Musculoskeletal Pain and Fatigue Associated with Psychological Distress During Exam Period Among Undergraduate Students

Abstract

Background: Musculoskeletal pain, fatigue, and psychological distress are frequently reported among university students during examination periods, with academic pressure, poor ergonomics, and psychological stress acting as key contributors. These overlapping symptoms can significantly impair student well-being and academic performance, yet their interrelationships and demographic predictors remain underexplored, particularly in South Asian contexts. Objective: This study aimed to determine the association between musculoskeletal pain, fatigue, and psychological distress among undergraduate students during exam periods and to identify demographic factors influencing these outcomes. Methods: A cross-sectional observational study was conducted among 190 undergraduate students aged 17 to 26 years from four universities in Karachi, Pakistan, during the April–May 2024 examination period. Participants were recruited using purposive sampling, with eligibility based on age and a history of musculoskeletal pain in the past year. Data were collected through the Nordic Musculoskeletal Questionnaire, Fatigue Severity Scale, and structured items assessing psychological distress. Statistical analyses included chi-square tests, Pearson correlation, and multivariable regression to assess associations and control for confounders. Results: All participants reported musculoskeletal discomfort in the previous week, with 44.2% experiencing very severe fatigue and 63% reporting elevated psychological distress. Female students and those in older age groups exhibited significantly higher fatigue and distress levels (p < 0.01). Strong correlations were observed between musculoskeletal pain, fatigue, and psychological distress, and regression analysis identified female gender and psychological distress as independent predictors of severe fatigue. Conclusion: Musculoskeletal pain, fatigue, and psychological distress are highly prevalent and interrelated among undergraduates during examination periods, particularly among female and older students. University-based ergonomic, mental health, and fatigue management interventions are recommended to mitigate these risks and enhance student well-being.