Academic pressure and suicide risk among adolescents: a dual mediation model of depression and school cohesion

Suicide is a major global health challenge among adolescents. The aim of this study was to examine the hypothesis that academic pressure influences suicide risk both directly and indirectly through depression and school cohesion. A cross-sectional survey of middle and high school students was conducted from December 2020 to September 2021 via multistage stratified cluster random sampling techniques. Data were collected on socio-demographic characteristics, suicide risk, academic pressure, school cohesion using the Student Perceptions of School Cohesion Scale, and depressive symptoms using the Patient Health Questionnaire-9. A structural equation model (SEM) was then constructed. A total of 3489 adolescents were included in the analysis. The prevalence of suicide risk was 14% among this sample. Structural equation modeling revealed a significant total effect of academic pressure on suicide risk (B = 0.140, β = 0.201, p < 0.001). The direct pathway was significant (B = 0.065, β = 0.094, p < 0.001), accounting for 46.6% of the total effect. Indirect effects occurred through three mediation pathways: a) through depression alone: B = 0.054, β = 0.078, p < 0.001, accounting for 38.9% of the total effect, b) through school cohesion alone: B = 0.012, β = 0.017, p < 0.001, accounting for 8.4% of the total effect, c) through the dual mediation of school cohesion and depression: B = 0.009, β = 0.012, p < 0.001, accounting for 6.1% of the total effect. Sex differences were identified. Depression and school cohesion are important mediators between academic pressure and suicide risk in adolescents. Targeting school cohesion may be a key strategy to ameliorate detriment of academic pressure on suicide risk.