Posture and mental health: Functional and psychological differences in college students with and without forward head posture

Abstract

Objectives

To examine differences in psychological patient-rated outcomes (PROs) between college-aged students with forward head posture (W-FHP) and those without (WO-FHP), and to explore the potential bidirectional association between posture and psychological well-being.

Design

Cross-sectional observational study.

Methods

A total of 112 college-aged participants were categorized into W-FHP (n = 56; craniovertebral angle ≤ 50°) and WO-FHP (n = 56). All participants completed validated PROs, including the Neck Disability Index (NDI), Generalized Anxiety Disorder Scale (GAD-7), Dispositional Positive Emotion Scale (DPES), and PROMIS-29 domains. Between-group comparisons were conducted using independent samples tests and linear regression models controlling for body mass index (BMI). Forward and reverse logistic regressions were used to assess whether posture predicted psychological outcomes and vice versa.

Results

Participants W-FHP reported significantly higher scores on the NDI, and PROMIS domains of Anxiety, Fatigue, Sleep Disturbance, and Pain Intensity compared to those without FHP. These differences remained significant after adjusting for BMI. Logistic regression revealed that posture predicted elevated anxiety risk (OR = 3.69), while reverse models showed that each unit increase in anxiety T-score was associated with increased odds of FHP classification (OR = 1.10), suggesting a reciprocal relationship.

Conclusion

College students W-FHP demonstrated worse psychological outcomes than those WO-FHP. These findings support embodied cognition theories and suggest that posture may serve as a low-cost, modifiable biomarker for subclinical psychological distress. Incorporating postural assessment into holistic health strategies may offer a novel, non-pharmacological approach to support mental well-being in student populations.