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Haug E, Rønnestad M, Smith ORF. Physical activity, problematic gaming behavior, and quality of life prior and during the first 9 months of the COVID-19 pandemic: Findings from a longitudinal study among university students. Scand J Med Sci Sports 2024; 34:e14666. [PMID: 38802723 DOI: 10.1111/sms.14666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/28/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Generally, there is limited information on longitudinal trends and the interrelations between physical activity (PA), problematic gaming behavior (PGB), described as a dysfunctional pattern of videogame activities, and quality of life (QoL) based on data that include measurements from both pre- and postpandemic onset. This is also the case for university students. As society faced unprecedented restrictions during this period, these aspects may have developed unfavorably. OBJECTIVE To examine PA, PGB, and QoL among Norwegian University students prior to and during the initial stages of the pandemic and assess their temporal interrelations. METHOD The data are derived from the "Students' Psychological Health Over Time" study (SPOT). Linear mixed models were used to examine the development from January 2020 to November 2020 over three time points for the total sample and across gender. A traditional cross-lagged panel model analysis was used to estimate temporal associations. Age, gender, socioeconomic status, and partner status were included as covariates. FINDINGS PA and QoL decreased linearly over time (Cohen's d = 0.12 and 0.35, respectively), while only male students reported a small reduction in PGB (Cohen's d = 0.03). PA levels decreased considerably more for male students than female students (Cohen's d = 0.17 and 0.09, respectively). There was a small reciprocal negative temporal association between PA and PGB (standardized β = -0.04 and -0.05, respectively). All other temporal associations were not statistically significant in the adjusted analysis. CONCLUSION The findings highlight gender-variant negative developments in PA and QoL and suggest a negative reciprocal interrelation between PA and PGB. The findings point to potential adverse health effects that should be taken into account when restrictive pandemic measures are considered.
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Affiliation(s)
- Ellen Haug
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
- Department of Teacher Education, NLA University College, Bergen, Norway
| | - Mathilde Rønnestad
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Otto Robert Frans Smith
- Department of Teacher Education, NLA University College, Bergen, Norway
- Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
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2
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Zurita-Ortega F, Galeano-Rojas D, Tenelanda-López D, Cresp-Barria M, Farias-Valenzuela C, Valdivia-Moral P. Association between Quality of Life, Confinement, and Sex in Adults: A Multigroup Structural Equation Analysis. Healthcare (Basel) 2024; 12:774. [PMID: 38610196 PMCID: PMC11011266 DOI: 10.3390/healthcare12070774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The state of confinement during the COVID-19 pandemic affected the quality of life of the general population. This study aims to define and contrast an explanatory model of the quality of life in adults and to analyze the relationships between these variables based on the state of confinement and sex. A total of 872 people from Chile aged between 17 and 50 (M = 21.70 years; SD= 3.272), of both sexes (60.90% male and 39.1% female) participated in this research, of whom 46.6% were not confined when tested and 53.4% were confined, analyzing the quality of life. A model of multi-group structural equations was performed, which adjusted very well (χ2 = 559.577; DF = 38; p < 0.001; IFC = 0.934; NFI = 0.916; IFI = 0.934; RMSEA = 0.061). The results show a positive and direct relationship among all the variables studied and the structural equation model proposed according to confinement and sex reveals a good fit in all the evaluation indexes. Stress and sleep, personality, and introspection were the indicators with the greatest influence in the four models, followed by the family and friends indicator with a medium correlation strength, such as the health monitoring dimension, although this was not as influential in confined individuals. The main conclusions are that the best adjustments are obtained in confined adults and females, and the data show that the psychological indicators obtained (stress and sleep, personality, and introspection) have the greatest influence on adults in the four models proposed with regard to their quality of life.
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Affiliation(s)
- Félix Zurita-Ortega
- Department of Didactics Musical, Plastic and Corporal Expression, Faculty of Education Science, University of Granada, 18071 Granada, Spain; (F.Z.-O.); (D.G.-R.)
| | - Dilan Galeano-Rojas
- Department of Didactics Musical, Plastic and Corporal Expression, Faculty of Education Science, University of Granada, 18071 Granada, Spain; (F.Z.-O.); (D.G.-R.)
| | - Dennys Tenelanda-López
- Faculty of Natural Resources, Escuela Superior Politécnica de Chimborazo, Riobamba 060150, Ecuador;
- School of Dentistry, Universidad Nacional de Chimborazo, Riobamba 060150, Ecuador
| | - Mauricio Cresp-Barria
- Departamento de Educación e Innovación, Universidad Católica de Temuco, Temuco 4780000, Chile;
| | | | - Pedro Valdivia-Moral
- Department of Didactics Musical, Plastic and Corporal Expression, Faculty of Education Science, University of Granada, 18071 Granada, Spain; (F.Z.-O.); (D.G.-R.)
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3
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Orban E, Li LY, Gilbert M, Napp AK, Kaman A, Topf S, Boecker M, Devine J, Reiß F, Wendel F, Jung-Sievers C, Ernst VS, Franze M, Möhler E, Breitinger E, Bender S, Ravens-Sieberer U. Mental health and quality of life in children and adolescents during the COVID-19 pandemic: a systematic review of longitudinal studies. Front Public Health 2024; 11:1275917. [PMID: 38259801 PMCID: PMC10800626 DOI: 10.3389/fpubh.2023.1275917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Background The COVID-19 pandemic has significantly impacted the mental health of children and families, i.e., due to measures like social distancing and remote schooling. While previous research has shown negative effects on mental health and health-related quality of life (HRQoL), most studies have focused on pre-post comparisons in the early pandemic stages. This systematic review aims to examine longitudinal studies to understand the long-term impacts of the pandemic on children and adolescents. Methods This systematic review adhered to the PRISMA guidelines and was preregistered in the international prospective register of systematic reviews (Record ID: CRD42022336930). We systematically searched PubMed/MEDLINE, Web of Science, PsycINFO, PSYNDEX, and the WHO-COVID-19 database and included studies published up to August 30, 2022. Based on pre-defined eligibility criteria, longitudinal and prospective studies that assessed the mental health or quality of life of children or adolescents (0-19 years) in the general population over a longer time span (at two or more measurement points) during the COVID-19 pandemic were included in the review. The methodological quality of the included studies was assessed using an adapted version of the Effective Public Health Practice Project (EPHPP) checklist. Narrative data synthesis was used to summarize the findings. Results A total of 5,099 results were obtained from literature searches, with 4,935 excluded during title/abstract screening. After reviewing 163 full-text articles, 24 publications were included in the review. Sample sizes ranged between n = 86 and n = 34,038. The length of the investigated time periods and the number of assessment points, as well as outcomes, varied. The majority of studies were of moderate methodological quality. Mental health outcomes were more frequently studied compared to measures of HRQoL. The findings from these studies mostly suggest that children and adolescents experienced heightened mental health problems, specifically internalizing symptoms like anxiety and depression. Further, there was a decline in their overall HRQoL over the course of the COVID-19 pandemic that did not necessarily subside when lockdowns ended. Conclusion It is crucial to continue monitoring the mental health and well-being of children and adolescents following the pandemic to identify groups at risks and plan interventions. This should ideally be conducted by large systematic studies, using validated instruments, and encompassing representative samples to obtain reliable and comprehensive insights with the aim of improving youth mental health care.
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Affiliation(s)
- Ester Orban
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lydia Yao Li
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martha Gilbert
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Napp
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Kaman
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Topf
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maren Boecker
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Child Neuropsychology Section, University Hospital RWTH Aachen, Aachen, Germany
| | - Janine Devine
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Reiß
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Flora Wendel
- Faculty of Medicine, Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Caroline Jung-Sievers
- Faculty of Medicine, Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Vanessa Sophie Ernst
- Institute for Community Medicine, Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Marco Franze
- Institute for Community Medicine, Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Eva Möhler
- Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Eva Breitinger
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Martinsen K, Lisøy C, Wentzel-Larsen T, Neumer SP, Rasmussen LMP, Adolfsen F, Sund AM, Ingul JM. School children's mental health during the COVID-19 pandemic. Front Psychol 2024; 14:1290358. [PMID: 38327509 PMCID: PMC10848797 DOI: 10.3389/fpsyg.2023.1290358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/13/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction The COVID-19 pandemic significantly impacted the daily routines of children, with social distancing and quarantine leading to reduced social interactions and potential increased conflicts within families. These factors can increase the risk for anxiety and depression while reducing overall quality of life. Methods Our study included 1843 school children aged 8 to 12 from 56 schools over a 2.5-year period before and during the pandemic. This multi-wave cross-sectional study utilized baseline data from an optimization trial of an indicated preventive intervention. The main outcomes were self-reported symptoms of anxiety and depression, and quality of life was the secondary outcome measure. Furthermore, responses to COVID-relevant questions were measured using a self-composed scale. Our objectives were to compare anxiety and depression symptom levels between cohorts of children who participated in the study before and during the pandemic, to examine if anxiety or depression predicted the COVID response, and whether anxiety and depression and subtypes of anxiety had an impact on quality of life during the pandemic. Linear regression and interaction models were used to examine relevant associations. Results Levels of anxiety and depression were higher in all waves compared to pre-pandemic levels. Quality of life was lower during the pandemic than before the pandemic, particularly among children with generalized anxiety symptoms. Quality of life was negatively associated with loneliness. Discussion Our study revealed that children reported higher anxious and depressive symptoms during the pandemic compared to pre-pandemic levels, as well as reduced quality of life. Lockdowns and restrictions may have contributed to this burden. Additionally, self-reported loneliness was a significant possible consequence of the restrictive measures imposed on children during the pandemic. Additional research is needed to investigate the long-term effects of the pandemic on children, particularly regarding the stability of elevated levels of anxiety and depression. Such studies could examine whether these conditions are indicative of a trajectory toward more severe internalizing disorders.Clinical trial registration: NCT04263558.
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Affiliation(s)
- Kristin Martinsen
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Carina Lisøy
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Tore Wentzel-Larsen
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Simon-Peter Neumer
- Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Lene-Mari Potulski Rasmussen
- Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Frode Adolfsen
- Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Anne Mari Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Jo Magne Ingul
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Berra S, Bernaschini ME, Mamondi V, Rajmil L. Gender differences in trajectories of health-related quality of life from childhood to adolescence in a 7-year follow-up study in a urban socially disadvantaged sample from Argentina. Qual Life Res 2024; 33:183-193. [PMID: 37736844 DOI: 10.1007/s11136-023-03515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE The transition from childhood to adolescence is a period of developmental changes, with social influences. Few previous studies have analyzed changes in health-related quality of life (HRQoL) during childhood and adolescence based on longitudinal studies in high-income countries. This study aimed to describe the evolution of HRQoL scores by gender in a school sample over a 7-year period in Argentina. METHODS Prospective cohort of children attending fourth grade in public schools. HRQoL was measured using the KIDSCREEN-52 questionnaire. Trajectories of HRQoL were estimated for girls and boys through multilevel models, adjusted by socioeconomic status (SES). RESULTS The study began in 2014 with a sample of 494 school children, reaching an 85.6% response rate in 2016, 31.4% in 2018, and 41.9% in 2021. Most of the predicted scores are negatively associated with linear age or/and quadratic age, suggesting a decrease in scores over the 7-year follow-up. Interactions between gender and age denote an increase in the differences in scores between girls and boys over time in favor of the latter. For the Index, Physical Well-being, Psychological Well-being, Autonomy, Parent relations, Social support and peers and Financial resources, individuals with medium or high SES have significantly higher scores than those with low SES. CONCLUSIONS HRQoL scores decrease during the transition period from childhood to adolescence, with girls showing the greatest decrease. There were also socioeconomic inequalities in the evolution of HRQoL in a context characterized by social segregation and economic crisis, possibly aggravated by the COVID-19 pandemic.
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Affiliation(s)
- Silvina Berra
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Valparaíso s/n. Ciudad Universitaria, 5000, Córdoba, Argentina.
- Escuela de Salud Pública, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.
| | - María Eugenia Bernaschini
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Valparaíso s/n. Ciudad Universitaria, 5000, Córdoba, Argentina
- Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Verónica Mamondi
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Luis Rajmil
- Pediatrician and Public Health Specialist. Retired, Barcelona, Spain
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Barbieri V, Wiedermann CJ, Piccoliori G, Mahlknecht A, Plagg B, Ausserhofer D, Ravens-Sieberer U, Engl A. Evolution of Youth's Mental Health and Quality of Life during the COVID-19 Pandemic in South Tyrol, Italy: Comparison of Two Representative Surveys. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050895. [PMID: 37238443 DOI: 10.3390/children10050895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has led to an increase in youth mental health problems worldwide. Studies have revealed substantial variation in the incidence of these problems across different regions. Longitudinal studies of children and adolescents in Italy are lacking. This study aimed to investigate the development of health-related quality of life (HRQoL) and mental health in Northern Italy by comparing surveys conducted in June 2021 and in March 2022. METHODS A representative, large cross-sectional, online survey investigated HRQoL, psychosomatic complaints, and symptoms of anxiety and depression among 5159 and 6675 children and adolescents in 2021 and 2022, respectively, using the KIDSCREEN-10 index, HBSC symptom checklist, SCARED, CES-DC, and PHQ-2 instruments. Statistical analyses included a multivariate linear regression analysis. RESULTS Baseline characteristics showed significant differences in demographic variables between the two surveys. Girls and their parents reported a significantly lower HRQoL in 2021 than in 2022. Psychosomatic complaints differed significantly between sexes, and the results showed no decrease in psychosomatic complaints, anxiety, or depression between 2021 and 2022. Predictors of HRQoL, anxiety, depressive symptoms, and psychosomatic complaints in 2022 differed from those in 2021. CONCLUSIONS The characteristics of the 2021 pandemic, including lockdowns and home schooling, may have contributed to the differences between the two surveys. As most pandemic restrictions ended in 2022, the results confirm the need for measures to improve the mental and physical health of children and adolescents after the pandemic.
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Affiliation(s)
- Verena Barbieri
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
| | - Christian J Wiedermann
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
- Department of Public Health, Medical Decision Making and Health Technology Assessment, University of Health Sciences, Medical Informatics and Technology, 6060 Hall, Austria
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
| | - Angelika Mahlknecht
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
| | - Barbara Plagg
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
- Faculty of Education, Free University of Bolzano, 39100 Bolzano, Italy
| | - Dietmar Ausserhofer
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Adolf Engl
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy
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Victoria-Montesinos D, Tárraga-Marcos A, Brazo-Sayavera J, Jiménez-López E, Gutiérrez-Espinoza H, Panisello Royo JM, Tárraga-López PJ, López-Gil JF. Adherence to the Mediterranean Diet and Health-Related Quality of Life during the COVID-19 Lockdown: A Cross-Sectional Study including Preschoolers, Children, and Adolescents from Brazil and Spain. Nutrients 2023; 15:nu15030677. [PMID: 36771384 PMCID: PMC9920644 DOI: 10.3390/nu15030677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Scientific literature has suggested positive associations between the Mediterranean diet (MD) and the health-related quality of life (HRQoL) in young populations. However, to our knowledge, this relationship is unexplored during a situation of social isolation (i.e., lockdown). The objective of the current study is to examine the relationship between the MD and HRQoL during the COVID-19 lockdown among preschoolers, children, and adolescents from Brazil and Spain. This cross-sectional study includes a sample of 1099 three- to seventeen-year-old participants (47.6% girls) who were recruited via social networks. The HRQoL was assessed with the EQ-5D-Y. The Quality Index for Children and Teenagers (KIDMED) questionnaire was applied to evaluate the relationship between the MD and HRQoL. The highest prevalence of reported problems was found for worried, sad, or unhappy participants (39.8%). Furthermore, the lowest proportion of HRQoL problems was observed for "mobility" (2.5%). The proportion of high adherence to the MD was 44.3%. Participants with greater MD adherence reported higher HRQoL mean scores when compared with those who did not adhere to the MD (83.7 ± 0.6 vs. 85.6 ± 0.7, respectively; p < 0.05). Adherence to the MD and especially daily fruit intake were related to higher HRQoL during the COVID-19 lockdown among Brazilian and Spanish young people aged three to seventeen years.
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Affiliation(s)
| | - Almudena Tárraga-Marcos
- Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla-La Mancha (UCLM), 02006 Albacete, Spain
| | - Javier Brazo-Sayavera
- PDU EFISAL, Centro Universitario Regional Noreste, Universidad de la República (UdelaR), Rivera 40000, Uruguay
- Department of Sports and Computer Science, Universidad Pablo de Olavide (UPO), 41013 Seville, Spain
| | - Estela Jiménez-López
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
| | - Héctor Gutiérrez-Espinoza
- Escuela de Fisioterapia, Universidad de las Américas, Quito 170504, Ecuador
- Correspondence: (P.J.T.-L.); (H.G.-E.)
| | | | - Pedro J. Tárraga-López
- Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla-La Mancha (UCLM), 02006 Albacete, Spain
- Correspondence: (P.J.T.-L.); (H.G.-E.)
| | - José Francisco López-Gil
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA 02138, USA
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