The personal, occupational, and psychological factors associated with the development of neck pain

In a recent study published in the BMC Public Health Journal, researchers performed a meta-analysis to identify the occupational, psychological, and personal factors related to neck pain among college students.

Study: Risk factors for neck pain in college students: a systematic review and meta-analysis. Image Credit: Olena Yakobchuk/Shutterstock


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic increased neck pain prevalence in college attendees because of the transition from in-person to remote learning and increased academic and work stress.

Studies have reported that pain in the neck region is the primary cause of sickness, less attention, lower educational achievement, and class skipping among college students, hurting students’ future employment prospects.

Thus, identifying neck pain-related factors may lead to creating preventative strategies and beginning early therapy.

About the study

In the present meta-analysis, researchers explored factors associated with neck pain among college students.

The team searched databases such as the Cochrane Library, Web of Science, PubMed, Embase, WanFang, Chinese Scientific Journal Database (VIP), and the Chinese National Knowledge Infrastructure (CNKI) database through December of 2022 for relevant randomized controlled trials (RCTs), and cohort, case-control, and cross-sectional studies, published in English or Chinese, and those with calculated odds ratio (OR) values.

The team excluded studies with missing data or no analysis of risk factors, inaccessible full texts, republished studies, and non-journal records such as conference presentations and dissertations. The Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) scales were used to assess the quality of the included studies.

The researchers calculated the pooled OR estimates to assess the impacts of the factors increasing neck pain risk. Two independent reviewers screened data, and disagreements were resolved by another reviewer.

The I2 statistic was used to assess heterogeneity in the included studies. Evidence quality was described as follows: (i) strong if the findings were obtained from ≥3.0 studies, of which ≥2.0 were homogeneous high-quality studies; (ii) moderate, in the case of pooled significant results obtained from a single study of high-quality and ≥1.0 low- or moderate-quality studies; (iii) limited evidence, if the results were derived from one study of high quality or several low- or moderate-quality studies; and (iv) very limited or no evidence, in the case of pooled significant results obtained from several studies with heterogeneity unrelated to methodological quality.

Results and discussion

Initially, 4,869 studies were identified, reduced to 3,519 after duplicate removal, and 3,440 studies were excluded following title and abstract screening. The full text of 79 studies was read, of which only 30 studies, comprising 18,395 individuals, were eligible.

Among the included studies, 15 were published in English and Chinese, respectively, and 24, two, and four were of the cross-sectional, cohort, and case-control type, respectively.

Stratifying by evidence quality, 14 and 16 studies were medium- and high-quality, respectively. In total, 33 probable risk determinants were identified, of which 11 were considered for the quantitative analysis. The other 22 significant factors were excluded due to the limited number of studies.

The 11 factors included improper pillow usage (OR, 2.2), physical inactivity (OR, 1.9), incorrect sitting postures (OR, 2.0), shoulder or neck trauma history (OR, 2.3), senior grade education (OR, 2.9), sleeping late at night (OR, 1.8), regularly using electronic products for long hours (OR, 1.5), prolonged head-bowing times (OR, 2.0), emotional trouble (OR, 2.1), increased psychological stress levels (OR, 1.6), and female sex (OR, 1.7). The I2 values for the corresponding ORs were 66%, 0.0%, 78%, 22%, 5.0%, 55%, 78%, 82%, 0.0%, 0.0%, and 0.0%, respectively.

Improper pillow usage is linked to incorrect pillow height, whereas appropriate height and moderate softness might help reduce neck discomfort.

Improper sitting postures, such as leg bumping and jittering of legs or the cross-legged position, as well as head-neck flexion, rotations, and lateral deviations, all impact the neck’s static and dynamic equilibrium, resulting in musculoskeletal discomfort.

Shoulder and neck trauma includes sprains, discomfort, such as a direct hit, landing on one’s head after a great fall, or suffering pain or stiffness in the head or neck region due to unexpected breakdowns.

Trauma can affect the cervical vertebrae by causing injury to the neck’s musculature, muscles, fascia, ligaments, and tendons.

Increased neck pain prevalence in college attendees is also attributed to the increased workload and exams, to prepare for which students stay up for long hours, and excessive work hours could deform the shoulders and neck, damaging the soft tissues and increasing neck pain risk.


Overall, the study findings showed 11 factors that could increase neck pain risk in college students, including improper usage of pillows, lack of physical activity, history of shoulder and neck trauma, improper sitting postures, senior grade, long-term daily usage of electronic products, staying up for long hours, prolonged head bowing, emotional concerns, female gender, and increased stress.

Future studies must assess the causal associations between the factors and neck pain outcomes, including studies published in other languages to increase the sample size, considering particular neck pain durations and specific assessment criteria for the risk factors.

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