects of social media are mostly concentrated among socially-isolated students. Both social support and resilience protect students from the negative effects of social media use. Policy implications include regulating social media while also bolstering social support and resilience as important protective factors.
31Types of On-Screen Content and Mental Health in Kindergarten Children.PubMed
Haiwa Wang, Jin Zhao, Zhangsheng Yu, et al.
JAMA Pediatr. 2024 Feb 1;178(2):125-132. doi: 10.1001/jamapediatrics.2023.5220.
IMPORTANCE: Excessive screen time has been associated with a higher risk for mental health problems, but whether the associations differ by screen content types is unclear. OBJECTIVE: To examine the allocation of and longitudinal changes in screen exposure across different content types and to explore their associations with mental health in children aged 3 to 6 years. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used 3-wave, lagged generalized estimating equation models to analyze data from the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) study in Shanghai, China. The cohort was a representative sample of kindergarten children. Data were collected between November 2016 and May 2019 when children were aged 3 to 4 years (wave 1), 4 to 5 years (wave 2), and 5 to 6 years (wave 3). Data analysis was performed between June 2022 and May 2023. EXPOSURE: Screen exposure (total daily time and time with each type of content, including educational programs, entertainment programs, non-child-directed programs, electronic games, and social media) was collected when children were aged 3, 5, and 6 years. MAIN OUTCOMES AND MEASURES: Mental health of children at age 3, 5, and 6 years was reported by parents using the Strengths and Difficulties Questionnaire. RESULTS: Of the 15 965 children included in the representative sample, 8270 were males (51.7%) and the mean (SD) age at wave 1 was 3.73 (0.30) years. As children developed from ages 3 to 6 years, the proportion of screen exposure to educational programs (≤1 hour per day: 45.0% [95% CI, 43.5%-46.5%] to 26.8% [95% CI, 25.3%-28.3%]) and entertainment programs (≤1 hour per day: 44.4% [95% CI, 42.8%-45.9%] to 32.1% [95% CI, 30.4%-33.9%]) decreased, whereas exposure to social media increased (≤1 hour per day: 1.5% [95% CI, 1.2%-1.9%] to 27.1% [95% CI, 25.5%-28.7%]). The associations between on-screen content and mental health varied. For a given total screen time, a higher proportion of screen exposure to educational programs was associated with a lower risk for mental health problems (adjusted odds ratio [AOR], 0.73; 95% CI, 0.60-0.90), whereas non-child-directed programs were associated with a higher risk for such problems (AOR, 2.82; 95% CI, 1.91-4.18). Regardless of the content, total screen time was consistently associated with mental health problems. CONCLUSIONS AND RELEVANCE: Results of this study indicated that both total screen time and different types of content were associated with mental health problems in children aged 3 to 6 years. Limiting children's screen time, prioritizing educational programs, and avoiding non-child-directed programs are recommended.
32The effects of adverse childhood experiences on subjective happiness: the serial mediation role of regulatory emotional self-efficacy and future anxiety.PubMed
Ayca Buyukcebeci
BMC Psychol. 2025 Sep 29;13(1):1068. doi: 10.1186/s40359-025-03426-0.
BACKGROUND: Adverse childhood experiences (ACE) are a widespread public health problem with long-term effects. These experiences may threaten individuals' hopes for the future and their wellbeing. Although there are studies focusing on the effects of ACE on skills of emotion regulation in the literature, there is limited research on the role of self-efficacy in this field. OBJECTIVE: This study aims to determine the effects of mediating roles of regulatory emotional self-efficacy and future anxiety in the effects of adverse childhood experiences on subjective happiness and the serial mediation effects of these variables. METHODS: This study was conducted in Turkiye using a cross-sectional design and with a sample size of 518 individuals (51% female, 49% male) who are in the age range of 18-36 and have different socio-economical demographics. The rate of reporting one or more ACEs in the sample was 68.4%. This study used a serial mediation model, which included regulatory emotional self-efficacy as first-order mediator and future anxiety as second-order mediator. RESULT: The results showed that both regulatory emotional self-efficacy and future anxiety played a mediator role in the relationship between adverse childhood experiences and subjective happiness. Additionally, with serial mediation effects, adverse childhood experiences reduced future anxiety and contributed to subjective happiness through regulatory emotional self-efficacy. This study demonstrated the importance of regulatory emotional self-efficacy development in practices geared towards increasing subjective happiness in adults with adverse childhood experiences.
33Subjective well-being and adaptation to life events: a meta-analysis.PubMed
Maike Luhmann, Wilhelm Hofmann, Michael Eid, et al.
J Pers Soc Psychol. 2012 Mar;102(3):592-615. doi: 10.1037/a0025948. Epub 2011 Nov 7.
Previous research has shown that major life events can have short- and long-term effects on subjective well-being (SWB). The present meta-analysis examines (a) whether life events have different effects on affective and cognitive well-being and (b) how the rate of adaptation varies across different life events. Longitudinal data from 188 publications (313 samples, N = 65,911) were integrated to describe the reaction and adaptation to 4 family events (marriage, divorce, bereavement, childbirth) and 4 work events (unemployment, reemployment, retirement, relocation/migration). The findings show that life events have very different effects on affective and cognitive well-being and that for most events the effects of life events on cognitive well-being are stronger and more consistent across samples. Different life events differ in their effects on SWB, but these effects are not a function of the alleged desirability of events. The results are discussed with respect to their theoretical implications, and recommendations for future studies on adaptation are given.
34Parental warmth during childhood predicts coping and well-being in adulthood.PubMed
Karena M Moran, Nicholas A Turiano, Amy L Gentzler
J Fam Psychol. 2018 Aug;32(5):610-621. doi: 10.1037/fam0000401. Epub 2018 Apr 30.
Numerous studies have shown that early life experiences can affect well-being later in life. Additionally, previous literature has emphasized the importance of exploring the role of mediators in developmental research (e.g., coping strategies). The present study used 3 waves of longitudinal data across 20 years from the national survey Midlife Development in the United States (N = 2,088) to examine the link between retrospectively reported parental warmth and well-being in adulthood by exploring 2 categories of coping strategies (emotion- and problem-focused strategies) as possible mediators. Three cross-lagged panel models, exhibiting good fit, were conducted in Mplus. Significant indirect effects were found where both negative and positive affect (Time 2) partially mediated the association between perceived parental warmth (Time 1) and emotion-focused coping (Time 3). Further, evidence for bidirectional effects were shown by the observed significant indirect effects of problem-focused coping (Time 2) partially explaining the association between perceived parental warmth (Time 1) and eudaimonic well-being (Time 3) as well as eudaimonic well-being (Time 2) partially explaining the link between parental warmth (Time 1) and problem-focused coping (Time 3). These findings suggest that it is important to consider early life experiences when examining both well-being and coping during adulthood. (PsycINFO Database Record
35Children with disabilities: a longitudinal study of child development and parent well-being.PubMed
P Hauser-Cram, M E Warfield, J P Shonkoff, et al.
Monogr Soc Res Child Dev. 2001;66(3):i-viii, 1-114; discussion 115-26.
This Monograph presents the results of the Early Intervention Collaborative Study, a longitudinal investigation of the cognitive and adaptive behavior development of children with developmental disabilities and the adaptation of their parents, extending from infancy through middle childhood. The study was designed to generate and test conceptual models of child and family development and contribute to the knowledge base that informs social policy and practice. The sample for the investigation reported here consists of 183 children with Down syndrome, motor impairment, developmental delay and their families who were recruited at the time of their enrollment in an early intervention program in Massachusetts or New Hampshire. Data were collected at five time points between entry to early intervention and the child's 10th birthday. Home visits were conducted at each time point and included child assessments, maternal interview, and questionnaires completed independently by both parents. Trajectories in children's development and parental well-being were analyzed using hierarchical linear modeling. Predictor variables were measured at age 3 years when children were exiting early intervention programs. Children's type of disability predicted trajectories of development in cognition, social skills, and daily living skills. Children's type of disability also predicted changes in maternal (but not paternal) child-related and parent-related stress. Beyond type of disability, child self-regulatory processes (notably behavior problems and mastery motivation) and one aspect of the family climate (notably mother-child interaction) were key predictors of change in both child outcomes and parent well-being. A different aspect of the family climate--family relations--also predicted change in child social skills. Parent assets, measured as social support and problem-focused coping, predicted change in maternal and paternal parent-related stress respectively. The implications of these findings for both the science of child development and the policies and practices of developmental intervention are discussed.
36Social-Emotional Competence: An Essential Factor for Promoting Positive Adjustment and Reducing Risk in School Children.PubMed
Celene E Domitrovich, Joseph A Durlak, Katharine C Staley, et al.
Child Dev. 2017 Mar;88(2):408-416. doi: 10.1111/cdev.12739. Epub 2017 Feb 18.
Social-emotional competence is a critical factor to target with universal preventive interventions that are conducted in schools because the construct (a) associates with social, behavioral, and academic outcomes that are important for healthy development; (b) predicts important life outcomes in adulthood; (c) can be improved with feasible and cost-effective interventions; and (d) plays a critical role in the behavior change process. This article reviews this research and what is known about effective intervention approaches. Based on that, an intervention model is proposed for how schools should enhance the social and emotional learning of students in order to promote resilience. Suggestions are also offered for how to support implementation of this intervention model at scale.
37Ordinary magic. Resilience processes in development.PubMed
A S Masten
Am Psychol. 2001 Mar;56(3):227-38. doi: 10.1037//0003-066x.56.3.227.
The study of resilience in development has overturned many negative assumptions and deficit-focused models about children growing up under the threat of disadvantage and adversity. The most surprising conclusion emerging from studies of these children is the ordinariness of resilience. An examination of converging findings from variable-focused and person-focused investigations of these phenomena suggests that resilience is common and that it usually arises from the normative functions of human adaptational systems, with the greatest threats to human development being those that compromise these protective systems. The conclusion that resilience is made of ordinary rather than extraordinary processes offers a more positive outlook on human development and adaptation, as well as direction for policy and practice aimed at enhancing the development of children at risk for problems and psychopathology.
38Global perspectives on resilience in children and youth.PubMed
Ann S Masten
Child Dev. 2014 Jan-Feb;85(1):6-20. doi: 10.1111/cdev.12205. Epub 2013 Dec 16.
Global concerns about the consequences of disasters, political violence, disease, malnutrition, maltreatment, and other threats to human development and well-being have sparked a surge of international interest in resilience science. This article highlights progress and issues in research that aims to understand variations in human adaptation to adverse experiences. Two key questions are considered: Why is a new wave of global research on resilience important for developmental science? and Why is developmental science important for global resilience? The conclusion calls for developmental scientists to engage in international efforts to promote resilience.
39Resilience in Development and Psychopathology: Multisystem Perspectives.PubMed
Ann S Masten, Cara M Lucke, Kayla M Nelson, et al.
Annu Rev Clin Psychol. 2021 May 7;17:521-549. doi: 10.1146/annurev-clinpsy-081219-120307. Epub 2021 Feb 3.
Resilience science in psychology and related fields emerged from clinical research on risk for psychopathology in the 1970s and matured over the ensuing decades with advances in theory, methods, and knowledge. Definitions and models of resilience shifted to reflect the expanding influence of developmental systems theory and the growing need to integrate knowledge about resilience across levels and disciplines to address multisystem threats. Resilience is defined for scalability and integrative purposes as the capacity of a dynamic system to adapt successfully through multisystem processes to challenges that threaten system function, survival, or development. Striking alignment of resilience factors observed in human systems, ranging from individuals to communities, suggests the possibility of networked, multisystem protective factors that work in concert. Evidence suggests that there may be resilience factors that provide transdiagnostic protection against the effects of adverse childhood experiences on risk for psychopathology. Multisystem studies of resilience offer promising directions for future research and its applications to promote mental health and positive development in children and youth at risk for psychopathology.
40Play brick therapy to aid the social skills of children and young people with autism spectrum disorder: the I-SOCIALISE cluster RCT.PubMed
Barry Wright, Ellen Kingsley, Cindy Cooper, et al.
Public Health Res (Southampt). 2023 Nov;11(12):1-137. doi: 10.3310/VGTR7431.
BACKGROUND: Social skills interventions are commonly recommended to help children and young people with autism spectrum disorder develop social skills, but some struggle to engage in these interventions. LEGO (LEGO System A/S, Billund, Denmark) based therapy, a group social skills intervention, aims to be more interesting and engaging. OBJECTIVE: To evaluate the clinical effectiveness of LEGO based therapy on the social and emotional skills of children and young people with autism spectrum disorder in school settings compared with usual support. Secondary objectives included evaluations of cost-effectiveness, acceptability and treatment fidelity. DESIGN: A cluster randomised controlled trial randomly allocating participating schools to either LEGO based therapy and usual support or usual support only. SETTING: Mainstream schools in the north of England. PARTICIPANTS: Children and young people (aged 7-15 years) with autism spectrum disorder, their parent/guardian, an associated teacher/teaching assistant and a facilitator teacher/teaching assistant (intervention schools only). INTERVENTION: Schools randomised to the intervention arm delivered 12 weekly sessions of LEGO based therapy, which promotes collaborative play and encourages social problem-solving in groups of three children and young people with a facilitator (trained teacher or teaching assistant). Participants received usual support from school and community services. Participants in the control arm received usual support only. Research assistants and statisticians were blind to treatment allocation. MAIN OUTCOME MEASURE: The social skills subscale of the Social Skills Improvement System (SSIS), completed by the children and young people's unblinded teacher pre randomisation and 20 weeks post randomisation. The SSIS social skills subscale measures social skills including social communication, co-operation, empathy, assertion, responsibility and self-control. Participants completed a number of other pre- and post-randomisation measures of emotional health, quality of life, loneliness, problem behaviours, academic competence, service resource utilisation and adverse events. RESULTS: A total of 250 children and young people from 98 schools were randomised: 127 to the intervention arm and 123 to the control arm. Intention-to-treat analysis of the main outcome measure showed a modest positive difference of 3.74 points (95% confidence interval -0.16 to 7.63 points, standardised effect size 0.18; = 0.06) in favour of the intervention arm. Statistical significance increased in per-protocol analysis, with a modest positive difference (standardised effect size 0.21; = 0.036). Cost-effectiveness of the intervention was found in reduced service use costs and a small increase in quality-adjusted life-years. Intervention fidelity and acceptability were positive. No intervention-related adverse events or effects were reported. CONCLUSIONS: The primary and pre-planned sensitivity analysis of the primary outcome consistently showed a positive clinical difference, with modest standardised effect sizes of between 0.15 and 0.21. There were positive health economics and qualitative findings, corroborated by the difference between arms for the majority of secondary outcomes, which were not statistically significant but favoured the intervention arm. Post hoc additional analysis was exploratory and was not used in drawing this conclusion. Given the small positive change, LEGO based therapy for children and young people with autism spectrum disorder in schools should be considered. LIMITATIONS: The primary outcome measure was completed by an unblinded teacher (rather than by the facilitator). FUTURE WORK: The study team recommends future research into LEGO based therapy, particularly in school environments. TRIAL REGISTRATION: This trial is registered as ISRCTN64852382. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 15/49/32) and is published in full in ; Vol. 11, No. 12. See the NIHR Funding and Awards website for further award information.
41Training the Social-Emotional Skills of Youth School Students in Physical Education Classes.PubMed
Romualdas Malinauskas, Vilija Malinauskiene
Front Psychol. 2021 Sep 8;12:741195. doi: 10.3389/fpsyg.2021.741195. eCollection 2021.
This study aimed to examine the impact of implementing an innovative Social-Emotional Skills Training Program in physical education classes at youth schools. This study used two surveys: the Schutte Self-Report Inventory (otherwise known as the Emotional Intelligence Scale) and the Social Skills Rating System (student form). The analysis included 104 youth school students (Mage = 16.91; SD = 1.12), who were randomly selected from two youth schools in the Kaunas region. Four classes were randomly assigned into an experimental ( = 49) and a control ( = 55) group. The experimental group participated in the Social-Emotional Skills Training Program. The intervention was targeted at the following social-emotional skills: empathy, cooperation, assertion, self-control, optimism, ability to understand and analyze emotions, appraisal, and utilization of emotions. The modified physical education classes were conducted by the physical education teacher, who was instructed by the researcher. Repeated measures multivariate ANOVA was used to analyze the effects of the Social-Emotional Skills Training Program. During the experiment, the applied training procedures had a statistically significant effect on the social-emotional skills of the experimental group of youth school students. Thus, the findings demonstrate that this program (for enhancing social-emotional skills of youth school students) positively impacted the social-emotional skills of the students. These results highlight the need to consider social-emotional skills training factors when interpreting the level of social-emotional skills among youth school students.
42Preschoolers' Attitudes, School Motivation, and Executive Functions in the Context of Various Types of Kindergarten.PubMed
Jana Kvintova, Lucie Kremenkova, Roman Cuberek, et al.
Front Psychol. 2022 Mar 3;13:823980. doi: 10.3389/fpsyg.2022.823980. eCollection 2022.
European policy has seen a number of changes and innovations in the field of early childhood preschool education over the last decade, which have been reflected in various forms in the policies of individual EU countries. Within the Czech preschool policy, certain innovations and approaches have been implemented in the field of early children education, such as the introduction of compulsory preschool education before entering primary school from 2017, emphasis on inclusive education, equal conditions in education and enabling state-supported diversity in the education concepts of kindergartens. The aim of our study was to assess the influence of various preschool education systems in the Czech Republic in the context of psychological variables reflecting selected children's outcomes which may contribute to future school achievement. The monitored variables were the attitudes, motivations and executive functions of children in the last year of preschool education. A comparison was made between the traditional preschool education program and the so-called alternative types of preschool education, such as Montessori, Waldorf and religious schools. The total sample was divided into four subgroups, namely a group of children attending traditional kindergartens (731, 84.9%), religious (65, 7.5%), Montessori (35, 4.1%), and Waldorf (30, 3.5%) kindergartens. To determine empirical data, the following research methods were used: Attitude Questionnaire, School Performance Motivation Scale, and Behavior Rating Inventory of Executive Function (BRIEF). The results of our survey show the fact that the type of kindergarten attended has a significant effect on the child's level of school performance motivation, attitudes toward school as well as executive functions. Significant differences were found between the different types of kindergartens attended in the monitored variables.
43Aspects of self-regulated learning and their influence on the mathematics achievement of fifth graders in the context of four different proclaimed curricula.PubMed
Jaroslav Říčan, Vlastimil Chytrý, Janka Medová
Front Psychol. 2022 Oct 11;13:963151. doi: 10.3389/fpsyg.2022.963151. eCollection 2022.
Metacognition is a part of the models of self-regulated learning. The consideration of a broader context resonates with a social cognitive perspective approach to learning which dominates the educational academic field with the theory of self-regulated learning. Metacognition is considered a crucial factor influencing mathematics achievement. Furthermore, the affective field including pupils' self-efficacy, interest and motivation are the phenomena involved in mathematical problem-solving. On the other hand, metacognitive knowledge and metacognitive regulations are not a regular part of mathematics education in the Czech Republic. The main aim of this study was to investigate the relation between pupils' attitude toward mathematics; metacognitive knowledge; self-efficacy and motivation; metacognitive monitoring; and their achievement in solving mathematical problems. All together 1,133 students of Grade 5 from four types of Czech schools participated in the study. There were traditional schools; schools teaching mathematics by genetic constructivism, i.e., Hejný's method; Montessori schools; and Dalton schools were involved. The assessed variables, namely relation to mathematics; metacognitive knowledge; self-efficacy and motivation; metacognitive monitoring; and mathematical achievement were used as an input to regression analysis. Item-response theory was used for assessing the performance of the students and demands of the tasks. The metacognitive monitoring was detected as the most significant predictor of mathematics achievement for higher- and lower-performing students as well as for the item with high and low demands. The study reveals how the different mathematics curricula (un)support the metacognitive processes involved in mathematical problem-solving. The information allows teachers to spend sufficient time with particular types of mathematics problems whose solutions is determined by activation of metacognitive processes. This demonstrates the importance of including the activities for development of metacognitive monitoring in mathematics education.
44Long-term effects of four preschool programs: ninth- and tenth-grade results.PubMed
L B Miller, R P Bizzell
Child Dev. 1984 Aug;55(4):1570-87.
Follow-up of achievement test and IQ data on low-income black youths who had participated for 1 year in Bereiter-Engelmann, DARCEE, Montessori, or Traditional prekindergarten was continued through ninth and tenth grades. Stable trends persisted. Montessori males and DARCEE females were high; Montessori males were performing at about grade level on reading and math; IQs parallelled achievement test results. Additional tests of fluid intelligence, task persistence, self-esteem, divergent thinking, task approach, and aspirations and expectations were administered in ninth and tenth grades. Results from program comparisons and factor analyses were consistent with those on IQ and school achievement. The possibility of relationships between techniques used in the different preschool programs and sex differences in children's developmental level was discussed.
45Nutrition knowledge and food consumption: can nutrition knowledge change food behaviour?PubMed
Anthony Worsley
Asia Pac J Clin Nutr. 2002;11 Suppl 3:S579-85. doi: 10.1046/j.1440-6047.11.supp3.7.x.
The status and explanatory role of nutrition knowledge is uncertain in public health nutrition. Much of the uncertainty about this area has been generated by conceptual confusion about the nature of knowledge and behaviours, and, nutrition knowledge and food behaviours in particular. So the paper describes several key concepts in some detail. The main argument is that 'nutrition knowledge' is a necessary but not sufficient factor for changes in consumers' food behaviours. Several classes of food behaviours and their causation are discussed. They are influenced by a number of environmental and intra-individual factors, including motivations. The interplay between motivational factors and information processing is important for nutrition promoters as is the distinction between declarative and procedural knowledge. Consideration of the domains of nutrition knowledge shows that their utility is likely to be related to consumers' and nutritionists' particular goals and viewpoints. A brief survey of the recent literature shows that the evidence for the influence of nutrition knowledge on food behaviours is mixed. Nevertheless, recent work suggests that nutrition knowledge may play a small but pivotal role in the adoption of healthier food habits. The implications of this overview for public health nutrition are: (i) We need to pay greater attention to the development of children's and adults' knowledge frameworks (schema building); (ii) There is a need for a renewed proactive role for the education sector; (iii) We need to take account of consumers' personal food goals and their acquisition of procedural knowledge which will enable them to attain their goals; (iv) Finally, much more research into the ways people learn and use food-related knowledge is required in the form of experimental interventions and longitudinal studies.
46The multiple mediating effects of grit and learning agility on academic burnout and learning engagement among Korean university students: a cross-sectional study.PubMed
Mi-Kyeong Jeon, Insook Lee, Mi-Young Lee
Ann Med. 2022 Dec;54(1):2710-2724. doi: 10.1080/07853890.2022.2122551.
INTRODUCTION: This article reports the results of a study conducted to assess the mediating effects of grit and learning agility on the relationship between academic burnout and learning engagement among undergraduate students. METHODS: A cross-sectional survey was conducted using a self-report questionnaire. Undergraduate students ( = 344) were recruited from one university in South Korea (58.0% female; average age 21.43) to complete assessments of academic burnout, grit, learning agility, and learning engagement. Data were analysed using descriptive statistics, Pearson's correlation coefficient, hierarchical regression and bootstrapping to verify the multiple parallel mediation effect. RESULTS: We found that the direct effect of academic burnout on learning engagement (B= -0.26, <.001) and the indirect effect of academic burnout as mediated by learning agility (B= -0.13; 95% CI, -0.20∼-0.06) were significant. This finding confirmed that 33.3% of the total effect of academic burnout on learning engagement was the result of indirect effects learning agility. CONCLUSION: These results indicate the necessity of developing an educational programme that focuses not only on reducing academic burnout but also on improving learning agility to increase undergraduate students' learning engagement. This study contributes to the development of a curriculum aimed at increasing the effectiveness of university education, promoting learning engagement, and reducing academic burnout.KEY MESSAGEOur study reports that academic burnout has both a direct effect on learning engagement and an indirect effect via learning agility. Learning agility mediates the relationship between academic burnout and learning engagement among undergraduate students.Although grit has been reported by many previous studies to mediate the relationship between the tendency to pursue happiness and the willingness to continue learning and effectively improving one's academic achievement and ability, our study did not find any mediating effect via grit in this context.
47The association between academic pressure and adolescent mental health problems: A systematic review.PubMed
Thomas Steare, Carolina Gutiérrez Muñoz, Alice Sullivan, et al.
J Affect Disord. 2023 Oct 15;339:302-317. doi: 10.1016/j.jad.2023.07.028. Epub 2023 Jul 10.
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.
48Academic stress, perceived parental pressure, and anxiety related to competitive entrance examinations and the general well-being among adolescents - A cross-sectional survey from Karnataka, India.PubMed
Khriebeizonuo Pienyu, Binu Margaret, Anjalin D'Souza
J Educ Health Promot. 2024 Dec 28;13:474. doi: 10.4103/jehp.jehp_2094_23. eCollection 2024.
BACKGROUND: In this competitive world, students undergo various scholastic stress and mental health issues. The scholastic stress has a great impact on students' life and results in the prevalence of several psychological consequences such as stress-related disorders, anxiety, depression, and nervousness, which disturb their academic performances. Therefore, the present study was conducted to assess academic stress, perceived parental pressure, and anxiety related to competitive entrance examinations and the general well-being among adolescents. MATERIALS AND METHODS: A cross-sectional survey was conducted in 2023 among 570 adolescents who were planning to give competitive entrance examination in Pre-University Colleges of Udupi District, Karnataka, India. The data were collected using Background Proforma, Academic Stress Scale related to Competitive Examination, Perceived Parental Academic Pressure Scale, Westside Test Anxiety Scale, and General Well-being Scale. The purposive sampling technique was used to select Pre-University Colleges, and the adolescents were selected using cluster sampling. The collected data were analysed by Jamovi 2.3.21 software using descriptive statistics. RESULTS: The results showed that the majority of adolescents, 490 (86.0%), have high academic stress, 496 (87.0%) experienced high perceived parental pressure, 163 (28.5%) had moderately high anxiety, and 351 (57.7%) have low general well-being. There was no significance difference between class of study and stream of study. CONCLUSION: The study concluded that it is essential for the health care professionals to collaborate with parents and teachers to support adolescents and give them a congenial environment that will promote the healthy physical and psychological well-being of the adolescents.
49Mental health and well-being of elite youth athletes: a scoping review.PubMed
Kate Gwyther, Vita Pilkington, Alan P Bailey, et al.
Br J Sports Med. 2024 Sep 4;58(17):1011-1019. doi: 10.1136/bjsports-2024-108244.
BACKGROUND: There is increasing recognition of the prevalence and risk factors for mental health symptoms and disorders among adult elite athletes, with less research involving elite youth athletes. This scoping review aimed to characterise the mental health and well-being of elite youth athletes who travel internationally and compete for their sport. METHOD: Four databases were searched in March 2023. Inclusion criteria were studies with elite youth athlete populations (mean age 12-17 years) reporting mental health and well-being outcomes. Data from included studies were charted by outcome, and risk/protective factors identified. RESULTS: Searches retrieved 3088 records, of which 33 studies met inclusion criteria, encapsulating data from 5826 athletes (2538 males, 3288 females). The most frequently studied issue was disordered eating (k=16), followed by anxiety (k=7), depression (k=5) and mixed anxiety/depression (k=2). Caseness estimates (a symptom level where mental health treatment is typically indicated) for disordered eating were wide ranging (0%-14% for males; 11%-41% for females), whereas only two studies estimated caseness for depression (7% in a mixed-sex sample; 14% for males, 40% for females) and one for anxiety (8% for males, 28% for females). Common risk factors for mental ill-health included sex, athlete status (compared with non-athletes) and social/relationship factors (with coaches/parents/peers). Contradictory evidence was observed for elite/competition level, which was associated with higher and lower rates of disordered eating. CONCLUSION: Further representative research into the mental health and well-being of elite youth athletes is needed to enhance understanding and guide prevention and intervention measures.
50Men, Mental Health and Elite Sport: a Narrative Review.PubMed
Gary Souter, Robin Lewis, Laura Serrant
Sports Med Open. 2018 Dec 19;4(1):57. doi: 10.1186/s40798-018-0175-7.
Mental health in elite sport is receiving more publicity due to an increase in male athletes sharing their personal experiences. Sports injury is recognised as the major risk factor for psychological distress amongst male athletes, although anecdotally this may be that athletes are more likely to discuss their emotional wellbeing when related to the injury they are experiencing. Stress can be amplified within elite sport and the pressure they experience in relation to competition and performance can be exacerbated by adverse life events. This ongoing stress does not end when their sporting career does, it can follow them into retirement. The physical and psychological demands placed upon them by the sporting environment may predispose athletes to developing depression. As an athlete's symptoms of mental illness intensify, their performance can be negatively affected leaving them vulnerable and exposed to further symptoms of common mental disorders. The pressure of performance can also expose male athletes to overtraining syndrome which can be difficult to distinguish from depression. Male athletes are more vulnerable to eating disorders compared with males in the general population and they do have anxieties, particularly around their bodies, but find it difficult to disclose their concerns. In addition to this, male athletes are more likely to use substances, including opioids to improve both sport and non-sport performance.Despite the prevalence of common mental disorders in male athletes, stigma still exists, and although some athletes discuss their issues publicly after their career has ended, the majority of athletes prefer to remain silent. There remains a view that athletes who seek help for psychological problems may be seen as weak. Although there is an improvement in help-seeking attitudes within elite sport, further research and education is needed to encourage men to talk about their mental health, share their experiences and to enjoy a greater sense of emotional wellbeing.
51COVID-19 and Youth Sports: What Are the Risks of Getting Back on the Field Too Quickly?PubMed
Charles Wang, Wyatt Vander Voort, Brian M Haus, et al.
Pediatr Ann. 2021 Nov;50(11):e465-e469. doi: 10.3928/19382359-20211019-01. Epub 2021 Nov 1.
The widespread shutdown in response to the coronavirus disease 2019 (COVID-19) pandemic, although varied across state and county levels, has undoubtedly impacted everyone to some degree. Within the pediatric population, the closure of schools and organized youth athletic programs has resulted in a unique situation that has made athletes physically deconditioned and at risk for injury. As sports and competition gradually restart, there are considerable risks to the skeletally immature athlete. The anatomic and physiologic changes that occur to bone and cartilage during growth make the young athlete particularly susceptible to both acute and overuse injuries. In the context of the pandemic, deconditioning, obesity, lack of variety, and the resultant mental health burden pose unique challenges in ensuring that young athletes safely return to the field. This review aims to identify risk factors for sport-related injuries and to outline strategies for minimizing these injuries as pediatric patients return-to-play after COVID-19. .
52Utilization of a rodent model to examine the neurological effects of early life adversity on adolescent pain sensitivity.PubMed
Sabrina Salberg, Melanie Noel, Nikita N Burke, et al.
Dev Psychobiol. 2020 Apr;62(3):386-399. doi: 10.1002/dev.21922. Epub 2019 Oct 3.
All children experience pain, and although many recover quickly, some go on to develop chronic pain. Adolescent chronic pain is a growing epidemic. It is unknown why some adolescents recover without incident and others experience persistent pain. Although unexplored, early life adversity may contribute to the development and maintenance of chronic pain. This study investigated the effects and underlying neurobiological mechanisms of an early life stressor on nociceptive (pain) sensitivity and emotional function in male and female Sprague-Dawley rats. Using maternal separation (MS) as an established model of early life stress, we addressed two aims: investigation of the effects of MS on behavior (anxiety and pain sensitivity), and investigation of the effects of MS on mRNA and pathophysiological changes associated with an acutely painful stimulus. Our results indicate that MS increased anxiety-like behavior and altered nociceptive responsivity in adolescent rats, with decreased mechanical withdrawal thresholds indicative of heightened and prolonged pain-related behavior. The MS groups also demonstrated increased expression of genes involved in regulating the stress and fight-or-flight response, mood, and neuroplasticity; as well as increased levels of inflammatory markers. We conclude that nociception, both at the behavioral and molecular level, is altered in response to the MS stressor.
53Association between academic pressure, NR3C1 gene methylation, and anxiety symptoms among Chinese adolescents: a nested case-control study.PubMed
Yilin Hua, Cuihong Huang, Yangfeng Guo, et al.
BMC Psychiatry. 2023 May 30;23(1):376. doi: 10.1186/s12888-023-04816-7.
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 (β 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 (β estimate = 0.010 [95% CI: 0.000 ~ 0.020], P = 0.046) and heavy (β 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 (β 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.
54Sleep and Mental Health Issues in Current and Former Athletes: A Mini Review.PubMed
Ashley Montero, David Stevens, Robert Adams, et al.
Front Psychol. 2022 Apr 7;13:868614. doi: 10.3389/fpsyg.2022.868614. eCollection 2022.
Sleep and mental health are important aspects of human health that work concurrently. However, sleep and mental health disorders are often overlooked and undiagnosed in sport due to the negative stigma associated with them. Evidence suggests that athletes are disproportionately affected by mental health issues and sleep problems. Internal and external pressures contribute to psychological distress. Variable competition times, travel and stress are detrimental to sleep quality. Retirement from sport can deteriorate sleep and psychological wellbeing, particularly for those who retired involuntarily and identify strongly with their athletic role. When untreated, these issues can manifest into a range of clinical disorders. This is concerning, not only for compromised athletic performance, but for general health and wellbeing beyond sport. Previous research has focussed on sleep and health independently among currently competing, or former, athletes. To date, no research has comprehensively assessed and compared sleep complaints and mental health issues between these two cohorts. Moreover, research has failed to obtain data across a variety of different competition levels, sports, and genders, leaving the current scope of the literature narrow. Comorbid conditions (e.g., concussion history, obesity), ex-college athletes, and mental health has been the focus of existing literature post-retirement. Future research would benefit from employing both quantitative and qualitative methodologies to comprehensively assess the prevalence and severity of sleep and mental health disorders across current and retired athletes. Research outcomes would inform education strategies, safeguarding athletes from these issues by reducing negative stigmas associated with help-seeking in sport and ultimately increase self-guided treatment.
55The double-edged sword of stress: A systematic meta-analysis on how stress impacts creativity.PubMed
Yi Huang, Rongjun Yu
Neurosci Biobehav Rev. 2025 May;172:106113. doi: 10.1016/j.neubiorev.2025.106113. Epub 2025 Mar 20.
The present study provides up-to-date meta-analytical estimates of the impact of experimentally induced stress on individuals' creative performance. Using a three-level meta-analytic model, we observed an overall negative effect of stress on creativity (d = -0.20). Our analysis reveals that this relationship is nuanced, and influenced by a variety of factors. Social-evaluative threats (SETs) did not significantly affect creativity overall (d = -0.08). Specifically, tests significantly reduced creativity, while competition showed a non-significant positive trend and (expected) performance evaluation showed a non-significant negative trend. Furthermore, results showed that mild SETs (one element) slightly but not significantly increased creativity, whereas severe SETs (three elements) significantly decreased it, indicating a curvilinear relationship. Non-social stressors, including time pressure and physical stress, significantly hindered creative performance (d = -0.45), with challenging tasks also showing a negative but non-significant effect. Additionally, the impact of stress on creativity varied by age group. Children's creativity was notably reduced by competition, physical stress, and challenging tasks, whereas adults and adolescents' creativity appeared to benefit from competition. Adults' creative performance was most negatively impacted by time pressure and remained relatively stable across other stressors. These findings underscore the complex and multifaceted nature of the effects of stress on creativity. The theoretical and practical implications are discussed.
56Peer PlayPubMed
Hannah K. Scott, Mark Cogburn
Play is the engagement of activity for enjoyment and recreation rather than for any set purpose. It is an expected, normal process in children. Moreover, play creates opportunities for the development of cognitive skills throughout childhood development. The purposes of play are to provide avenues to think and express emotions, consider alternative ways of viewing a situation, explore new ways of reacting to situations, provide outlets for imagination, and to understand cause-and-effect in relationships. Play is prosocial and evolves as the child progresses through infancy and childhood. The earliest and most rudimentary indication of play is the social smile, which occurs at about 4 to 6 weeks of age. By 3 months, play progresses to regular smiling and cooing when a baby is face-to-face with a person. Between the ages of 3 to 6 months, infants actively seek interaction with others and begin to play “baby games” like peek-a-boo with their caregivers. At this milestone, children begin using their caregiver for enjoyment in addition to comfort and security. Play at this stage is repetitive and often ranges in intensity according to how the baby responds to the game. Play starts “primitively” as sensorimotor play from 1 to 2 years with an exploration of properties and functions of objects. During this age, pretend play is initiated with the imitation of ordinary activities like pretending to eat or imitating caregivers. Between the ages of 1 and 2, imaginative or pretend play replaces sensorimotor play. Pretend play is a direct imitation of ordinary activities. Pretend play extends to symbolic play, which is the use of one object for another. Symbolic play can be a vehicle for relief from reality. By the age of 2, a toddler’s engagement with others will extend to peers their same age, not just their caregivers. Play takes form in solitary play, parallel play, and social play. Solitary play is a child playing independently with no outside interaction. Playing alongside another child, both intent on similar objects of the play without direct interaction is known as parallel play. If you were to look in on a room full of toddlers, several of them might be at the same playing station, each consumed in their task without actively engaging the children around them. They may enjoy doing the same thing in parallel, but they do not show evidence of sharing the same fantasy. Social play at this stage lacks imagination and is more focused on imitation of each other’s behavior, a shared interest in similar toys, and/or playing simple games like chase. These peer interactions begin the foundation of prosocial skills with others. As children coordinate their actions in response to another child and share feelings, they become aware that other children have thoughts and feelings. For example, if a child falls from the monkey bars, another child may cry to an adult. The observant child is now aware that the other child is hurting and needs assistance. At this time, peer play involves sharing uninhibited by possessiveness as the child prizes socializing over autonomy. However, as the autonomous self develops between ages 2 to 3, sharing declines. As the toddler develops his sense of self, exhibited by the emergence of possessive pronouns like “I,” “me,” “my,” and “mine,” play with peers often deteriorates swiftly and cannot be sustained due to constant conflict. Before, the goal was to socialize by sharing a toy; now the goal is to possess the toy by competing for it. Although some parents scold or discipline their children for not sharing, this is an important period as a toddler develops an autonomous sense of self. Sharing, if modeled by caregivers, will eventually develop over time. Play is a symbolic representation of a child’s experience and can be useful to discharge emotional reactions to stressful situations. Play can be used as part of an observable measure of cognitive ability. Language acquisition is still developing and can be a source of internal stress as the child has difficulty communicating frustration. Language lags far behind nonverbal cues of cognitive processes, and thus the cognitive capacities of children are often underestimated. Between the ages of 3 to 6 years, play provides the opportunity for cognitive skills to develop and increases the child’s mental capacities. For example, a child in this stage can imagine an idea, fantasize about it, then quickly turn it into a scenario which can be acted out with peers. Subsequently, the child can now react and test out different feelings without judgment. The cognitive skills acquired through play help advance academic skills in the early elementary years and are essential to development. As is often said, “Play is the work of the preschooler.” Prosocial behavior increases with a focus on interactions with peers of the same age. At this stage, children live to play. Parallel play shifts to cooperative play as children begin interactions based on a shared idea. At this age, a child identifies with children of the same age who can relate and validate their concerns. They now expect a response from their peers, want to be noticed by their peers, and most importantly, seek to be accepted by them. This shift allows for the development of perspective taking, empathy, turn taking, sharing, cooperation, and negotiation. As the child reaches ages 4 to 5, play leads to real friendships. Children begin to have a preference on whom they want to play with and are more likely to share similar fantasy interests with their preferred peer group. They will spend more time together, have more conflicts (usually about the direction of their fantasy play), and will negotiate solutions to keep the interaction intact and continue playing. Play at this time is more imaginative and complex without being constrained to reality or rule-following. Rule-following develops later in the school-age child. Play takes two routes at this time: either the exploration of reality through role play, e.g., dress-up, or the use of play to master anxiety. For example, a boy may dress as an invincible superhero to compensate for the anxious feelings of a small, young, vulnerable child. The middle childhood timeframe begins around age 6 and extends until age 12, or when a child begins puberty. Same-sex peer friendships are predominant during this time. Fantasy play is less prominent as the child shifts to more organized or ritualized play via games and sports. Fantasy is still prevalent, but not outwardly enacted. Before this stage, a child would have acted out a fantasy while simultaneously offering a narration, aloud, for others to hear. This combination of observable fantasy decreases significantly or disappears. Internal fantasy increases and mimed play in peer groups can be observed. If adults are present, children will keep their fantasies private. Fantasy at this age occurs alone or with very close peers who accept them and are therefore less likely to cast negative judgments on their ideas. The work of middle childhood lies in the mastery of school work, intellectual competence, and physical skills. Play now becomes a break from the demands of reality. Recess is the paramount example of switching gears from reality to fantasy play. To further illustrate this point, parents often allow their children time to play and decompress from the demands of the day before starting their homework. During play, the child may imagine the self in more competent roles or as a grown up. The child begins to use systematic and logical thinking and doesn’t have to rely on imaginative thinking to understand the world and his role in it. Peer play evolves into games involving structure, rules, and competition. As the child ages, even spontaneous play develops into games requiring planning and strategy. As a child enters puberty, fantasy play is largely abandoned as social interactions are based on reality. Organized play can continue in the form of sports. Play that is novel to this century is play via video gaming. Video games are marketed to all age groups and can take place in a variety of settings. They can be individual, cooperative, or competitive. Video gaming is an alternate form of fantasy play where the player is virtually transported through vast video game environments and must accomplish tasks to proceed.
57Super-additive cooperation.PubMed
Charles Efferson, Helen Bernhard, Urs Fischbacher, et al.
Nature. 2024 Feb;626(8001):1034-1041. doi: 10.1038/s41586-024-07077-w. Epub 2024 Feb 21.
Repeated interactions provide an evolutionary explanation for one-shot human cooperation that is counterintuitive but orthodox. Intergroup competition provides an explanation that is intuitive but heterodox. Here, using models and a behavioural experiment, we show that neither mechanism reliably supports cooperation. Ambiguous reciprocity, a class of strategies that is generally ignored in models of reciprocal altruism, undermines cooperation under repeated interactions. This finding challenges repeated interactions as an evolutionary explanation for cooperation in general, which further challenges the claim that repeated interactions in the past can explain one-shot cooperation in the present. Intergroup competitions also do not reliably support cooperation because groups quickly become extremely similar, which limits scope for group selection. Moreover, even if groups vary, group competitions may generate little group selection for multiple reasons. Cooperative groups, for example, may tend to compete against each other. Whereas repeated interactions and group competitions do not support cooperation by themselves, combining them triggers powerful synergies because group competitions constrain the corrosive effect of ambiguous reciprocity. Evolved strategies often consist of cooperative reciprocity with ingroup partners and uncooperative reciprocity with outgroup partners. Results from a behavioural experiment in Papua New Guinea fit exactly this pattern. They thus suggest neither an evolutionary history of repeated interactions without group competition nor a history of group competition without repeated interactions. Instead, our results suggest social motives that evolved under the joint influence of both mechanisms.
58Temperament and self-based correlates of cooperative, competitive and individualistic learning preferences.PubMed
Małgorzata A Gocłowska, Nawal Aldhobaiban, Andrew J Elliot, et al.
Int J Psychol. 2017 Jun;52(3):180-188. doi: 10.1002/ijop.12206. Epub 2015 Aug 28.
People vary in the extent to which they prefer cooperative, competitive or individualistic achievement tasks. In this research, we conducted two studies designed to investigate correlates and possible roots of these social interdependence orientations, namely approach and avoidance temperament, general self-efficacy, implicit theories of intelligence, and contingencies of self-worth based in others' approval, competition and academic competence. The results indicated that approach temperament, general self-efficacy and incremental theory were positively related, and entity theory was negatively related to cooperative preferences (|r| range from .11 to .41); approach temperament, general self-efficacy, competition contingencies and academic competence contingencies were positively related to competitive preferences (|r| range from .16 to .46); and avoidance temperament, entity theory, competitive contingencies and academic competence contingencies were positively related, and incremental theory was negatively related to individualistic preferences (|r| range from .09 to .15). The findings are discussed with regard to the meaning of each of the three social interdependence orientations, cultural differences among the observed relations and implications for practitioners.
59How do parents' educational fields affect the choice of educational field?PubMed
Håvard Helland, Øyvind N Wiborg
Br J Sociol. 2019 Mar;70(2):481-501. doi: 10.1111/1468-4446.12370. Epub 2018 Apr 26.
This study examines the links between parental education and students' choice of field of study in Norwegian higher education. In our interpretation of the results, we suggest a status group perspective that integrates risk aversion models, micro-class theory, and cultural reproduction schemes. Complete Norwegian register data for all individuals born from 1955 to 1980 allow for a fine-grained examination of diverse fields of study not attempted in earlier studies. The findings reveal that intergenerational reproduction of educational fields is widespread, but its extent varies across fields of study. The tendency is most pronounced among children of professional, educated parents with masters and higher-level degrees. Moreover, the analysis shows that students who do not choose the same field as their parents nonetheless tend to choose educational fields close to those of their parents.
60Parental educational background and residency training selection of minority and nonminority medical students.PubMed
M C Boucree, A C Epps, J C Pisano
J Natl Med Assoc. 1988 Jan;80(1):23-33.
The subject of background variables influential in the choice of postgraduate medical specialty training has been described in numerous papers. Few, if any, have examined the influential patterns in minority students' residency training selection when compared with nonminority students. No studies reviewed examined the differential patterns that may have an impact on specialty selection in these subgroups, especially in regard to maternal and paternal educational status. This study analyzes the interrelationship between minority and nonminority medical students, their parental educational background, and selection of postgraduate specialty, and suggests that parental educational background be investigated further as a predicative indicator of medical student specialty career selection.
61Community Participation of School-Age Children: Who is at Risk of Restricted Participation?PubMed
Chi-Wen Chien, Chung-Ying Lin
Phys Occup Ther Pediatr. 2021;41(5):447-463. doi: 10.1080/01942638.2021.1900489. Epub 2021 Mar 24.
AIMS: This study aimed to identify children with restricted community participation and examine the extent to which the child, family, and environmental factors were associated with restricted participation. METHODS: A school-based sample of 92 children with disabilities and 391 children without disabilities aged 5-12 years was recruited in Hong Kong. Parents completed the Participation and Environment Measure for Children and Youth and a demographic questionnaire. Moreover, children completed the Children's Depression Inventory. Rasch analysis was used to determine the criteria that differentiated between children with and without participation restriction, based on frequency of activities. Logistic regression was used to identify the factors associated with participation restriction. RESULTS: One hundred seventy-three children (35.8% of the sample), including 42 with disabilities, were identified as having restricted participation. Participation restriction was associated with higher depressive symptoms in children (odds ratio (OR) = 1.05, 95% confidence interval (CI) [1.01, 1.08]), lower environmental resources (OR = 0.97, 95% CI [0.96, 0.99]), and coming from families with three or more children (OR = 2.80, 95% CI [1.44, 5.46]). CONCLUSIONS: The results suggest that a sizable number of children are at risk for restricted participation in the community. Healthcare services and strategies that address the associated factors are needed to promote children's community participation.
62Development and Preliminary Validation of a Self-Report Coping Response Measure in a Community Sample of Children in Middle Childhood.PubMed
Katie Quy, Jennifer Gibb, Louise Neil, et al.
J Pers Assess. 2020 Sep-Oct;102(5):628-640. doi: 10.1080/00223891.2019.1606003. Epub 2019 May 17.
Coping plays a key role in psychological adjustment. However, whereas coping in adulthood has been extensively studied, coping in childhood remains relatively sparsely researched. This might be in part due to the fact that measures of coping have yet to be developed that are suitable for use with young children. This article describes the development and preliminary validation of the Profile of Coping Dimensions in Children (PCDC), a new, theory-driven measure of coping suitable for use in middle childhood, designed to assess coping as a multidimensional construct across 11 dimensions linked with well-being. Patterns of coping across age and gender were also examined. Participants were 2,566 children between 7 and 11 years old, attending 15 primary (elementary) schools in the southeast of England. The measure was administered along with other questionnaires designed to measure anxiety, somatization, and perceived stress and happiness. The measure was found to be easy to use, and suitable for use in this age group. Coping response styles assessed using the measure were found to vary by age and gender, and were differentially associated with measures of anxiety, somatization, and perceived stress and happiness. Results provide preliminary support for the utility of the measure as a multidimensional assessment of coping in middle childhood.
63Cortisone in hair of elementary school girls and its relationship with childhood stress.PubMed
Barbara Vanaelst, Nathalie Michels, Tineke De Vriendt, et al.
Eur J Pediatr. 2013 Jun;172(6):843-6. doi: 10.1007/s00431-013-1955-1. Epub 2013 Feb 1.
UNLABELLED: Children may be exposed to stressful situations with adverse effects on their physiological and psychological health. As cortisone may be a useful additional biomarker for stress research and as it has been shown to be detectable in human hair, this study measured physiological concentrations of hair cortisone in 223 elementary school girls and explored its relationship with child-reported estimates of stress, more specifically questionnaires on major life events (i.e., Coddington Life Events Scale for Children), emotions (i.e., anger, anxiety, sadness, and happiness), and coping strategies (i.e., emotion- versus problem-focused coping). Cortisone concentrations were positively correlated with the overall life event score for the past 6 months (rho = 0.223, p = 0.004), as well as with the negative event score for this period (rho = 0.227, p = 0.003; N = 165). Cortisone did not correlate with emotions or coping styles reported by the children. CONCLUSION: Despite its exploratory nature, this study may suggest elevated hair cortisone concentrations under psychosocial stress in young children. Although the observed findings should be interpreted with prudence, this study may encourage further research elucidating the potential importance and relevance of hair cortisone analysis as an additional or substituting stress biomarker for hair cortisol.
64Gut microbiome patterns depending on children's psychosocial stress: Reports versus biomarkers.PubMed
Nathalie Michels, Tom Van de Wiele, Fiona Fouhy, et al.
Brain Behav Immun. 2019 Aug;80:751-762. doi: 10.1016/j.bbi.2019.05.024. Epub 2019 May 18.
AIM: Chronic stress increases disease vulnerability factors including inflammation, a pathological characteristic potentially regulated by the gut microbiota. We checked the association between the gut microbiome and psychosocial stress in children/adolescents and investigated which stress parameter (negative versus positive emotion, self-report versus parental report, events versus emotions, biomarker cortisol versus parasympathetic activity) is the most relevant indicator herein. METHODS: Gut microbiome sequencing was completed in fecal samples from 93 Belgian 8-16y olds. Stress measures included negative events, negative emotions, emotional problems reported by parents, happiness, hair cortisol and heart rate variability (pnn50 parameter reflecting parasympathetic activity). Alpha diversity, beta diversity and linear discriminant analysis were the unadjusted analyses. Age, sex, socio-economic status, diet, physical activity, sleep and weight status were adjusted for via a redundancy analysis and differential abundance via zero-inflated negative binomial regression. RESULTS: High stress as reflected by low pnn50 and more negative events were associated with a lower alpha diversity as indicated by the Simpson index. Happiness and pnn50 showed significant differences between high and low stress groups based on weighted UniFrac distance, and this remained significant after confounder adjustment. Adjusted and unadjusted taxonomic differences were also most pronounced for happiness and pnn50 being associated respectively with 24 OTU (=11.8% of bacterial counts) and 31 OTU (=13.0%). As a general pattern, high stress was associated with lower Firmicutes at the phylum level and higher Bacteroides, Parabacteroides, Rhodococcus, Methanobrevibacter and Roseburia but lower Phascolarctobacterium at genus level. Several genera gave conflicting results between different stress measures e.g. Ruminococcaceae UCG014, Tenericutes, Eubacterium coprostanoligenes, Prevotella 9 and Christensenellaceae R7. Differential results in preadolescents versus adolescents were also evident. CONCLUSION: Even in this young healthy population, stress parameters were cross-sectionally associated with gut microbial composition but this relationship was instrument specific. Positive emotions and parasympathetic activity appeared the strongest parameters and should be integrated in future microbiota projects amongst other stress measures.
65Ethical advice in paediatric care.PubMed
Joe Brierley, Emma Cave, Dave Archard
Arch Dis Child. 2022 Mar;107(3):e18. doi: 10.1136/archdischild-2021-322671. Epub 2021 Nov 29.
The need for local ethics advice during the COVID-19 pandemic has put a spotlight on clinical ethics committees (CECs) and services. In this review, we focus on paediatric CECs that raise both generic questions and specific issues. In doing this, we acknowledge the broader roles of education, research and staff support some bioethics teams have developed but focus on the main areas of clinical ethics support to clinical teams. We raise 12 questions about the role, remit and responsibilities of CECs, provide preliminary answers to these and set out the next steps for the development of ethics support both in paediatric practice and more generally.
66The Me first communication model.PubMed
Kate Martin, Louise Morton, Joanna Reid, et al.
Nurs Child Young People. 2019 Mar 6;31(2):38-47. doi: 10.7748/ncyp.2019.e1064.
This article explores communication and decision-making with children and young people in healthcare. Children and young people report that healthcare professionals are good at explaining and helping them to understand what will happen to them, but that they do not feel involved in decision-making about their care or treatment. To improve communication with children and young people, they need to be involved in decision-making about their care and treatment. In partnership with children, young people and healthcare professionals Common Room Consulting, Great Ormond Street Hospital for Children NHS Foundation Trust and Health Education England have co-produced a communication model, Me first, to support decision-making with children and young people in healthcare. This article introduces the Me first model and explores how it can be applied in clinical practice.
67Educating children and adolescents about vaccines: a review of current literature.PubMed
Alexander R Maisonneuve, Holly O Witteman, Jamie Brehaut, et al.
Expert Rev Vaccines. 2018 Apr;17(4):311-321. doi: 10.1080/14760584.2018.1456921. Epub 2018 Apr 12.
INTRODUCTION: Until recently, research on vaccine hesitancy has focused primarily on parent populations. Although adolescent knowledge and views are gaining momentum within the literature, particularly with regards to the human papillomavirus and influenza, children remain a virtually unstudied population with regards to vaccine hesitancy. AREAS COVERED: This review focuses on the lack of literature in this area and argues for more vaccine hesitancy research involving child and adolescent populations. It also outlines special issues to consider when framing health promotion messages for children and adolescents. Finally, we explore the use of new and existing technologies as delivery mechanisms for education on vaccines and immunizations in populations of children and adolescents. EXPERT COMMENTARY: Children undergo cognitive development and experiences with vaccines (e.g. pain or education) have the potential to create future attitudes toward vaccines. This can influence future vaccine behaviour, including their participation in decision-making around adolescent vaccines, their decisions to vaccinate themselves when they are adults, and their decisions to vaccinate their own children. Interventions aimed at children, such as education, can create positive attitudes toward vaccines. These can also potentially influence parental attitudes toward vaccines as children convey this knowledge to them. Both of these impacts require further study.
68Network analysis of social-emotional skills in children and adolescents across ten cities: Evidence from the 2019 OECD Survey on Social and Emotional Skills.PubMed
Ming Huo, Bo Ning
Soc Sci Med. 2025 Sep;381:118286. doi: 10.1016/j.socscimed.2025.118286. Epub 2025 Jun 5.
This study analyzes data from the 2019 OECD Survey on Social and Emotional Skills (SSES), assessing social-emotional skills of 10- and 15-year-olds (n=60,985) across ten cities in nine countries: the United States (Houston), Canada (Ottawa), Russia (Moscow), Finland (Helsinki), Portugal (Sintra), Turkey (Istanbul), China (Suzhou), South Korea (Daegu), and Colombia (Bogotá and Manizales). Fifteen skills were examined, including assertiveness, cooperation, creativity, curiosity, emotional control, empathy, energy, optimism, persistence, responsibility, self-control, sociability, stress resistance, tolerance, and trust. Using network analysis, this study identified that cooperation and optimism were consistently among the most central skills, although the degree of their centrality varied across different age groups and cities. In contrast, energy showed weaker connections to other skills among 10-year-olds but stronger connections among 15-year-old in every city. The networks of children and adolescents differed in overall structure and in the global strength of skill interconnections, both in cross-city and most city-specific comparisons. The transition from childhood to adolescence is marked not only by differences in the importance of specific skills, but also by changes in the interactions among them.
69A Core Components Framework for Evaluating Implementation of Competency-Based Medical Education Programs.PubMed
Elaine Van Melle, Jason R Frank, Eric S Holmboe, et al.
Acad Med. 2019 Jul;94(7):1002-1009. doi: 10.1097/ACM.0000000000002743.
PURPOSE: The rapid adoption of competency-based medical education (CBME) provides an unprecedented opportunity to study implementation. Examining "fidelity of implementation"-that is, whether CBME is being implemented as intended-is hampered, however, by the lack of a common framework. This article details the development of such a framework. METHOD: A two-step method was used. First, a perspective indicating how CBME is intended to bring about change was described. Accordingly, core components were identified. Drawing from the literature, the core components were organized into a draft framework. Using a modified Delphi approach, the second step examined consensus amongst an international group of experts in CBME. RESULTS: Two different viewpoints describing how a CBME program can bring about change were found: production and reform. Because the reform model was most consistent with the characterization of CBME as a transformative innovation, this perspective was used to create a draft framework. Following the Delphi process, five core components of CBME curricula were identified: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment. With some modification in wording, consensus emerged amongst the panel of international experts. CONCLUSIONS: Typically, implementation evaluation relies on the creation of a specific checklist of practices. Given the ongoing evolution and complexity of CBME, this work, however, focused on identifying core components. Consistent with recent developments in program evaluation, where implementation is described as a developmental trajectory toward fidelity, identifying core components is presented as a fundamental first step toward gaining a more sophisticated understanding of implementation.
70Managing curriculum reform in the transition to competency-based education using entrustable professional activitiesPubMed
Fremen Chihchen Chou, Siobhan Fitzpatrick, David R. Taylor, et al.
Curriculum reform in health professions education is essential to address evolving societal expectations for healthcare. Competency-based education (CBE), advocated by leaders in healthcare such as the Lancet Commission and the World Health Organization, aims to bridge the gap between traditional training in the health professions and modern healthcare needs. This chapter outlines a comprehensive approach to curriculum reform, emphasizing the integration of change management for the human aspects and project management for the technical aspects, to ensure successful implementation. Drawing from different models, five essential themes to manage curriculum reform emerge: communication, iterative design, leadership, teamwork, evaluation and refinement. The transition to a CBE program based on entrustable professional activities (EPAs) necessitates a major curriculum reform that can be considered a systemic overhaul. This process involves planning, implementing, and monitoring changes while preparing and supporting stakeholders to embrace and sustain these changes. This chapter utilizes Van Melle’s core components framework of CBE to set the blueprint for an EPA-based curriculum, guiding the development of EPAs as training outcomes, creating tailored instruction and learning experiences to foster competency acquisition, and establishing programmatic assessment to inform entrustment progression. By leveraging international experiences and ensuring contextualization and localization, this chapter provides a robust framework to navigate the complexities of transitioning to CBE. The chapter concludes by presenting a practical, step-by-step method for managing curriculum reform through the phases of initiation, implementation, and sustainability. The principles and strategies outlined offer valuable insights for educational leaders, program directors, and policymakers aiming to effectively align education with healthcare practice.
71Empowering the Vulnerable: The Impact of SEL on Traumatized Children's Academic and Social Outcomes in Crises.PubMed
Anies Al-Hroub, Rawand Al-Hroub
Curr Psychiatry Rep. 2024 Dec;26(12):777-781. doi: 10.1007/s11920-024-01555-8. Epub 2024 Nov 11.
PURPOSE OF REVIEW: This article critically reviews the impact of Social and Emotional Learning (SEL) on traumatized children's academic and social outcomes, focusing on studies from the past three years across diverse contexts. It emphasizes the need for culturally sensitive, trauma-informed programs that cater to various settings, while also exploring the critical roles of parents and educators in SEL implementation. Additionally, the paper highlights challenges in deploying SEL in crisis-affected regions and offers strategies to address systemic barriers. RECENT FINDINGS: Recent studies show that SEL interventions significantly foster emotional regulation, resilience, empathy, and social integration, vital for personal well-being and successful social adaptation. However, the effect of SEL on academic performance, particularly in literacy and numeracy, remains inconsistent. Cultural adaptation of SEL programs is critical to their success, especially in non-Western settings, with a growing focus on trauma-informed approaches to address the needs of children affected by crises, including the COVID-19 pandemic. Despite these benefits, challenges such as resource limitations, lack of policy support, and the need for educator training continue to impede effective SEL implementation. SEL offers a vital framework for supporting traumatized children, particularly in crisis-affected regions. This review explores five key themes: the enhancement of emotional regulation and social integration, the necessity of cultural adaptation, the involvement of parents and educators, the challenges of implementing SEL in crisis contexts, and the importance of developing trauma-informed policies. The article also identifies future research directions, emphasizing the need for systemic reforms and culturally adapted SEL models.
72Mindfulness-based training effect on attention, impulsivity, and emotional regulation among children with ADHD: The role of family engagement in randomized controlled trials.PubMed
Nadia Waheed Elzohairy, Gehan Abdelslam Mahmoud Elzlbany, Basma Ibrahim Khamis, et al.
Arch Psychiatr Nurs. 2024 Dec;53:204-214. doi: 10.1016/j.apnu.2024.10.001. Epub 2024 Oct 9.
BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is among the most common psychiatric conditions affecting school-aged children, marked by diverse levels of inattention, hyperactivity, and impulsivity. Mindfulness-based training intervention throughout childhood enhances those symptoms, improving emotional regulation and well-being, hence improving their quality of life. AIM: To investigate the effects of mindfulness-based training on attention, impulsivity, and emotional regulation among children diagnosed with ADHD. DESIGN: A randomized controlled trial (RCT) was used to carry out this study. SETTING: This study was conducted at the outpatient Medical National Institute in Damanhur. The subjects were 60 children and their parents for the control and study groups (30 in each group). TOOLS: Researchers used three tools to collect the necessary data: Tool I, A Socio-demographic and Academic Data Questionnaire; Tool II, the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS); and Tool III, The Emotion Regulation Questionnaire. RESULTS: The difference in the level of attention, impulsivity, and emotional regulation between the study and control groups after the mindfulness-based training intervention was statistically significant. CONCLUSION: Mindfulness-based interventions are effective in improving inattention, impulsivity, and emotional regulation among children with ADHD and increasing their performance in all activities. RECOMMENDATIONS: Health care professionals should consider incorporating mindfulness-based techniques into standard treatment protocols for children with ADHD. Families should be educated about the benefits of mindfulness as family involvement appears to strengthen the effectiveness of these interventions. These programs should be accessible in schools, community centers, and therapeutic settings to guarantee general distribution. RCT: NCT06131190, Date: 11-9-2023.
73Mindfulness-based programs and school adjustment: A systematic review and meta-analysis.PubMed
Jessica Mettler, Bassam Khoury, Stephanie Zito, et al.
J Sch Psychol. 2023 Apr;97:43-62. doi: 10.1016/j.jsp.2022.10.007. Epub 2023 Jan 25.
Mindfulness-based programs (MBPs) are increasingly used in educational institutions to enhance students' mental health and resilience. However, reviews of the literature suggest this use may have outpaced the evidence base and further research is needed to better understand the mechanisms underlying these programs' effectiveness and which outcomes are being affected. The purpose of this meta-analysis was to investigate the strength of MBPs' effects on school adjustment and mindfulness outcomes while also considering the potential influence of study and program characteristics, including the role of comparison groups, students' educational level, the type of program being used, and the facilitator's training and previous mindfulness experience. Following a systematic review of five databases, 46 studies using a randomized controlled design with students from preschool to undergraduate levels were selected. At post-program, the effect of MBPs compared to control groups was (a) small for overall school adjustment outcomes, academic performance, and impulsivity; (b) small to moderate for attention; and (c) moderate for mindfulness. No differences emerged for interpersonal skills, school functioning, or student behaviour. The effects of MBPs on overall school adjustment and mindfulness differed based on students' educational level and the type of program being delivered. Moreover, only MBPs delivered by outside facilitators with previous experience of mindfulness had significant effects on either school adjustment or mindfulness. This meta-analysis provides promising evidence of the effectiveness of MBPs in educational contexts to improve students' school adjustment outcomes beyond typically assessed psychological benefits, even when using randomized controlled designs.
74Being present at school: implementing mindfulness in schools.PubMed
Jeff Q Bostic, Michael D Nevarez, Mona P Potter, et al.
Child Adolesc Psychiatr Clin N Am. 2015 Apr;24(2):245-59. doi: 10.1016/j.chc.2014.11.010. Epub 2015 Jan 17.
Developmentally sensitive efforts to help students learn, practice, and regularly use mindfulness tactics easily and readily in and beyond the classroom are important to help them manage future stresses. Mindfulness emphasizes consciously focusing the mind in the present moment, purposefully, without judgment or attachment. Meditation extends this to setting aside time and places to practice mindfulness, and additionally, yoga includes physical postures and breathing techniques that enhance mindfulness and meditation. Several mindfulness programs and techniques have been applied in schools, with positive benefits reported. Some elements of these programs require modifications to be sensitive to the developmental state of the children receiving mindfulness training.
75A comparative study between mindfulness-enhanced exercise training with tai chi and resistance training for college students' mental health: Efficacy, trajectories, and mechanisms.PubMed
Ping Qu, Honghao Deng, Qian Cao, et al.
Appl Psychol Health Well Being. 2025 Dec;17(6):e70102. doi: 10.1111/aphw.70102.
Previous studies have demonstrated that mindfulness-enhanced exercise training (MEET) exerts positive effects on mental health of college students. This research aims to compare the similarities and differences in efficacy, trajectories of effects, and the underly mechanism between two distinct types of MEET, which integrates mindfulness practices with tai chi (MTC) or resistance training (MR). A total of 149 undergraduate students were randomly assigned to either the MTC or MR group. Participants attended 26 weekly sessions. Mindfulness, anxiety, and well-being were assessed at baseline, post-intervention, and 4-month follow-up, with 25 weekly measurements tracking temporal changes. Mixed analysis of variance (ANOVA) was used to evaluate intervention effects, while Hierarchical Linear Modeling (HLM) and Dynamic Structural Equation Modeling (DSEM) were used to analyze longitudinal trajectories and dynamic relationships. Mixed ANOVAs revealed that both interventions improved mindfulness and well-being and reduced anxiety, with benefits sustained at follow-up. HLM indicated linear improvement trajectories, reflecting cumulative gains. Interaction analyses revealed that MTC produced faster initial mindfulness improvements, whereas MR yielded stronger well-being gains in later phases. DSEM identified a bidirectional relationship: mindfulness reduced anxiety and enhanced well-being, while these changes reinforced mindfulness. These findings suggest that MEET enhances mental health in students regardless of exercise modality, supporting mindfulness as a flexible component of wellness programs.
76Breath-Focused Mindfulness and Compassion Training in Parent-Child Dyads: Pilot Intervention Study.PubMed
Satish Jaiswal, Jason Nan, Seth Dizon, et al.
JMIR Form Res. 2025 Jul 17;9:e69607. doi: 10.2196/69607.
BACKGROUND: Depression in children is a concerning societal issue and can be associated with poor academic performance, school dropout, and poor overall quality of life. Additionally, child depression is often associated with parallel stress and depression in parents. OBJECTIVE: This scenario highlights the urgent need for the development and implementation of accessible and scalable solutions that may cobenefit child and parent mental well-being. METHODS: This pilot study introduced "Cooperative Compassion" (CoCo), a parent-child cotraining digital application aimed at promoting mindfulness and compassion through brief, performance-adaptive sessions. A community sample of 24 parent-child dyads (children's mean age 9.5, SD 3.27 years; female: n=14, male: n=10; Asian: n=5, White: n=11, mixed race: n=7, other race: n=1; and parents' mean age 44.5, SD 6.5 years; 20 female: n=20, male: n=4; Asian: n=8, White: n=14, mixed race: n=2) of high average affluence socioeconomic scores participated in the study. These parent-child dyads completed 30 sessions of CoCo training over 3 months with baseline and postintervention assessments occurring within 2 weeks of training initiation or completion, respectively. UNLABELLED: The program was feasible, with 80% (n=19) of families completing over 90% (n=22) of sessions and providing positive feedback. Mental health assessments showed a nonsignificant effect in the expected direction in children's depression scores (Cohen d=-0.19; 95% CI -8.89 to 1.74; P=.07) and significant reductions in parental stress (d=-0.41; 95% CI -2.63 to -0.16; P=.02), anxiety (d=-0.47; 95% CI -2.67 to -0.20; P=.02), and depression (d=-0.50; 95% CI -3.25 to -0.08; P=.03), with sustained benefits at the 3-month follow-up. Parental mindfulness improvements were correlated with stress reduction (ρ=-0.45; P=.03). On an emotion bias task used as an objective assessment of cognition, children demonstrated improved processing speed after the intervention (d=0.54; 95% CI 0.012-0.083; P=.005), and a marginal improvement was also observed in parents (d=0.19; 95% CI -0.004 to 0.030; P=.05). Cortical source imaging of electroencephalographic recordings was acquired simultaneous to an attention-to-breathing assessment that showed significant reduction in task-related default mode network activity (d=-0.62; 95% CI -0.0096 to -0.0002; P=.01). CONCLUSIONS: Post-CoCo intervention decrease in default mode network activity on the attention-to-breath task in parent-child dyads may be indicative of cortical plasticity reflecting reduced mind-wandering and thereby, enhanced focus after training. The current promising behavioral and cognitive results suggest the need for a larger sample size and a randomized controlled study design. Overall, these findings highlight the potential for brief, digital mindfulness and compassion cotraining to improve family mental health and well-being.
77Addressing students' social and emotional needs: the role of mental health teams in schools.PubMed
Norris M Haynes
J Health Soc Policy. 2002;16(1-2):109-23. doi: 10.1300/j045v16n01_10.
Children in today's society face many stresses from a variety of sources that have a major impact on thier psychosocial adjustment and academic performance in school. These stressful events and thier consequences on the quality of life and academic success are particularly significant among low-income and ethnic minority students in American society. Many schools have adopted strategies to help students who are impacted by stressful life events to deal affectively with their problems in an attempt to reduce school failure and school dropout rates among these students. Most notable among these strategies are school-based mental health programs including the establishment of school-based mental health teams which seek to proactively address individual student concerns while improving the general climate of schools. The evidence seems to support the claim that these school-based services have a positive impact on students' social and emotional well-being as well as on their academic achievements. However, with more careful monitoring and much more consistent support from administrators and policy makers, these school-based approaches can more fully realize their potential to enhance the quality of life and to positively impact the future of many poor and ethnic minority students.
78Mental health needs in a large urban school district: Findings from a web-based survey.PubMed
Elizabeth Koschmann, Robin Jacob, Katja Robinson, et al.
Health Serv Res. 2022 Aug;57(4):830-841. doi: 10.1111/1475-6773.13924. Epub 2022 Mar 4.
OBJECTIVE: To explore the mental health needs of students, and the professional development and support needs of teachers and school health professionals, as a way to foster community engagement and help set priorities for a comprehensive school mental health system in the Detroit Public Schools Community District (DPSCD). SETTING: The study team surveyed all DPSCD staff in June 2019 and all students in grades 8-12 between October and December 2019. STUDY DESIGN: A descriptive study based on anonymous, web-based surveys focused on student trauma exposure and mental health symptoms, student mental health resource utilization, staff burnout, and professional development needs. DATA COLLECTION: All students (grades 8-12) and district staff were eligible to participate; the student survey was made available in six languages. Parents/guardians could opt children out; schools could exclude children unable to complete the survey independently. Student surveys were administered in school; staff surveys were sent via email. PRINCIPAL FINDINGS: Thirty-four percent of DPSCD students reported moderate/severe depression symptoms; 22% had seriously considered suicide in the past year. Rates exceed national averages; 37% of students with severe depression and 34% of those with suicidal ideation had not accessed mental health supports. Staff indicated high levels of burnout and substantial interest in learning about self-care strategies or coping with vicarious trauma. Over 75% of teachers and school mental health professionals expressed interest in learning about best practices for supporting students impacted by trauma or mental illness. CONCLUSIONS: A large number of DPSCD students are experiencing symptoms of depression and anxiety, and many students who need care are not accessing it. Addressing the mental health needs of students is a high priority for staff, but they need more training and support, as well as support for their own vicarious trauma and high levels of burnout.
79Reimagining Social and Emotional Supports in Schools for Immigrant Students: A Contextual and Structural Approach.PubMed
Roya Ijadi-Maghsoodi, Jocelyn I Meza, Lilian Bravo, et al.
Acad Pediatr. 2024 Jul;24(5S):32-41. doi: 10.1016/j.acap.2023.11.007.
Immigrant students and families experience disproportionate exposure to trauma, immigration-related stress, structural inequities, and poor access to mental health and social services which can lead to mental health inequities. Immigrant students and their families also have many strengths that can buffer potential negative mental health outcomes. Schools, which address social and emotional development in addition to academic achievement, are critical institutions that can play a unique role in enhancing the strengths and responding to the needs of immigrant students and families. In this review, we adapt the Behavioral Model for Vulnerable Populations to acknowledge the contextual and macro-level factors (e.g., relevant policies, environmental influences, and structural factors) and the predisposing, enabling, and need factors that immigrant students and families experience and impact access to school mental health and social services. We discuss school-based interventions that show efficacy for improving mental health outcomes and focus on addressing acculturative stress among immigrant students. We also discuss models to address social determinants of health need among immigrant students and families within schools, including the community schools model applied to immigrant students and families. We conclude this review by providing recommendations and strategies for pediatricians and schools to transform school-based supports for immigrant students and families and promote equitable outcomes. Our recommendations include incorporating multi-level school supports for addressing mental health, social need, and acculturative stress among immigrant students, along with reinforcing the strengths of immigrant students, and promoting school collaborations with pediatricians, school-based health centers, and trusted community partners.
80Mental health promotion and problem prevention in schools: what does the evidence say?PubMed
Katherine Weare, Melanie Nind
Health Promot Int. 2011 Dec;26 Suppl 1:i29-69. doi: 10.1093/heapro/dar075.
The European Union Dataprev project reviewed work on mental health in four areas, parenting, schools, the workplace and older people. The schools workpackage carried out a systematic review of reviews of work on mental health in schools from which it identified evidence-based interventions and programmes and extracted the general principles from evidence-based work. A systematic search of the literature uncovered 52 systematic reviews and meta-analyses of mental health in schools. The interventions identified by the reviews had a wide range of beneficial effects on children, families and communities and on a range of mental health, social, emotional and educational outcomes. The effect sizes associated with most interventions were generally small to moderate in statistical terms, but large in terms of real-world impacts. The effects associated with interventions were variable and their effectiveness could not always be relied on. The characteristics of more effective interventions included: teaching skills, focusing on positive mental health; balancing universal and targeted approaches; starting early with the youngest children and continuing with older ones; operating for a lengthy period of time and embedding work within a multi-modal/whole-school approach which included such features as changes to the curriculum including teaching skills and linking with academic learning, improving school ethos, teacher education, liaison with parents, parenting education, community involvement and coordinated work with outside agencies. Interventions were only effective if they were completely and accurately implemented: this applied particularly to whole-school interventions which could be ineffective if not implemented with clarity, intensity and fidelity. The implications for policy and practice around mental health in schools are discussed, including the suggestion of some rebalancing of priorities and emphases.