Failing an exam led to higher risk of psychological problems and substance abuse for students
A new study shows that pupils who failed the final exam in upper secondary school more often saw their GP with mental health problems afterwards. They were also less likely to complete upper secondary school and pursue higher education.
For many students, exams mean stress, sleep difficulties and stomach aches.
Young pupils and students feel fear and anxiety about looking stupid, about failing or not coping with the situation.
Now a new study from the Norwegian Institute of Public Health (NIPH) shows that failing an exam in the last year of upper secondary school can have serious consequences for adolescents.
Students who failed were 21 per cent more likely to see a GP due to psychological problems than those who received the lowest passing grade of 2.
The study was recently published in the scientific journal Child Development.
“Students who fail the final year of upper secondary school often fall behind their classmates by at least one year. This can contribute to an increased burden on their mental health,” says researcher Kathryn Christine Beck in a press release (in Norwegian) from the NIPH.
Beck is one of the researchers behind the new study.
She and her colleagues looked at students who had seen their GP after failing their Norwegian exam in upper secondary school. The pupils reported mental health issues like stress, anxiety, depression and sleep problems, but also substance abuse involving alcohol, drugs and medications.
Norwegian grading scale in upper secondary school
- 6 Outstanding competence in the subject
- 5 Very good competence in the subject
- 4 Good competence in the subject
- 3 Fairly good competence in the subject
- 2 Low level of competence in the subject
- 1 Very low level of competence in the subject
Pursued higher education less often
The researchers also found a link between failing the exam and not completing upper secondary school.
Youth who failed had a 57 per cent reduced probability of completing upper secondary school even five years after the exam, compared to pupils who scored a 2. This was the case despite the option open to all to take the exam again.
They were also less likely to pursue higher education within five years of taking the exam.
“These young people could have fewer opportunities when they enter the labour market without having completed upper secondary school, so the consequences of dropping out and for further education are particularly worrying,” Beck says in the press release.
Failing happens more often in written exams
The kind of exam a pupil is picked to take makes a difference, according to researchers at Statistics Norway (SSB).
In 2019, SSB researchers investigated the consequences of being selected for a written exam as compared to an oral exam in the second year of upper secondary school.
It turns out that pupils who had to take the written exam had more than 2.5 times the risk of failing.
“Sitting the exam is a mandatory requirement to complete upper secondary education, so having ‘bad luck’ in the exam selection has long-term consequences for weaker students,” say SSB researchers Martin Eckhoff Andresen and Sturla A. Løkken.
“Approximately half of the students who failed the written exam still don’t have a diploma from upper secondary school when they’re 25 years old,” Løkken said at the time.
Possible to compare
The researchers at the NIPH had a good reason to compare pupils who failed the written exam with pupils who scored a 2. It was important that the study participants performed relatively equally at school. This ruled out the differences being due to other factors, such as their abilities in schoolwork.
Most of the students also had similar family backgrounds, which means that the parents had the same level of education and immigration background.
Determining causality in observational studies like this one is not always easy. For example, might students have already had poor mental health before the exam, which was one of the reasons they failed the exam?
To check for this, the researchers looked at whether any differences showed up between the students who failed and those who got a 2 three years BEFORE they sat the exam.
“We found no significant differences between the groups when it came to the probability of receiving a psychiatric diagnosis from a doctor before the exam, but observed a significant difference only one year after the exam,” Beck said.
Pupils who usually got good grades
Beck and her colleagues also studied pupils who usually received good grades in the exam subjects.
When these students then failed the final exam, they faced even greater mental health challenges.
Among students with a GPA between 4 and 6 who failed the exam, 81 per cent had an increased likelihood of visiting a GP for mental health problems.
“These students might have had higher expectations for performing well on the exam, and failing could be a shock that leads to increased psychological distress,” says Beck.
18 052 pupils
The researchers used Norwegian national registry data when they investigated the connection between youth who failed the exam or earned a 2 and visits to a GP for mental health problems.
A total of 18 052 pupils were included in the study. Almost everyone sat for the exam in their last year of upper secondary school between 2006 and 2018.
Of all the students included in the study, exactly 6.82 per cent received a mental health diagnosis – regardless of their exam grade.
The researchers compared the pupils with exam grades of 2 and 1 and who had very similar family backgrounds and previous school performance.
21 per cent increase
Of the pupils who scored a 2, 7.8 per cent received a mental health diagnosis, compared to 9.4 per cent of those who failed the exam.
The difference between these two figures is 1.6 percentage points. After taking into account family background and previous school performance, this corresponds to approximately a 21 per cent increase in the probability of a mental health diagnosis.
This number is what researchers use when describing how much higher the probability is of getting a mental health diagnosis if you fail the exam.
“Decision-makers who want to improve young people's mental health and reduce dropout rates should explore alternatives to using exams as the only decisive means of assessment,” says Beck.
Kathryn Christine Beck et.al: Distressing testing: A propensity score analysis of high-stakes exam failure and mental health. Child Development. August 2023.