Musculoskeletal Pain in Undergraduates With Psychological Distress and Poor Sleep Quality

Abstract

Background: Musculoskeletal pain is common among university students and may be amplified by poor sleep and psychological distress, collectively impairing wellbeing and academic functioning. Objective: To examine the association between sleep quality and musculoskeletal pain and to assess psychological distress correlates of sleep quality among undergraduate students. Methods: A descriptive cross-sectional study was conducted in Karachi, Pakistan (August 2024–January 2025) across multiple universities and coaching centers. Undergraduate students aged 18–25 years completed the Nordic Musculoskeletal Questionnaire (12-month pain), Pittsburgh Sleep Quality Index (PSQI), and Depression Anxiety Stress Scale-21 (DASS-21), alongside demographic items. Multivariable logistic regression evaluated the association between PSQI global score and presence of musculoskeletal pain, adjusting for age, gender, and occupation. Multivariable linear regression examined predictors of PSQI score. Results: Among 299 students (mean age 21.6±1.68; 65.9% female), 76.6% reported musculoskeletal pain, most commonly in the neck (53.5%), lower back (50.8%), and shoulders (43.5%). Poor sleep quality was prevalent (mean PSQI 9.27±5.88; 39.1% categorized as poor). Higher PSQI score was independently associated with musculoskeletal pain (adjusted OR 1.116 per unit; 95% CI 1.037–1.202; p=0.004), and females had higher odds of pain than males (adjusted OR 4.336; 95% CI 2.051–9.167; p<0.001). Difficulty winding down (p=0.021), reduced positive emotion (p=0.034), breathing difficulty (p=0.042), and low motivation (p=0.035) were associated with poorer sleep. Conclusion: Musculoskeletal pain and sleep impairment are highly prevalent in undergraduates; poorer sleep quality is independently associated with increased odds of musculoskeletal pain, with psychological distress contributing to impaired sleep, particularly among females.