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.