The Influencing Factors of High‐Achieving Students’ Mental Health: A Systematic Review

Purpose This systematic review aims to identify and analyze factors affecting mental health among high‐achieving students through a comprehensive examination of personal, family, school, and social dimensions. Design and Methods Four electronic databases (PubMed, Web of Science, PsycINFO, and ERIC) were systematically searched through December 31, 2024, examining literature published between 2014 and 2024. Studies were included if they: (1) focused on students in the top 10% of academic performance through standardized measures or formal gifted identification; (2) examined mental health outcomes using validated instruments; (3) employed quantitative or mixed‐methods designs. We excluded qualitative‐only studies, dissertations, and conference abstracts. Study quality was assessed using established frameworks: STROBE for cross‐sectional studies, TREND for quasiexperimental designs, and MMAT for mixed‐methods studies, with triple independent review achieving high inter‐rater reliability. Data were synthesized using thematic synthesis guided by ecological systems theory, categorizing factors into personal, family, school, and social/contextual domains. After screening 931 articles and removing duplicates, 39 studies met the inclusion criteria. Findings Analysis of 39 studies revealed perfectionism as the most extensively studied factor, with three distinct profiles identified: adaptive perfectionists, maladaptive perfectionists, and nonperfectionists. Maladaptive perfectionism consistently predicted elevated anxiety, depression, and emotional exhaustion, with effects moderated by cognitive flexibility and emotional intelligence. Significant cultural variations emerged—East Asian students demonstrated distinct academic pressure responses compared to Western contexts. Protective factors included cognitive flexibility, resilience, and family support; risk factors encompassed maladaptive perfectionism and achievement‐oriented parental psychological control. Limitations Key limitations include the predominance of cross‐sectional designs (approximately 62% of studies) limiting causal inference, geographic concentration in Western and East Asian contexts with underrepresentation of African and Latin American research, and English‐language restriction potentially excluding relevant non‐English studies. Practical Implications Educational institutions should implement comprehensive support systems that address both individual and environmental factors affecting high‐achieving students’ mental health, with particular attention to cultural contexts. Interventions should focus on enhancing protective factors while addressing risk factors through culturally sensitive approaches.