Workload, chronic pain, and mental health among university teachers in China

Workload, chronic pain, and mental health among university teachers in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Workload, chronic pain, and mental health among university teachers in China xinzhu wang, kaixian fu, yuxia zhang, chengjia tang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7601292/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background : University teachers in China face immense academic workload, which consequently gives rise to health issues. This study aimed to explore the effects of workload on the psychological health of university teachers and to explain why these effects occur using chronic pain as a mediator. Methods: A total of 451 university teachers were surveyed in three second-tier universities in Sichuan Province in 2024 using paper-pencil-based questionnaires. Workload, mental health, and chronic pain were assessed. Pearson’s correlation and linear regression analyses were used to test the mediation model and hypothesis. Results : The university teachers had relatively high levels of workload (M=3.27) and low levels of mental health (M=2.95). The prevalence of chronic pain in various body regions was as follows: shoulder (45.68%), neck (41.46%), low back (36.36%), head (33.26%), and abdomen (31.49%). Linear regression analyses showed that workload significantly predicted mental health ( β =-0.474, p <0.01) and chronic pain ( β =0.517, p <0.01). When workload was controlled for, chronic pain significantly predicted mental health ( β =-0.162, p <0.01) , indicating that chronic pain can mediates the relationship between workload and mental health. in addition, physical exercise is associated with both chronic pain ( β =-0.206, p <0.01) and mental health ( β =0.113, p <0.01), lastly, the rank of associate professor is negatively associated with mental health ( β =-0.094, p <0.01) with lecture title serving as the reference group. Conclusions: The mediation model was well supported, and chronic pain mediates the relationship between workload and mental health among university teachers. Health sciences/Diseases Health sciences/Health care Health sciences/Health occupations Biological sciences/Psychology Social science/Psychology Health sciences/Risk factors Workload Chronic pain Mental health University teachers China Figures Figure 1 Figure 2 1 Introduction In recent years, the Chinese government has implemented a series of ongoing reforms in higher education to enhance its educational standards and bridge the gap with developed countries. Consequently, universities have introduced incentive and competitive systems to motivate faculty members towards continuous improvement in their academic pursuits. For instance, many top universities employ an incentive system known as 'going up or going away'[ 1 ], where young academics risk losing their positions if they fail to meet the evaluation criteria for promotion within one employment period. Since 2017, the implementation of the 'Double First-Class' initiative——aimed at developing numerous world-class universities and disciplines by 2050 —— has further intensified teaching demands within higher education institutions [ 2 ]. As a result, teachers now face significantly increased workload compared to previous years. A study conducted among teachers from 35 'Double First-Class' titled universities revealed that they worked an average of 59 hours per week during normal semesters [ 3 ]. Heavy workload may have detrimental effects on physical health. A recent study revealed that the most prevalent health issues among university teachers were dyslipidemia (37.00%), elevated blood uric acid (33.63%), overweight/obesity (32.13%), high blood pressure (13.12%), and elevated fasting glucose levels (9.25%).While age and personal lifestyle factors such as smoking and alcohol consumption contribute, pressure from heavy workload is considered one of the primary causes for these health issues [ 4 ]. Physiological symptoms like thyroid gland disease, hyperlipidemia, hypertension, fatty liver, and hyperglycemia are increasingly observed in young academics nowadays compared to previous years when these symptoms were more common among older individuals[ 5 ]. Due to the heavy workload associated with establishing their own households, young academics are more susceptible to both physical and mental health problems[ 6 ]. In short, In China, the increasing academic workload has led to a deteriorating trend in teachers' physical well-being [ 1 ]. There is compelling evidence indicating that the academic workload is a significant source of stress and burnout, while also contributing to low levels of mental well-being among academics [ 7 ]. A study conducted in 2012 found that over 80% of university teachers in China reported medium to high levels of workload related to teaching, scientific research, and other aspects; and those with higher workloads were more likely to experience job burnout and depressive symptoms [ 8 ]. Another review published in 2014 demonstrated that Chinese university teachers had lower levels of mental health compared to the general population due to multifaceted academic workloads [ 8 ]. Compared to their older counterparts in academia, young scholars are more prone to experiencing anxiety, stress, depression, and other negative emotions due to the elevated levels of work-related pressure they encounter in university settings [ 1 ]. The biopsychosocial model underscores the intricate interplay between biological, psychological, and social determinants, asserting that mental and physical health issues frequently co-occur as a consequence of adverse social factors[ 9 ]. Research has demonstrated that physical and psychological symptoms increase together, with a correlation of 0.5 between psychological distress scales and physical symptom checklists[ 10 ]. The comorbidity of mental and physical health problems is well documented, especially when illness becomes chronic[ 11 ]. Chronic pain is widely recognized as a prevalent chronic condition. The biopsychosocial model views physical disorders such as chronic pain as the main causes of declining mental health[ 9 ]. It was revealed that chronic pain is associated with severity of depression, recent suicidality, and anxiety symptoms[ 12 , 13 ]. A comprehensive study conducted across 15 primary care sites and 14 countries, involving a sample of 5,438 patients, found that among the 22% of patients who reported persistent pain for over six months, there was a four-fold increase in comorbid anxiety or depressive disorders. These associations were consistent across diverse cultural contexts[ 14 ]. Up to date, there exist two deficiencies in the research pertaining to the health of university educators in China. Firstly, limited attention has been given by researchers towards the issue of chronic pain experienced by university teachers. Mental workload can contribute to the development of chronic pain symptoms[ 15 ], and up until 2016, approximately 35.9% of the Chinese population aged between 18 and 65 years experienced chronic body pain[ 16 ]. Secondly, most researchers tend to dichotomize physical and mental health, neglecting the examination of the reciprocal influence between physical and mental health. Previous literature considers chronic pain a significant risk factor for the development of depression and anxiety symptoms[ 17 ]. The co-occurrence of chronic pain and mental illness are demonstrated in many studies[ 18 , 19 ]. Examining the comorbidity of physical and mental health in the context of chronic stress may facilitate the development of appropriate strategies for enhancing overall well-being. We postulate that the presence of chronic pain, indicative of physical distress in a high-demand occupational environment, may partially elucidate the association between workload and compromised mental well-being. The main hypothesis in the present study is therefore formulated as follows: chronic pain may serve as a mediator in the relationship between workload and mental health among university teachers. 2 Methods 2.1 Instruments This study employed a three-item workload assessment derived from NASA-TLX, a multidimensional scale designed to assess perceived workload [ 20 ]. The three items refer to cognitive load (the level of cognitive activity required at work, encompassing memory, decision-making, and thinking), physical load (the level of physical activity at work, such as standing, walking briskly, climbing stairs), and time load (the level of time urgency at work, including rushing, staying up late, working overtime). Participants were requested to retrospectively assess their perceived workload in terms of cognitive, physical, and time throughout the semester using a five-point Likert scale ranging from "1" denoting "very low" to "5" representing "very high". The Cronbach's alpha coefficient for the three items in this study was 0.78. Mental health was assessed using the WHO-5 well-being index, a widely utilized scale in mental health research known for its robust reliability and validity [ 21 ]. This instrument comprises 5 items that capture individuals' mental states (e.g., moods and feeling active) over the past two weeks. In this study, participants rated their responses on a 5-point Likert scale ranging from "1 (never)" to "5 (often)". The mean score was employed as an indicator of overall mental health status, with higher scores reflecting better mental well-being. Cronbach's coefficient is 0.85 in this study, indicating satisfactory reliability. We employed a five-item scale to assess chronic pain [ 22 ]. Chronic pain is defined as a persistent and recurring condition lasting for more than three months, which aligns with the established definition in relevant literature [ 23 , 24 ]. Participants were asked to indicate if they experienced such pain in the neck, shoulder, lower back, head, and abdomen within the past three months. Response options included "Yes (codes as 1)" or "No (codes as 0)", and their summed score reflects the severity of chronic pain symptoms. Higher scores indicated greater levels of pain symptomatology. The Gottman's halving coefficient yielded an acceptable reliability level of 0.55. 2.2 Controlling variables In addition to conventional demographic characteristics such as age, gender(meal = 0,female = 1), marital status(single = 0,married = 1), and professional title(a dummy variable, Lecturer = 0, Associate Professor = 1, Professor = 1), this study considered lifestyle factors as crucial covariates, which encompassed drinking behavior (no = 0, yes = 1), smoking habits(no = 0,yes = 1), sleep quality, and physical exercise. Sleep quality is measured with a self-rated item, stating, “in the past three months my sleep was restoring”, anchored on a 5-point Likert scale with “never = 1” and “almost every day = 5” [ 25 ]. Physical exercise is also measured with a single item adapted from[ 26 ], which states: "Over the past three months, I have engaged in moderate to vigorous physical activities (such as running, brisk walking, basketball, table tennis, swimming, yoga, weightlifting, dancing) for a minimum duration of 20 minutes per session." Respondents were demanded to response on a 5-point Liker scale with “never = 1” and “almost every day = 5”. 2.3 Participants We employed convenience sampling strategies to distribute 651 paper-pencil-based questionnaires to universities teachers in ten universities in Sichuan province, China, in 2024. Prior to conducting the survey, we assured all participants that the raw data collected can be shared and emphasize that the survey strictly adhered to privacy regulations. Ultimately, a total of 451 valid questionnaires were collected, resulting in an effective response rate of 69.38%. The characteristics of the study sample are presented in Table 1 . Table 1 Basic Characteristics of the respondents(N = 451) Variable Level Frequency Percentage Age (M = 36.10, SD = 7.11) 26–31 109 24.17 32–37 198 43.90 38–43 77 17.07 44-49- 38 8.43 50–56 29 6.43 Gender Male 201 44.56 Female 250 55.43 Marriage Single 156 34.59 Married 295 65.41 Smoking habits No 304 67.41 Yes 147 32.59 Drinking behavior No 265 58.76 Yes 186 41.24 Physical Exercise (M = 2.87, SD = 1.11) Seldom 38 8.43 Occasionally 114 25.28 Sometimes 192 42.57 Often 82 18.18 Almost every day 25 5.54 Sleep quality (M = 2.84, SD = 1.24) Seldom 75 16.63 Occasionally 116 25.72 Sometimes 117 25.94 Often 93 20.62 Almost every day 50 11.09 Professional title Lecturer 183 40.58 Associate Professor, 173 38.36 Professor 95 21.06 3 Results 3.1 Means, standard deviations, and correlations The means, standard deviations, and correlations of continuous variables were presented in Table 3. Table 2 Mean, standard deviation and correlations of key variables M SD Workload Chronic pain Mental health Workload 3.27 1.02 1 Chronic pain 1.88 1.53 0.618 ** 1 Mental health 2.95 0.81 -0.602 ** -0.492 ** 1 Note - Statistically significant difference: * p<0.05 , ** p <0.01. The mean scores for workload, chronic pain, and mental health were 3.27, 3.78, and 2.95 respectively. Table 2 demonstrates that workload was correlated with chronic pain positively ( r =0.618, p< 0.01) and with mental health ( r =-0.602, p< 0.01). Additionally, there is a negative correlation between chronic pain and mental health ( r =-0.492, p< 0.01). In terms of teachers' workload, the average values for physical load, mental load, and time load are 2.86, 3.23, and 3.71 respectively. The box plot specifically illustrates the variations in these three areas (refer to FIG.1. “+” indicates the mean values). What’ more, we found that the prevalence of chronic pain in various body regions was as follows: shoulder (45.68%), neck (41.46%), low back (36.36%), head (33.26%), and abdomen (31.49%). 3.2 Mediating role of chronic pain In this study, a three-step regression technique was employed to identify the mediating roles among the variables[27]. Initially, a dependent variable (Y) was regressed on an independent variable (X); if the regression effect proved significant, we proceeded to the second step where the mediator variable (M) was regressed on X. Subsequently, in order to establish mediation, Y was regressed simultaneously on both X and M in the third step. The significance of M as a mediating variable is determined by its ability to significantly predict Y in this final step. Our objective in this study was to demonstrate that chronic pain mediates the relationship between workload and mental health. The results of regression analysis were presented in table 3. Table 3 Results of linear regression analysis Step1: Mental health Step2: Chronic pain Step3: Mental health β t β t β t (Constant) 8.890 ** 0.73 9.107 Workload -0.474 -10.655 ** 0.517 11.833 ** -0.390 -7.728 ** Age 0.076 1.383 -0.074 -1.382 0.064 1.174 Gender 0.016 0.374 -0.055 -1.344 0.007 0.161 Marriage 0.054 1.431 0.045 1.193 0.062 1.637 Life style Smoking habits 0.008 0.219 0.058 1.549 0.018 0.469 Drinking behavior 0.065 1.623 0.03 0.751 0.070 1.762 Physical exercise 0.147 3.447 ** -0.206 -4.92 ** 0.113 2.624 ** Sleep quality 0.022 0.551 0.03 0.759 0.027 0.679 Professional title Associative professor -0.094 -1.978 * 0.024 0.515 -0.090 -1.918 Professor 0.059 1.036 -0.017 -0.296 0.057 1.000 Chronic pain -0.162 -3.380 ** F 30.472 ** 33.038 ** 29.397 ** Adj.R 2 0.396 0.416 0.410 Note - Statistically significant difference: * p<0.05 , ** p <0.01. In gender, male=0, female=1; in marriage, single=0, married=1; in drinking behavior, no=0, yes=1; in smoking habits, no=0, yes=1; in professional title, lecture is the reference group. Step 1 demonstrated a significant and negative association between workload and mental health ( β =-0.474, p< 0.01). The results of Step 2 demonstrated a significant positive association between workload and chronic pain ( β= 0.517, p <0.01). In step 3, we conducted a regression analysis to examine the simultaneous effects of workload and chronic pain on mental health. Controlling for workload, we found that chronic pain had a significant effect on mental health ( β =-0.162, p< 0.01). Additionally, our results revealed that even in the presence of chronic pain, workload still exerted a significant influence on mental health ( β =-0.390, p <0.01), albeit with a smaller effect size compared to step 1 ( β =-0.474, p <0.01). Therefore, we have reached the conclusion that chronic pain serves as a partial mediator in the relationship between workload and mental health among university teachers, thereby providing strong support for our hypothesis. The corresponding values of β s pertaining to the mediating role are presented in Figure 2. Regarding the controlling variables, a significant association was observed between physical exercise and mental health ( β =0.147, p <0.01, step 1 in table 3; β =0.113, p <0.01, step 3 in table 3), as well as chronic pain ( β =-0.206, p <0.01, step 2 in table 3). Furthermore, it was found that the rank of associate professor is negatively associated with mental health ( β =-0.094, p <0.01, step 1 in table 3) with lecture title serving as the reference group. The results presented in Figure 2 demonstrate that the direct effect of the "workload → mental health" pathway was estimated to be 0.474, while the indirect effect through the "workload → chronic pain → mental health" pathway was found to be 0.084 (i.e., calculated as 0.517 multiplied by 0.162). Consequently, it can be inferred that approximately 17.67% (i.e., derived from dividing 0.084 by 0.474) of the total effect can be attributed to the mediating role of chronic pain between workload and mental health. 4 Discussion 4.1 Descriptive statistics for workload, chronic pain, and mental health The findings of this study indicate that university teachers face a high workload, with an average value of 3.27 on the 5-point Likert scale, surpassing the median value of 3.00. Furthermore, among the three dimensions of workload, time load emerges as the most prominent, followed by mental load and physical load. Such findings align the fact that with the enhancement of higher education quality in China, faculty members in Chinese universities are confronted with the challenge of enduring extensive working hours. [ 3 ] revealed that teachers in some key universities worked an average of 59 hours per week during normal semesters. The prevalence rates of shoulder pain, neck pain, low back pain, headache, and abdominal pain in university teachers were 45.68%, 41.46%, 36.36%, 32.26%, and 31.49% respectively in this study. These findings closely align with the results reported by[ 28 ], which indicated that neck and/or shoulder pain as well as low back pain are the most commonly observed chronic conditions among school teachers. Evidently, the occurrence of chronic pian in the shoulder, neck, and low back is associated with prolonged sitting posture at work. In this study, university faculty reported a mean score of 2.95 on the 5-point Likert scale for measuring mental health, indicating a low level of mental well-being. This finding is consistent with the results from a nationwide survey conducted in 2020, which involved 29,000 educators from 145 universities and revealed an increasing prevalence of mental health issues among university faculty members, including depression, obsessive-compulsive disorder, and emotional anxiety[ 29 ]. 4.2 The mediating role of chronic pain The results of the regression analysis strongly supported our hypothesis, which posited that chronic pain mediates the relationship between workload and mental health among university faculty. Firstly, when controlling for age, gender, marriage, professional title, and lifestyle factors (as shown in step 1 of Table 3 ), workload exhibited a significant negative association with mental health. This finding is consistent with previous studies. For instance, a study indicated that excessive workloads can give rise to heightened levels of workaholism, thereby resulting in compromised overall mental well-being among university teachers[ 30 ]. A comprehensive meta-analysis indicates that work-related stress significantly contributes to the occurrence of depression and anxiety among teachers worldwide [ 31 ]. Secondly, the linear regression analysis in step 2 (Table 3 ) revealed a positive association between workload and chronic pain, suggesting that heavy and prolonged workloads may potentially contribute to the development of chronic pain among university educators. Such a finding is consistent with the results in the previous studies[ 15 , 32 ], which revealed that work-related stress (such as long workhours and high cognitive -demanding stress) can lead to chronic pain at varying degree of magnitude. Thirdly, the linear regression analysis in step 3 (Table 3 ) demonstrated a negative association between chronic pain and mental health when workload and other controlling variables entering in the regression model. This finding is in line with the opinions in previous literature, for instance,[ 33 ] investigated patients diagnosed with rheumatoid arthritis and found that chronic pain can cause depressive symptoms.[ 19 ] concluded that chronic pain and anxiety disorders co-occur because of shared complex physiological mechanisms. In conclusion, chronic pain can mediate the relationship between workload and mental health among university teachers, aligning with the biopsychosocial model. However, this mediating effect of chronic pain only accounts for 17.67% of the total effect, suggesting the existence of alternative pathways through which workload impacts mental health. for instance, addiction to work and work–life conflicts are two potential mediators in the relationship between work stress and mental well-being in university professors[ 34 ]. 4.3 The effects of controlling variables In terms of lifestyle, our findings suggest a positive association between physical exercise and mental health, as well as a negative association with chronic pain. These results are consistent with previous research, including a study demonstrating the direct and indirect benefits of exercise for individuals experiencing chronic pain[ 35 ], and a review highlighting the potential improvement in mental well-being through physical exercise[ 36 ]. In addition, the regression analysis reveals a significant correlation between the teachers’ professional title and their mental well-being. Specifically, associate professors exhibit lower levels of mental health compared to lecturers, which aligns with the findings reported in [ 37 ]. This outcome can be attributed to the heightened competition faced by associate professors during their promotion to full professorship, resulting in increased work pressure. 4.4 Implications The biopsychosocial model holds that the comorbidity of mental and physical health problems is a common phenomenon, especially when illness becomes chronic. This study has demonstrated that mental health can be negatively impacted by chronic pain resulting from high workload, which supports the model's assertion that chronic physical illness is a significant contributor to mental health issues. Previous research has indicated that an increase in physical symptoms corresponds with an increased risk of anxiety and depressive symptoms[ 38 ]. For instance, contracting COVID-19 can result in substantial depression and anxiety[ 39 ]. The concept of health encompasses the harmonious integration of physical and mental well-being, with both domains exerting reciprocal influences on each other. In addition to the biopsychosocial model, numerous other theories, including allostatic load theory, neuroinflammation theory, and traditional Chinese medicine theory, propose shared mechanisms underlying the co-occurrence of physical and mental ailments. Therefore, when elucidating the mechanism of mental illness in a high work stress environment, it is crucial to consider the mediating role of physical illness. The present study holds significant practical implications in two key aspects. Firstly, during the implementation of higher education reforms, it is imperative to appropriately reduce the workload, particularly the time burden, as excessive workload detrimentally affects teachers' physical and mental well-being. The long-term impact of excessive workload on the health of university teachers can lead to a decline in their overall efficiency and productivity. Secondly, engaging in regular physical exercise can effectively enhance both physical and mental health; thus, university educators should allocate dedicated time for adequate physical exercise. The optimal approach for promoting the mental well-being of university educators lies not in imparting them with mental health knowledge or psychological counseling, but rather in effectively mitigating work-related stressors and fostering a culture that encourages physical exercise among teachers. 4.5 Strength and limitations The primary strength of this study lies in its deep analysis of the physiological mechanisms through which workload impacts mental health. This study suggests a simultaneous occurrence of chronic pain and declining mental health in high-intensity workload situations, highlighting the potential impact of chronic pain on mental well-being. Previous research has seldom explored concurrent changes in physical and mental health during stressful circumstances. Consequently, this study provides support for the notion of comorbidity between physical and mental conditions. This study has three limitations. Firstly, the absence of measurement for chronic pain intensity hinders a comprehensive understanding of its mediating role in the relationship between workload and mental health. Secondly, we did not conduct a specific analysis on the distinct impacts of three different workloads on chronic pain and mental health, thereby hindering a comprehensive understanding of the influence of workload on physical and mental well-being. Lastly, the limited sample size compromises the external validity of our findings. Future studies should address these limitations and yield more profound findings. 5. Conclusion This study explored the relationships between workload, chronic pain, and mental health among Chinese university teachers. The findings indicate associations between higher workload levels and lower mental health scores, with Chronic pain as a significant mediator. Additionally, more frequent physical exercise correlated with lower chronic pain and better mental health. These findings highlight the connections between work demands, physical symptoms, and psychological well-being in academic environments. Declarations Ethics approval and consent to participate The Academic Committee of the Department of Teacher Education at Xichang University serves as the institutional review board (IRB) of the university. Ethical approval for this study (Project No. 240626) was granted by this committee and the study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all subjects. Consent for publication Not Applicable Availability of data and materials The raw data for this study is available by contacting the corresponding author. Competing interests There is no any competing interest among them. Funding This study was supported by two projects: （1）Doctoral Startup Fund in Xichang university，Project Title: "Impact of Early Adversity on Psychological Resilience in College Students"Project ID: YBS2025002 Authors' contributions Xin zhuwang and Kai xianfu were in charge of data processing, writing and editing; Cheng jiatang,and Yuxia zhang were responsible for conducting investigations and collecting samples. Acknowledgements NO. References REN, M. and l.p. LIU, "Insomnia in academia": administrative logic and time pressure of young teachers in colleges and universities. Journal of Chinese youth research, 2021. No.306 (08): p. 14-21+35.DOI: 10.19633/j.cnki.11-2579/d.2021.0110. Peters, M.A. and T. 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Acta Psychologica Sinica, 2004. 36 (5): p. 614-620.DOI: https://kns.cnki.net/kcms2/article/abstract?v=3uoqIhG8C44YLTlOAiTRKgchrJ08w1e7eeyE9jLkqq-sZavCEc9sNv2QE9xij0JBkLGFfUBTQArWArcBKjgG3Hufxqkq2tCn&uniplatform=NZKPT. Yue, P., F. Liu, and L. Li, Neck/shoulder pain and low back pain among school teachers in China, prevalence and risk factors. BMC Public Health, 2012. 12 (1): p. 789.DOI: 10.1186/1471-2458-12-789. GuBIing and DengTong, Research on the Mental Health of College Teachers. Journal of Higher Education, 2023. 9 (04): p. 134-137.DOI: 10.19980/j.CN23-1593/G4.2023.04.033. Pace, F., et al., The relation between workload and personal well-being among university professors. Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues, 2021. 40 (7): p. 3417-3424.DOI: 10.1007/s12144-019-00294-x. Agyapong, B., et al., Stress, Burnout, Anxiety and Depression among Teachers: A Scoping Review. Int J Environ Res Public Health, 2022. 19 (17).DOI: 10.3390/ijerph191710706. Amiri, S., Longer working hours and musculoskeletal pain: a meta-analysis. International Journal of Occupational Safety and Ergonomics, 2023. 29 (1): p. 1-16.DOI: 10.1080/10803548.2022.2036488. Brown, G.K., A causal analysis of chronic pain and depression. J Abnorm Psychol, 1990. 99 (2): p. 127-37.DOI: 10.1037//0021-843x.99.2.127. Pace, F., et al., The relation between workload and personal well-being among university professors. Current Psychology, 2021. 40 (7): p. 3417-3424.DOI: 10.1007/s12144-019-00294-x. Borisovskaya, A., E. Chmelik, and A. Karnik, Exercise and Chronic Pain , in Physical Exercise for Human Health , J. Xiao, Editor. 2020, Springer Singapore: Singapore. p. 233-253.DOI: 10.1007/978-981-15-1792-1_16. Pascoe, M., et al., Physical activity and exercise in youth mental health promotion: A scoping review. BMJ open sport & exercise medicine, 2020. 6 (1): p. e000677. Liqing, L., Investigation and Analysis of the Mental Health of University Teachers——Taking Jiangxi Province as an Example Journal of Jiangxi Science & Technology Normal University, 2016(06): p. 120-124. Kroenke, K., et al., Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med, 1994. 3 (9): p. 774-9.DOI: https://doi.org/10.1001/archfami.3.9.774. Mazza, M.G., et al., Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain, behavior, and immunity, 2020. 89 : p. 594-600.DOI: 10.1016/j.bbi.2020.07.037. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":26037,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7601292/v1/1c3c04c4c2d107d60b8c9770.png"},{"id":99030392,"identity":"99d685e9-b98f-4fdf-b96f-4cdd2c627404","added_by":"auto","created_at":"2025-12-26 08:26:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":43926,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe mediating role of chronic pain\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7601292/v1/c0d9718ba8e5cc10383f6c21.png"},{"id":99323009,"identity":"4ea4070a-03e4-484f-bd7d-e6052cd76b38","added_by":"auto","created_at":"2025-12-31 16:44:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":986884,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7601292/v1/45665867-813e-464e-81c3-bc332b3e4493.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Workload, chronic pain, and mental health among university teachers in China","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eIn recent years, the Chinese government has implemented a series of ongoing reforms in higher education to enhance its educational standards and bridge the gap with developed countries. Consequently, universities have introduced incentive and competitive systems to motivate faculty members towards continuous improvement in their academic pursuits. For instance, many top universities employ an incentive system known as 'going up or going away'[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], where young academics risk losing their positions if they fail to meet the evaluation criteria for promotion within one employment period. Since 2017, the implementation of the 'Double First-Class' initiative\u0026mdash;\u0026mdash;aimed at developing numerous world-class universities and disciplines by 2050 \u0026mdash;\u0026mdash; has further intensified teaching demands within higher education institutions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As a result, teachers now face significantly increased workload compared to previous years. A study conducted among teachers from 35 'Double First-Class' titled universities revealed that they worked an average of 59 hours per week during normal semesters [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHeavy workload may have detrimental effects on physical health. A recent study revealed that the most prevalent health issues among university teachers were dyslipidemia (37.00%), elevated blood uric acid (33.63%), overweight/obesity (32.13%), high blood pressure (13.12%), and elevated fasting glucose levels (9.25%).While age and personal lifestyle factors such as smoking and alcohol consumption contribute, pressure from heavy workload is considered one of the primary causes for these health issues [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Physiological symptoms like thyroid gland disease, hyperlipidemia, hypertension, fatty liver, and hyperglycemia are increasingly observed in young academics nowadays compared to previous years when these symptoms were more common among older individuals[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Due to the heavy workload associated with establishing their own households, young academics are more susceptible to both physical and mental health problems[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In short, In China, the increasing academic workload has led to a deteriorating trend in teachers' physical well-being [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is compelling evidence indicating that the academic workload is a significant source of stress and burnout, while also contributing to low levels of mental well-being among academics [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A study conducted in 2012 found that over 80% of university teachers in China reported medium to high levels of workload related to teaching, scientific research, and other aspects; and those with higher workloads were more likely to experience job burnout and depressive symptoms [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Another review published in 2014 demonstrated that Chinese university teachers had lower levels of mental health compared to the general population due to multifaceted academic workloads [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Compared to their older counterparts in academia, young scholars are more prone to experiencing anxiety, stress, depression, and other negative emotions due to the elevated levels of work-related pressure they encounter in university settings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe biopsychosocial model underscores the intricate interplay between biological, psychological, and social determinants, asserting that mental and physical health issues frequently co-occur as a consequence of adverse social factors[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Research has demonstrated that physical and psychological symptoms increase together, with a correlation of 0.5 between psychological distress scales and physical symptom checklists[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The comorbidity of mental and physical health problems is well documented, especially when illness becomes chronic[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Chronic pain is widely recognized as a prevalent chronic condition. The biopsychosocial model views physical disorders such as chronic pain as the main causes of declining mental health[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It was revealed that chronic pain is associated with severity of depression, recent suicidality, and anxiety symptoms[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A comprehensive study conducted across 15 primary care sites and 14 countries, involving a sample of 5,438 patients, found that among the 22% of patients who reported persistent pain for over six months, there was a four-fold increase in comorbid anxiety or depressive disorders. These associations were consistent across diverse cultural contexts[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUp to date, there exist two deficiencies in the research pertaining to the health of university educators in China. Firstly, limited attention has been given by researchers towards the issue of chronic pain experienced by university teachers. Mental workload can contribute to the development of chronic pain symptoms[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and up until 2016, approximately 35.9% of the Chinese population aged between 18 and 65 years experienced chronic body pain[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Secondly, most researchers tend to dichotomize physical and mental health, neglecting the examination of the reciprocal influence between physical and mental health. Previous literature considers chronic pain a significant risk factor for the development of depression and anxiety symptoms[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The co-occurrence of chronic pain and mental illness are demonstrated in many studies[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Examining the comorbidity of physical and mental health in the context of chronic stress may facilitate the development of appropriate strategies for enhancing overall well-being. We postulate that the presence of chronic pain, indicative of physical distress in a high-demand occupational environment, may partially elucidate the association between workload and compromised mental well-being. The main hypothesis in the present study is therefore formulated as follows: chronic pain may serve as a mediator in the relationship between workload and mental health among university teachers.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Instruments\u003c/h2\u003e \u003cp\u003eThis study employed a three-item workload assessment derived from NASA-TLX, a multidimensional scale designed to assess perceived workload [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The three items refer to cognitive load (the level of cognitive activity required at work, encompassing memory, decision-making, and thinking), physical load (the level of physical activity at work, such as standing, walking briskly, climbing stairs), and time load (the level of time urgency at work, including rushing, staying up late, working overtime). Participants were requested to retrospectively assess their perceived workload in terms of cognitive, physical, and time throughout the semester using a five-point Likert scale ranging from \"1\" denoting \"very low\" to \"5\" representing \"very high\". The Cronbach's alpha coefficient for the three items in this study was 0.78.\u003c/p\u003e \u003cp\u003eMental health was assessed using the WHO-5 well-being index, a widely utilized scale in mental health research known for its robust reliability and validity [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This instrument comprises 5 items that capture individuals' mental states (e.g., moods and feeling active) over the past two weeks. In this study, participants rated their responses on a 5-point Likert scale ranging from \"1 (never)\" to \"5 (often)\". The mean score was employed as an indicator of overall mental health status, with higher scores reflecting better mental well-being. Cronbach's coefficient is 0.85 in this study, indicating satisfactory reliability.\u003c/p\u003e \u003cp\u003eWe employed a five-item scale to assess chronic pain [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Chronic pain is defined as a persistent and recurring condition lasting for more than three months, which aligns with the established definition in relevant literature [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Participants were asked to indicate if they experienced such pain in the neck, shoulder, lower back, head, and abdomen within the past three months. Response options included \"Yes (codes as 1)\" or \"No (codes as 0)\", and their summed score reflects the severity of chronic pain symptoms. Higher scores indicated greater levels of pain symptomatology. The Gottman's halving coefficient yielded an acceptable reliability level of 0.55.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Controlling variables\u003c/h2\u003e \u003cp\u003eIn addition to conventional demographic characteristics such as age, gender(meal\u0026thinsp;=\u0026thinsp;0,female\u0026thinsp;=\u0026thinsp;1), marital status(single\u0026thinsp;=\u0026thinsp;0,married\u0026thinsp;=\u0026thinsp;1), and professional title(a dummy variable, Lecturer\u0026thinsp;=\u0026thinsp;0, Associate Professor\u0026thinsp;=\u0026thinsp;1, Professor\u0026thinsp;=\u0026thinsp;1), this study considered lifestyle factors as crucial covariates, which encompassed drinking behavior (no\u0026thinsp;=\u0026thinsp;0, yes\u0026thinsp;=\u0026thinsp;1), smoking habits(no\u0026thinsp;=\u0026thinsp;0,yes\u0026thinsp;=\u0026thinsp;1), sleep quality, and physical exercise.\u003c/p\u003e \u003cp\u003eSleep quality is measured with a self-rated item, stating, \u0026ldquo;in the past three months my sleep was restoring\u0026rdquo;, anchored on a 5-point Likert scale with \u0026ldquo;never\u0026thinsp;=\u0026thinsp;1\u0026rdquo; and \u0026ldquo;almost every day\u0026thinsp;=\u0026thinsp;5\u0026rdquo; [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePhysical exercise is also measured with a single item adapted from[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], which states: \"Over the past three months, I have engaged in moderate to vigorous physical activities (such as running, brisk walking, basketball, table tennis, swimming, yoga, weightlifting, dancing) for a minimum duration of 20 minutes per session.\" Respondents were demanded to response on a 5-point Liker scale with \u0026ldquo;never\u0026thinsp;=\u0026thinsp;1\u0026rdquo; and \u0026ldquo;almost every day\u0026thinsp;=\u0026thinsp;5\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Participants\u003c/h2\u003e \u003cp\u003eWe employed convenience sampling strategies to distribute 651 paper-pencil-based questionnaires to universities teachers in ten universities in Sichuan province, China, in 2024. Prior to conducting the survey, we assured all participants that the raw data collected can be shared and emphasize that the survey strictly adhered to privacy regulations. Ultimately, a total of 451 valid questionnaires were collected, resulting in an effective response rate of 69.38%. The characteristics of the study sample are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic Characteristics of the respondents(N\u0026thinsp;=\u0026thinsp;451)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(M\u0026thinsp;=\u0026thinsp;36.10, SD\u0026thinsp;=\u0026thinsp;7.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u0026ndash;37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u0026ndash;43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44-49-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSmoking habits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDrinking behavior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePhysical Exercise\u003c/p\u003e \u003cp\u003e(M\u0026thinsp;=\u0026thinsp;2.87, SD\u0026thinsp;=\u0026thinsp;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeldom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlmost every day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSleep\u003c/p\u003e \u003cp\u003equality\u003c/p\u003e \u003cp\u003e(M\u0026thinsp;=\u0026thinsp;2.84, SD\u0026thinsp;=\u0026thinsp;1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeldom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOften\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlmost every day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eProfessional title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLecturer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssociate Professor,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Means, standard deviations, and correlations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe means, standard deviations, and correlations of continuous variables were presented in Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Mean, standard deviation and correlations of key variables\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"457\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWorkload\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eChronic pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMental health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWorkload\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.27\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.02\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eChronic pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.88\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.53\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.618\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMental health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.95\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.81\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.602\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.492\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote - Statistically significant difference: \u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u0026lt;0.05\u003c/em\u003e, \u003csup\u003e**\u003c/sup\u003e\u003cem\u003e\u0026nbsp;p \u0026lt;0.01.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe mean scores for workload, chronic pain, and mental health were 3.27, 3.78, and 2.95 respectively.\u003c/p\u003e\n\u003cp\u003eTable 2 demonstrates that workload was correlated with chronic pain positively (\u003cem\u003er\u003c/em\u003e=0.618, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.01) and with mental health (\u003cem\u003er\u003c/em\u003e=-0.602, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.01). Additionally, there is a negative correlation between chronic pain and mental health (\u003cem\u003er\u003c/em\u003e=-0.492, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.01).\u003c/p\u003e\n\u003cp\u003eIn terms of teachers\u0026apos; workload, the average values for physical load, mental load, and time load are 2.86, 3.23, and 3.71 respectively. The box plot specifically illustrates the variations in these three areas (refer to FIG.1. \u0026ldquo;+\u0026rdquo; indicates the mean values).\u003c/p\u003e\n\u003cp\u003eWhat\u0026rsquo; more, we found that the prevalence of chronic pain in various body regions was as follows: shoulder (45.68%), neck (41.46%), low back (36.36%), head (33.26%), and abdomen (31.49%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Mediating role of chronic pain\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, a three-step regression technique was employed to identify the mediating roles among the variables[27]. Initially, a dependent variable (Y) was regressed on an independent variable (X); if the regression effect proved significant, we proceeded to the second step where the mediator variable (M) was regressed on X. Subsequently, in order to establish mediation, Y was regressed simultaneously on both X and M in the third step. The significance of M as a mediating variable is determined by its ability to significantly predict Y in this final step. Our objective in this study was to demonstrate that chronic pain mediates the relationship between workload and mental health.\u003c/p\u003e\n\u003cp\u003eThe results of regression analysis were presented in table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Results of linear regression analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStep1: Mental health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStep2: Chronic pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStep3: Mental health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.890\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWorkload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-10.655\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.833\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-7.728\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLife style\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSmoking habits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDrinking behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.762\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePhysical exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.447\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-4.92\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.624\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSleep quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProfessional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAssociative professor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-1.978\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-1.918\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProfessor\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChronic pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-3.380\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e30.472\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e33.038\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e29.397\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eAdj.R\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.410\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote - Statistically significant difference: \u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u0026lt;0.05\u003c/em\u003e, \u003csup\u003e**\u003c/sup\u003e\u003cem\u003e\u0026nbsp;p \u0026lt;0.01.\u003c/em\u003e In gender, male=0, female=1; in marriage, single=0, married=1; in drinking behavior, no=0, yes=1; in smoking habits, no=0, yes=1; in\u003c/p\u003e\n\u003cp\u003eprofessional title, lecture is the reference group.\u003c/p\u003e\n\u003cp\u003eStep 1 demonstrated a significant and negative association between workload and mental health (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.474, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.01).\u003c/p\u003e\n\u003cp\u003eThe results of Step 2 demonstrated a significant positive association between workload and chronic pain (\u003cem\u003e\u0026beta;=\u003c/em\u003e0.517,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e\u0026lt;0.01).\u003c/p\u003e\n\u003cp\u003eIn step 3, we conducted a regression analysis to examine the simultaneous effects of workload and chronic pain on mental health. Controlling for workload, we found that chronic pain had a significant effect on mental health (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.162, \u003cem\u003ep\u0026lt;\u003c/em\u003e0.01). Additionally, our results revealed that even in the presence of chronic pain, workload still exerted a significant influence on mental health (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.390, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01), albeit with a smaller effect size compared to step 1 (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.474,\u003cem\u003e\u0026nbsp;p\u003c/em\u003e\u0026lt;0.01).\u003c/p\u003e\n\u003cp\u003eTherefore, we have reached the conclusion that chronic pain serves as a partial mediator in the relationship between workload and mental health among university teachers, thereby providing strong support for our hypothesis. The corresponding values of \u003cem\u003e\u0026beta;\u003c/em\u003es pertaining to the mediating role are presented in Figure 2.\u003c/p\u003e\n\u003cp\u003eRegarding the controlling variables, a significant association was observed between physical exercise and mental health (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.147, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, step 1 in table 3; \u003cem\u003e\u0026beta;\u003c/em\u003e=0.113, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, step 3 in table 3), as well as chronic pain (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.206, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, step 2 in table 3). Furthermore, it was found that the rank of associate professor is negatively associated with mental health (\u003cem\u003e\u0026beta;\u003c/em\u003e=-0.094, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, step 1 in table 3) with lecture title serving as the reference group.\u003c/p\u003e\n\u003cp\u003eThe results presented in Figure 2 demonstrate that the direct effect of the \u0026quot;workload \u0026rarr; mental health\u0026quot; pathway was estimated to be 0.474, while the indirect effect through the \u0026quot;workload \u0026rarr; chronic pain \u0026rarr; mental health\u0026quot; pathway was found to be 0.084 (i.e., calculated as 0.517 multiplied by 0.162). Consequently, it can be inferred that approximately 17.67% (i.e., derived from dividing 0.084 by 0.474) of the total effect can be attributed to the mediating role of chronic pain between workload and mental health.\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Descriptive statistics for workload, chronic pain, and mental health\u003c/h2\u003e \u003cp\u003eThe findings of this study indicate that university teachers face a high workload, with an average value of 3.27 on the 5-point Likert scale, surpassing the median value of 3.00. Furthermore, among the three dimensions of workload, time load emerges as the most prominent, followed by mental load and physical load. Such findings align the fact that with the enhancement of higher education quality in China, faculty members in Chinese universities are confronted with the challenge of enduring extensive working hours. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] revealed that teachers in some key universities worked an average of 59 hours per week during normal semesters.\u003c/p\u003e \u003cp\u003eThe prevalence rates of shoulder pain, neck pain, low back pain, headache, and abdominal pain in university teachers were 45.68%, 41.46%, 36.36%, 32.26%, and 31.49% respectively in this study. These findings closely align with the results reported by[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], which indicated that neck and/or shoulder pain as well as low back pain are the most commonly observed chronic conditions among school teachers. Evidently, the occurrence of chronic pian in the shoulder, neck, and low back is associated with prolonged sitting posture at work.\u003c/p\u003e \u003cp\u003eIn this study, university faculty reported a mean score of 2.95 on the 5-point Likert scale for measuring mental health, indicating a low level of mental well-being. This finding is consistent with the results from a nationwide survey conducted in 2020, which involved 29,000 educators from 145 universities and revealed an increasing prevalence of mental health issues among university faculty members, including depression, obsessive-compulsive disorder, and emotional anxiety[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.2 The mediating role of chronic pain\u003c/h2\u003e \u003cp\u003eThe results of the regression analysis strongly supported our hypothesis, which posited that chronic pain mediates the relationship between workload and mental health among university faculty. Firstly, when controlling for age, gender, marriage, professional title, and lifestyle factors (as shown in step 1 of Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e), workload exhibited a significant negative association with mental health. This finding is consistent with previous studies. For instance, a study indicated that excessive workloads can give rise to heightened levels of workaholism, thereby resulting in compromised overall mental well-being among university teachers[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. A comprehensive meta-analysis indicates that work-related stress significantly contributes to the occurrence of depression and anxiety among teachers worldwide [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSecondly, the linear regression analysis in step 2 (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e) revealed a positive association between workload and chronic pain, suggesting that heavy and prolonged workloads may potentially contribute to the development of chronic pain among university educators. Such a finding is consistent with the results in the previous studies[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], which revealed that work-related stress (such as long workhours and high cognitive -demanding stress) can lead to chronic pain at varying degree of magnitude.\u003c/p\u003e \u003cp\u003eThirdly, the linear regression analysis in step 3 (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e) demonstrated a negative association between chronic pain and mental health when workload and other controlling variables entering in the regression model. This finding is in line with the opinions in previous literature, for instance,[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] investigated patients diagnosed with rheumatoid arthritis and found that chronic pain can cause depressive symptoms.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] concluded that chronic pain and anxiety disorders co-occur because of shared complex physiological mechanisms.\u003c/p\u003e \u003cp\u003eIn conclusion, chronic pain can mediate the relationship between workload and mental health among university teachers, aligning with the biopsychosocial model. However, this mediating effect of chronic pain only accounts for 17.67% of the total effect, suggesting the existence of alternative pathways through which workload impacts mental health. for instance, addiction to work and work\u0026ndash;life conflicts are two potential mediators in the relationship between work stress and mental well-being in university professors[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.3 The effects of controlling variables\u003c/h2\u003e \u003cp\u003eIn terms of lifestyle, our findings suggest a positive association between physical exercise and mental health, as well as a negative association with chronic pain. These results are consistent with previous research, including a study demonstrating the direct and indirect benefits of exercise for individuals experiencing chronic pain[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and a review highlighting the potential improvement in mental well-being through physical exercise[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, the regression analysis reveals a significant correlation between the teachers\u0026rsquo; professional title and their mental well-being. Specifically, associate professors exhibit lower levels of mental health compared to lecturers, which aligns with the findings reported in [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. This outcome can be attributed to the heightened competition faced by associate professors during their promotion to full professorship, resulting in increased work pressure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Implications\u003c/h2\u003e \u003cp\u003eThe biopsychosocial model holds that the comorbidity of mental and physical health problems is a common phenomenon, especially when illness becomes chronic. This study has demonstrated that mental health can be negatively impacted by chronic pain resulting from high workload, which supports the model's assertion that chronic physical illness is a significant contributor to mental health issues. Previous research has indicated that an increase in physical symptoms corresponds with an increased risk of anxiety and depressive symptoms[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. For instance, contracting COVID-19 can result in substantial depression and anxiety[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The concept of health encompasses the harmonious integration of physical and mental well-being, with both domains exerting reciprocal influences on each other. In addition to the biopsychosocial model, numerous other theories, including allostatic load theory, neuroinflammation theory, and traditional Chinese medicine theory, propose shared mechanisms underlying the co-occurrence of physical and mental ailments. Therefore, when elucidating the mechanism of mental illness in a high work stress environment, it is crucial to consider the mediating role of physical illness.\u003c/p\u003e \u003cp\u003eThe present study holds significant practical implications in two key aspects. Firstly, during the implementation of higher education reforms, it is imperative to appropriately reduce the workload, particularly the time burden, as excessive workload detrimentally affects teachers' physical and mental well-being. The long-term impact of excessive workload on the health of university teachers can lead to a decline in their overall efficiency and productivity. Secondly, engaging in regular physical exercise can effectively enhance both physical and mental health; thus, university educators should allocate dedicated time for adequate physical exercise. The optimal approach for promoting the mental well-being of university educators lies not in imparting them with mental health knowledge or psychological counseling, but rather in effectively mitigating work-related stressors and fostering a culture that encourages physical exercise among teachers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Strength and limitations\u003c/h2\u003e \u003cp\u003eThe primary strength of this study lies in its deep analysis of the physiological mechanisms through which workload impacts mental health. This study suggests a simultaneous occurrence of chronic pain and declining mental health in high-intensity workload situations, highlighting the potential impact of chronic pain on mental well-being. Previous research has seldom explored concurrent changes in physical and mental health during stressful circumstances. Consequently, this study provides support for the notion of comorbidity between physical and mental conditions.\u003c/p\u003e \u003cp\u003eThis study has three limitations. Firstly, the absence of measurement for chronic pain intensity hinders a comprehensive understanding of its mediating role in the relationship between workload and mental health. Secondly, we did not conduct a specific analysis on the distinct impacts of three different workloads on chronic pain and mental health, thereby hindering a comprehensive understanding of the influence of workload on physical and mental well-being. Lastly, the limited sample size compromises the external validity of our findings. Future studies should address these limitations and yield more profound findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study explored the relationships between workload, chronic pain, and mental health among Chinese university teachers. The findings indicate associations between higher workload levels and lower mental health scores, with Chronic pain as a significant mediator. Additionally, more frequent physical exercise correlated with lower chronic pain and better mental health. These findings highlight the connections between work demands, physical symptoms, and psychological well-being in academic environments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Academic Committee of the Department of Teacher Education at Xichang University serves as the institutional review board (IRB) of the university. Ethical approval for this study (Project No. 240626) was granted by this committee and the study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw data for this study is available by contacting the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no any competing interest among them.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by two projects:\u003c/p\u003e\n\u003cp\u003e（1）Doctoral Startup Fund in Xichang university，Project Title: \"Impact of Early Adversity on Psychological Resilience in College Students\"Project ID: YBS2025002\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXin zhuwang and Kai xianfu were in charge of data processing, writing and editing; Cheng jiatang,and Yuxia zhang were responsible for conducting investigations and collecting samples.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNO.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eREN, M. and l.p. 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Chmelik, and A. Karnik, \u003cem\u003eExercise and Chronic Pain\u003c/em\u003e, in \u003cem\u003ePhysical Exercise for Human Health\u003c/em\u003e, J. Xiao, Editor. 2020, Springer Singapore: Singapore. p. 233-253.DOI: 10.1007/978-981-15-1792-1_16.\u003c/li\u003e\n\u003cli\u003ePascoe, M., et al., \u003cem\u003ePhysical activity and exercise in youth mental health promotion: A scoping review.\u003c/em\u003e BMJ open sport \u0026amp; exercise medicine, 2020. \u003cstrong\u003e6\u003c/strong\u003e(1): p. e000677.\u003c/li\u003e\n\u003cli\u003eLiqing, L., \u003cem\u003eInvestigation and Analysis of the Mental Health of University Teachers\u0026mdash;\u0026mdash;Taking Jiangxi Province as an Example \u003c/em\u003eJournal of Jiangxi Science \u0026amp; Technology Normal University, 2016(06): p. 120-124.\u003c/li\u003e\n\u003cli\u003eKroenke, K., et al., \u003cem\u003ePhysical symptoms in primary care. Predictors of psychiatric disorders and functional impairment.\u003c/em\u003e Arch Fam Med, 1994. \u003cstrong\u003e3\u003c/strong\u003e(9): p. 774-9.DOI: https://doi.org/10.1001/archfami.3.9.774.\u003c/li\u003e\n\u003cli\u003eMazza, M.G., et al., \u003cem\u003eAnxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors.\u003c/em\u003e Brain, behavior, and immunity, 2020. \u003cstrong\u003e89\u003c/strong\u003e: p. 594-600.DOI: 10.1016/j.bbi.2020.07.037.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Workload, Chronic pain, Mental health, University teachers, China","lastPublishedDoi":"10.21203/rs.3.rs-7601292/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7601292/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: University teachers in China face immense academic workload, which consequently gives rise to health issues. This study aimed to explore the effects of workload on the psychological health of university teachers and to explain why these effects occur using chronic pain as a mediator.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A total of 451 university teachers were surveyed in three second-tier universities in Sichuan Province in 2024 using paper-pencil-based questionnaires. Workload, mental health, and chronic pain were assessed. Pearson’s correlation and linear regression analyses were used to test the mediation model and hypothesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The university teachers had relatively high levels of workload (M=3.27) and low levels of mental health (M=2.95). The prevalence of chronic pain in various body regions was as follows: shoulder (45.68%), neck (41.46%), low back (36.36%), head (33.26%), and abdomen (31.49%). Linear regression analyses showed that workload significantly predicted mental health (\u003cem\u003eβ\u003c/em\u003e=-0.474, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01) and chronic pain (\u003cem\u003eβ\u003c/em\u003e=0.517, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01). When workload was controlled for, chronic pain significantly predicted mental health (\u003cem\u003eβ\u003c/em\u003e=-0.162, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01) , indicating that chronic pain can mediates the relationship between workload and mental health. in addition, physical exercise is associated with both chronic pain (\u003cem\u003eβ\u003c/em\u003e=-0.206, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01) and mental health (\u003cem\u003eβ\u003c/em\u003e=0.113, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01), lastly, the rank of associate professor is negatively associated with mental health (\u003cem\u003eβ\u003c/em\u003e=-0.094, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.01) with lecture title serving as the reference group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe mediation model was well supported, and chronic pain mediates the relationship between workload and mental health among university teachers.\u003c/p\u003e","manuscriptTitle":"Workload, chronic pain, and mental health among university teachers in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-26 08:25:59","doi":"10.21203/rs.3.rs-7601292/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-31T17:55:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48567823977845712750593081304548172430","date":"2025-12-25T09:33:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-24T10:53:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-24T06:22:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-18T10:33:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-17T07:59:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-17T07:56:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d226a1ab-98a8-4631-9a32-6eb8db62801c","owner":[],"postedDate":"December 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":60201883,"name":"Health sciences/Diseases"},{"id":60201884,"name":"Health sciences/Health care"},{"id":60201885,"name":"Health sciences/Health occupations"},{"id":60201886,"name":"Biological sciences/Psychology"},{"id":60201887,"name":"Social science/Psychology"},{"id":60201888,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-12-26T08:25:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-26 08:25:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7601292","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7601292","identity":"rs-7601292","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}