. 2025 Feb 5;13(1):100.

doi: 10.1186/s40359-024-02136-3.

Using the HBSC Symptom Checklist to measure junior secondary school students' psychosomatic complaints in the Chinese Mainland: Rasch-based validation, population-based norm, and norm-referenced scoring algorithm

Yuhang Zhu¹, Xianzhu Cong², Zhenliang Qiu³, Ricky Jeffrey⁴, Ranran Li⁵, Li Jing³, Gaopei Zhu⁶, Xi Yang², Shuang Li², Jinling Wang⁷, Xu Xu⁸, Hongliu Zhu⁹, Xinjian Wang¹⁰, Ling Huang¹¹, Xueqin Sun¹², Di Wu¹³, Kai Zhang¹⁴, Xunhong Miao¹⁵, Rui Wen¹⁶, Qinglang Huang¹⁷, Zhuang He¹⁸, Juan Li¹⁹, Alina Cosma²⁰, Fuyan Shi²¹, Suzhen Wang²²; PROSQoL-JSSS research group

Collaborators, Affiliations

Collaborators

PROSQoL-JSSS research group:
A Kha, Haiyan Cai, Heqiong Chen, Ke Chen, Yaojun Chen, Conglan Cui, Ruijia Fu, Xiaomin Guo, Cuiduan He, Tao Jiang, Kunga Bäzang, Chunfang Li, Meilian Li, Xiajun Liao, Mei Shi, Hanguang Tan, Yichang Wang, Fei Wei, Hongxia Yu, Bing Yuan, Chengrong Yue, Xiaojing Zhang, Zhenfu Zhang, Weili Zhao, Xiaoyao Zhao, Xiuke Zhao, Huafeng Zheng, Yanjun Zhong, Lingyun Chen, Min Guan, Jingxuan He, Xiaoyu Huang, Shengqiang Jiang, Jianglong Ning, Xinye Qu, Yufang Tao, Chunyan Wang, Dezhong Xu, Lili Xu, Jie Yang, Nan Yang, Yunhui Zhong, Yaofei Zhou, Xiaojuan Zhu, Zijing Chen, Jiahao Li, Pengyu Lou, Qingduo Mao, Qing Shao, Min Wang, Xinling Wang, Bingyi Wu, Mengyuan Yue, Han Zhang, Mengjie Zhang, Xuewen Zhang

Affiliations

¹ Teaching and Research Section of Health Statistics, School of Public Health, Shandong Second Medical University, No. 7166 Baotong West Street, Weicheng, Weifang, Shandong, 261053, China. zhuyuhang369@163.com.
² Teaching and Research Section of Health Statistics, School of Public Health, Shandong Second Medical University, No. 7166 Baotong West Street, Weicheng, Weifang, Shandong, 261053, China.
³ No. 1 High School of Anhui Sixian County, No. 172 Sishui Boulevard, Hongcheng Sub-district, Sixian, Suzhou, Anhui, 234300, China.
⁴ School of Education and English, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, No. 199 Taikang East Road, Yinzhou, Ningbo, Zhejiang, 315100, China.
⁵ Department of Experimental and Applied Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, MF-557, Amsterdam, 1081 BT, Netherlands.
⁶ Department of Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Lixia, Jinan, Shandong, 250012, China.
⁷ Weifang Dongming School, No. 2933 Beigong East Street, Kuiwen, Weifang, Shandong, 261061, China.
⁸ Tongsheng No. 1 Junior High School of Lishui Town, No. 1 Renyuan Road, Lishui, Nanhai, Foshan, Guangdong, 528244, China.
⁹ Ningxiang No. 13 Senior High School, No. 45 Chuwei West Road, Yutan, Ningxiang, Changsha, Hunan, 410600, China.
¹⁰ Department of Counseling Psychology, College of Health and Welfare, Dongshin University, No. 67 Dongshin University Road, Naju-si, Jeollanam-do, 58245, South Korea.
¹¹ Mental Health Education Center, School of Teacher Education, Aba Teachers College, Foshan Boulevard, Shuimo, Wenchuan, Ngawa (Aba), Sichuan, 623002, China.
¹² Teaching and Research Section of Basic Nursing, School of Nursing, Bengbu Medical University, No. 2600 Donghai Boulevard, Longzihu, Bengbu, Anhui, 233030, China.
¹³ The Second Teaching and Research Section of English Major, School of Foreign Languages, Shandong Second Medical University, No. 7166 Baotong West Street, Weicheng, Weifang, Shandong, 261053, China.
¹⁴ Ningxiang Meihua High School, No. 98 Longxi East Road, Ningxiang, Changsha, Hunan, 410699, China.
¹⁵ Suzhou Education and Sports Bureau, No. 609 Huishui East Road, Yongqiao, Suzhou, Anhui, 234000, China.
¹⁶ No. 2 High School of Xinfeng County, Zhongqiao Road, Jiading, Xinfeng, Ganzhou, Jiangxi, 341600, China.
¹⁷ Jingxi Ethnic Senior High School, No. 30 Wanji Boulevard, Xinjing, Jingxi, Baise, Guangxi, 533800, China.
¹⁸ Teaching and Research Section of Applied Psychology, School of Educational Sciences, Guiyang University, No. 103 Jianlongdong Road, Nanming, Guiyang, Guizhou, 550005, China. hezhuang@gyu.edu.cn.
¹⁹ Teaching and Research Section of Social Medicine and Health Management, School of Health Management, Binzhou Medical University, No. 346 Guanhai Road, Laishan, Yantai, Shandong, 264003, China. lijuan892@163.com.
²⁰ Trinity Centre for Global Health, Trinity College Dublin, the University of Dublin, No. 7-9 Leinster Street South, Dublin, D02 K104, Ireland. cosmaa@tcd.ie.
²¹ Teaching and Research Section of Health Statistics, School of Public Health, Shandong Second Medical University, No. 7166 Baotong West Street, Weicheng, Weifang, Shandong, 261053, China. shifuyan@126.com.
²² Teaching and Research Section of Health Statistics, School of Public Health, Shandong Second Medical University, No. 7166 Baotong West Street, Weicheng, Weifang, Shandong, 261053, China. wangsz@wfmc.edu.cn.

PMID: 39910596
PMCID: PMC11796065
DOI: 10.1186/s40359-024-02136-3

Using the HBSC Symptom Checklist to measure junior secondary school students' psychosomatic complaints in the Chinese Mainland: Rasch-based validation, population-based norm, and norm-referenced scoring algorithm

Yuhang Zhu et al. BMC Psychol. 2025.

. 2025 Feb 5;13(1):100.

doi: 10.1186/s40359-024-02136-3.

Authors

Collaborators

PROSQoL-JSSS research group:
A Kha, Haiyan Cai, Heqiong Chen, Ke Chen, Yaojun Chen, Conglan Cui, Ruijia Fu, Xiaomin Guo, Cuiduan He, Tao Jiang, Kunga Bäzang, Chunfang Li, Meilian Li, Xiajun Liao, Mei Shi, Hanguang Tan, Yichang Wang, Fei Wei, Hongxia Yu, Bing Yuan, Chengrong Yue, Xiaojing Zhang, Zhenfu Zhang, Weili Zhao, Xiaoyao Zhao, Xiuke Zhao, Huafeng Zheng, Yanjun Zhong, Lingyun Chen, Min Guan, Jingxuan He, Xiaoyu Huang, Shengqiang Jiang, Jianglong Ning, Xinye Qu, Yufang Tao, Chunyan Wang, Dezhong Xu, Lili Xu, Jie Yang, Nan Yang, Yunhui Zhong, Yaofei Zhou, Xiaojuan Zhu, Zijing Chen, Jiahao Li, Pengyu Lou, Qingduo Mao, Qing Shao, Min Wang, Xinling Wang, Bingyi Wu, Mengyuan Yue, Han Zhang, Mengjie Zhang, Xuewen Zhang

Affiliations

¹ Teaching and Research Section of Health Statistics, School of Public Health, Shandong Second Medical University, No. 7166 Baotong West Street, Weicheng, Weifang, Shandong, 261053, China. zhuyuhang369@163.com.
² Teaching and Research Section of Health Statistics, School of Public Health, Shandong Second Medical University, No. 7166 Baotong West Street, Weicheng, Weifang, Shandong, 261053, China.
³ No. 1 High School of Anhui Sixian County, No. 172 Sishui Boulevard, Hongcheng Sub-district, Sixian, Suzhou, Anhui, 234300, China.
⁴ School of Education and English, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, No. 199 Taikang East Road, Yinzhou, Ningbo, Zhejiang, 315100, China.
⁵ Department of Experimental and Applied Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, MF-557, Amsterdam, 1081 BT, Netherlands.
⁶ Department of Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Lixia, Jinan, Shandong, 250012, China.
⁷ Weifang Dongming School, No. 2933 Beigong East Street, Kuiwen, Weifang, Shandong, 261061, China.
⁸ Tongsheng No. 1 Junior High School of Lishui Town, No. 1 Renyuan Road, Lishui, Nanhai, Foshan, Guangdong, 528244, China.
⁹ Ningxiang No. 13 Senior High School, No. 45 Chuwei West Road, Yutan, Ningxiang, Changsha, Hunan, 410600, China.
¹⁰ Department of Counseling Psychology, College of Health and Welfare, Dongshin University, No. 67 Dongshin University Road, Naju-si, Jeollanam-do, 58245, South Korea.
¹¹ Mental Health Education Center, School of Teacher Education, Aba Teachers College, Foshan Boulevard, Shuimo, Wenchuan, Ngawa (Aba), Sichuan, 623002, China.
¹² Teaching and Research Section of Basic Nursing, School of Nursing, Bengbu Medical University, No. 2600 Donghai Boulevard, Longzihu, Bengbu, Anhui, 233030, China.
¹³ The Second Teaching and Research Section of English Major, School of Foreign Languages, Shandong Second Medical University, No. 7166 Baotong West Street, Weicheng, Weifang, Shandong, 261053, China.
¹⁴ Ningxiang Meihua High School, No. 98 Longxi East Road, Ningxiang, Changsha, Hunan, 410699, China.
¹⁵ Suzhou Education and Sports Bureau, No. 609 Huishui East Road, Yongqiao, Suzhou, Anhui, 234000, China.
¹⁶ No. 2 High School of Xinfeng County, Zhongqiao Road, Jiading, Xinfeng, Ganzhou, Jiangxi, 341600, China.
¹⁷ Jingxi Ethnic Senior High School, No. 30 Wanji Boulevard, Xinjing, Jingxi, Baise, Guangxi, 533800, China.
¹⁸ Teaching and Research Section of Applied Psychology, School of Educational Sciences, Guiyang University, No. 103 Jianlongdong Road, Nanming, Guiyang, Guizhou, 550005, China. hezhuang@gyu.edu.cn.
¹⁹ Teaching and Research Section of Social Medicine and Health Management, School of Health Management, Binzhou Medical University, No. 346 Guanhai Road, Laishan, Yantai, Shandong, 264003, China. lijuan892@163.com.
²⁰ Trinity Centre for Global Health, Trinity College Dublin, the University of Dublin, No. 7-9 Leinster Street South, Dublin, D02 K104, Ireland. cosmaa@tcd.ie.
²¹ Teaching and Research Section of Health Statistics, School of Public Health, Shandong Second Medical University, No. 7166 Baotong West Street, Weicheng, Weifang, Shandong, 261053, China. shifuyan@126.com.
²² Teaching and Research Section of Health Statistics, School of Public Health, Shandong Second Medical University, No. 7166 Baotong West Street, Weicheng, Weifang, Shandong, 261053, China. wangsz@wfmc.edu.cn.

PMID: 39910596
PMCID: PMC11796065
DOI: 10.1186/s40359-024-02136-3

Abstract

Background: The Symptom Checklist (SCL) developed by the Health Behaviour in School‑aged Children (HBSC) study is widely used to capture the psychosomatic complaints (PSC) of non-clinical children and adolescents. Although its psychometric properties have been well established internationally, the performance of the Mandarin Chinese version remains unclear. This study evaluates the Mandarin Chinese HBSC-SCL's psychometric properties, develops its norm, and creates the corresponding scoring algorithm.

Methods: Data were collected from a two-wave cross-sectional survey conducted between June 20 and July 11, 2022, across eight Chinese Human Geography Regions (CHGRs). The sample included 3290 junior secondary school students, obtained through convenience sampling (first wave) and multistage, stratified, cluster sampling (second wave). The surveys were administered anonymously in the school setting, using a paper-and-pencil, self-administered questionnaire. The Mandarin Chinese HBSC-SCL's unidimensionality was verified using confirmatory factor analysis (CFA), and its psychometric properties were comprehensively evaluated using the partial credit model (PCM) of the Rasch measurement method. Based on the above scientific evidence, the population-based norm and norm-referenced scoring algorithm were developed and created.

Results: The CFA confirmed that the HBSC-SCL can be considered unidimensional in the Chinese Mainland. Evidence-based on the six features of the Rasch model indicated that the Mandarin Chinese HBSC-SCL has satisfactory psychometric properties. All 5-category rating scales of eight items appropriately differentiated the students' PSC and demonstrated strong goodness-of-fit. This version also exhibited good unidimensionality and local independence. The Rasch model generated two kinds of reliability indicators, with the item indicators performing well. The person-item map demonstrated acceptable person and item matches, and provided new perspectives for future improvements. Additionally, no substantial uniform differential item functioning (UDIF) was detected across 13 groups (e.g., survey waves, gender, chronological age).

Conclusions: The Mandarin Chinese HBSC-SCL demonstrates satisfactory psychometric properties and performs well in the Chinese Mainland context. It provides concise self-reported PSC measures for junior secondary school students, potentially applicable to a broader Chinese-speaking population. Its ease of administration, scoring, and interpretation makes it suitable for routine school monitoring, large-scale population surveys, and clinical applications. Additionally, the population-based norm and norm-referenced scoring algorithm support the broader application of this version and offer new insights for interpreting PSC sum scores.

Keywords: HBSC Symptom Checklist; Health Behaviour in School‑aged Children; Junior secondary school students; Mandarin Chinese; Norm-referenced scoring algorithm; Population-based norm; Psychometric properties; Psychosomatic complaints; Rasch measurement method.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Medical Ethics Committee of Weifang Medical University (now known as Shandong Second Medical University) approved the study protocol (Ethics Approval No. 2022YX-50). Informed consent was obtained from all participating students and their parent(s) or guardian(s) included in the study. The collection and transfer of data were carried out according to strict security and data encryption. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
Flowchart of the norm-referenced scoring algorithm

**Fig. 2**
The category probability curves for eight items of the Mandarin Chinese HBSC Symptom Checklist (HBSC-SCL) (N = 3180)

**Fig. 3**
A person-item map (Wright map) of 3180 students who responded to the eight items of the Mandarin Chinese HBSC Symptom Checklist (HBSC-SCL)

See this image and copyright information in PMC

References

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Using the HBSC Symptom Checklist to measure junior secondary school students' psychosomatic complaints in the Chinese Mainland: Rasch-based validation, population-based norm, and norm-referenced scoring algorithm

Collaborators

Affiliations

Using the HBSC Symptom Checklist to measure junior secondary school students' psychosomatic complaints in the Chinese Mainland: Rasch-based validation, population-based norm, and norm-referenced scoring algorithm

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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