ArticleBMC public health2026
Prevalence, symptom phenotype, and multidomain associated factors of fatigue among Chinese college students: a nationwide cross-sectional study.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFatigue is a highly prevalent but understudied health complaint among college students. This nationwide study aimed to estimate the prevalence, severity distribution, and lifestyle determinants of fatigue among Chinese college students using a validated multidimensional instrument.
methodsA geographically stratified cross-sectional survey was conducted across 30 Chinese provinces. Full-time college students completed an anonymous online questionnaire including the Brief Fatigue Inventory (BFI), sociodemographic characteristics, lifestyle behaviors, and self-reported disease history. Hierarchical multiple linear regression was used to identify independent predictors of BFI Total Score.
resultsA total of 3,014 valid responses were analyzed (63.9% female). The overall mean BFI Total Score was 4.06 ± 2.01. Using established cutoffs, 49.0% experienced clinically meaningful fatigue (moderate or severe). The most prevalent co-occurring symptoms were difficulty concentrating (60.3%) and low mood (56.6%), indicating a predominantly cognitive-affective fatigue phenotype. Sleep duration was the strongest modifiable lifestyle predictor; sleeping fewer than 5 h per night was associated with a BFI increase of 0.90 points relative to the 7-8 h reference (β = 0.90, p < 0.001). Breakfast skipping (β = 0.20, p = 0.008) and late-night eating (β = 0.51, p < 0.001) were also significant independent predictors after full adjustment. A history of anxiety disorder was the single strongest predictor overall (β = 1.22, p < 0.001). The full model explained 13.3% of the variance in BFI Total Score (R²=0.133).
conclusionClinically meaningful fatigue affects nearly half of Chinese college students and presents a predominantly cognitive-affective phenotype. Anxiety disorder history and sleep deprivation are the leading determinants. Integrating psychological screening into fatigue consultations and implementing institutional sleep-protective policies are evidence-based priorities for campus health systems.
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