Background: The Grade 5 Scholarship Examination is a highly competitive school placement test frequently associated with intensive academic preparation and reduced leisure time. Although numerous studies have explored the mental health effects of high-stakes examinations, most have focused on adolescents. Methods: An analytical cross-sectional study was conducted among 368 Grade 5 students in the Kurunegala Education Zone. Psychological distress was assessed using the Sinhalavalidated DASS-21. Multivariate linear regression examined associations between examination exposure and depression, anxiety , and stress scores, adjusting for sociodemographic, socioeconomic, parenting, and academic factors. Results: Examination-exposed students reported significantly longer weekly tuition hours and lower participation in extracurricular and physical activities (all p