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Stress and psychosomatic symptoms in Chinese school children: cross-sectional survey
  1. Therese Hesketh1,
  2. Yan Zhen2,
  3. Li Lu2,
  4. Zhou Xu Dong2,
  5. Ye Xu Jun2,
  6. Zhu Wei Xing2
  1. 1UCL Centre for International Health and Development,London, UK
  2. 2Institute of Family and Social Medicine, Zhejiang University, Hangzhou, PR China
  1. Correspondence to Professor Therese M Hesketh, UCL Centre for International Health and Development, 30 Guilford Street, London WC1N 1EH, UK; t.hesketh{at}


Objective The Chinese educational system is highly competitive from the start of primary school with great emphasis on academic performance and intolerance of failure. This study aimed to explore the pressures on primary schoolchildren, and to determine the relationship between these pressures and psychosomatic symptoms: abdominal pain and headache.

Design Cross-sectional survey using self-completion questionnaires.

Setting/participants 9- to 12-year-olds in primary schools in urban and rural areas of Zhejiang Province, eastern China.

Outcome measures Proportion of children with defined school-related stressors and frequency of psychosomatic illness.

Results Completed questionnaires were obtained from 2191 children. All stressors were common in boys and girls and in urban and rural schools. Eighty-one per cent worry ‘a lot’ about exams, 63% are afraid of the punishment of teachers, 44% had been physically bullied at least sometimes, with boys more often victims of bullying, and 73% of children are physically punished by parents. Over one-third of children reported psychosomatic symptoms at least once per week, 37% headache and 36% abdominal pain. All individual stressors were highly significantly associated with psychosomatic symptoms. Children identified as highly stressed (in the highest quartile of the stress score) were four times as likely to have psychosomatic symptoms.

Conclusions The competitive and punitive educational environment leads to high levels of stress and psychosomatic symptoms in Chinese primary schoolchildren. Measures to reduce unnecessary stress on children in schools should be introduced urgently.

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  • Funding This study was funded though a grant from the Wellcome Trust.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the UCL Institute of Child Health, Zhejiang Education Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent Obtained from the parents.