How school grades can affect mental health – particularly for girls
Schools increasingly rely on testing, grading and performance accountability. In England, Ofsted inspections and school league tables sharpen the focus on measurable performance. Similar developments have taken place in Sweden, where repeated reforms have introduced earlier and more detailed assessments.
Performance-driven school environments shape young people’s wellbeing. Yet despite frequent reforms to evaluation systems, their psychological consequences rarely take centre stage in policy debates.
Our new study connects these trends with rising youth mental health issues. Our research shows that earlier and more formal grading can increase clinically diagnosed mental health problems, particularly among girls.
Our research examined a Swedish reform introduced in 2012 that moved the start of formal grading from grade eight (around age 14) to grade six (around age 12). This meant official grades and clearer signals of relative performance arrived two years earlier than before.
To estimate the effects, we compared children born just before and just after the reform cut-off. Because exposure depended strictly on date of birth, students on either side were similar in background but differed in whether they received earlier grades. We also accounted for certain underlying trends across this time period, such as an overall increase in mental health diagnoses over time. Comparing cohorts in this way allows us to isolate whether earlier grading itself led to changes in mental health diagnoses.
Our analysis draws on nationwide linked education and health registers covering more than 520,000 children born between July 1992 and June 2000. We examined psychiatric diagnoses recorded in outpatient and inpatient care during the year students entered grade nine (the end of lower-secondary school).
Earlier grades affect girls’ mental health
Earlier grading increased diagnoses of depression and anxiety among girls, with the largest effects among girls whose academic achievement ranged from low to average. Effects for boys were smaller and less consistent.
Among girls, the share diagnosed with depression or anxiety increased from 1.4% to 2.0%. While the absolute change (0.6 percentage points) may appear modest, psychiatric diagnoses at this age are relatively uncommon. The change represents roughly a two-fifths increase compared with before the reform.
Our findings point to academic pressure and social comparison as likely reasons for this increase in mental health problems. Formal grades make performance more visible at a younger age, clearly signalling how a child ranks among their peers. At a stage when young people’s understanding of themselves is still developing, this may heighten their sensitivity to comparison and perceived failure.
One plausible explanation is greater sensitivity to performance feedback among girls. In earlier research, we found that when girls received grades more favourable than their measured performance would predict, their mental health improved. This suggests they may be particularly responsive to evaluative feedback, and therefore more vulnerable when grading intensifies.
Wider consequences
Our findings indicate that academic pressure may contribute to gender gaps in adolescent mental health. If girls are more likely to internalise the pressure and stress of academic evaluation, earlier grading may unintentionally widen the well-documented existing gender disparities in mental health.
Read more: Making sense of the widening gender mental health gap: what teenage girls told us
We do not argue that grading is inherently harmful. Grades can motivate, guide learning and inform parents and teachers. But timing and design matter. When evaluation becomes more formal earlier in schooling, unintended psychological costs can emerge alongside academic goals.
As grading systems continue to evolve, questions of timing and intensity deserve careful thought. Schools are not only institutions for measuring performance, but environments where young people form their identities. Designing education systems that support both learning and healthy development requires taking both aims seriously.
Education policy inevitably involves trade-offs. Systems designed to measure and raise standards also shape students’ daily experience. Our findings suggest that when policymakers move formal evaluation to younger ages, they should weigh mental health impacts alongside academic benefits.
Accountability policies should consider psychological effects. This does not mean abandoning grading, but evaluation systems should be sensitive to the development stage of students and accompanied by relevant support that helps students interpret feedback constructively.
Students respond differently to evaluation. Reforms that work well for some may create strain for others, particularly those already vulnerable to performance pressure. Monitoring wellbeing alongside academic outcomes can help identify unintended consequences early.
Anna Linder receives funding from the Swedish Research Council for Health, Working Life and Welfare and the Public Health Agency of Sweden.
Gawain Heckley currently receives funding from Swedish Research Council , Swedish Research Council for Health, Working Life and Welfare and Jan Wallanders och Tom Hedelius stiftelse.
Ulf Gerdtham receives funding from Swedish Council for Working Life and Social Research.