homeworks effect on students mental health

Is it time to get rid of homework? Mental health experts weigh in.

It's no secret that kids hate homework. And as students grapple with an ongoing pandemic that has had a wide range of mental health impacts, is it time schools start listening to their pleas about workloads?

Some teachers are turning to social media to take a stand against homework. 

Tiktok user @misguided.teacher says he doesn't assign it because the "whole premise of homework is flawed."

For starters, he says, he can't grade work on "even playing fields" when students' home environments can be vastly different.

"Even students who go home to a peaceful house, do they really want to spend their time on busy work? Because typically that's what a lot of homework is, it's busy work," he says in the video that has garnered 1.6 million likes. "You only get one year to be 7, you only got one year to be 10, you only get one year to be 16, 18."

Mental health experts agree heavy workloads have the potential do more harm than good for students, especially when taking into account the impacts of the pandemic. But they also say the answer may not be to eliminate homework altogether.

Emmy Kang, mental health counselor at Humantold , says studies have shown heavy workloads can be "detrimental" for students and cause a "big impact on their mental, physical and emotional health."

"More than half of students say that homework is their primary source of stress, and we know what stress can do on our bodies," she says, adding that staying up late to finish assignments also leads to disrupted sleep and exhaustion.

Cynthia Catchings, a licensed clinical social worker and therapist at Talkspace , says heavy workloads can also cause serious mental health problems in the long run, like anxiety and depression. 

And for all the distress homework  can cause, it's not as useful as many may think, says Dr. Nicholas Kardaras, a psychologist and CEO of Omega Recovery treatment center.

"The research shows that there's really limited benefit of homework for elementary age students, that really the school work should be contained in the classroom," he says.

For older students, Kang says, homework benefits plateau at about two hours per night. 

"Most students, especially at these high achieving schools, they're doing a minimum of three hours, and it's taking away time from their friends, from their families, their extracurricular activities. And these are all very important things for a person's mental and emotional health."

Catchings, who also taught third to 12th graders for 12 years, says she's seen the positive effects of a no-homework policy while working with students abroad.

"Not having homework was something that I always admired from the French students (and) the French schools, because that was helping the students to really have the time off and really disconnect from school," she says.

The answer may not be to eliminate homework completely but to be more mindful of the type of work students take home, suggests Kang, who was a high school teacher for 10 years.

"I don't think (we) should scrap homework; I think we should scrap meaningless, purposeless busy work-type homework. That's something that needs to be scrapped entirely," she says, encouraging teachers to be thoughtful and consider the amount of time it would take for students to complete assignments.

The pandemic made the conversation around homework more crucial 

Mindfulness surrounding homework is especially important in the context of the past two years. Many students will be struggling with mental health issues that were brought on or worsened by the pandemic , making heavy workloads even harder to balance.

"COVID was just a disaster in terms of the lack of structure. Everything just deteriorated," Kardaras says, pointing to an increase in cognitive issues and decrease in attention spans among students. "School acts as an anchor for a lot of children, as a stabilizing force, and that disappeared."

But even if students transition back to the structure of in-person classes, Kardaras suspects students may still struggle after two school years of shifted schedules and disrupted sleeping habits.

"We've seen adults struggling to go back to in-person work environments from remote work environments. That effect is amplified with children because children have less resources to be able to cope with those transitions than adults do," he explains.

'Get organized' ahead of back-to-school

In order to make the transition back to in-person school easier, Kang encourages students to "get good sleep, exercise regularly (and) eat a healthy diet."

To help manage workloads, she suggests students "get organized."

"There's so much mental clutter up there when you're disorganized. ... Sitting down and planning out their study schedules can really help manage their time," she says.

Breaking up assignments can also make things easier to tackle.

"I know that heavy workloads can be stressful, but if you sit down and you break down that studying into smaller chunks, they're much more manageable."

If workloads are still too much, Kang encourages students to advocate for themselves.

"They should tell their teachers when a homework assignment just took too much time or if it was too difficult for them to do on their own," she says. "It's good to speak up and ask those questions. Respectfully, of course, because these are your teachers. But still, I think sometimes teachers themselves need this feedback from their students."

More: Some teachers let their students sleep in class. Here's what mental health experts say.

More: Some parents are slipping young kids in for the COVID-19 vaccine, but doctors discourage the move as 'risky'

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More than two hours of homework may be counterproductive, research suggests.

A Stanford education researcher found that too much homework can negatively affect kids, especially their lives away from school, where family, friends and activities matter.   "Our findings on the effects of homework challenge the traditional assumption that homework is inherently good," wrote Denise Pope , a senior lecturer at the Stanford Graduate School of Education and a co-author of a study published in the Journal of Experimental Education .   The researchers used survey data to examine perceptions about homework, student well-being and behavioral engagement in a sample of 4,317 students from 10 high-performing high schools in upper-middle-class California communities. Along with the survey data, Pope and her colleagues used open-ended answers to explore the students' views on homework.   Median household income exceeded $90,000 in these communities, and 93 percent of the students went on to college, either two-year or four-year.   Students in these schools average about 3.1 hours of homework each night.   "The findings address how current homework practices in privileged, high-performing schools sustain students' advantage in competitive climates yet hinder learning, full engagement and well-being," Pope wrote.   Pope and her colleagues found that too much homework can diminish its effectiveness and even be counterproductive. They cite prior research indicating that homework benefits plateau at about two hours per night, and that 90 minutes to two and a half hours is optimal for high school.   Their study found that too much homework is associated with:   • Greater stress : 56 percent of the students considered homework a primary source of stress, according to the survey data. Forty-three percent viewed tests as a primary stressor, while 33 percent put the pressure to get good grades in that category. Less than 1 percent of the students said homework was not a stressor.   • Reductions in health : In their open-ended answers, many students said their homework load led to sleep deprivation and other health problems. The researchers asked students whether they experienced health issues such as headaches, exhaustion, sleep deprivation, weight loss and stomach problems.   • Less time for friends, family and extracurricular pursuits : Both the survey data and student responses indicate that spending too much time on homework meant that students were "not meeting their developmental needs or cultivating other critical life skills," according to the researchers. Students were more likely to drop activities, not see friends or family, and not pursue hobbies they enjoy.   A balancing act   The results offer empirical evidence that many students struggle to find balance between homework, extracurricular activities and social time, the researchers said. Many students felt forced or obligated to choose homework over developing other talents or skills.   Also, there was no relationship between the time spent on homework and how much the student enjoyed it. The research quoted students as saying they often do homework they see as "pointless" or "mindless" in order to keep their grades up.   "This kind of busy work, by its very nature, discourages learning and instead promotes doing homework simply to get points," said Pope, who is also a co-founder of Challenge Success , a nonprofit organization affiliated with the GSE that conducts research and works with schools and parents to improve students' educational experiences..   Pope said the research calls into question the value of assigning large amounts of homework in high-performing schools. Homework should not be simply assigned as a routine practice, she said.   "Rather, any homework assigned should have a purpose and benefit, and it should be designed to cultivate learning and development," wrote Pope.   High-performing paradox   In places where students attend high-performing schools, too much homework can reduce their time to foster skills in the area of personal responsibility, the researchers concluded. "Young people are spending more time alone," they wrote, "which means less time for family and fewer opportunities to engage in their communities."   Student perspectives   The researchers say that while their open-ended or "self-reporting" methodology to gauge student concerns about homework may have limitations – some might regard it as an opportunity for "typical adolescent complaining" – it was important to learn firsthand what the students believe.   The paper was co-authored by Mollie Galloway from Lewis and Clark College and Jerusha Conner from Villanova University.

Clifton B. Parker is a writer at the Stanford News Service .

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Health Hazards of Homework

March 18, 2014 | Julie Greicius Pediatrics .

A new study by the Stanford Graduate School of Education and colleagues found that students in high-performing schools who did excessive hours of homework “experienced greater behavioral engagement in school but also more academic stress, physical health problems, and lack of balance in their lives.”

Those health problems ranged from stress, headaches, exhaustion, sleep deprivation, weight loss and stomach problems, to psycho-social effects like dropping activities, not seeing friends or family, and not pursuing hobbies they enjoy.

In the Stanford Report story about the research, Denise Pope , a senior lecturer at the Stanford Graduate School of Education and a co-author of the  study published in the  Journal of Experimental Education , says, “Our findings on the effects of homework challenge the traditional assumption that homework is inherently good.”

The study was based on survey data from a sample of 4,317 students from 10 high-performing high schools in California communities in which median household income exceeded $90,000. Of the students surveyed, homework volume averaged about 3.1 hours each night.

“It is time to re-evaluate how the school environment is preparing our high school student for today’s workplace,” says Neville Golden, MD , chief of adolescent medicine at Stanford Medicine Children’s Health and a professor at the School of Medicine. “This landmark study shows that excessive homework is counterproductive, leading to sleep deprivation, school stress and other health problems. Parents can best support their children in these demanding academic environments by advocating for them through direct communication with teachers and school administrators about homework load.”

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Stanford research shows pitfalls of homework

A Stanford researcher found that students in high-achieving communities who spend too much time on homework experience more stress, physical health problems, a lack of balance and even alienation from society. More than two hours of homework a night may be counterproductive, according to the study.

Education scholar Denise Pope has found that too much homework has negative effects on student well-being and behavioral engagement. (Image credit: L.A. Cicero)

A Stanford researcher found that too much homework can negatively affect kids, especially their lives away from school, where family, friends and activities matter.

“Our findings on the effects of homework challenge the traditional assumption that homework is inherently good,” wrote Denise Pope , a senior lecturer at the Stanford Graduate School of Education and a co-author of a study published in the Journal of Experimental Education .

The researchers used survey data to examine perceptions about homework, student well-being and behavioral engagement in a sample of 4,317 students from 10 high-performing high schools in upper-middle-class California communities. Along with the survey data, Pope and her colleagues used open-ended answers to explore the students’ views on homework.

Median household income exceeded $90,000 in these communities, and 93 percent of the students went on to college, either two-year or four-year.

Students in these schools average about 3.1 hours of homework each night.

“The findings address how current homework practices in privileged, high-performing schools sustain students’ advantage in competitive climates yet hinder learning, full engagement and well-being,” Pope wrote.

Pope and her colleagues found that too much homework can diminish its effectiveness and even be counterproductive. They cite prior research indicating that homework benefits plateau at about two hours per night, and that 90 minutes to two and a half hours is optimal for high school.

Their study found that too much homework is associated with:

• Greater stress: 56 percent of the students considered homework a primary source of stress, according to the survey data. Forty-three percent viewed tests as a primary stressor, while 33 percent put the pressure to get good grades in that category. Less than 1 percent of the students said homework was not a stressor.

• Reductions in health: In their open-ended answers, many students said their homework load led to sleep deprivation and other health problems. The researchers asked students whether they experienced health issues such as headaches, exhaustion, sleep deprivation, weight loss and stomach problems.

• Less time for friends, family and extracurricular pursuits: Both the survey data and student responses indicate that spending too much time on homework meant that students were “not meeting their developmental needs or cultivating other critical life skills,” according to the researchers. Students were more likely to drop activities, not see friends or family, and not pursue hobbies they enjoy.

A balancing act

The results offer empirical evidence that many students struggle to find balance between homework, extracurricular activities and social time, the researchers said. Many students felt forced or obligated to choose homework over developing other talents or skills.

Also, there was no relationship between the time spent on homework and how much the student enjoyed it. The research quoted students as saying they often do homework they see as “pointless” or “mindless” in order to keep their grades up.

“This kind of busy work, by its very nature, discourages learning and instead promotes doing homework simply to get points,” Pope said.

She said the research calls into question the value of assigning large amounts of homework in high-performing schools. Homework should not be simply assigned as a routine practice, she said.

“Rather, any homework assigned should have a purpose and benefit, and it should be designed to cultivate learning and development,” wrote Pope.

High-performing paradox

In places where students attend high-performing schools, too much homework can reduce their time to foster skills in the area of personal responsibility, the researchers concluded. “Young people are spending more time alone,” they wrote, “which means less time for family and fewer opportunities to engage in their communities.”

Student perspectives

The researchers say that while their open-ended or “self-reporting” methodology to gauge student concerns about homework may have limitations – some might regard it as an opportunity for “typical adolescent complaining” – it was important to learn firsthand what the students believe.

The paper was co-authored by Mollie Galloway from Lewis and Clark College and Jerusha Conner from Villanova University.

Opinion | Social-Emotional Learning

If we’re serious about student well-being, we must change the systems students learn in, here are five steps high schools can take to support students' mental health., by tim klein and belle liang     oct 14, 2022.

Shutterstock / SvetaZi

Educators and parents started this school year with bated breath. Last year’s stress led to record levels of teacher burnout and mental health challenges for students.

Even before the pandemic, a mental health crisis among high schoolers loomed. According to a survey administered by the Centers for Disease Control and Prevention in 2019, 37 percent of high school students said they experienced persistent sadness or hopelessness and 19 percent reported suicidality. In response, more than half of all U.S. states mandated that schools have a mental health curriculum or include mental health in their standards .

As mental health professionals and co-authors of a book about the pressure and stress facing high school students, we’ve spent our entire careers supporting students’ mental health. Traditionally, mental health interventions are individualized and they focus on helping students manage and change their behaviors to cope with challenges they’re facing. But while working with schools and colleges across the globe as we conducted research for our book , we realized that most interventions don’t address systemic issues causing mental health problems in the first place.

It’s time we acknowledge that our education systems are directly contributing to the youth mental health crisis. And if we are serious about student well-being, we must change the systems they learn in.

Here are five bold steps that high schools can take to boost mental health.

Limit Homework or Make it Optional

Imagine applying for a job, and the hiring manager informs you that in addition to a full workday in the office, you’ll be assigned three more hours of work every night. Does this sound like a healthy work-life balance? Most adults would consider this expectation ridiculous and unsustainable. Yet, this is the workload most schools place on high school students.

Research shows that excessive homework leads to increased stress, physical health problems and a lack of balance in students' lives. And studies have shown that more than two hours of daily homework can be counterproductive , yet many teachers assign more.

Homework proponents argue that homework improves academic performance. Indeed, a meta-analysis of research on this issue found a correlation between homework and achievement. But correlation isn’t causation. Does homework cause achievement or do high achievers do more homework? While it’s likely that homework completion signals student engagement, which in turn leads to academic achievement, there’s little evidence to suggest that homework itself improves engagement in learning.

Another common argument is that homework helps students develop skills related to problem-solving, time-management and self-direction. But these skills can be explicitly taught during the school day rather than after school.

Limiting homework or moving to an optional homework policy not only supports student well-being, but it can also create a more equitable learning environment. According to the American Psychological Association, students from more affluent families are more likely to have access to resources such as devices, internet, dedicated work space and the support necessary to complete their work successfully—and homework can highlight those inequities .

Whether a school limits homework or makes it optional, it’s critical to remember that more important than the amount of homework assigned, is designing the type of activities that engage students in learning. When students are intrinsically motivated to do their homework, they are more engaged in the work, which in turn is associated with academic achievement.

Cap the Number of APs Students Can Take

Advanced Placement courses give students a taste of college-level work and, in theory, allow them to earn college credits early. Getting good grades on AP exams is associated with higher GPAs in high school and success in college, but the research tends to be correlational rather than causational.

In 2008, a little over 180,000 students took three or more AP exams. By 2018, that number had ballooned to almost 350,000 students .

However, this expansion has come at the expense of student well-being.

Over the years, we’ve heard many students express that they feel pressure to take as many AP classes as possible, which overloads them with work. That’s troubling because studies show that students who take AP classes and exams are twice as likely to report adverse physical and emotional health .

AP courses and exams also raise complex issues of equity. In 2019, two out of three Harvard freshmen reported taking AP Calculus in high school, according to Jeff Selingo, author of “ Who Gets In and Why: A Year Inside College Admissions ,” yet only half of all high schools in the country offer the course. And opportunity gaps exist for advanced coursework such as AP courses and dual enrollment, with inequitable distribution of funding and support impacting which students are enrolling and experiencing success. According to the Center for American Progress, “National data from the Civil Rights Data Collection show that students who are Black, Indigenous, and other non-Black people of color (BIPOC) are not enrolled in AP courses at rates comparable to their white and Asian peers and experience less success when they are—and the analysis for this report finds this to be true even when they attend schools with similar levels of AP course availability.”

Limiting the number of AP courses students take can protect mental health and create a more equitable experience for students.

Eliminate Class Rankings

In a study we conducted about mental health problems among high school girls, we found that a primary driver of stress was their perception of school as a hypercompetitive, zero-sum game where pervasive peer pressure to perform reigns supreme.

Class rankings fuel these cutthroat environments. They send a toxic message to young people: success requires doing better than your peers.

Ranking systems help highly selective colleges decide which students to admit or reject for admission. The purpose of high school is to develop students to their own full potential, rather than causing them to fixate on measuring up to others. Research shows that ranking systems undercut students’ learning and damage social relationships by turning peers into opponents.

Eliminating class rankings sends a powerful message to students that they are more than a number.

Become an Admission Test Objector

COVID-19 ushered in the era of test-optional admissions. De-centering standardized tests in the college application process is unequivocally a good thing. Standardized tests don’t predict student success in college , they only widen the achievement gap between privileged and underprivileged students and damage students' mental health .

Going “test optional” is an excellent first step, but it's not enough.

Even as more colleges have made tests optional, affluent students submit test scores at a higher rate than their lower-income peers and are admitted at higher rates , suggesting that testing still gives them an edge.

High schools must adhere to standardized test mandates, but they don’t have to endorse them. They can become test objectors by publicly proclaiming that these tests hold no inherent value. They can stop teaching to the test and educate parents on why they are doing so. Counseling departments can inform colleges that their school is a test objector so admission teams won’t penalize students.

Of course, students and families will still find ways to wield these tests as a competitive advantage. Over time, the more schools and educators unite to denounce these tests, the less power they will hold over students and families.

Big change starts with small steps.

Stand For What You Value

Critics may argue that such policies might hurt student outcomes. How will colleges evaluate school rigor if we limit AP courses and homework? How will students demonstrate their merits without class rankings and standardized test scores?

The truth is, the best school systems in the world succeed without homework, standardized test scores or an obsession with rigorous courses. And many U.S. schools have found creative and empowering ways to showcase student merit beyond rankings and test scores.

If we aren’t willing to change policies and practices that have been shown to harm students’ well-being, we have to ask ourselves: Do we really value mental health?

Thankfully, it doesn’t have to be an either/or scenario: We can design school systems that help students thrive academically and psychologically.

Belle Liang and Tim Klein are mental health professionals and co-authors of “How To Navigate Life: The New Science of Finding Your Way in School, Career and Life.”

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Barriers Associated with the Implementation of Homework in Youth Mental Health Treatment and Potential Mobile Health Solutions

Brian e. bunnell.

1 Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA

2 Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, USA

Lynne S. Nemeth

3 Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, SC, USA

Leslie A. Lenert

Nikolaos kazantzis.

4 Cognitive Behavior Therapy Research Unit and School of Psychological Sciences, Monash University, Clayton, VIC, Australia

Esther Deblinger

5 Child Abuse Research Education & Service (CARES) Institute, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA

Kristen A. Higgins

Kenneth j. ruggiero.

6 Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, USA

Author Contributions

Associated Data

Background:.

Homework, or between-session practice of skills learned during therapy, is integral to effective youth mental health TREATMENTS. However, homework is often under-utilized by providers and patients due to many barriers, which might be mitigated via m Health solutions.

Semi-structured qualitative interviews were conducted with nationally certified trainers in Trauma Focused Cognitive Behavioral Therapy (TF-CBT; n =21) and youth TF-CBT patients ages 8–17 ( n =15) and their caregivers ( n =12) to examine barriers to the successful implementation of homework in youth mental health treatment and potential m Health solutions to those barriers.

The results indicated that many providers struggle to consistently develop, assign, and assess homework exercises with their patients. Patients are often difficult to engage and either avoid or have difficulty remembering to practice exercises, especially given their busy/chaotic home lives. Trainers and families had positive views and useful suggestions for m Health solutions to these barriers in terms of functionality (e.g., reminders, tracking, pre-made homework exercises, rewards) and user interface (e.g., easy navigation, clear instructions, engaging activities).

Conclusions:

This study adds to the literature on homework barriers and potential m Health solutions to those barriers, which is largely based on recommendations from experts in the field. The results aligned well with this literature, providing additional support for existing recommendations, particularly as they relate to treatment with youth and caregivers.

Introduction

Homework, or between-session practice of skills learned during therapy, is one of the most integral, yet underutilized components of high-quality, evidence-based mental health care ( Kazantzis & Deane, 1999 ). Homework activities (e.g., self-monitoring, relaxation, exposure, parent behavior management) are assigned by providers in-session and completed by patients between sessions with the goal of “practicing” therapeutic skills in the environment where they will be most needed ( Kazantzis, Deane, Ronan, & L’Abate, 2005 ). There are numerous benefits to the implementation of homework during mental health treatment ( Kazantzis et al., 2016 ; Kazantzis, Deane, & Ronan, 2004 ). Homework enables the generalization of skills and behaviors learned during therapy, facilitates treatment processes, provides continuity between sessions, allows providers to better grasp patients’ learning, and strengthens that learning, leading to improved maintenance of treatment gains ( Hudson & Kendall, 2002 ; Scheel, Hanson, & Razzhavaikina, 2004 ). Meta-analytic and systematic reviews have shown that homework use by providers and adherence by patients predict increased treatment engagement, decreased treatment dropout, and medium-to-large effects on improvements in clinical outcomes for use (Cohen’s d =.48–.77) and adherence ( d =.45–.54) ( Hudson & Kendall, 2002 ; Kazantzis, Deane, & Ronan, 2000 ; Kazantzis & Lampropoulos, 2002 ; Kazantzis, Whittington, & Dattilio, 2010 ; Mausbach, Moore, Roesch, Cardenas, & Patterson, 2010 ; Scheel et al., 2004 ; Sukhodolsky, Kassinove, & Gorman, 2004 ). Simply put, 68% vs . 32% of patients can be expected to improve when therapy involves homework ( Kazantzis et al., 2010 ).

Despite its many benefits, homework is implemented with variable effectiveness in mental health treatment. Only 68% of general mental health providers and ~55% of family providers report using homework “often” to “almost always” ( Dattilio, Kazantzis, Shinkfield, & Carr, 2011 ; Kazantzis, Lampropoulos, & Deane, 2005 ). Further, providers report using homework in an average of 57% of sessions, although this rate is higher for CBT practitioners (66%) vs . non-CBT practitioners (48%). Moreover, only 25% of providers report using expert recommended systematic procedures for recommending homework (i.e., specifying frequency, duration, and location; writing down homework assignments for patients) ( Kazantzis & Deane, 1999 ). A national survey revealed that 93% or general mental health providers estimate rates of patient adherence to homework to be low to moderate ( Kazantzis, Lampropoulos, et al., 2005 ), and research studies report low to moderate rates of youth/caregiver adherence during treatment (i.e., ~39–63%; ( Berkovits, O’Brien, Carter, & Eyberg, 2010 ; Clarke et al., 1992 ; Danko, Brown, Van Schoick, & Budd, 2016 ; Dattilio et al., 2011 ; Gaynor, Lawrence, & Nelson-Gray, 2006 ; Helbig & Fehm, 2004 ; Lyon & Budd, 2010 ; Simons et al., 2012 ).

Numerous barriers to the successful implementation of homework during mental health treatment have largely been suggested by experts in the field, rather than specifically measured ( Dattilio et al., 2011 ), and have generally been classified as occurring on the provider-, patient-, task-, and environmental-level ( Kazantzis & Shinkfield, 2007 ). Provider-level barriers can relate to the therapeutic relationship and the degree to which a collaborative approach is used, provider beliefs about homework and the patient’s adherence, and providers’ ability to effectively design homework tasks ( Callan et al., 2012 ; Coon, Rabinowitz, Thompson, & Gallagher-Thompson, 2005 ; Friedberg & Mcclure, 2005 ; Garland & Scott, 2002 ; Kazantzis & Shinkfield, 2007 ). Patient-level barriers can include patient avoidance and symptomatology, negative beliefs toward the task, not understanding the rationale or how to do the task, forgetting, and beliefs about their ability to complete homework tasks. ( Bru, Solholm, & Idsoe, 2013 ; Callan et al., 2012 ; Dattilio et al., 2011 ; Friedberg & Mcclure, 2005 ; Garland & Scott, 2002 ; Hudson & Kendall, 2005 ; Kazantzis & Shinkfield, 2007 ; Leahy, 2002 ). Relatedly, core beliefs central to the patients’ psychopathology can be activated during homework–thereby triggering withdrawal and avoidance patterns ( Kazantzis & Shinkfield, 2007 ). Task-level barriers include poor match between tasks and therapy goals, tasks that are perceived as vague or unclear, tasks that are perceived as too difficult or demanding in terms of time or effort, tasks being viewed as boring, and general aversiveness of the idea of completing homework ( Bru et al., 2013 ; Callan et al., 2012 ; Dattilio et al., 2011 ; Friedberg & Mcclure, 2005 ; Garland & Scott, 2002 ; Hudson & Kendall, 2005 ). Environmental factors have been noted to include practical obstacles, lack of family/caregiver support, dysfunctional home environments, lack of time due to busy schedules, and lack of reward or reinforcement ( Callan et al., 2012 ; Dattilio et al., 2011 ; Hudson & Kendall, 2005 ).

The advancement and ubiquitousness of technologies such as m Health resources (e.g., mobile- and web-based apps) provide a tremendous opportunity to overcome barriers to homework use and adherence and resultantly, improve the quality of mental health treatment. m Health solutions to improve access and quality of care, have been widely investigated, are effective in facilitating behavior change, practical, desired by patients and providers, and available at low cost ( Amstadter, Broman-Fulks, Zinzow, Ruggiero, & Cercone, 2009 ; Boschen & Casey, 2008 ; Donker et al., 2013 ; Ehrenreich, Righter, Rocke, Dixon, & Himelhoch, 2011 ; Hanson et al., 2014 ; Heron & Smyth, 2010 ; Krebs & Duncan, 2015 ; Luxton, McCann, Bush, Mishkind, & Reger, 2011 ; Ruggiero, Saunders, Davidson, Cook, & Hanson, 2017 ). Existing m Health resources include features that can support homework implementation (e.g., voice and SMS reminders and feedback, self-monitoring and assessment, and modules and activities that can be used to facilitate between-session practice; Bakker, Kazantzis, Rickwood, & Rickard, 2016 ; Tang & Kreindler, 2017 ), but these resources were not designed with the express intention of addressing barriers to homework implementation, particularly for youth and family patient populations.

The extant literature on barriers to homework implementation is limited in that it is largely based on expert recommendations. Therefore, the first aim of this study was to explore provider, youth, and caregiver patient perspectives on barriers to the successful implementation of homework during youth mental health treatment. Further, m Health solutions to those barriers have not been explored, especially for youth and family patients. Thus, the second and third aims of this study were to obtain suggestions for m Health solutions to homework barriers and explore perceptions on the benefits and challenges associated with those m Health solutions.

Institutional Review Board approval was obtained prior to enrolling any participants in the study. The approach for this study was based on the constructivist grounded theory, which acknowledges the researcher’s prior knowledge and influence in the process and supports and guides conceptual framework development to understand interrelations between constructs ( Charmaz, 2006 ). This qualitative study used a thematic analysis of semi-structured interviews in a sample of nationally certified trainers in Trauma-Focused Cognitive Behavioral Therapy (TFCBT; Cohen, Mannarino, & Deblinger, 2017 ), youth who had engaged in TF-CBT, and their caregivers. The initial goal was to conduct interviews with 15–20 interviewees in each group to achieve theoretical saturation (i.e., no new information was derived), consistent with a prior study by members of the research team which used similar semi-structured interviews with national TF-CBT trainers ( Hanson et al., 2014 ), and recommendations by Morse (2000) given the relatively narrow scope and clear nature of the study. Interviews were conducted until interviewers and the study lead determined that no new pertinent information was being obtained.

Participants

National trainers..

Twenty-one national trainers in TF-CBT were interviewed. National trainers are mental health providers who completed a 15-month TF-CBT Train-the-Trainer program led by the TF-CBT developers. Trainers work extensively with numerous community mental health providers to problem-solve common barriers to clinical practice and thus, provide a unique perspective on the barriers to successful homework implementation and possible m Health solutions to those barriers. An e-mail invitation was sent to a list of approved TF-CBT trainers. Twenty-four trainers responded to this e-mail, 22 of whom agreed to participate in an interview, one of whom was unreachable after initial scheduling. Interviews were completed with a total of 21 trainers, who received a $25 gift card in compensation for their time.

Trainers had been treating children for an average of 23.29 years ( SD =8.80) and had been training providers for an average of 14.95 years ( SD =8.98). In the year prior to the interview, they led an average of 17 provider trainings ( SD =21.67) and trained roughly 345 providers ( SD =339.90). All trainers were licensed, and the majority were Clinical Psychologists (47.6%) and Social Workers (33.3%). The average age of trainers was 47.48 years ( SD =13.63) and the majority were female (71.4%), white (95.2%), and non-Hispanic/Latino (85.7%; see Table 1 ).

Trainer Demographics

Twelve families were interviewed for this study. Families were included if they had one or more youth between the ages of 8 and 17 years-of-age and a caregiver who had engaged in at least four sessions for TF-CBT. These criteria were chosen because TF-CBT is typically recommended for youth between the ages of 8 and 17 years-of-age and it was estimated that four sessions would have likely allowed for adequate time for patients to have received homework assignments, consistent with the authors’ experience and prior TF-CBT literature ( Deblinger, Pollio, & Dorsey, 2016 ; Scheeringa, Weems, Cohen, Amaya-Jackson, & Guthrie, 2011 ). Families were recruited via advertisements online and at local community mental health clinics, and from a participant pool from a prior study ( Davidson et al., 2019 ). Twenty-nine families initially expressed interest in participating in the study. Six families were ineligible because they had not received TF-CBT and contact was lost with six families after their initial contact. Seventeen families were scheduled for an interview, five of which were unreachable after initially being scheduled, and interviews were completed with 12 families. Written informed consent from caregivers and assent from youth above the age of 15 were obtained in-person for four families and via a telemedicine-based teleconsent platform (i.e., https://musc.doxy.me ) for eight families. Families received a $30 gift card in compensation for their time.

A total of 15 youth who had engaged in TF-CBT, and their caregivers ( n =12; three families had two youth who had received treatment) were interviewed. Six youth were still in treatment at the time of their interview and nine had finished treatment an average of 49 weeks ( SD =42.32) prior to the interview. The average age of youth was 13.20 years ( SD =3.19), roughly half were female (53.3%), the majority were white (80%), and all were non-Hispanic/Latino. The average age of caregivers was 44.83 years ( SD =7.90), 66.7% were female, and all were White and non-Hispanic/Latino. Youth and caregivers rated their comfort with technology, in general, on a 10-point Likert scale (i.e., 1–10) with higher scores representing higher levels of comfort. Youth reported being very comfortable with technology (M=9.62, SD =1.12), as did their caregivers (M=7.83, SD =2.63; see Table 2 ).

Family Demographics

Trauma-Focused Cognitive Behavioral Therapy

TF-CBT is a well-established and widely disseminated mental health treatment ( Cohen et al., 2017 ; Deblinger, Mannarino, Cohen, Runyon, & Steer, 2011 ; Silverman et al., 2008 ; Wethington et al., 2008 ). It is a conjoint youth-caregiver mental health treatment typically conducted over ~12, 90-minute sessions that address nine major treatment components (i.e., P sychoeducation; P arenting Skills; R elaxation Skills; A ffective Expression and Modulation Skills; C ognitive Coping and Processing Skills; T rauma Narration and Processing; I n Vivo Exposure; C onjoint Child Parent Activities; and E nhancing Future Safety and Development). TF-CBT also addresses a broad range of symptom domains including trauma- and stress-related disorders, disruptive behavior disorders/behaviors, depression/depressive symptoms, and anxiety disorders ( Cohen et al., 2017 ). TF-CBT was chosen as a model treatment for this study because of its broad symptom focus, inclusion of treatment components used in a variety of youth mental health treatments, and involvement of youth and their caregivers, offering potential to improve the applicability of the study’s results to a range of youth mental health treatment approaches.

Procedures for Data Collection

Interviews were conducted via telephone for trainers, and either in-person or via telephone for families based on their preference. A postdoctoral fellow and masters-level research assistant conducted the interviews, which were audio-recorded and transcribed using a professional transcription service. Interviews included three major components. The first component included demographic questions. The second included a brief orientation to the goal of the study, which was to develop a new technology-based resource to help providers and patients during the implementation of homework during mental health treatment. The third component included questions that aimed to assess perspectives on barriers to homework implementation, elicit suggestions for m Health solutions to those barriers, and examine perceptions on the benefits and challenges associated with m Health solutions to homework barriers. The average duration of interviews was 41 minutes for trainers and 37 minutes for families. See Supplementary Materials for complete interviews.

Data Analysis

Transcribed interviews were coded using NVivo qualitative analysis software. NVivo was used to identify common themes (nodes) as they related to (1) patient-, provider-, task-, and environmental-barriers to homework implementation, (2) suggestions for m Health solutions to homework barriers, and (3) benefits and challenges associated with m Health homework solutions. Initial and secondary coding passes were conducted to identify and refine theme classifications as they emerged and impose a data-derived hierarchy to the nodes identified. Focused coding was used to refine the coding and ensure that data were coded completely with minimal redundancy ( Miles & Huberman, 1994 ). Themes were initially proposed by the first author and reviewed by an expert in qualitative and mixed methods research (the second author) and an internationally recognized expert in the implementation of homework and related barriers during CBT (the fourth author). Divergent perspectives on theme descriptions ( n =2) and classifications ( n =1) were compared until agreement was reached.

Results are organized by the main topics explored in this study, including: 1) barriers to the successful implementation of homework, coded on provider, patient, task, and environmental levels; 2) potential m Health solutions to those homework barriers; and 3) perceived benefits and challenges of those potential m Health solutions. Results within each of these topics are presented first from the perspectives of trainers and second from the perspectives of families.

Barriers to the Successful Implementation of Homework

Trainer perspectives..

As displayed in Table 3 , trainers identified several barriers to homework implementation on the provider-, patient-, task-, and environmental-level.

Trainer Perspectives on Homework Barriers

Provider-Level Barriers.

Many trainers felt that providers tend to have difficulty engaging patients in assigned tasks, leading some providers to become discouraged by low levels of engagement. As stated by one trainer,

“I think they recognize that [homework assignments] do have value, but in terms of what I feel, a lot of clinicians are not having success with families completing homework, so it’s diminishing the sense of value…something they’ve tried to put into place and they are not feeling there’s any success in it.”

Trainers also noted that many providers do not see homework as an integral part of therapy. One trainer commented,

“I think there are a lot of concrete barriers, but to me probably the biggest barrier will be the–I think that still to this day [providers] like to think that therapy happens in that one hour.”

Other interrelated difficulties faced by providers related to their capacity to effectively and consistently develop, assess, and assign meaningful and patient-centered homework exercises.

As stated by one trainer,

“I see a lot of that just shooting from the hip, kind of off the cuff, ‘let’s do this,’ but yet, it’s not backed by anything concrete or tangible…I think probably one of the biggest pieces again is the failure on the clinician’s part to follow that up and too often review it at the end of the session.”

Another said,

“I think clinicians don’t always appreciate how hard it is to actually do homework that requires you to make some behavioral change.”

Barriers also related to providers’ time and resources for implementing homework, as conveyed by one trainer’s comment,

“I mean, these people…every minute of every day is filled up with doing, billing, writing, charting, going to meetings, getting supervision, and seeing patients, and then they go home exhausted.”

Patient-Level Barriers.

Many trainers stated that, similar to some providers, patients often do not see homework as an important part of therapy. Put by one trainer,

“I think that some [patients] just feel that coming to the session is enough and that should resolve everything, and that you know, doing homework is just kind of an extra thing…I don’t really need to do it to benefit from the therapy.”

Perhaps relatedly, trainers also noted that patients generally forget to do homework assignments, and often forget why, how, when, and where assignments should be done.

Task-Level Barriers.

Task-level barriers noted by trainers included assignments not always aligning with patient values or treatment goals and that the term ‘homework’ being aversive to patients of all ages. One trainer commented,

“I think it has to be something that [patients] see the value in. And again, we go back to that engagement and them trusting you as well as you explaining to them why this could be helpful…If it didn’t help, we need to change it.”

Another trainer laughed while stating,

“when we use the word homework, we might as well just throw a stink bomb in the room.”

Environmental-Level Barriers.

Finally, on the environmental-level, many trainers suggested that patients’ home lives are busy and chaotic, leaving little-to-no time for homework.

Explained by one trainer,

“I think that for parents…they have many other things in their life; work, parenting, partnerships that they are working on, just day to day chores or things that they have to do in terms of their family or other responsibilities. So, [homework] often feels like, I think for families, to add another thing…it just feels like a lot.”

Associated barriers included limited caregiver involvement and reinforcement for completing homework assignments. One trainer commented,

“So, let’s not forget that the parents need to be encouraged and checked on to make sure the kid is doing it. They have to work at it – It’s not going to just happen. So, helping the parents to see that they’re going to need to work to make sure the kids do it, because again, the kids would rather eat ice-cream than do the work. I mean change is hard.”

Another stated,

“I would say, lack of reinforcement for homework, so maybe for getting what you assign for homework and not reviewing it or the kiddo or the family learning pretty quickly, you know, why do it, because there’s not a lot of support around it. You know, if [patients] don’t get reinforced, whether tangibly or verbally, they may not continue that.”

Family Perspectives.

Families identified several barriers to homework implementation on the patient-, task-, and environmental-level which were similar to many of those noted by national trainers (see Table 4 ).

Family Perspectives on Homework Barriers

Families believed that patients often avoid homework as a result of their symptoms. In other words, the patient’s unhelpful coping strategies are being triggered.

One caregiver commented,

“Sometimes people don’t even want to dig into their feelings even to do the assignment either, you know. It stirs up things. You know, when you’re dealing with feelings, sometimes you don’t want to experience that feeling…you shut down. You don’t want to feel that at that time.”

“When you already have a child that has ADHD or behavior problems, it’s hard to get them motivated and to get them to do these exercises at home.”

Families also felt that patients simply forget to complete homework or bring it to their next session. One child stated,

“That’s my problem, she’ll give me homework, we met once a week, basically, and I would forget it because I’ve got a lot going on, and when I come in and she’s like, ‘Did you do your homework,’ I’m like, ‘Oh man’.”

Similar to trainers, families felt that patients often forget why, how, when and where assignments should be done. As stated by one caregiver,

“I think sometimes it can also be just, like maybe not fully understanding what is being asked of them to do. I know the therapist will ask them in the office, ‘do you understand?’ and of course the kids always go, ‘yes I do, can I go home now’?”

With respect to task-level barriers, most families viewed homework assignments as boring. General consensus from families was that patients–particularly youth– would more often than not just rather be doing something more interesting.

On the environmental level, all families noted that the home-life of patients is busy and chaotic, leaving little perceived time for homework. Everyday responsibilities such as schoolwork, employment, household chores, and familial responsibilities often take precedence. One caregiver stated,

“Well I think it sounds good in the office and then you get home and you just get quite busy and it gets pushed aside.”

Another commented,

“But I know what he’s saying…sometimes seven-and-a-half hours at school and then sometimes his therapy would be an hour-and-a-half. And thank goodness, his teacher was so flexible that on days he has therapy he did not have homework [for school], but he was just so emotionally and physically drained. When he got home, all he wanted to do was just rest or play. Because that’s the therapy, it can be just exhausting.”

Families also believed that that there is often a lack of reinforcement for completing homework assignments.

m Health Solutions to Homework Barriers

Trainer suggestions..

Trainers provided several suggestions for m Health solutions to homework barriers ( Table 5 ). Most trainers felt that reminders and schedules to help patients remember to complete homework assignments would be a crucial feature. One trainer suggested, “Maybe some kind of reminder feature, something that would kind of record into their daily calendars that they use, or an alarm, or something like a daily reminder…set to the times they are most likely to do the homework.”

Trainer Suggestions for m Health Solutions to Homework Barriers

Trainers also suggested including reports or activity summaries of homework completion along with behavior and symptom tracking tools. One trainer thoughtfully commented, “If the homework app can somehow help to provide some data on the actual implementation of certain skills during the week that would be very valuable because I think the constructive feedback and the positive feedback that’s offered by therapists about performance of those skills between sessions can be really valuable.”

Trainers suggested including a variety of interactive, fun, and rewarding activities that engage children and caregivers. For example, one trainer stated,

“I think the more interactive you can make it between parent and child and the more of a game you can make it…kids are more likely to do that and to kind of use those skills.” All trainers ( n =21) felt that a text message-based system for reminding patients to complete homework assignments would be beneficial.

Family Suggestions.

Families suggested that the main function of the resource should serve to provide reminders (e.g., text messages or push notifications) for patients to complete homework assignments as well as instructions for how and when they should be completed. Another common suggestion was to include a reward system within the resource to reinforce engagement with homework assignments. Some suggestions for this reward system included coins, experience points, levels, and customizable avatar characters. One child thoughtfully related,

“there could be a digital reward system like stars or gems or something. Then it could be redeemed or something in the therapist’s office. Like I remember it was a while ago, I remember my therapist said if I was able to do something that I was having trouble with, we would have like brownies or something the next visit.”

Families also recommended that the resource include interactive and fun activities. The most common suggestion was to “gamify” homework assignments to make them more fun and interesting to patients. For example, a caregiver noted,

“I think that if you are able to play a game or level up after you did your activity…I don’t think you would have a problem with them doing the activity. They would be so excited to be able to play the game.”

Families providers also recommended reports and activity summaries so that progress could be tracked and reported to providers to be reviewed during the next treatment session ( Table 6 ). All families ( n =12) felt that a text message-based system for reminding patients to complete homework assignments would be beneficial.

Family Suggestions for m Health Solutions to Homework Barriers

Benefits and Challenges of m Health Solutions to Homework Barriers

The majority of trainers responded that an m Health solution to homework barriers would increase provider use of ( n =20; 95.2%) and family adherence to ( n =21; 100%) homework during mental health treatment. The majority of trainers also responded that such a resource would positively affect the therapeutic relationship ( n =15; 71.4%), increase treatment efficiency ( n =18; 85.7%), and improve treatment effectiveness ( n =18; 85.7%). Neutral responses were provided by all trainers who did not respond affirmatively to these questions (i.e., no negative responses were provided). Trainers also commented on the potential clinical utility of an m Health homework resource in that it would help providers with tracking and assigning homework and patients with skill development while promoting high levels of engagement in youth patients. Access, comfort with technology, and convenience were also noted benefits (See Table 7 ). One trainer commented,

Trainer Perspectives on Benefits and Challenges relating to m Health Solutions to Homework Barriers No. of Trainers

“I feel like so many people now enjoy so much more doing things on electronics and so definitely in sessions with kids I’m often recommending having a clinician use apps…sometimes technology is the way to really hook families in and engage them.”

“You know everybody has a phone and if we can have some apps where…I mean it’s so exciting to me what you are talking about. I can’t think of a better idea, I really can’t. I mean people always have their phones on them even if you are really, really poor, people tend to have a phone.”

Challenges identified by trainers centered around confidentiality, access and comfort with technology, and potential negative impacts on the therapeutic process. For example, one trainer stated,

“I do not know if people worry about if somebody else saw the app and wondered, ‘oh you are in therapy, oh what happened to you?’ So, some things around privacy issues and confidentiality, but those will be pretty easy to fix.”

The majority of families believed that the an m Health homework resource would make practicing therapy skills at home more fun or interesting ( n =11; 91.7%), would help families practice skills more often ( n =12; 100%), would positively affect the therapeutic relationship ( n =12; 100%), and would improve treatment effectiveness ( n =11; 91.7%). Neutral responses were provided by all families who did not respond affirmatively to these questions (i.e., no negative responses were provided). Families also suggested that an m Health homework resource would have excellent clinical utility, helping to improve communication between providers and families, make treatment and homework more rewarding, encourage more engagement from youth One caregiver commented,

“I think it would encourage the kids to get [homework] done even before the parents. The kids would want to do it on the phone, they love messing with phones.”

“I think by having the reminders, as well as having something there that’s interactive for the kids and the caregivers both. I think it would be a huge help.”

Similar to trainers, challenges noted by families related to confidentiality and some families not having access to the technology or the internet. Additional family perspectives on benefits and challenges are provided in Table 8 .

Family Perspectives on Benefits and Challenges relating to m Health Solutions to Homework Barriers

The aims of this study were to assess barriers to the successful implementation of homework during youth mental health treatment, obtain suggestions for m Health solutions to those barriers, and explore perceptions on the benefits and challenges associated with m Health solutions to homework barriers through semi-structured qualitative interviews with relevant stakeholders. National trainers in TF-CBT provided a unique perspective on the common challenges met by mental health providers and their patients as well as potential solutions to those challenges, particularly given their extensive experience problem-solving common clinical challenges with community mental health providers. Interviews with youth TF-CBT patients and their caregivers provided important perspectives from those most affected by homework barriers in mental health treatment.

Perspectives on Barriers to the Successful Implementation of Homework

Trainer and family perspectives on the various barriers to the successful implementation of homework during mental health treatment aligned well with the heuristic proposed by Kazantzis and Shinkfield (2007) , which classifies barriers as occurring on the provider-, patient-, task-, and environmental-levels. Most of the provider-level barriers noted by trainers were consistent with expert recommendations from the research literature, such as providers’ beliefs relating to homework and patient engagement in homework ( Coon et al., 2005 ; Friedberg & Mcclure, 2005 ; Garland & Scott, 2002 ), difficulty designing homework activities and individualizing them to specific patients ( Kazantzis & Shinkfield, 2007 ), forgetting about homework and running out of time during the session ( Friedberg & Mcclure, 2005 ), difficulty with consistency and not wanting to put too many demands on patients ( Coon et al., 2005 ), and difficulty effectively assessing patient barriers ( Kazantzis & Shinkfield, 2007 ). Experts have proposed a model for practice that directly addresses many of these provider-level barriers by proposing an ideal process for facilitating engagement in homework ( Kazantzis, MacEwan, & Dattilio, 2005 ).

Trainer and family perspectives on the most common patient-level homework barriers were similar and were also consistent with the extant literature. These included patients’ avoidance or symptoms ( Coon et al., 2005 ; Dattilio et al., 2011 ; Friedberg & Mcclure, 2005 ; Garland & Scott, 2002 ; Hudson & Kendall, 2005 ; Leahy, 2002 ), forgetting to complete assignments ( Coon et al., 2005 ; Hudson & Kendall, 2005 ), not understanding when, where, or how to do assignments or the rationale ( Dattilio et al., 2011 ; Friedberg & Mcclure, 2005 ; Garland & Scott, 2002 ), and beliefs about homework tasks and their ability to complete them ( Dattilio et al., 2011 ; Kazantzis & Shinkfield, 2007 ). Interestingly, whereas the most commonly endorsed patient-level barrier by trainers was patients not seeing homework as an integral part of therapy or important, the most commonly endorsed barriers by families included avoidance or symptoms, forgetfulness, and lack of understanding about assignments, reflecting differing views on the more significant barriers faced by patients. This discrepancy in the trainers/providers vs . families’ perspectives regarding between session assignments suggests the importance of therapists’ focusing more time on explaining assignments, discussing potential challenges, emphasizing the benefits of completing assignments in overcoming symptoms/difficulties and ultimately inspiring follow through.

Task-level barriers reported by both trainers and families included assignments not aligning with patient values or treatment goals ( Coon et al., 2005 ; Dattilio et al., 2011 ; Hudson & Kendall, 2005 ). Many trainers reported that the word “homework” is an aversive term to patients, particularly to youth patients. Perhaps relatedly, many families reported that children view homework assignments are boring. Negative associations with homework may be addressed by referring to “homework” as practice assignments, experiments, exercises, or action plans, as recommended by a recent Beck Institute blog post by Drs. Judith Beck and Francine Broder ( Beck & Broder, 2016 ).

Finally, environment-level barriers noted by trainers and families included the home lives of patients being busy and chaotic – leaving little time to complete homework assignments; a lack of caregiver involvement in the case of youth; and a lack of reward or reinforcement for completing homework assignments, all of which have been previously noted ( Bru et al., 2013 ; Coon et al., 2005 ; Dattilio et al., 2011 ; Kazantzis & Shinkfield, 2007 ). In sum, trainer and family perspectives on barriers to the successful implementation of homework were largely consistent with those suggested by experts. Further, there was a general agreement between trainers and families with respect to those barriers. It is important to note the interrelatedness of several barriers within various levels. For example, patients not understanding the importance of homework or seeing it as an integral part of therapy could very much reflect a mismatch in alliance, tasks needed to achieve therapy goals, or a poor therapist rationale and opportunity for client feedback and discussion. Further, a patient’s understanding of the rationale for homework might be dependent on the provider’s skill in its explanation.

Trainers and families provided numerous suggestions for m Health solutions to homework barriers. These functionality and content suggestions included: reminders and schedules to overcome barriers to forgetting; behavior and symptom tracking and reports or activity summaries to assist providers in assessing homework completion; a variety of homework activities to choose from to help providers struggling with developing activities; resources for caregivers to improve caregiver support; and an integrated reward system to make completing homework rewarding and reinforcing for patients. Other suggested features related more to user interface and user experience. For example, interviewees felt that the m Health resource should allow easy navigation to relevant resources; include clear instructions via video, text, and audio to help patients understand and remember how to do assignments; include interactive and fun activities to help make the assignments less boring and less like “homework;” and be patient-centered and developmentally appropriate. Trainers and families also felt that a text message-based system for reminding patients to complete homework assignments would be beneficial, indicating that this approach would provide a good alternative to a purely app-based resource.

As outlined in recent reviews, there are several studies on m Health resources that include the functionality and content features suggested in this study and can also be used to facilitate homework implementation ( Bakker et al., 2016 ; Tang & Kreindler, 2017 ). For example, a number of m Health resources can be used for self-monitoring and symptom tracking, and many have engaging activities that can be used to support between-session learning and skill development in the areas of relaxation, cognitive therapy, imaginal exposure, and parent behavioral management ( Bunnell et al., 2019 ; Jungbluth & Shirk, 2013 ; Kristjánsdóttir et al., 2013 ; Newman, Przeworski, Consoli, & Barr Taylor, 2014 ; Reger et al., 2013 ; Shapiro et al., 2010 ; Whiteside, Ale, Vickers Douglas, Tiede, & Dammann, 2014 ). SMS- and app-based reminders and feedback on progress can also be used to encourage continued engagement in skills practice ( Aguilera & Muñoz, 2011 ; Harrison et al., 2011 ; Reger et al., 2013 ; Wiederhold, Boyd, Sulea, Gaggioli, & Riva, 2014 ). However, as stated previously, most of these resources were not designed with the express intention of addressing barriers to homework implementation, particularly for youth and family patient populations, leaving room for future work in this area.

Trainers and families expressed very positive views on m Health solutions to homework barriers. Trainers felt that m Health would increase provider use and family adherence to homework, positively affect the therapeutic relationship, and increase treatment efficiency and effectiveness. Families felt that it would make practicing therapy skills at home more fun or interesting, help families practice skills more often, positively affect the therapeutic relationship, and improve treatment effectiveness. A potential benefit commonly noted by trainers and families was a high likelihood that youth would engage with the resource given their generally strong interest in technology, and that this would help to reinforce the practice of skills learned during therapy. A particular benefit noted was increased access to helpful resources between-sessions. Trainers and families expressed concerns about issues relating to confidentiality. While they did not view this as a fatal flaw of the resource, they suggested implementing appropriate safeguards to protect patient privacy and clearly explaining data protection to encourage use.

Limitations

There are several limitations to this study. Regarding generalizability of results, the selection of trainers and families interviewed was based on experience with TF-CBT, a specific treatment protocol for childhood trauma. Although interview questions were kept general during interviews, referring to mental health treatment rather than solely to TF-CBT, the views expressed by interviewees may relate more to TF-CBT than other child mental health treatments. However, a strength of this research is that TF-CBT has a broad symptom focus (e.g., PTSD, anxiety, depression, anger, disruptive behavior) and includes treatment components used in numerous youth mental health treatments (e.g., psychoeducation, relaxation, cognitive coping, affective modulation, exposure), which suggests that results would be applicable to a range of child mental health treatments. Additionally, national trainers in TF-CBT have consistent exposure to working closely with community mental health providers and regularly help them to problem-solve common barriers in clinical practice. This added insight into difficulties experienced by numerous mental health providers rather than asking individual providers about their experience. This is a strength of this study but also a potential limitation as not directly measured, thus an assumption. The views of trainers may not be completely representative of the every-day challenges to homework implementation experienced by community mental health providers. Given the small samples size and lack of diversity, the results should be interpreted with caution as they may not reflect the experiences or views of therapists and patients who utilize homework across different treatment approaches, therapy settings, and populations.

With respect to interview questions and results, they tended to focus on barriers and challenges and provided less of an opportunity for trainers and family members to share factors that may have led to successes with homework assignments. Such information could also importantly support the development and presentation of m health solutions by therapists. Relatedly, families were asked about barriers faced by youth and caregivers, and not by providers, which would have provided interesting data on family perspectives on providers’ limitations. Although comfort with technology in general was assessed in youth and caregivers, it was not specified as comfort with m Health, and ratings were not collected from trainers. As such, a potential limitation of this study is that participants’ comfort specifically with mHealth was unknown. Furthermore, this study focused specifically on m Health without a comparison to other low-tech solutions, which might have resulted in inflated levels of interest in m health solutions to homework barriers. A final limitation is that interviews were coded by the first author, and there is potential for variability in coding that was not accounted for (i.e., the same themes might have been classified in different ways). Despite this limitation, themes were reviewed and by an internationally recognized expert in the implementation of homework and related barriers during CBT (the fourth author) and compared until agreement was reached, supporting the derived themes.

Conclusions

This study provides important new information on barriers to the successful implementation of homework during youth mental health treatment, based on perspectives of providers, youth, and caregivers with that treatment experience. This study adds to the literature on these barriers, which has been based largely on recommendations from experts in the field. The results of this study aligned well with this literature, providing additional support for these recommendations. Valuable insights on potential m Health solutions to these homework barriers were also provided. These data are being used to inform the development of an m Health resource that aims to address homework barriers in hopes of improving provider use and patient adherence to homework during youth mental health treatment, with the ultimate goal of improving the quality of care received by patients in community mental health settings.

Supplementary Material

10608_2020_10090_moesm1_esm, acknowledgments.

Compliance with Ethical Standards

Funding. Dr. Bunnell was supported by the National Institute of Mental Health (grant numbers F32 MH108250 and K23 MH118482).

Disclosure of Potential Conflicts of Interest

Conflict of Interest. The authors declare that they have no conflict of interest.

Research Involving Human Participants and/or Animals

Statement of Human Rights.

Ethics approval. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board at the Medical University of South Carolina (Pro00047774) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement on the Welfare of Animals

Ethical approval. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

• Aguilera A, & Muñoz RF. (2011). Text messaging as an adjunct to CBT in low-income populations: A usability and feasibility pilot study . Professional Psychology: Research and Practice , 42 ( 6 ), 472–478. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Amstadter AB, Broman-Fulks J, Zinzow H, Ruggiero KJ, & Cercone J. (2009). Internet-based interventions for traumatic stress-related mental health problems: A review and suggestion for future research . Clinical Psychology Review , 29 ( 5 ), 410–420. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bakker D, Kazantzis N, Rickwood D, & Rickard N. (2016). Mental health smartphone apps: Review and evidence-based recommendations for future developments . JMIR Mental Health , 3 ( 1 ), e7. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Beck JS, & Broder FR. (2016). The new “Homework” in cognitive behavior therapy . Beck Institute for Cognitive Behavior Therapy . Retrieved November 24, 2019, from https://beckinstitute.org/the-new-homework-in-cognitive-behavior-therapy/ [ Google Scholar ]
• Berkovits MD, O’Brien KA, Carter CG, & Eyberg SM. (2010). Early identification and intervention for behavior problems in primary care: A comparison of two abbreviated versions of parent-child interaction therapy . Behavior Therapy , 41 ( 3 ), 375–387. [ PubMed ] [ Google Scholar ]
• Boschen MJ, & Casey LM. (2008). The use of mobile telephones as adjuncts to cognitive behavioral psychotherapy . Professional Psychology: Research and Practice , 39 ( 5 ), 546–552. [ Google Scholar ]
• Bru L, Solholm R, & Idsoe T. (2013). Participants’ experiences of an early cognitive behavioral intervention for adolescents with symptoms of depression . Emotional and Behavioural Difficulties , 18 ( 1 ), 24–43. [ Google Scholar ]
• Bunnell BE, Davidson TM, Winkelmann JR, Maples-Keller JL, Ridings LE, Dahne J, … Ruggiero KJ. (2019). Implementation and utility of an automated text messaging system to facilitate symptom self-monitoring and identify risk for post-traumatic stress disorder and depression in trauma center patients . Telemedicine and E-Health . [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Callan JA, Dunbar-Jacob J, Sereika SM, Stone C, Fasiczka A, Jarrett RB, & Thase ME. (2012). Barriers to cognitive behavioral therapy homework completion scaledepression version: Development and psychometric evaluation . International Journal of Cognitive Therapy , 5 ( 2 ), 219–235. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Charmaz K. (2006). Constructing grounded theory: A practical guide through qualitative analysis . New York, NY: SAGE Publications. [ PubMed ] [ Google Scholar ]
• Clarke G, Hops H, Lewinsohn PM, Andrews J, Seeley JR, & Williams J. (1992). Cognitive-behavioral group treatment of adolescent depression: Prediction of outcome . Behavior Therapy , 23 ( 3 ), 341–354. [ Google Scholar ]
• Cohen JA, Mannarino AP, & Deblinger E. (2017). Treating trauma and traumatic grief in children and adolescents , 2nd ed. New York, NY, US: Guilford Press. [ Google Scholar ]
• Coon DW, Rabinowitz YG, Thompson LW, & Gallagher-Thompson D. (2005). Older adults. In Kazantzis N, Deane F, Ronan K, & L’Abate L. (Eds.), Using Homework Assignments in Cognitive Behavior Therapy (pp. 117–152). New York, NY: Routledge. [ Google Scholar ]
• Danko CM, Brown T, Van Schoick L, & Budd KS. (2016). Predictors and correlates of homework completion and treatment outcomes in parent–child interaction therapy . Child and Youth Care Forum , 45 ( 3 ), 467–485. [ Google Scholar ]
• Dattilio FM, Kazantzis N, Shinkfield G, & Carr AG. (2011). A survey of homework use, experience of barriers to homework, and attitudes about the barriers to homework among couples and family therapists . Journal of Marital and Family Therapy , 37 ( 2 ), 121–136. [ PubMed ] [ Google Scholar ]
• Davidson TM, Bunnell BE, Saunders BE, Hanson RF, Danielson CK, Cook D, … Ruggiero KJ. (2019). Pilot evaluation of a tablet-based application to improve quality of care in child mental health treatment . Behavior Therapy , 50 ( 2 ), 367–379. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Deblinger E, Mannarino AP, Cohen JA, Runyon MK, & Steer RA. (2011). Trauma-Focused Cognitive Behavioral Therapy for children: Impact of the trauma narrative and treatment length . Depression and Anxiety , 28 ( 1 ), 67–75. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Deblinger E, Pollio E, & Dorsey S. (2016). Applying Trauma-Focused Cognitive–Behavioral Therapy in group format . Child Maltreatment , 21 ( 1 ), 59–73. [ PubMed ] [ Google Scholar ]
• Donker T, Petrie K, Proudfoot J, Clarke J, Birch M-R, & Christensen H. (2013). Smartphones for smarter delivery of mental health programs: a systematic review . Journal of Medical Internet Research , 15 ( 11 ), e247. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ehrenreich B, Righter B, Rocke DA, Dixon L, & Himelhoch S. (2011). Are mobile phones and handheld computers being used to enhance delivery of psychiatric treatment ? The Journal of Nervous and Mental Disease , 199 ( 11 ), 886–891. [ PubMed ] [ Google Scholar ]
• Friedberg RD, & Mcclure JM. (2005). Adolescents. In Kazantzis N, Deane F, Ronan K, & L’Abate L. (Eds.), Using Homework Assignments in Cognitive Behavior Therapy (pp. 95–116). New York, NY: Routledge. [ Google Scholar ]
• Garland A, & Scott J. (2002). Using homework in therapy for depression . Journal of Clinical Psychology , 58 ( 5 ), 489–498. [ PubMed ] [ Google Scholar ]
• Gaynor ST, Lawrence PS, & Nelson-Gray RO. (2006). Measuring homework compliance in cognitive-behavioral therapy for adolescent depression: Review, preliminary findings, and implications for theory and practice . Behavior Modification , 30 ( 5 ), 647–672. [ PubMed ] [ Google Scholar ]
• Hanson RF, Gros KS, Davidson TM, Barr S, Cohen J, Deblinger E, … Ruggiero KJ. (2014). National trainers’ perspectives on challenges to implementation of an empirically-supported mental health treatment . Administration and Policy in Mental Health and Mental Health Services Research , 41 ( 4 ), 522–534. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Harrison V, Proudfoot J, Wee PP, Parker G, Pavlovic DH, & Manicavasagar V. (2011, December). Mobile mental health: Review of the emerging field and proof of concept study . Journal of Mental Health . [ PubMed ] [ Google Scholar ]
• Helbig S, & Fehm L. (2004). Problems with homework in CBT: Rare exception or rather frequent? Behavioural and Cognitive Psychotherapy , 32 ( 3 ), 291–301. [ Google Scholar ]
• Heron KE, & Smyth JM. (2010). Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments . British Journal of Health Psychology , 15 ( 1 ), 1–39. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hudson JL, & Kendall PC. (2002). Showing you can do it: Homework in therapy for children and adolescents with anxiety disorders . Journal of Clinical Psychology , 58 ( 5 ), 525–534. [ PubMed ] [ Google Scholar ]
• Hudson JL, & Kendall PC. (2005). Children. In Kazantzis N, Deane F, Ronan K, & L’Abate L. (Eds.), Using Homework Assignments in Cognitive Behavior Therapy (pp. 75–94). New York, NY: Routledge. [ Google Scholar ]
• Jungbluth NJ, & Shirk SR. (2013). Promoting homework adherence in cognitive-behavioral therapy for adolescent depression . Journal of Clinical Child and Adolescent Psychology , 42 ( 4 ), 545–553. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kazantzis N, & Deane FP. (1999). Psychologists’ use of homework assignments in clinical practice . Professional Psychology: Research and Practice , 30 ( 6 ), 581–585. [ Google Scholar ]
• Kazantzis N, Deane FP, & Ronan KR. (2000). Homework assignments in cognitive and behavioral therapy: A meta-analysis . Clinical Psychology: Science and Practice , 7 ( 2 ), 189–202. [ Google Scholar ]
• Kazantzis N, Deane FP, & Ronan KR. (2004). Assessing compliance with homework assingments: Review and recommendations for clinical practice . Journal of Clinical Psychology , 60 ( 6 ), 627–641. [ PubMed ] [ Google Scholar ]
• Kazantzis N, Deane FP, Ronan KR, & L’Abate L. (2005). Using Homework Assignments in Cognitive Behavior Therapy . New York, NY: Routledge. [ Google Scholar ]
• Kazantzis N, & Lampropoulos GK. (2002). Reflecting on homework in psychotherapy: What can we conclude from research and experience? Journal of Clinical Psychology , 58 ( 5 ), 577–585. [ PubMed ] [ Google Scholar ]
• Kazantzis N, Lampropoulos GK, & Deane FP. (2005). A national survey of practicing psychologists’ use and attitudes toward homework in psychotherapy . Journal of Consulting and Clinical Psychology , 73 ( 4 ), 742–748. [ PubMed ] [ Google Scholar ]
• Kazantzis N, MacEwan J, & Dattilio F. (2005). A guiding model for practice. In Kazantzis N, Deane F, Ronan K, & L’Abate L. (Eds.), Using Homework Assignments in Cognitive Behavior Therapy (pp. 359–407). New York: Routledge. [ Google Scholar ]
• Kazantzis Nikolaos, & Shinkfield G. (2007). Conceptualizing patient barriers to nonadherence with homework assignments . Cognitive and Behavioral Practice , 14 ( 3 ), 317–324. [ Google Scholar ]
• Kazantzis Nikolaos, Whittington C, & Dattilio F. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology : Science and Practice , 17 ( 2 ), 144–156. [ Google Scholar ]
• Kazantzis Nikolaos, Whittington C, Zelencich L, Kyrios M, Norton PJ, & Hofmann SG. (2016). Quantity and quality of homework compliance: A meta-analysis of relations with outcome in cognitive behavior therapy . Behavior Therapy , 47 ( 5 ), 755–772. [ PubMed ] [ Google Scholar ]
• Krebs P, & Duncan DT. (2015). Health app use among US mobile phone owners: A national survey . JMIR MHealth and UHealth , 3 ( 4 ), e101. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kristjánsdóttir ÓB, Fors EA, Eide E, Finset A, Stensrud TL, Van Dulmen S, … Eide H. (2013). A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: Randomized controlled trial . Journal of Medical Internet Research , 15 ( 1 ), e5. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Leahy RL. (2002). Improving homework compliance in the treatment of generalized anxiety disorder . Journal of Clinical Psychology , 58 ( 5 ), 499–511. [ PubMed ] [ Google Scholar ]
• Luxton DD, McCann RA, Bush NE, Mishkind MC, & Reger GM. (2011). MHealth for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology : Research and Practice , 42 ( 6 ), 505–512. [ Google Scholar ]
• Lyon AR, & Budd KS. (2010). A community mental health implementation of Parent–Child Interaction Therapy (PCIT) . Journal of Child and Family Studies , 19 ( 5 ), 654–668. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Mausbach BT, Moore R, Roesch S, Cardenas V, & Patterson TL. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis . Cognitive Therapy and Research , 34 ( 5 ), 429–438. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Miles MB, & Huberman AM. (1994). Qualitative data analysis: An expanded sourcebook . Thousand Oaks, CA: Sage Publications. [ Google Scholar ]
• Morse JM. (2000). Determining sample size . Qualitative Health Research , 10 ( 1 ), 3–5. [ PubMed ] [ Google Scholar ]
• Newman MG, Przeworski A, Consoli AJ, & Barr Taylor C. (2014). A randomized controlled trial of ecological momentary intervention plus brief group therapy for generalized anxiety disorder . Psychotherapy , 51 ( 2 ), 198–206. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Reger GM, Hoffman J, Riggs D, Rothbaum BO, Ruzek J, Holloway KM, & Kuhn E. (2013). The “PE coach” smartphone application: An innovative approach to improving implementation, fidelity, and homework adherence during prolonged exposure . Psychological Services , 10 ( 3 ), 342–349. [ PubMed ] [ Google Scholar ]
• Ruggiero KJ, Saunders BE, Davidson TM, Cook DL, & Hanson R. (2017). Leveraging technology to address the quality chasm in children’s evidence-based psychotherapy . Psychiatric Services , 68 , 650–652. [ PubMed ] [ Google Scholar ]
• Scheel MJ, Hanson WE, & Razzhavaikina TI. (2004). The process of recommending homework in psychotherapy: A review of therapist delivery methods, client acceptability, and factors that affect compliance . Psychotherapy , 41 ( 1 ), 38–55. [ Google Scholar ]
• Scheeringa MS, Weems CF, Cohen JA, Amaya-Jackson L, & Guthrie D. (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in threethrough six year-old children: a randomized clinical trial . Journal of Child Psychology and Psychiatry , 52 ( 8 ), 853–860. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Shapiro JR, Bauer S, Andrews E, Pisetsky E, Bulik-Sullivan B, Hamer RM, & Bulik CM. (2010). Mobile therapy: Use of text-messaging in the treatment of bulimia nervosa . International Journal of Eating Disorders , 43 ( 6 ), 513–519. [ PubMed ] [ Google Scholar ]
• Silverman WK, Ortiz CD, Viswesvaran C, Burns BJ, Kolko DJ, Putnam FW, & Amaya-Jackson L. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events . Journal of Clinical Child & Adolescent Psychology , 37 ( 1 ), 156–183. [ PubMed ] [ Google Scholar ]
• Simons AD, Marti CN, Rohde P, Lewis CC, Curry J, & March J. (2012). Does homework “matter” in cognitive behavioral therapy for adolescent depression? Journal of Cognitive Psychotherapy , 26 ( 4 ), 390–404. [ Google Scholar ]
• Sukhodolsky DG, Kassinove H, & Gorman BS. (2004). Cognitive-behavioral therapy for anger in children and adolescents: A meta-analysis . Aggression and Violent Behavior , 9 ( 3 ), 247–269. [ Google Scholar ]
• Tang W, & Kreindler D. (2017). Supporting homework compliance in cognitive behavioural therapy: essential features of mobile apps . JMIR Mental Health , 4 ( 2 ), e20. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Wethington HR, Hahn RA, Fuqua-Whitley DS, Sipe TA, Crosby AE, Johnson RL, … Task Force on Community Preventive Services. (2008). The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents . American Journal of Preventive Medicine , 35 ( 3 ), 287–313. 10.1016/j.amepre.2008.06.024 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Whiteside SPH, Ale CM, Vickers Douglas K, Tiede MS, & Dammann JE. (2014). Case examples of enhancing pediatric ocd treatment with a smartphone application . Clinical Case Studies , 13 ( 1 ), 80–94. 10.1177/1534650113504822 [ CrossRef ] [ Google Scholar ]
• Wiederhold BK, Boyd C, Sulea C, Gaggioli A, & Riva G. (2014). Marketing analysis of a positive technology app for the self-management of psychological stress . Studies in Health Technology and Informatics , 199 , 83–87. [ PubMed ] [ Google Scholar ]

How Does Homework Affect Students Mental Health?

• Post author By Zoro
• March 12, 2024
• No Comments on How Does Homework Affect Students Mental Health?

Homework is a big part of school and helps us do well in our studies. But, lately, people are worried about how it might affect how we feel. This blog will look into how does homework affect students mental health—the good and the not-so-good. Homework is awesome because it makes us better at things, helps us manage our time, and teaches us to be responsible. But sometimes, it can make us feel stressed or tired. 

Let’s explore both sides and figure out how we can make homework work better for us. Together, we can make sure that homework helps us learn and keeps us feeling good too!

Before we start talking about the homework, let us discuss some of its positive sides.

Table of Contents

The Positive Side of Homework

Critical thinking and problem-solving:.

Homework assignments often require students to engage in critical thinking and problem-solving. By tackling challenging problems independently, students develop analytical skills and the ability to approach complex issues with confidence. This cognitive engagement positively contributes to their mental development.

Consolidation of Knowledge:

Repetition is a key factor in learning, and homework provides an avenue for students to consolidate their understanding of academic concepts. Revisiting and applying knowledge through assignments reinforces learning, leading to a deeper comprehension of the subject matter. This reinforcement fosters a positive attitude towards learning and academic achievement.

Self-Directed Learning:

Homework empowers students to become self-directed learners. By independently researching, organizing information, and completing assignments, students take control of their education. This autonomy not only enhances academic performance but also cultivates a sense of self-efficacy, positively influencing their overall mental well-being.

Preparation for Future Challenges:

Beyond academic content, homework prepares students for future challenges in higher education and the workforce. The ability to manage tasks, meet deadlines, and assume responsibility for one’s work is a valuable skill set that extends beyond the classroom. This preparation instills a proactive and resilient mindset, contributing positively to students’ mental readiness for future endeavors.

Enhanced Communication Skills:

Some homework assignments involve written or oral communication, encouraging students to express their thoughts and ideas effectively. The development of communication skills is not only beneficial academically but also in various aspects of life. The ability to articulate ideas with clarity and confidence positively influences self-expression and interpersonal relationships, contributing to overall mental well-being.

Sense of Purpose and Achievement:

Successfully completing homework assignments provides students with a sense of purpose and achievement. Each completed task, no matter how small, contributes to a feeling of progress and accomplishment. This positive reinforcement fosters a healthy mindset, instilling the belief that effort and dedication lead to success, both academically and personally.

How Does Homework Affect Students Mental Health

The negative side of homework, diminished leisure time:.

A heavy load of homework can eat into the time meant for relaxation and hobbies, leaving students with limited opportunities to unwind. This lack of leisure can contribute to feelings of burnout and negatively impact their overall mental well-being.

Strain on Family Relationships:

Excessive homework can strain relationships at home as students struggle to balance academic demands with family time. This strain may lead to increased tension, creating an unhealthy environment that can contribute to stress and anxiety.

Reduced Personal Time:

Beyond impacting social life, an overwhelming amount of homework can also reduce a student’s personal time. Lack of time for self-care and personal activities can leave students feeling overwhelmed and contribute to a decline in mental health.

Negative Perception of Learning:

When homework becomes too demanding, it may lead students to associate learning with stress and pressure. This negative perception can affect their overall attitude towards education, potentially diminishing their interest in learning and harming their mental well-being.

Increased Pressure and Competition:

A constant stream of homework assignments may intensify the competitive atmosphere among students. The pressure to excel academically can create a stressful environment, fostering feelings of inadequacy and negatively impacting mental health.

Limited Time for Reflection:

Excessive homework often leaves little time for students to reflect on what they’ve learned. Reflection is crucial for understanding and internalizing knowledge, and the lack of it can contribute to a superficial understanding of subjects, potentially affecting mental clarity and overall well-being.

Finding The Balance

In the world of homework, it’s important to find a sweet spot that makes learning effective without stressing us out. One key is open communication—teachers, students, and parents chatting about what’s expected from homework. Clear rules and fair expectations make homework less overwhelming and more manageable.

Taking breaks during study time is like giving our brains a breather. Short breaks help us recharge, making it easier to concentrate. It’s like hitting the reset button for our minds, reducing stress, and making us feel better overall.

Quality matters more than quantity. Instead of drowning in lots of homework, we can focus on really understanding and using what we learn. It’s like enjoying a good meal rather than stuffing ourselves with snacks. This approach makes learning more meaningful and less stressful.

So, finding the balance means talking openly about homework, taking breaks to stay fresh, and focusing on understanding rather than piling up tasks. When we get this mix right, homework becomes a friendlier part of learning, helping our brains grow without causing unnecessary stress.

In the journey of homework and mental well-being, finding the right balance is like creating a recipe for success. By talking openly about homework, taking breaks, and valuing quality over quantity, we can make learning a more enjoyable experience. It’s not just about finishing tasks; it’s about understanding and growing.

Let’s remember that homework is meant to help us, not stress us out. So, as we navigate this homework adventure, let’s keep the communication lines open, take those refreshing breaks, and focus on the good stuff. When we find this balance, homework becomes a positive part of our learning journey, nurturing not just our minds but also our overall well-being.

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When Is Homework Stressful? Its Effects on Students’ Mental Health

Are you wondering when is homework stressful? Well, homework is a vital constituent in keeping students attentive to the course covered in a class. By applying the lessons, students learned in class, they can gain a mastery of the material by reflecting on it in greater detail and applying what they learned through homework. 

However, students get advantages from homework, as it improves soft skills like organisation and time management which are important after high school. However, the additional work usually causes anxiety for both the parents and the child. As their load of homework accumulates, some students may find themselves growing more and more bored.

Students may take assistance online and ask someone to do my online homework . As there are many platforms available for the students such as Chegg, Scholarly Help, and Quizlet offering academic services that can assist students in completing their homework on time. 

Negative impact of homework

There are the following reasons why is homework stressful and leads to depression for students and affect their mental health. As they work hard on their assignments for alarmingly long periods, students’ mental health is repeatedly put at risk. Here are some serious arguments against too much homework.

No uniqueness

Homework should be intended to encourage children to express themselves more creatively. Teachers must assign kids intriguing assignments that highlight their uniqueness. similar to writing an essay on a topic they enjoy.

Moreover, the key is encouraging the child instead of criticizing him for writing a poor essay so that he can express himself more creatively.

Lack of sleep

One of the most prevalent adverse effects of schoolwork is lack of sleep. The average student only gets about 5 hours of sleep per night since they stay up late to complete their homework, even though the body needs at least 7 hours of sleep every day. Lack of sleep has an impact on both mental and physical health.

No pleasure

Students learn more effectively while they are having fun. They typically learn things more quickly when their minds are not clouded by fear. However, the fear factor that most teachers introduce into homework causes kids to turn to unethical means of completing their assignments.

Excessive homework

The lack of coordination between teachers in the existing educational system is a concern. As a result, teachers frequently end up assigning children far more work than they can handle. In such circumstances, children turn to cheat on their schoolwork by either copying their friends’ work or using online resources that assist with homework.

Anxiety level

Homework stress can increase anxiety levels and that could hurt the blood pressure norms in young people . Do you know? Around 3.5% of young people in the USA have high blood pressure. So why is homework stressful for children when homework is meant to be enjoyable and something they look forward to doing? It is simple to reject this claim by asserting that schoolwork is never enjoyable, yet with some careful consideration and preparation, homework may become pleasurable.

No time for personal matters

Students that have an excessive amount of homework miss out on personal time. They can’t get enough enjoyment. There is little time left over for hobbies, interpersonal interaction with colleagues, and other activities. 

However, many students dislike doing their assignments since they don’t have enough time. As they grow to detest it, they can stop learning. In any case, it has a significant negative impact on their mental health.

Children are no different than everyone else in need of a break. Weekends with no homework should be considered by schools so that kids have time to unwind and prepare for the coming week. Without a break, doing homework all week long might be stressful.

How do parents help kids with homework?

Encouraging children’s well-being and health begins with parents being involved in their children’s lives. By taking part in their homework routine, you can see any issues your child may be having and offer them the necessary support.

Set up a routine

Your student will develop and maintain good study habits if you have a clear and organized homework regimen. If there is still a lot of schoolwork to finish, try putting a time limit. Students must obtain regular, good sleep every single night.

Observe carefully

The student is ultimately responsible for their homework. Because of this, parents should only focus on ensuring that their children are on track with their assignments and leave it to the teacher to determine what skills the students have and have not learned in class.

Listen to your child

One of the nicest things a parent can do for their kids is to ask open-ended questions and listen to their responses. Many kids are reluctant to acknowledge they are struggling with their homework because they fear being labelled as failures or lazy if they do.

However, every parent wants their child to succeed to the best of their ability, but it’s crucial to be prepared to ease the pressure if your child starts to show signs of being overburdened with homework.

Talk to your teachers

Also, make sure to contact the teacher with any problems regarding your homework by phone or email. Additionally, it demonstrates to your student that you and their teacher are working together to further their education.

Homework with friends

If you are still thinking is homework stressful then It’s better to do homework with buddies because it gives them these advantages. Their stress is reduced by collaborating, interacting, and sharing with peers.

Additionally, students are more relaxed when they work on homework with pals. It makes even having too much homework manageable by ensuring they receive the support they require when working on the assignment. Additionally, it improves their communication abilities.

However, doing homework with friends guarantees that one learns how to communicate well and express themselves. 

Review homework plan

Create a schedule for finishing schoolwork on time with your child. Every few weeks, review the strategy and make any necessary adjustments. Gratefully, more schools are making an effort to control the quantity of homework assigned to children to lessen the stress this produces.

Bottom line

Finally, be aware that homework-related stress is fairly prevalent and is likely to occasionally affect you or your student. Sometimes all you or your kid needs to calm down and get back on track is a brief moment of comfort. So if you are a student and wondering if is homework stressful then you must go through this blog.

While homework is a crucial component of a student’s education, when kids are overwhelmed by the amount of work they have to perform, the advantages of homework can be lost and grades can suffer. Finding a balance that ensures students understand the material covered in class without becoming overburdened is therefore essential.

Zuella Montemayor did her degree in psychology at the University of Toronto. She is interested in mental health, wellness, and lifestyle.

Psychreg is a digital media company and not a clinical company. Our content does not constitute a medical or psychological consultation. See a certified medical or mental health professional for diagnosis.

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How does homework affect students.

Posted by Kenny Gill

Homework is essential in the learning process of all students. It benefits them in managing time, being organized, and thinking beyond the classroom work. When students develop good habits towards homework, they enjoy good grades. The amount of homework given to students has risen by 51 percent. In most cases, this pushes them to order for custom essays online. A lot of homework can be overwhelming, affecting students in negative ways.

How homework affects the psyche of students Homework plays a crucial role in ensuring students succeeds both inside and outside the classroom. The numerous hours they spend in class, on school work, and away from family and friends lead to them experiencing exhaustion. Too much homework leads to students becoming disheartened by the school, and it chips away at their motivation for succeeding.

As a result, homework becomes an uphill battle, which they feel they will never win despite putting an effort. When they continue to find homework difficult, they consider other ways of working on it, such as cheating.

Getting enough time to relax, engage with friends and family members helps the students to have fun, thus, raising their spirit and their psyche on school work.  However, when homework exceeds, it affects their emotional well-being making them sad and unproductive students who would rather cheat their way through school.

As a result, they have to struggle with a lack of enough sleep, loss of weight, stomach problems, headaches, and fatigue. Poor eating habits where students rely on fast foods also occasions as they struggle to complete all their assignments. When combined with lack of physical activity, the students suffer from obesity and other health-related conditions. Also, they experience depression and anxiety. The pressure to attend all classes, finish the much homework, as well as have time to make social connections cripples them.

How can parents help with homework? Being an active parent in the life of your child goes a long way towards promoting the health and well-being of children. Participating in their process of doing homework helps you identify if your child is facing challenges, and provide the much-needed support.

The first step is identifying the problem your child has by establishing whether their homework is too much. In elementary school, students should not spend over twenty minutes on homework while in high school they should spend an average of two hours. If it exceeds these guidelines, then you know that the homework is too much and you need to talk with the teachers.

The other step is ensuring your child focuses on their work by eliminating distractions. Texting with friends, watching videos, and playing video games can distract your child. Next, help them create a homework routine by having a designated area for studying and organizing their time for each activity.

Why it is better to do homework with friends Extracurricular activities such as sports and volunteer work that students engage in are vital. The events allow them to refresh their minds, catch up, and share with friends, and sharpen their communication skills. Homework is better done with friends as it helps them get these benefits. Through working together, interacting, and sharing with friends, their stress reduces.

Working on assignments with friends relaxes the students. It ensures they have the help they need when tackling the work, making even too much homework bearable. Also, it develops their communication skills. Deterioration of communication skills is a prominent reason as to why homework is bad. Too much of it keeps one away from classmates and friends, making it difficult for one to communicate with other people.

Working on homework with friends, however, ensures one learns how to express themselves and solve issues, making one an excellent communicator.

How does a lot of homework affect students’ performance? Burnout is a negative effect of homework. After spending the entire day learning, having to spend more hours doing too much homework lead to burnout. When it occurs, students begin dragging their feet when it comes to working on assignments and in some cases, fail to complete them. Therefore, they end up getting poor grades, which affects their overall performance.

Excessive homework also overshadows active learning, which is essential in the learning process. It encourages active participation of students in analyzing and applying what they learn in class in the real world. As a result, this limits the involvement of parents in the process of learning and children collaboration with friends. Instead, it causes boredom, difficulties for the students to work alongside others, and lack of skills in solving problems.

Should students have homework? Well, this is the question many parents and students ask when they consider these adverse effects of homework. Homework is vital in the learning process of any student. However, in most cases, it has crossed the line from being a tool for learning and becomes a source of suffering for students. With such effects, a balance is necessary to help students learn, remain healthy, and be all rounded individuals in society.

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Great info and really valuable for teachers and tutors. This is a really very wonderful post. I really appreciate it; this post is very helpful for education.

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Does Homework Cause Stress? Exploring the Impact on Students’ Mental Health

How much homework is too much?

Jump to: The Link Between Homework and Stress | Homework’s Impact on Mental Health | Benefits of Homework | How Much Homework Should Teacher’s Assign? | Advice for Students | How Healium Helps

Homework has become a matter of concern for educators, parents, and researchers due to its potential effects on students’ stress levels. It’s no secret students often find themselves grappling with high levels of stress and anxiety throughout their academic careers, so understanding the extent to which homework affects those stress levels is important. 

By delving into the latest research and understanding the underlying factors at play, we hope to curate insights for educators, parents, and students who are wondering  is homework causing stress in their lives?

The Link Between Homework and Stress: What the Research Says

Over the years, numerous studies investigated the relationship between homework and stress levels in students. 

One study published in the Journal of Experimental Education found that students who reported spending more than two hours per night on homework experienced higher stress levels and physical health issues . Those same students reported over three hours of homework a night on average.

This study, conducted by Stanford lecturer Denise Pope, has been heavily cited throughout the years, with WebMD eproducing the below video on the topic– part of their special report series on teens and stress : 

Additional studies published by Sleep Health Journal found that long hours on homework on may be a risk factor for depression while also suggesting that reducing workload outside of class may benefit sleep and mental fitness .

Lastly, a study presented by Frontiers in Psychology highlighted significant health implications for high school students facing chronic stress, including emotional exhaustion and alcohol and drug use.

Homework’s Potential Impact on Mental Health and Well-being

Homework-induced stress on students can involve both psychological and physiological side effects. 

1. Potential Psychological Effects of Homework-Induced Stress:

• Anxiety: The pressure to perform academically and meet homework expectations can lead to heightened levels of anxiety in students. Constant worry about completing assignments on time and achieving high grades can be overwhelming.

• Sleep Disturbances : Homework-related stress can disrupt students’ sleep patterns, leading to sleep anxiety or sleep deprivation, both of which can negatively impact cognitive function and emotional regulation.

• Reduced Motivation: Excessive homework demands could drain students’ motivation, causing them to feel fatigued and disengaged from their studies. Reduced motivation may lead to a lack of interest in learning, hindering overall academic performance.

2. Potential Physical Effects of Homework-Induced Stress:

• Impaired Immune Function: Prolonged stress could weaken the immune system, making students more susceptible to illnesses and infections.

• Disrupted Hormonal Balance : The body’s stress response triggers the release of hormones like cortisol, which, when chronically elevated due to stress, can disrupt the delicate hormonal balance and lead to various health issues.

• Gastrointestinal Disturbances: Stress has been known to affect the gastrointestinal system, leading to symptoms such as stomachaches, nausea, and other digestive problems.

• Cardiovascular Impact: The increased heart rate and elevated blood pressure associated with stress can strain the cardiovascular system, potentially increasing the risk of heart-related issues in the long run.

• Brain impact: Prolonged exposure to stress hormones may impact the brain’s functioning , affecting memory, concentration, and cognitive abilities.

The Benefits of Homework

It’s important to note that homework also offers many benefits that contribute to students’ academic growth and development, such as: 

• Development of Time Management Skills: Completing homework within specified deadlines encourages students to manage their time efficiently. This valuable skill extends beyond academics and becomes essential in various aspects of life.

• Preparation for Future Challenges : Homework helps prepare students for future academic challenges and responsibilities. It fosters a sense of discipline and responsibility, qualities that are crucial for success in higher education and professional life.

• Enhanced Problem-Solving Abilities: Homework often presents students with challenging problems to solve. Tackling these problems independently nurtures critical thinking and problem-solving skills.

While homework can foster discipline, time management, and self-directed learning, the middle ground may be to  strike a balance that promotes both academic growth and mental well-being .

How Much Homework Should Teachers Assign?

As a general guideline, educators suggest assigning a workload that allows students to grasp concepts effectively without overwhelming them . Quality over quantity is key, ensuring that homework assignments are purposeful, relevant, and targeted towards specific objectives. 

Advice for Students: How to balance Homework and Well-being

Finding a balance between academic responsibilities and well-being is crucial for students. Here are some practical tips and techniques to help manage homework-related stress and foster a healthier approach to learning:

• Effective Time Management : Encourage students to create a structured study schedule that allocates sufficient time for homework, breaks, and other activities. Prioritizing tasks and setting realistic goals can prevent last-minute rushes and reduce the feeling of being overwhelmed.

• Break Tasks into Smaller Chunks : Large assignments can be daunting and may contribute to stress. Students should break such tasks into smaller, manageable parts. This approach not only makes the workload seem less intimidating but also provides a sense of accomplishment as each section is completed.

• Find a Distraction-Free Zone : Establish a designated study area that is free from distractions like smartphones, television, or social media. This setting will improve focus and productivity, reducing time needed to complete homework.

• Be Active : Regular exercise is known to reduce stress and enhance mood. Encourage students to incorporate physical activity into their daily routine, whether it’s going for a walk, playing a sport, or doing yoga.

• Practice Mindfulness and Relaxation Techniques : Encourage students to engage in mindfulness practices, such as deep breathing exercises or meditation, to alleviate stress and improve concentration. Taking short breaks to relax and clear the mind can enhance overall well-being and cognitive performance.

• Seek Support : Teachers, parents, and school counselors play an essential role in supporting students. Create an open and supportive environment where students feel comfortable expressing their concerns and seeking help when needed.

How Healium is Helping in Schools

Stress is caused by so many factors and not just the amount of work students are taking home.  Our company created a virtual reality stress management solution… a mental fitness tool called “Healium” that’s teaching students how to learn to self-regulate their stress and downshift in a drugless way. Schools implementing Healium have seen improvements from supporting dysregulated students and ADHD challenges to empowering students with body awareness and learning to self-regulate stress . Here’s one of their stories. 

By providing students with the tools they need to self-manage stress and anxiety, we represent a forward-looking approach to education that prioritizes the holistic development of every student. 

To learn more about how Healium works, watch the video below.

About the Author

Sarah Hill , a former interactive TV news journalist at NBC, ABC, and CBS affiliates in Missouri, gained recognition for pioneering interactive news broadcasting using Google Hangouts. She is now the CEO of Healium, the world’s first biometrically powered immersive media channel, helping those with stress, anxiety, insomnia, and other struggles through biofeedback storytelling. With patents, clinical validation, and over seven million views, she has reshaped the landscape of immersive media.

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The Impact of Homework on Student Mental Health

By Happy Sharer

Introduction

Homework is a key part of the educational process. It is often seen as an essential part of learning and helping students to develop important skills. However, there is growing evidence that too much homework can have a negative effect on student mental health. This article will explore the impact of homework on student mental health, examining the correlation between workload and stress levels, analyzing the effects of too much homework on student anxiety, and understanding how homework can lead to depression in students.

Exploring the Impact of Homework on Student Mental Health

Homework has long been seen as an important part of the educational process, but it can also become a source of stress for students. A recent study by the American Psychological Association found that more than two-thirds of students reported feeling overwhelmed by their homework load. The study also found that students who felt overwhelmed were more likely to experience symptoms of depression and anxiety. It is clear that the amount of homework assigned to students can have a significant impact on their mental health.

Examining the Correlation Between Homework and Student Stress Levels

The amount of homework assigned to students can have a direct impact on their stress levels. Too much homework can lead to feelings of frustration and overwhelm, which can then lead to increased stress levels. A study published in the journal Developmental Psychology found that when students had more homework assignments, they experienced higher levels of stress. The study also found that students who had more homework assignments were more likely to report feeling overwhelmed and anxious.

It is also important to consider the relationship between homework and academic performance. Studies have suggested that too much homework can lead to decreased academic performance, which can then lead to increased stress levels. A study published in the Journal of Experimental Education found that when students had more homework, their performance on tests was lower than those with less homework. This suggests that too much homework can lead to increased stress levels, as students feel pressure to perform at a higher level.

In order to reduce homework-related stress, it is important for students to prioritize their work. Planning ahead and breaking down tasks into smaller, more manageable chunks can help students to feel more organized and in control. Taking regular breaks throughout the day can also help students to stay focused and motivated. Finally, it is important to ensure that students are getting enough sleep in order to maintain their energy levels and reduce stress.

Analyzing the Effects of Too Much Homework on Student Anxiety

Too much homework can also lead to increased anxiety levels in students. A study published in the journal Clinical Child and Family Psychology Review found that when students had more homework, they were more likely to experience symptoms of anxiety. The study also found that students with excessive amounts of homework were more likely to report feeling overwhelmed and unable to cope with the workload.

It is important to understand the psychological effects of too much homework on students. Excessive amounts of homework can lead to feelings of frustration and helplessness, which can then lead to increased anxiety levels. Furthermore, students may start to see homework as a burden rather than an opportunity to learn, which can lead to decreased motivation and further feelings of anxiety.

In order to reduce homework-related anxiety, it is important to set realistic goals and expectations. Setting achievable goals and deadlines can help students to stay focused and motivated. It is also important to ensure that students are getting enough rest and taking regular breaks throughout the day. Finally, it is important to talk to teachers and parents about any concerns or worries that students may have about their workload.

Understanding How Homework Can Lead to Depression in Students

Too much homework can also lead to depression in students. A study published in the journal Pediatrics found that when students had more homework, they were more likely to experience symptoms of depression. The study also found that students with excessive amounts of homework were more likely to report feeling overwhelmed, frustrated, and helpless.

It is important to understand the psychological effects of too much homework on students. Excessive amounts of homework can lead to feelings of hopelessness and failure, which can then lead to increased depression levels. Furthermore, students may start to see homework as a chore rather than an opportunity to learn, which can lead to decreased motivation and further feelings of depression.

In order to reduce homework-related depression, it is important to focus on developing positive coping skills. Taking time to relax and practice mindfulness can help students to manage their emotions and stay focused. It is also important to ensure that students are getting enough sleep and taking regular breaks throughout the day. Finally, it is important to talk to teachers and parents about any concerns or worries that students may have about their workload.

Investigating the Relationship Between Homework and Student Self-Esteem

Finally, it is important to consider the relationship between homework and student self-esteem. A study published in the journal Developmental Psychology found that when students had more homework, they were more likely to report feeling inadequate and inferior. The study also found that students with excessive amounts of homework were more likely to report feeling overwhelmed and helpless.

It is important to understand the psychological effects of too much homework on students. Excessive amounts of homework can lead to feelings of worthlessness and failure, which can then lead to decreased self-esteem. Furthermore, students may start to see homework as a burden rather than an opportunity to learn, which can lead to decreased motivation and further feelings of inadequacy.

In order to increase homework-related self-esteem, it is important to focus on developing positive self-talk. Taking time to recognize achievements and celebrate successes can help students to stay motivated and build confidence. It is also important to ensure that students are getting enough rest and taking regular breaks throughout the day. Finally, it is important to talk to teachers and parents about any concerns or worries that students may have about their workload.

In conclusion, it is clear that the amount of homework assigned to students can have a significant impact on their mental health. Too much homework can lead to increased stress levels, anxiety, depression, and decreased self-esteem. It is therefore important to ensure that students are not overloaded with homework and are given the opportunity to learn in a healthy environment. By reducing the amount of homework assigned to students, we can help them to develop important skills without compromising their mental wellbeing.

(Note: Is this article not meeting your expectations? Do you have knowledge or insights to share? Unlock new opportunities and expand your reach by joining our authors team. Click Registration to join us and share your expertise with our readers.)

Hi, I'm Happy Sharer and I love sharing interesting and useful knowledge with others. I have a passion for learning and enjoy explaining complex concepts in a simple way.

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Does Homework Affect Mental Health?

Homework can be a source of frustration and stress for students, but how does it affect their mental health? As studies into this area continue to gather evidence, it is clear that there is a correlation between homework and mental health. In this article, we will explore the potential impacts of homework on students’ mental health, from the perspectives of both students and educators.

Yes, homework can affect mental health. It can lead to feelings of stress, frustration and even anger. Too much homework can also lead to sleep deprivation, which can have a negative impact on mental health. It’s important to balance homework with other activities such as exercise, spending time with family and friends, and participating in hobbies.

The Relationship Between Homework and Time Management

How to manage homework and mental health, the role of schools and parents, the impact of technology, can too much homework harm your child’s health, does homework impact mental health.

Homework can be a difficult task for students, especially when they are overwhelmed with the amount of work they have to complete. It is important to consider how homework impacts the mental health of students. While there is no single answer to this question, research suggests that homework can have a negative effect on mental health. Studies have found that students who spend a lot of time on homework have higher levels of stress and anxiety, as well as lower levels of academic performance.

One of the most common negative effects of homework on mental health is stress. Students who have too much homework can become overwhelmed, leading to feelings of frustration, hopelessness, and helplessness. This can lead to increased levels of stress, which can have a negative impact on mental health. Furthermore, stress can lead to difficulty concentrating, difficulty sleeping, and decreased motivation.

Another way that homework can negatively impact mental health is through academic performance. Research has found that students who spend too much time on homework have lower grades and are less likely to complete their assignments. This can lead to a decrease in self-esteem, as students may feel like they are not capable of achieving their academic goals. It can also lead to an increase in anxiety, as students may feel like they are not able to keep up with their peers.

Time management is an important skill for any student, and it can be difficult to manage when there is a lot of homework to complete. Students who have too much homework may find that they do not have enough time to complete their assignments, leading to feelings of frustration and helplessness. This can lead to poor time management skills, which can have a negative impact on mental health.

Furthermore, when students have too much homework, it can lead to procrastination. This can be a problem because it can lead to an inability to focus and get tasks done, which can have a negative impact on mental health. Poor time management skills can also lead to an inability to prioritize tasks, which can have a negative effect on overall performance.

It is important for students to find ways to manage their homework and mental health. One way to do this is to break up assignments into smaller chunks. This can help students to focus on one task at a time, which can reduce stress and anxiety. Additionally, students should try to take breaks while completing assignments, as this can help them to stay focused and motivated.

Furthermore, it is important for students to set realistic goals when it comes to completing their homework. Setting realistic goals can help students to stay motivated and can help them to avoid feeling overwhelmed. Additionally, students should try to find ways to make their homework more enjoyable, such as working with a friend or listening to music.

Schools and parents can also play an important role in helping students manage their homework and mental health. Schools can provide students with resources and support to help them manage their workload. Parents can also provide support and guidance to help students manage their workload. Additionally, both schools and parents can help students to set realistic goals and to develop good time management skills.

Technology can also have a positive impact on mental health when it comes to homework. Many students use technology to help them complete their assignments more quickly and efficiently. Additionally, technology can help students to stay organized and motivated. For example, many students use online calendars and to-do lists to help them keep track of their assignments.

Overall, homework can have a negative impact on mental health, but there are ways to manage this impact. Students should strive to find ways to make their homework more manageable, such as breaking up assignments into smaller chunks and setting realistic goals. Additionally, schools and parents can provide support and guidance to help students manage their workload. Finally, technology can be used to help students stay organized and motivated.

Related Faq

Q1: What is the purpose of homework? A1: Homework is typically assigned to students by their teachers as a way to review and practice the material learned in class. It is meant to reinforce the skills and knowledge taught in class and to help students develop good study habits, critical thinking, and problem solving skills.

Q2: What are the potential positive effects of doing homework? A2: Doing homework can potentially have positive effects on a student’s mental health. It can help to improve a student’s self-esteem and confidence by allowing them to practice their skills and gain a sense of accomplishment when completing their homework correctly. It can also help to reduce stress and anxiety by allowing students to work at their own pace and in the comfort of their own home.

Q3: What are the potential negative effects of doing homework? A3: The potential negative effects of doing homework can include an increase in stress and anxiety levels due to the pressure of completing assignments in a limited amount of time. It can also lead to feelings of frustration and dissatisfaction if a student is unable to complete the assignment correctly or quickly enough. Additionally, excessive amounts of homework can lead to a lack of sleep and decreased physical activity, both of which can contribute to mental health issues.

Q4: How can parents help their children manage their homework-related stress? A4: Parents can help their children manage their homework-related stress by creating a supportive environment in which their children feel comfortable and safe asking for help. Additionally, parents can ensure their children have a balanced schedule by limiting the amount of time spent on homework and encouraging physical activity and other activities. They can also help by providing a quiet, well-lit work area and allowing their children to break up their assignments into smaller tasks to make them seem more manageable.

Q5: How can teachers help their students manage their homework-related stress? A5: Teachers can help their students manage their homework-related stress by providing clear instructions and expectations for assignments. They can also ensure that the amount of homework assigned is appropriate for the student’s age and ability level. Additionally, teachers can provide resources for students who may need extra help, such as additional tutoring or study groups.

Q6: Is there a correlation between homework and poor mental health? A6: While there is no definitive answer to this question, there is evidence to suggest that excessive amounts of homework can be detrimental to a student’s mental health. Studies have found that too much homework can lead to increased stress and anxiety levels, as well as decreased physical activity levels. Additionally, it can lead to a lack of sleep, which can also have a negative effect on mental health.

The answer to the question of whether or not homework affects mental health is a resounding yes. Homework can have a positive effect on mental health when managed in a balanced and reasonable way, but when taken to extremes, it can become a source of stress, anxiety, and depression. The key is to ensure that homework is assigned in moderation and that students have the support they need to manage it. With the right balance, homework can help students build problem-solving skills, increase their confidence, and provide an opportunity to practice time management.

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How Does Homework Affect Students’ Mental Health?

Health, social life, and academic performance may all be impacted by homework. So here is how homework affects students’ mental health.

Nobody bargained or requested homework, so it is an after-school obligation. It is merely the additional work that every student is required to complete over a set period of time after school each day. Depending on the school, the teacher, and the student’s abilities, homework assignments could take more or less time.

A benefit of homework for students is that it helps them develop soft skills like organization and time management, which are crucial after high school. However, the extra work frequently makes both the child and the parents anxious. Some students may find themselves getting border and border as their homework load increases.

Read and learn more about homework and students’ mental health.

Table of Contents

It should come as no surprise that excessive homework can cause stress and anxiety. According to studies, students who receive an excessive amount of homework are more likely to exhibit depressive symptoms, such as feeling overwhelmed, unmotivated, and lonely.

In addition to these psychological repercussions, doing too much homework can cause physical problems like headaches, fatigue, and restless nights.

The negative effects of having too much homework can be even worse for kids. Inadequacy and frustration may result from children feeling under pressure to complete assignments accurately and promptly. Due to their intense workloads, they might also feel as though they are missing out on important social interactions with their friends.

The Negative Impact of Homework

The following are some of the factors that make homework demanding, depressing, and harmful to students’ mental health. Students’ mental health is continually in jeopardy as they work diligently on their assignments for alarmingly long periods of time. These compelling defenses against excessive homework are provided.

No Uniqueness

The purpose of homework should be to inspire kids to express themselves more creatively. The tasks that teachers give students must be engaging and emphasize their individuality. similar to writing an essay on a topic they enjoy.

Additionally, it’s important to support the child rather than criticize him for producing a subpar essay so that he can express himself more creatively.

Lack of Sleep

Lack of sleep is one of the most common negative effects of schoolwork. As a result of staying up late to finish their homework, students on average only get about 5 hours of sleep each night, despite the fact that humans require at least 7 hours of sleep each day. Both physical and mental health are impacted by sleep deprivation.

No Pleasure

When students are having fun, they learn more effectively. Usually, when their minds are not clouded by fear, they learn things more quickly. However, the element of fear that the majority of teachers introduce into homework prompts children to use unethical methods to complete their assignments.

Excessive Homework

In the current educational system, there is a lack of coordination between the teachers. Teachers consequently frequently end up giving students far more work than they can handle. In these situations, kids resort to doing their homework for them by either copying their friends’ work or using online homework helpers.

Anxiety Level

Stress brought on by homework can make people more anxious, which may lower their blood pressure levels. Do you know that in the United States, 3.5% of young people have high blood pressure?

Why then, when homework is supposed to be fun and something kids look forward to doing, does it often cause stress in kids? It is straightforward to refute this claim by stating that schoolwork is never enjoyable, but with some careful thought and planning, homework may actually be enjoyable.

No Time for Personal Matters

When students have too much homework, they don’t have enough free time. They are ecstatic all the time. For hobbies, socializing with coworkers, and other activities, there isn’t much time left.

Due to a lack of time, many students, however, dislike completing their assignments. They may stop learning as they come to hate it. It has a serious detrimental effect on their mental health in any case.

Everyone needs a break from time to time, including kids. Schools should take into account providing weekends without homework so that children can relax and get ready for the upcoming week. Having to complete homework every day of the week without a break could be demanding.

How Can Parents Help?

When it comes to protecting their kids’ mental health from the effects of homework, parents can be a huge help. The completion of assignments on time and without excessive stress can be ensured by talking to kids about expectations and limits.

Encouragement of communication about any issues kids might be having with their homework is also crucial. If kids say they’re frustrated or overwhelmed, parents should be understanding and supportive.

Parents should also pay attention to how much time their kids spend on their homework. Reevaluating the amount of homework assigned may be necessary if a child consistently struggles to finish assignments within the allotted timeframe.

In order to make sure that their kids are still having fun and interacting with other kids, parents should keep an eye on what their kids are doing.

Conclusion: Too Much Homework

In summary, too much homework can be bad for students’ mental health. Finding a balance between schoolwork and extracurricular activities is crucial for students, and parents can be very helpful in assisting their kids with workload management.

Therefore, it’s crucial to strike a balance that guarantees students comprehend the material covered in class without becoming overworked.

Does Homework Affect Your Brain?

Practice is a process that makes sure knowledge is ingrained in the brain. By repeating new skills, one can improve their memory and learn new ones. The purpose of homework, which is based on classwork, is to help students integrate new skills through practice.

Do Teachers Assign Too Much Homework?

Statistics show that giving students too much homework can be unhealthy for their health, leading to anxiety and burnout. Most teachers assign roughly 1-2 pages of homework , which may not appear to be much at first, but when added together, it can easily overwhelm a student.

What Are the Problems With Homework?

Many students wrote that homework causes them to sleep less than they should and leads to “ headaches, exhaustion, sleep deprivation, weight loss, and stomach problems ” as well as a lack of balance in their lives. The majority struggled with anxiety and/or had trouble finding time for important tasks outside of school.

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Mental Health and Wellbeing Resources for Students at Harvard

We hope that you find these resources to be helpful:

• The Mental Health and Wellbeing Online Learning Module equips students with information and tips on ways to support individual wellbeing, where to seek help when needed, and how to help a friend in need.
• Counseling and Mental Health Services (CAMHS) provides direct support.  One example of the resources we provide is the recently launched TimelyCare virtual platform , which offers each student up to 12 telehealth therapy sessions per academic year.
• The Center for Wellness and Health Promotion offers workshops and other services to nurture individual and collective wellbeing.
• The Student Wellbeing at Harvard website offers additional resources and opportunities to help students prioritize and expand wellbeing , engage in the campus community, and find support when needed.
• The Harvard Chan Office for Students also has some resource listings as well

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How Exercise Strengthens Your Brain

Physical activity improves cognitive and mental health in all sorts of ways. Here’s why, and how to reap the benefits.

By Dana G. Smith

Growing up in the Netherlands, Henriette van Praag had always been active, playing sports and riding her bike to school every day. Then, in the late-1990s, while working as a staff scientist at the Salk Institute for Biological Studies in San Diego, she discovered that exercise can spur the growth of new brain cells in mature mice. After that, her approach to exercise changed.

“I started to take it more seriously,” said Dr. van Praag, now an associate professor of biomedical science at Florida Atlantic University. Today, that involves doing CrossFit and running five or six miles several days a week.

Whether exercise can cause new neurons to grow in adult humans — a feat previously thought impossible, and a tantalizing prospect to treat neurodegenerative diseases — is still up for debate . But even if it’s not possible, physical activity is excellent for your brain, improving mood and cognition through “a plethora” of cellular changes, Dr. van Praag said.

What are some of the benefits, specifically?

Exercise offers short-term boosts in cognition. Studies show that immediately after a bout of physical activity, people perform better on tests of working memory and other executive functions . This may be in part because movement increases the release of neurotransmitters in the brain, most notably epinephrine and norepinephrine.

“These kinds of molecules are needed for paying attention to information,” said Marc Roig, an associate professor in the School of Physical and Occupational Therapy at McGill University. Attention is essential for working memory and executive functioning, he added.

The neurotransmitters dopamine and serotonin are also released with exercise, which is thought to be a main reason people often feel so good after going for a run or a long bike ride.

The brain benefits really start to emerge, though, when we work out consistently over time. Studies show that people who work out several times a week have higher cognitive test scores, on average, than people who are more sedentary. Other research has found that a person’s cognition tends to improve after participating in a new aerobic exercise program for several months.

Dr. Roig added the caveat that the effects on cognition aren’t huge, and not everyone improves to the same degree. “You cannot acquire a super memory just because you exercised,” he said.

Physical activity also benefits mood . People who work out regularly report having better mental health than people who are sedentary. And exercise programs can be effective at treating people’s depression, leading some psychiatrists and therapists to prescribe physical activity. The Centers for Disease Control and Prevention’s recommendation of 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week is a good benchmark.

Perhaps most remarkable, exercise offers protection against neurodegenerative diseases. “Physical activity is one of the health behaviors that’s shown to be the most beneficial for cognitive function and reducing risk of Alzheimer’s and dementia,” said Michelle Voss, an associate professor of psychological and brain sciences at the University of Iowa.

How does exercise do all that?

It starts with the muscles. When we work out, they release molecules that travel through the blood up to the brain. Some, like a hormone called irisin, have “neuroprotective” qualities and have been shown to be linked to the cognitive health benefits of exercise, said Christiane Wrann, an associate professor of medicine at Massachusetts General Hospital and Harvard Medical School who studies irisin . (Dr. Wrann is also a consultant for a pharmaceutical company, Aevum Therapeutics, hoping to harness irisin’s effects into a drug.)

Good blood flow is essential to obtain the benefits of physical activity. And conveniently, exercise improves circulation and stimulates the growth of new blood vessels in the brain. “It’s not just that there’s increased blood flow,” Dr. Voss said. “It’s that there’s a greater chance, then, for signaling molecules that are coming from the muscle to get delivered to the brain.”

Once these signals are in the brain, other chemicals are released locally. The star of the show is a hormone called brain-derived neurotrophic factor, or B.D.N.F., that is essential for neuron health and creating new connections — called synapses — between neurons. “It’s like a fertilizer for brain cells to recover from damage,” Dr. Voss said. “And also for synapses on nerve cells to connect with each other and sustain those connections.”

A greater number of blood vessels and connections between neurons can actually increase the size of different brain areas. This effect is especially noticeable in older adults because it can offset the loss of brain volume that happens with age. The hippocampus, an area important for memory and mood, is particularly affected. “We know that it shrinks with age,” Dr. Roig said. “And we know that if we exercise regularly, we can prevent this decline.”

Exercise’s effect on the hippocampus may be one way it helps protect against Alzheimer’s disease, which is associated with significant changes to that part of the brain. The same goes for depression; the hippocampus is smaller in people who are depressed, and effective treatments for depression , including medications and exercise, increase the size of the region.

What kind of exercise is best for your brain?

The experts emphasized that any exercise is good, and the type of activity doesn’t seem to matter, though most of the research has involved aerobic exercise. But, they added, higher-intensity workouts do appear to confer a bigger benefit for the brain.

Improving your overall cardiovascular fitness level also appears to be key. “It’s dose-dependent,” Dr. Wrann said. “The more you can improve your cardiorespiratory fitness, the better the benefits are.”

Like Dr. van Praag, Dr. Voss has incorporated her research into her life, making a concerted effort to engage in higher intensity exercise. For example, on busy days when she can’t fit in a full workout, she’ll seek out hills to bike up on her commute to work. “Even if it’s a little,” she said, “it’s still better than nothing.”

Dana G. Smith is a Times reporter covering personal health, particularly aging and brain health. More about Dana G. Smith

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ORIGINAL RESEARCH article

The influence of early diet quality on the mental health of college students: the mediation effects of height and qi-deficiency.

• Xichang College, Xichang, China

Background: In China, the prevalence of mental health issues among college students is a significant concern in society. This study aims to investigate the impact of early dietary quality on the psychological well-being of college students and elucidate the underlying mechanisms through which these effects occur, specifically focusing on height and qi -deficiency as mediators according to Chinese traditional medicine (CTM).

Methods: A total of 655 college students were surveyed in October 2023 using paper-pencil-based questionnaires at four second-tier universities in Sichuan Province. The assessment included mental health, height, and qi -deficiency. Pearson’s correlation and linear regression analyses were employed to examine the mediation model and test the hypotheses.

Results: The college students exhibited acceptable levels of early diet quality ( M = 3.72) and mental health ( M = 3.63), while also presenting mild qi -deficiency symptoms ( M = 2.25). Their average height was measured at 164.61 cm. Early diet quality demonstrated significant associations with mental health ( r = 0.38, p < 0.01), height ( r = 0.32, p < 0.01), and qi -deficiency ( r = −0.32, p < 0.01). Mental health displayed correlations with height ( r = 0.32, p < 0.01) and qi -deficiency ( r = −0.49, p < 0.01). The results of linear regression analyses revealed significant associations between early diet quality and mental health ( β = 0.31, p < 0.01), height ( β = 0.21, p < 0.01), as well as qi -deficiency ( β = −0.26, p < 0.01). Furthermore, when early diet quality was included in the regression model, both height ( β = 0.21, p < 0.01) and qi -deficiency ( β = −0.35, p < 0.01) emerged as significant mediators in the relationship with mental health.

Conclusion: The mediation model and hypotheses were strongly supported, demonstrating that early diet quality exerted an influence on the mental health of college students through two distinct pathways: height and qi -deficiency. Moreover, the mediating effect of qi -deficiency was found to be more pronounced than that of height in the relationship between early diet quality and mental health among college students.

1 Introduction

In recent years, the mental health concerns of college students in China have garnered significant attention. From 2010 to 2020, there was a notable increase in the prevalence rates of anxiety, depression, sleep disturbances, and suicide attempts among this population ( 1 ). Previous research has demonstrated that college students’ mental health concerns can be partially attributed to early adversity, particularly social and psychological stressors such as abuse, emotional neglect, and familial poverty experienced during childhood ( 2 , 3 ). Among early adversities, the long-term impact of early diet quality on college students’ mental health has received limited attention. Drawing upon contemporary research and Chinese traditional medicine theory (CTM), this study aims to elucidate the underlying mechanism through which early diet quality exerts enduring effects on the mental well-being of college students.

Early-life poor diet quality has been found to be associated with mental health outcomes across an individual’s lifespan. A study revealed that malnutrition (including anemia and developmental delays) at the age of 3 years significantly predicts the onset of schizophrenia at the age of 23 years, with intelligence quotient (IQ) at 11 years old acting as a mediating variable ( 4 ). Children who experienced malnutrition at the age of 3 exhibited heightened levels of aggression or hyperactivity by the age of 8, demonstrated increased externalizing problems by the age of 11, and displayed more pronounced behavioral disorders and excessive exercise patterns by the age of 17, irrespective of their psychosocial adversities. A dose–response relationship was observed between the severity of malnutrition at age 3 and externalizing behavior issues at ages 8 and 17. The association between malnutrition and externalizing behavior problems is mediated by low IQ ( 5 ). A longitudinal cohort study revealed a significant correlation between early-life malnutrition and the development of paranoid, schizoid, avoidant, and dependent personality traits in individuals during middle age ( 6 ).

Evidence suggests that the relationship between early diet quality and adult mental health may be mediated by physical well-being. Firstly, the quality of one’s diet during early life is a robust predictor of physical health in adulthood. A study demonstrated that individuals who consume nutrient-rich foods (such as meat, fish, and milk) less frequently during late childhood exhibit poorer health outcomes later in life. They are more susceptible to chronic diseases, experience higher rates of acute illnesses, report increased levels of physical discomfort or pain, and display stunted growth ( 7 ). The findings of another study indicate that nutritional status during childhood (including experiences of starvation and infrequent consumption of fish and meat) can serve as a significant predictor for early physical health, specifically height as a proxy variable, as well as long-term physical health outcomes beyond the age of 30 years ( 8 ). Based on data from the China Health and Pension Follow-up Survey (2013–2015), researchers discovered a positive correlation between childhood malnutrition and an increased susceptibility to various chronic illnesses as well as diminished cognitive abilities among older individuals ( 9 ). Other similar studies have also proved that the quality of diet in childhood is closely related to the lifelong physical health of individuals ( 10 , 11 ).

Furthermore, compelling evidence exists that elucidates the intricate relationship between physical and mental health. A longitudinal study encompassing a sample size of 10,693 individuals revealed that prior physical well-being can significantly impact one’s present mental well-being ( 12 ). Naylor et al. proposed that a significant proportion of clinical mental illnesses can be largely attributed to suboptimal physical health ( 13 ). Inadequate nutrition, particularly during childhood, can augment vulnerability to infectious diseases, thereby precipitating immunological dysfunction ( 14 ), and immunological dysfunction is considered as a shared and common mechanism underlying both mental and physical illness in adulthood ( 15 ). According to CTM, physical and mental health are inseparable, with physical health serving as the fundamental basis for mental well-being. Empirical evidence has demonstrated that enhancing an individual’s physical condition can yield favorable outcomes in terms of psychological disorders ( 16 ).

The state of qi in CTM serves as a reliable indicator of physical health status. Qi , one of the fundamental substances constituting the human body, is regarded as an essential form of energy and power within the body. Qi -deficiency refers to a lack of vitality that hinders overall bodily empowerment ( 17 ). People with evident qi- deficiency are more prone to physical ailments. Generally, the presence of insufficient energy and vitality, accompanied by fatigue and weariness, can be attributed to qi -deficiency ( 18 ). Prolonged qi -deficiency results in vascular blood stasis, ultimately leading to somatic discomfort and, in severe cases, atherosclerotic plaques within the vasculature, which are primary etiological factors of cardiovascular and cerebrovascular diseases ( 19 ). The inadequate generation of qi in the body due to poor diet and hunger leads to qi -deficiency, thereby adversely affecting both physical and mental well-being ( 17 ). The lifelong qi -deficiency constitution can be easily attributed to a prolonged inadequate diet and childhood malnutrition, which have long-term implications on health.

Multiple studies have demonstrated that height serves as a reliable indicator of physical well-being throughout an individual’s lifespan ( 20 ). For instance, a study encompassing a substantial sample size of 67,452 individuals revealed a significant association between height and overall health outcomes ( 21 ). The early-life burden of undernutrition and disease not only contributes to childhood mortality but also engenders enduring health risks for survivors, which are evidenced by stunted growth in adulthood and susceptibility to diseases in later life ( 22 ). Cámara et al. posited that adult height, serving as an indicator of childhood health, can serve as a proxy for the association between childhood health and later-life health outcomes ( 23 ). Utilizing adult height as a surrogate measure for physical well-being in adults, Wang and Niu discovered that early nutrition and the sanitary conditions of their living environment can significantly serve as predictors of individuals’ adult physical health ( 8 ). Height is widely acknowledged as a commonly used indicator for assessing early-life circumstances and physical well-being ( 24 , 25 ).

Based on the aforementioned, we postulated that the mental health issues prevalent among contemporary college students can be partially ascribed to their substandard dietary quality during early life. Inadequate dietary quality in early stages leads to compromised physical well-being, subsequently augmenting the vulnerability to mental health problems during emerging adulthood. Consequently, this study endeavors to explore the pathway linking early diet quality and mental health of college students through an examination of physical well-being proxies such as height and qi-deficiency. Thus, we put forth the following three hypotheses:

H1 : Early diet quality affects the mental health of college students;

H2 : Height mediates the association between early diet quality and the mental health of college students;

H3 : Qi -deficiency mediates the association between early diet quality and the mental health of college students.

The research model illustrated in Figure 1 below clearly delineates these three research hypotheses.

Figure 1 . The research model and hypotheses of this study. The (+) sign denotes a positive correlation, and the (−) sign indicates a negative correlation.

2 Research methods

2.1 measurements of key variables.

Mental health was measured using the WHO-5 well-being index, which has been commonly used in studies on mental health and shows good reliability and validity ( 26 ). The assessment comprises of a set of five items, wherein participants are required to provide self-reports on their mental states (e.g., moods and sleep patterns) over the preceding two-week period. In the present study, a 5-point Likert scale response was employed for this measurement, ranging from 1 (never) to 5 (all the time). One of the items states, “I have felt cheerful and been in good spirits.” The mean score of all the items was utilized to assess the level of mental health, with higher means indicating better mental well-being. In this study, the Cronbach’s alpha coefficient for the five items was 0.75, demonstrating good reliability.

The measurement of qi -deficiency in this study was conducted using a set of five items, which were developed based on rigorous medical research in the field of CTM ( 17 , 27 ). The participants were instructed to retrospectively recall their physical sensations experienced within the past three months and provide responses to each of the five items using a 5-point Likert scale, ranging from 1 (never) to 5 (all the time). One of the items reads, “I feel fatigue after mild activities.” The Cronbach’s alpha coefficient of this scale was 0.84, indicating a high level of internal consistency and reliability. The mean score of all the items was utilized to assess the level of qi -deficiency, with higher means indicating declining health condition.

Previous studies have indicated that self-reported height in adults serves as a reliable proxy for their actual height ( 8 , 28 ); Therefore, this study employed self-reported height as an indicator of participants’ true stature. Participants were instructed to provide their height response to the question, “how tall are you without shoes in cm?”

The early diet quality was assessed using a five-item questionnaire adapted from Cao et al.’s study ( 29 ). which asked participants to recall their dietary habits before the age of 12, including on-time consumption of breakfast, fruit intake, meat and egg consumption, and milk drinking. One of the items is: “I had breakfast on time.” The 5-point Likert scale was used with “1” indicating “never” and “5” indicating “almost every day.” The Cronbach’s alpha coefficient of 0.75 indicated good reliability in measuring early diet quality. The early diet quality index is determined by calculating the average score of the five items, with a higher score indicating better early diet quality.

2.2 Controlling variables

Previous research has established that the mental health of college students is linked to family residence (0 = rural area, 1 = urban area) ( 30 ), academic pressure ( 31 ), and family economic status ( 32 ). Therefore, in addition to common control variables such as sex (0 = female, 1 = male), major (0 = science, 1 = art), and age, all three aforementioned variables were controlled for in this study.

We employed a single question to assess the prevailing academic pressure, wherein participants were requested to rate their current academic pressure on a 5-point Likert scale ranging from “1” denoting “no pressure at all” to “5” indicating “very high pressure.” Simultaneously, we utilized one question to gauge the present economic status of their families, whereby participants subjectively evaluated their family’s financial condition on a 5-point Likert scale with “1” representing “very poor” and “5” signifying “very rich.”

2.3 Sampling procedure

We employed convenience sampling strategies to distribute 860 paper-pencil-based questionnaires among students enrolled in four second-tier universities in Sichuan Province during October 2023. Prior to conducting the survey, verbal informed consent was obtained from all participating students. Ultimately, a total of 655 valid questionnaires were collected, resulting in an effective response rate of 76.16%. The detailed characteristics of the study sample are presented in Table 1 .

Table 1 . Basic characteristics of the sample ( N  = 655).

3.1 Means, standard deviations, and correlations

Descriptive statistics and correlations are presented in Table 2 .

Table 2 . Descriptive statistics and correlation of continuous variables.

The mean scores of early diet quality and mental health were 3.72 and 3.63, respectively, slightly exceeding the midpoint value of 3.00 on the 5-point Likert scale. The average height was recorded as 164.61 cm. The average qi -deficiency score was found to be 2.25. Moreover, the mean academic pressure and family economic status scores were reported as 3.45 and 3.38, respectively, slightly surpassing the midpoint value of 3.00 on the 5-point Likert scale.

The results presented in Table 2 demonstrate a positive correlation between early diet quality and both mental health ( r  = 0.38, p  < 0.01) and height ( r  = 0.32, p  < 0.01), as well as a negative correlation with qi -deficiency ( r  = −0.32, p  < 0.01). Additionally, mental health is negatively correlated with qi -deficiency ( r  = −0.49, p  < 0.01) and positively correlated with height ( r  = 0.32, p  < 0.01). Academic pressure exhibits a negative correlation with mental health ( r  = −0.20, p  < 0.01), while family economic status shows a positive correlation with mental health ( r  = 0.12, p  < 0.01).

3.2 Regression analysis

The present study employed a three-step regression technique to discern the mediating roles among the variables ( 33 ). In the initial step, a regression analysis was conducted to examine the relationship between an independent variable, X, and a dependent variable, Y. If the regression effect was found to be significant, subsequent steps were performed. In the second step, another independent variable M was included in the regression model with X as predictors. The third step involved regressing Y on both X and M simultaneously. A mediating role for M would be supported if it significantly predicted Y in this final step. This study aimed to demonstrate that height and qi -deficiency act as significant mediators in explaining the association between early diet quality and mental health.

In step 1 ( Table 3 ), the regression analysis examined the association between early diet quality and mental health, while in step 2 ( Table 3 ), separate regression analyses were conducted to explore the relationships between early diet quality and both height and qi- deficiency.

Table 3 . Mediation effect analysis based on a three-step regression.

The results of Step 1 demonstrated a significant and negative association between early diet quality and mental health ( β  = 0.31, p  < 0.01), thus confirming the first hypothesis.

Regarding the controlling variables, we observed a significant association between family residence and mental health ( β  = 0.19, p  < 0.01), suggesting that individuals from urban areas exhibited superior mental well-being compared to their rural counterparts. Additionally, academic pressure demonstrated a negative correlation with mental health ( β  = −0.12, p  < 0.01). Age, sex, major, and family economic status did not yield statistically significant effects on mental health.

Step 2 revealed a significant positive association between early diet quality and height ( β  = 0.21, p  < 0.01), as well as a negative association with qi -deficiency ( β  = −0.26, p  < 0.01).

Subsequently, in step 3, we performed a multiple regression analysis to examine the simultaneous effects of height, qi -deficiency, and early diet quality on mental health. The detailed results can be found in Table 3 .

The regression results from step 3 demonstrated that, in the presence of height and qi -deficiency, early diet quality continued to exert significant effects on mental health ( β  = 0.18, p  < 0.01), albeit with a smaller effect size compared to step 1 ( β  = 0.31, p  < 0.01).

In addition, after controlling for early diet quality in the regression analysis, it was found in step 3 that height ( β  = 0.21, p < 0.01) and qi -deficiency ( β  = −0.35, p  < 0.01) exerted significant effects on mental health.

Therefore, height and qi -deficiency partially mediated the relationship between early diet quality and mental health, indicating that hypothesis 3 is well supported.

The mediating role of height and qi- deficiency is illustrated in Figure 2 .

Figure 2 . The research model and hypotheses in this study.

The overall impact of the pathway “early diet quality → mental health” was 0.31, with an indirect effect through the pathway “early diet quality → height → mental health” of 0.04 (i.e., 0.21 * 0.21). Therefore, the mediating role of height between early diet quality and mental health accounted for approximately 12.90% (i.e., 0.04/0.31) of the total effect. Similarly, the indirect effect through the pathway “early diet quality → qi -deficiency → mental health” was 0.091 (i.e., 0.26 * 0.35). Hence, the mediating effect of qi -deficiency between early diet quality and mental health contributed to around 29.03% (i.e., 0.09/0.31) of the total effect. The mediating effect of qi -deficiency exhibited a greater magnitude compared to height in the association between early diet quality and the mental health of college students.

4 Discussion

4.1 descriptive statistics for early diet quality, mental health, height, and qi -deficiency.

The findings of this study indicate that the average early diet quality score among college students in China exceeded the midpoint value of 3.00 on the 5-point Likert scale. It can be inferred that the early diet quality of college students was deemed acceptable rather than excellent. This conclusion aligns with previous studies conducted between 2010 and 2017, which highlighted malnutrition as an ongoing public health concern among Chinese adolescents ( 34 , 35 ).

The mean mental health score slightly exceeded the midpoint value of 3.00 on the 5-point Likert scale, indicating that college students exhibited an acceptable rather than excellent level of mental health status. This finding aligns with previous studies highlighting the prevalence of mental health issues among Chinese college students ( 1 ).

In this study, the average height of college students was found to be 164.61 cm (170.89 cm for males and 159.73 cm for females), which surpassed the mean height observed among Chinese adults aged 18 to 44 in the years spanning from 2015 to 2019 (169.70 cm for males and 158.00 cm for females) ( 36 ). The primary reason for this outcome is primarily attributed to the fact that college students, on average, exhibit a greater height compared to the general adult population.

College students reported an average qi -deficiency score of 2.25 on the 5-point Likert scale, indicating a mild state of qi -deficiency among college students based on CTM principles. Since no prior surveys have been conducted on qi -deficiency specifically in this population, direct comparisons with other studies are not feasible.

4.2 Relationship between early diet quality and the mental health of college students

The first hypothesis posits that early diet quality is a significant predictor of mental health, which is strongly supported by the regression analysis ( β  = 0.31, p  < 0.01) in step 1 ( Table 3 ). This finding aligns with previous studies conducted by Venables and Raine ( 4 ), Liu et al. ( 5 ), and Hock et al. ( 6 ), all of which have demonstrated the substantial impact of early diet quality on mental health outcomes during adulthood.

Our second hypothesis posits that height serves as a mediator in the relationship between early diet quality and mental health, which is strongly supported by the regression analysis conducted in steps 2 and 3 ( Table 3 ). Firstly, our findings reveal a positive predictive effect of early diet quality on height ( β  = 0.21, p  < 0.01), indicating a significant and favorable impact of early nutrition on the physical well-being of college students. This outcome aligns with previous literature ( 8 , 22 , 37 ), where it has been highlighted that early nutrition and diseases are crucial non-genetic factors influencing growth and adult body height ( 37 ). Secondly, we observe a positive association between height and mental health among college students ( β  = 0.21, p  < 0.01), suggesting that physical well-being contributes to mental well-being—a finding consistent with prior research ( 13 , 16 ). For instance, Happell et al.’s literature review demonstrated the beneficial effects of improving physical status on mental health ( 16 ).

The third hypothesis, which posits that qi -deficiency may serve as a mediator in the relationship between early diet quality and mental health, is also strongly supported. Firstly, there was a significant predictive association between early diet quality and qi -deficiency ( β  = −0.261, p  < 0.01; step 2 in Table 3 ). According to CTM, prolonged inadequate dietary intake or childhood illnesses are primary factors contributing to the development of a constitution characterized by qi -deficiency ( 38 ). For instance, suboptimal nutrition during childhood can impair the functioning of internal organs (particularly the spleen and stomach), leading to lifelong qi -deficiency ( 39 ). Secondly, our findings demonstrate a significant impact of qi -deficiency on mental health ( β  = −0.35, p  < 0.01; step 3 in Table 3 ), aligning with previous research findings ( 40 , 41 ). A study revealed that both sexes exhibited associations between major depression and conditions characterized by either qi -stagnation or qi -deficiency; particularly noteworthy was the link observed between major depression and male individuals with qi -deficiency ( 41 ).

In summary, all three hypotheses were strongly supported, indicating that early diet quality has a significant impact on the mental health of college students through the mediating pathways of height and qi -deficiency. Notably, the mediating effect of qi -deficiency was found to be greater than that of height. Given that both height and qi- deficiency reflect an individual’s physical health status, these findings suggest that early diet quality can indirectly influence adult mental health through its effects on physical health in adulthood.

4.3 Effects of controlling variables

Regarding the controlling variables, our findings indicate that individuals residing in urban areas exhibit superior mental well-being compared to their rural counterparts. This disparity can be attributed to the fact that families in urban regions of China possess greater access to family and public educational resources for their children, including financial support and educational opportunities ( 42 ). Additionally, we observed a negative association between academic pressure and mental health. This can be explained by the notion that heightened academic pressure elicits an immunological response, ultimately leading to detrimental effects on both physical and mental health ( 43 ).

4.4 Theoretical and practical implications

The findings of this study suggest that early dietary quality may have an indirect impact on mental health in early adulthood through its influence on physical health. This outcome aligns with the concept of health in CTM, which emphasizes the interdependence of physical and mental well-being ( 44 ). Furthermore, it is consistent with contemporary research indicating a close relationship between physical and mental illnesses, sharing common underlying mechanisms ( 45 ). For instance, previous research has demonstrated that inadequate nutrition during childhood can heighten susceptibility to infectious diseases, thereby leading to immunological dysfunction ( 14 ), which serves as a shared mechanism for both mental and physical disorders ( 15 ).

Furthermore, this study suggests that physical health acts as a mediator in the relationship between early diet quality and mental health among college students. It identifies two specific pathways, namely height and qi -deficiency, with the mediating effect of qi -deficiency being significantly stronger than that of height. Previous studies have commonly considered height as a reliable proxy for early nutrition and overall health throughout life. However, this study proposes that compared to height, qi -deficiency may serve as a more accurate proxy for early nutrition and long-term health outcomes. According to CTM, poor diet quality leading to qi- deficiency during early life can render individuals more susceptible to both physical and mental health issues across their lifespan. In summary, from a theoretical standpoint, this study elucidates the precise mechanism through which early diet quality influences mental health during young adulthood.

In practical terms, this study suggests that the prevention of psychological issues among college students should commence with their childhood experiences, including early dietary quality. The issue of dietary quality in primary schools continues to be a matter of public health concern, particularly in towns and rural areas. It is well-known that many boarding school students in these regions exhibit aversion toward the provided meals, leading to common occurrences of picky eating, breakfast skipping, and infrequent milk consumption. Evidently, such practices can have detrimental effects on their physical well-being, resulting in stunted growth and qi -deficiency; ultimately potentially impacting their mental health during their future college years.

Furthermore, this study can aid college students in early detection of subtle indicators of declining physical and mental well-being. In the context of CTM, qi -deficiency can be regarded as an initial sign of deteriorating physical and mental health. When college students experience symptoms such as excessive sweating after minimal exercise and a lack of strength, they should modify their lifestyle to restore qi levels in the body instead of persisting with unhealthy eating habits like consuming junk food or skipping breakfast until clinical intervention becomes necessary. To summarize, for college students who had poor dietary quality during childhood, attending to their own qi -deficiency status is highly beneficial for healthcare.

5 Strengths and shortcomings of this study

This study possesses two distinct theoretical advantages. Firstly, it highlights the significance of both height and qi -deficiency as mediators in the relationship between early diet quality and mental health. While previous studies have often employed height as a proxy variable for early experiences and lifelong health ( 21 , 25 ), few have examined its role as an intermediary variable between early diet quality and mental health during early adulthood. Moreover, although some Chinese scholars have identified a strong correlation between qi -deficiency and psychological disorders such as anxiety and depression ( 41 , 46 ), limited research has explored the mediating effect of qi -deficiency on the association between early diet quality and mental health during early adulthood. Secondly, this study demonstrates that qi -deficiency plays a stronger mediating role than height in linking early diet quality to mental health outcomes, suggesting that qi -deficiency may be a better predictor of college students’ mental well-being compared to their height. This finding aligns with the concept in CTM that emphasizes the fundamental importance of qi –a vital substance providing energy and power – for both physical and psychological well-being ( 47 ).

This study holds practical significance as it pertains to the prevention of mental health issues. Qi -deficiency serves as a valuable indicator in this regard, enabling college students to promptly adjust their lifestyle (e.g., adopting a healthier diet and prioritizing rest) upon experiencing symptoms such as excessive sweating after minimal exercise and lack of strength. While inadequate dietary habits during early life may impact height and contribute to qi -deficiency in adulthood, the latter can be effectively addressed through the adoption of a healthy lifestyle ( 17 ), whereas adult height remains unmodifiable. Given the Chinese government’s current emphasis on mental illness prevention, it is crucial to acknowledge the substantial influence that qi -deficiency exerts on mental health.

However, this study has several limitations. Firstly, we did not incorporate other physical discomforts such as stomach discomfort, menstrual pain, and cold extremities to assess the physical well-being of college students. Based on interview responses from the study participants, these symptoms are prevalent among college students. By including these indicators in our assessments, a more comprehensive measurement of physical health status can be achieved, enabling a more detailed estimation of the mediating role of height and qi -deficiency. Secondly, our sampling technique was non-randomized and limited to second-tier universities without representation from first-tier institutions. Consequently, the sample used in this study lacks representativeness which compromises its external validity. Future research should address these limitations to further explore the intricate relationship between early diet quality and both physical and mental health during early adulthood.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The studies involving human participants were reviewed and approved by the Research Ethics Committee of Xichang University (LG2021), and was conducted in accordance with the principles outlined in the Declaration of Helsinki. The participants provided their written informed consent to participate in this study.

Author contributions

XW: Writing – original draft, Writing – review & editing, Methodology. XH: Conceptualization, Methodology, Writing – review & editing. KF: Data curation, Investigation, Writing – review & editing. YZ: Investigation, Validation, Writing – review & editing.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by College Teachers’ mental health: self induced and prevention under pressure (Xichang college, LGLS202201), Research Project on Higher Education Teaching Reform of the National Ethnic Affairs Commission “Research on the Education Path of Chinese Ethnic Community Awareness in Universities in Ethnic Regions Based on Cultural Identity” (ZL21093), and Key Project of the 14th Five Year Plan for Social Science Research in Sichuan Province “Research on Education of Chinese Ethnic Community Awareness in Schools in Ethnic Regions Based on Cultural Identity” (SC22A008).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1. Chen, Y, Zhang, Y, and Yu, G. Prevalence of mental health problems among college students in mainland China from 2010 to 2020: a meta-analysis. Science . (2022) 30:991–1004. doi: 10.3724/SP.J.1042.2022.00991

Crossref Full Text | Google Scholar

2. Wang, X, and Fu, K. Long-term effects of early adversity on the mental health of college students: the mitigating effect of physical exercise. Front Psychol . (2023) 14:1102508. doi: 10.3389/fpsyg.2023.1102508

PubMed Abstract | Crossref Full Text | Google Scholar

3. Husky, MM, Sadikova, E, Lee, S, Alonso, J, Auerbach, RP, Bantjes, J, et al. Childhood adversities and mental disorders in first-year college students: results from the world mental health international college student initiative. Psychol Med . (2023) 53:2963–73. doi: 10.1017/S0033291721004980

4. Venables, PH, and Raine, A. Poor nutrition at age 3 and schizotypal personality at age 23: the mediating role of age 11 cognitive functioning. Am J Psychiatry . (2012) 169:822–30. doi: 10.1176/appi.ajp.2012.11081173

5. Liu, J, Raine, A, Venables, PH, and Mednick, SA. Malnutrition at age 3 years and externalizing behavior problems at ages 8, 11, and 17 years. Am J Psychiatry . (2004) 161:2005–13. doi: 10.1176/appi.ajp.161.11.2005

6. Hock, RS, Bryce, CP, Fischer, L, First, MB, Fitzmaurice, GM, Costa, PT, et al. Childhood malnutrition and maltreatment are linked with personality disorder symptoms in adulthood: results from a Barbados lifespan cohort. Psychiatry Res . (2018) 269:301–8. doi: 10.1016/j.psychres.2018.05.085

7. Qi, Y, and Niu, J. Does childhood nutrition predict health outcomes during adulthood? Evidence from a population-based study in China. J Biosoc Sci . (2015) 47:650–66. doi: 10.1017/S0021932014000509

8. Wang, X, and Niu, Y. Review of advertising ethics recognition model based on individual autonomy. Foreign Econ Manag . (2014) 34:35–45. doi: 10.19934/j.cnki.shxyj.2019.01.007

9. Yafei, L. Does starvation in childhood affect health in old age? Econ Rev . (2018) 6:113–26.

Google Scholar

10. Cui, H, Smith, JP, and Zhao, Y. Early-life deprivation and health outcomes in adulthood: evidence from childhood hunger episodes of middle-aged and elderly Chinese. J Dev Econ . (2020) 143:102417–78. doi: 10.1016/j.jdeveco.2019.102417

11. Zhou, Q, Yin, Z, Wu, W, and Li, N. Childhood familial environment and adulthood depression: evidence from a Chinese population-based study. Int Health . (2020) 12:299–316. doi: 10.1093/inthealth/ihz084

12. Ohrnberger, J, Fichera, E, and Sutton, M. The relationship between physical and mental health: a mediation analysis. Soc Sci Med . (2017) 195:42–9. doi: 10.1016/j.socscimed.2017.11.008

13. das, P, Naylor, C, and Majeed, A. Bringing together physical and mental health within primary care: a new frontier for integrated care. Royal Soc Med . (2016) 109:364–6. doi: 10.1177/0141076816665270

14. Keusch, GT. The history of nutrition: malnutrition, infection and immunity. J Nutr . (2003) 133:336S–40S. doi: 10.1093/jn/133.1.336s

15. Lotti, T, and França, K. Psycho-neuro-endocrine-immunology: A psychobiological concept. Adv Integrat Dermatol . (2019):9–23. doi: 10.1002/9781119476009.ch2

16. Happell, B, Davies, C, and Scott, D. Health behaviour interventions to improve physical health in individuals diagnosed with a mental illness: a systematic review. Int J Ment Health Nurs . (2012) 21:236–47. doi: 10.1111/j.1447-0349.2012.00816.x

17. Chiang, H-C, Yang, ST, Lee, KC, Huang, PY, Hsu, M, and Chang, HH. From theory to clinic: key components of qi deficiency in traditional Chinese medicine. Altern Ther Health Med . (2012) 18:28–36.

PubMed Abstract | Google Scholar

18. Li, X.-T., Kuang, H.-X., and Zhao, J., Why is Qi-invigorating therapy in Chinese medicine suitable for mitochondrial diseases? A bioenergetic perspective. Complementary therapies for the body, mind and soul . Rijeka: InTech Open Access Publisher. (2015): p. 243–283.

19. Wu, Y. Collateral theory and vascular lesion treatment. Am J Chin Med . (2009) 37:241–52. doi: 10.1142/S0192415X09006801

20. Rashad, I. Height, health, and income in the US, 1984–2005. Econ Human Biol . (2008) 6:108–26. doi: 10.1016/j.ehb.2007.10.002

21. Chiou, J-S, Cheng, CF, Liang, WM, Chou, CH, Wang, CH, Lin, WD, et al. Your height affects your health: genetic determinants and health-related outcomes in Taiwan. BMC Med . (2022) 20:250. doi: 10.1186/s12916-022-02450-w

22. Bozzoli, C, Deaton, A, and Quintana-Domeque, C. Adult height and childhood disease. Demography . (2009) 46:647–69. doi: 10.1111/apt.15667

23. Huang, W, Lei, X, Ridder, G, Strauss, J, and Zhao, Y. Health, height, height shrinkage, and SES at older ages: evidence from China. Am Econ J Appl Econ . (2013) 5:86–121. doi: 10.1257/app.5.2.86

24. Yanbi, H, and Jingming, L. Childhood health and social class reproduction. Sociol Res . (2019) 1:156–82.

25. Cámara, AD, Puche, J, Ramon-Muñoz, JM, and Ramon-Muñoz, JM. Height and inequality in Spain: a long-term perspective. Revista de Historia Económica . (2019) 37:205–38. doi: 10.1017/S0212610919000089

26. Moon, YS, Kim, HJ, and Kim, DH. The relationship of the Korean version of the WHO five well-being index with depressive symptoms and quality of life in the community-dwelling elderly. Asian J Psychiatr . (2014) 9:26–30. doi: 10.1016/j.ajp.2013.12.014

27. Kim, J, Ku, B, and Kim, KH. Validation of the qi blood yin yang deficiency questionnaire on chronic fatigue. Chin Med . (2016) 11:24–11. doi: 10.1186/s13020-016-0092-y

28. Ng, CD. Biases in self-reported height and weight measurements and their effects on modeling health outcomes. SSM Population Health . (2019) 7:100405. doi: 10.1016/j.ssmph.2019.100405

29. Wen-jun, CAO, Ying, G, Wei-wei, P, and Jian-zhong, Z. Development and psychometric tests of a Chinese version of the HPLP-II scales. Chin J Dis Control Prevent . (2016) 20:286–9. doi: 10.16462/j.cnki.zhjbkz.2016.03.018

30. Wang, J, and Geng, L. Effects of socioeconomic status on physical and psychological health: lifestyle as a mediator. Int J Environ Res Public Health . (2019) 16:281. doi: 10.3390/ijerph16020281

31. Córdova Olivera, P, Gasser Gordillo, P, Naranjo Mejía, H, la Fuente Taborga, I, Grajeda Chacón, A, and Sanjinés Unzueta, A. Academic stress as a predictor of mental health in university students. Cogent Educ . (2023) 10:2232686. doi: 10.1080/2331186X.2023.2232686

32. Wang, C, Yan, S, Jiang, H, Guo, Y, Gan, Y, Lv, C, et al. Socio-demographic characteristics, lifestyles, social support quality and mental health in college students: a cross-sectional study. BMC Public Health . (2022) 22:1583. doi: 10.21203/rs.3.rs-75584/v2

33. Wen, Z, Lei, C, Kit-Tai, H, and Hongyun, L. Testing and application of the mediating effects. Acta Psychol Sin . (2004) 36:614–20.

34. Ji, CY. Malnutrition in adolescents remains a public health problem. China Health Standard Manag . (2011) 2:46–9. doi: CNKI:SUN:WSBZ.0.2011-03-022

35. Yi, S. Analysis on prevalence of malnutrition among Han students in China from 2010 to 2014. Capital J Public Health . (2017) 11:95–98+105. doi: 10.16760/j.cnki.sdggws.2017.03.002

36. Liu, Y. The report on the nutrition and chronic disease status of Chinese residents (2020) was released. Chinese. Food Nutr . (2020) 26:2. doi: 10.19870/j.cnki.11-3716/ts.2020.12.001

37. Silventoinen, K. Determinants of variation in adult body height. J Biosoc Sci . (2003) 35:263–85. doi: 10.1017/S0021932003002633

38. Li, D. On the formation factors of Qi deficiency constitution. J Basic Med Tradit Chinese Med . (1998) 4:8–10. doi: 10.19945/j.cnki.issn.1006-3250.1998.09.004

39. Peiguang, P, Benqian, P, and Junliang, Z. Spleen and stomach theory and Qi deficiency constitution. Chin J Clin Rehab . (2006) 10:165–6.

40. Li, XJ, Qiu, WQ, da, XL, Hou, YJ, Ma, QY, Wang, TY, et al. A combination of depression and liver Qi stagnation and spleen deficiency syndrome using a rat model. Anat Rec . (2020) 303:2154–67. doi: 10.1002/ar.24388

41. Kondo, T, Tokunaga, S, Sugahara, H, Yoshimasu, K, Akamine, M, Kanemitsu, Y, et al. Qi-deficiency, Qi-stagnation, Qi-flowback, blood deficiency, and fluid retention in patients with depression, psychiatric disorders, or psychosomatic disorders. Psychology . (2011) 2:643–59.

42. GAO, Y. Educational attainment and Hukou inequality. J Soc Dev . (2015) 4:43–63.

43. Seiler, A, Fagundes, CP, and Christian, LM. The impact of everyday stressors on the immune system and health. Stress Chall Immun Space . (2020):71–92. doi: 10.1007/978-3-030-16996-1_6

44. Aung, SKH, Fay, H, and Hobbs, RF. Traditional Chinese medicine as a basis for treating psychiatric disorders: a review of theory with illustrative cases. Med Acupunct . (2013) 25:398–406. doi: 10.1089/acu.2013.1007

45. Hostinar, CE, Nusslock, R, and Miller, GE. Future directions in the study of early-life stress and physical and emotional health: implications of the neuroimmune network hypothesis. J Clin Child Adolesc Psychol . (2018) 47:142–56. doi: 10.1080/15374416.2016.1266647

46. Liao, Y-C, Chou, CY, Chang, CT, Li, TC, Sun, MF, Chang, HH, et al. Qi deficiency is associated with depression in chronic hemodialysis patients. Complement Ther Med . (2017) 30:102–6. doi: 10.1016/j.ctim.2016.12.008

47. Chiang, H-C, Chang, H-H, and Huang, P-Y. On the qi deficiency in traditional Chinese medicine. Taiwan J Obstet Gynecol . (2014) 53:317–23. doi: 10.1016/j.tjog.2013.06.013

Keywords: early diet quality, mental health, height, qi -deficiency, Chinese traditional medicine

Citation: Wang X, He X, Fu K and Zhang Y (2024) The influence of early diet quality on the mental health of college students: the mediation effects of height and qi -deficiency. Front. Public Health . 12:1363866. doi: 10.3389/fpubh.2024.1363866

Received: 31 December 2023; Accepted: 18 March 2024; Published: 09 April 2024.

Reviewed by:

Copyright © 2024 Wang, He, Fu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Xinyu He, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Study unpicks why childhood maltreatment continues to impact on mental and physical health into adulthood

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Childhood maltreatment can continue to have an impact long into adulthood because of how it effects an individual’s risk of poor physical health and traumatic experiences many years later, a new study has found.

We’ve known for some time that people who experience abuse or neglect as a child can continue to experience mental health problems long into adulthood Sofia Orellana

Individuals who experienced maltreatment in childhood – such as emotional, physical and sexual abuse, or emotional and physical neglect – are more likely to develop mental illness throughout their entire life, but it is not yet well understood why this risk persists many decades after maltreatment first took place.

In a study published in Proceedings of the National Academy of Sciences, scientists from the University of Cambridge and Leiden University found that adult brains continue to be affected by childhood maltreatment in adulthood because these experiences make individuals more likely to experience obesity, inflammation and traumatic events, all of which are risk factors for poor health and wellbeing, which in turn also affect brain structure and therefore brain health.

The researchers examined MRI brain scans from approximately 21,000 adult participants aged 40 to 70 years in UK Biobank, as well as information on body mass index (an indicator of metabolic health), CRP (a blood marker of inflammation) and experiences of childhood maltreatment and adult trauma.

Sofia Orellana, a PhD student at the Department of Psychiatry and Darwin College, University of Cambridge, said: “We’ve known for some time that people who experience abuse or neglect as a child can continue to experience mental health problems long into adulthood and that their experiences can also cause long term problems for the brain, the immune system and the metabolic system, which ultimately controls the health of your heart or your propensity to diabetes for instance. What hasn’t been clear is how all these effects interact or reinforce each other.”

Using a type of statistical modelling that allowed them to determine how these interactions work, the researchers confirmed that experiencing childhood maltreatment made individuals more likely to have an increased body mass index (or obesity) and experience greater rates of trauma in adulthood. Individuals with a history of maltreatment tended to show signs of dysfunction in their immune systems, and the researchers showed that this dysfunction is the product of obesity and repeated exposure to traumatic events.

Next, the researchers expanded their models to include MRI measures of the adult’s brains and were able to show that widespread increases and decreases in brain thickness and volume associated with greater body mass index, inflammation and trauma were attributable to childhood maltreatment having made these factors more likely in the first place. These changes in brain structure likely mean that some form of physical damage is occurring to brain cells, affecting how they work and function.

Although there is more to do to understand how these effects operate at a cellular level in the brain, the researchers believe that their findings advance our understanding of how adverse events in childhood can contribute to life-long increased risk of brain and mind health disorders.

Professor Ed Bullmore from the Department of Psychiatry and an Honorary Fellow at Downing College, Cambridge, said: “Now that we have a better understanding of why childhood maltreatment has long term effects, we can potentially look for biomarkers – biological red flags – that indicate whether an individual is at increased risk of continuing problems. This could help us target early on those who most need help, and hopefully aid them in breaking this chain of ill health.”

The research was supported by MQ: Transforming Mental Health, the Royal Society, Medical Research Council, National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre, the NIHR Applied Research Collaboration East of England, Girton College and Darwin College.

Reference Orellana, SC et al. Childhood maltreatment influences adult brain structure through its effects on immune, metabolic and psychosocial factors. PNAS; 9 Apr 2024 ; DOI: 10.1073/pnas.230470412

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