Too perfect to be healthy?: A quantitative and qualitative study of perfectionism, expectations, and mental health among students aged 13-16 in specialized sports, performing arts and regular lower secondary school

Abstract

Background: Concerns have been raised among practitioners and researchers about the increasing professionalization of young performers, which may generate negative experiences resulting from high expectations, perfectionism, and rigid schedules. Such experiences make young student-athletes and performing arts students susceptible to mental and physical strains. Still, original research on young teenage student-athletes and performing arts students are limited compared to mainstream students’ mental health and aspects of perfectionism and expectations. By adopting quantitative and qualitative methods, this thesis aimed to lay the foundation for further comprehensive knowledge. Contributing to increased knowledge is pivotal to informing best practices that promote mental health development and well-being. This thesis is even more relevant now, as Norwegian TD sports schools have increased in numbers without a comprehensive evidence base to draw on.

Objectives: The overarching objective was to gain further knowledge about school-aged students’ perfectionism, expectations, and mental health. The first paper aimed to identify how different perfectionism factors may co-exist in adolescents and how such profiles might be differently related to potentially adverse and positive mental health outcomes among talent development (TD) and regular students aged 13-14. The second paper aimed to identify how potential positive and adverse mental health indicators may co-occur in adolescents. Further, stability and transition between mental health profiles from age 13 to 16 and their association with self-oriented and socially prescribed perfectionism, gender, and school type were explored. The third paper aimed to provide in-depth insight into how self-oriented and socially prescribed expectations might be experienced by TD students in sports, ballet, and music aged 14-15.

Methods: Two quantitative studies, one cross-sectional and one prospective, were designed, targeting perfectionism and positive (resilience and self-worth) and negative mental health indicators (anxiety, depressive symptoms, and weight-shape concerns). The third study used a qualitative design with broad perspectives of expectations, i.e., because experiences of unrealistic expectations are involved in perfectionism. Students were recruited from Norwegian lower secondary schools: all three specialized TD sports schools existing at the initiation of study I, one TD ballet and one classical music class, and 11 schools referred to as regular in the thesis. In total, 832 (53.2% girls) and 946 (50.4% girls) students were included in paper I and II, respectively; this included 166 and 168 TD students in papers I and II, respectively. The qualitative paper (III) included 27 TD students. Cross-sectional perfectionism profiles (paper I) were explored by latent profile analysis (LPA). Mental health profiles (paper II) were explored by LPA and prospectively by latent transition analysis. The qualitative study was based on semi-structured interviews and analyzed by reflexive thematic analysis.

Results: Five identified perfectionism profiles (paper I) were related differently to adverse and positive mental health indicators. Students with co-occurring high levels of perfectionism (high mixed perfectionism) and a profile dominant by perfectionistic concerns (PC) fared worse, i.e., higher anxiety, depression, weight-shape concerns, and lower resilience and self-worth, than students with non-perfectionism and a profile dominant of personal standards and self-oriented perfectionism. Relatively high proportions experienced high mixed and PC-dominant perfectionism among student performers (22%) and regular students (38%). In paper II, four mental health profiles (distressed-body concerned, dissatisfied, moderate mentally healthy, mentally healthy) showed distinct patterns of co-occurring anxiety, depression, weight-shape concerns, and self-worth. Two mental profiles revealed relatively high proportions with co-occurring high-above or above average anxiety, depressive symptoms, weight-shape concerns, and low-below or below average self-worth: distressed-body concerned, 9-11% and dissatisfied profiles, 26-31%, at T1 and T2 respectively. High overall mental health profile stability (72-93%) was identified from age 13 to 16. Two notable transitions were that TD boys who transitioned were likely changing to healthier profiles and girls to unhealthier ones. The highest proportion of TD schoolboys was in the mentally healthy profile (T1: 52%, T2: 53%), the moderate profile in TD schoolgirls (T1: 44%, T2: 41%) and regular schoolboys (T1: 46%, T2: 43%) and the most common among regular school girls were the dissatisfied profile (T1: 41.5%, T2: 46%). Socially prescribed perfectionism predicted more unhealthy mental health profiles. In paper III, four main themes illustrated some of the complexities of young performers’ experiences with self oriented and socially prescribed expectations and their struggles with balancing them. The students’ feeling of responsibility to fulfill expectations from several areas, high workloads, and tight schedules was a source of a physically and mentally demanding everyday life. Most TD students frequently felt tired (sometimes exhausted), and even some described more anxiousness, irritation, headaches, and concentration difficulties when experiencing they could not keep up with the expectations.

Conclusion: The thesis findings add to the extant literature further central knowledge and insight about perfectionism, expectations, and mental health in an understudied group of young student-athletes and performing arts students, as well as regular students. The occurrence of perfectionism and mental health symptoms in line with international trends provided further evidence suggesting a need for sincere attention to perfectionism and unbalanced expectations at the variance of realistic expectations in the effort to reduce the risk of mental health difficulties and enhance the well-being of student performers and regular students. Last, this thesis’s findings highlight the critically valuable role of coaches, teachers, and parents of young student performers as they play decisive roles in facilitating positive and supportive environments.