National trends in the prevalence of depression and suicidal ideation stratified by academic achievement among adolescents, 2006 to 2022 in South Korea

Although severe depression and suicidal ideation among adolescents could be driven by excessive academic competition, research on this problem is still insufficient. Therefore, this study aims to analyze the relationship between academic achievement, depression, and suicidal ideation based on large-scale data. This study utilized data from the nationwide Korea Youth Risk Behavior Web-based Survey conducted from 2006 to 2022, investigating a total of 1,138,802 adolescents. Weighted proportions with 95% confidence intervals (CIs) and crude numbers and percentages were utilized to analyze and present the results in various formats. To accurately assess the association of academic achievement with depression and suicidal ideation, weighted odds ratios and their 95% CIs were calculated using weighted logistic regression analysis. Compared to students with high academic achievement, those with moderate achievement showed a 1.12 (95% CI = 1.11–1.13) times higher risk of depression, while those with low achievement had a 1.54 (1.52–1.56) times higher risk. Similarly, students with low academic achievement had a 1.49 (95% CI = 1.47–1.51) times higher risk of suicidal ideation. The prevalence of both depression and suicidal ideation decreased before the coronavirus disease 2019 pandemic but steadily increased during the pandemic. Females experienced higher rates of depression in each academic achievement group (high: weighted odds ratio = 1.49 [95% CI = 1.46–1.52]; middle: 1.59 [1.56–1.63]; low: 1.72 [1.69–1.75]) and suicidal ideation (high: 1.60 [1.57–1.64]; middle: 1.63 [1.59–1.68]; low: 1.82 [1.78–1.86]) than males. This study suggests that academic achievement can be associated with depression and suicidal ideation. Therefore, implementing mental health and educational programs targeting students with lower academic achievement may be crucial.