title: The association between psychological distress and musculoskeletal symptoms experienced by Chinese high school students.
abstract: METHODS
  A cross-sectional nonexperimental study.
  
  
  OBJECTIVE
  To determine the prevalence of musculoskeletal symptoms during a 6-month period and explore the contributing factors associated with these symptoms in Chinese senior class high school students. We also explored the relationship between psychological distress and musculoskeletal symptoms in this population.
  
  
  BACKGROUND
  Musculoskeletal symptoms with no underlying identifiable pathology are a management puzzle to medical professionals. Finding the prevalence of musculoskeletal symptoms is the first step in the prevention of further chronic pain syndromes in young adults. No study, however, has directly measured the prevalence of musculoskeletal symptoms in this population. Investigations of the contributing factors to these symptoms, though rare, can provide information to assist in the prevention of further injuries.
  
  
  METHODS
  The Musculoskeletal Symptom Questionnaire (MSQ) and the 12-question version of the Chinese Health Questionnaire (CHQ-12) were randomly distributed to students (n = 550) in 4 different high schools in the Tainan area of Taiwan. Of these, 471 students returned the questionnaires for analysis. Descriptive statistics were computed for means, standard deviations, and frequencies. Chi-square statistics were used for analysis of the association between psychological distress and musculoskeletal symptoms.
  
  
  RESULTS
  The most frequent complaints of musculoskeletal symptoms among the adolescent Chinese student population were reported as being located in the following anatomical areas: neck (56%), shoulder (45%), and back (37%). Based on the results from the CHQ-12, all of the participants were divided into 2 groups: a high psychological (CHQ-12 score > or = 5) and a low psychological (CHQ-12 score < 5) distress group. There were significant differences of prevalence of musculoskeletal symptoms between these 2 groups (P < .05), especially for the neck region (P = .003).
  
  
  CONCLUSIONS
  The results showed that the prevalence of musculoskeletal symptoms was high in this adolescent population and demonstrated a certain association with psychological distress. We suggest that surveys of this type may serve as preclinical detectors of future musculoskeletal disorders and may permit early interventions. Developing an intervention that addresses both physical and psychological problems may be beneficial for this population.
authors.affiliation: Department of Physical Therapy, Medical College, National Cheng Kung University, Tainan, Taiwan, Republic of China. cycho@mail.ncku.edu.tw
authors.forename: Chiung-Yu
authors.initials: CY
authors.lastname: Cho
authors.forename: Ing-Shou
authors.initials: IS
authors.lastname: Hwang
authors.forename: Chwen Cheng
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D001416:Back Pain / Q000453:epidemiology / Q000523:psychology*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D019547:Neck Pain / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D011897:Random Allocation; D020069:Shoulder Pain / Q000453:epidemiology / Q000523:psychology*; D013315:Stress, Psychological / Q000453:epidemiology*; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires