How to assess quality of life in child and adolescent psychiatry

Effectiveness of a family-management program for family having children with acute lymphoblastic leukemia: a quasi-experimental study

PURPOSE

To examine the impact of a family-management program (FMP) on family management, family, and child quality of life (QOL) among parents of children with acute lymphoblastic leukemia (ALL).

METHODS

Participants included 46 parents of children aged 2-5 years with ALL. Participants were recruited via a convenience sampling method at a tertiary hospital in Thailand. Twenty-three intervention participants received a 3-weekly FMP and routine care while the other 23 control participants received only routine cancer care. Data was collected in the hospital setting and/or via telephone follow-up calls. Study outcomes were evaluated at 3 time points (i.e., baseline, post-intervention, and follow-up) using the following: Family Management Measure, Beach Center Family Quality of Life Scale, and Quality of Life of Children with cancer module. Data were analyzed using two-way repeated-measures analysis of variance (ANOVA).

RESULTS

The findings revealed that family management and child QOL in the intervention group was higher than the control group at follow-up (p < .05), but not for family QOL. Within the intervention group, there was significant improvement in family management, family QOL and child QOL at post-intervention and follow-up.

CONCLUSIONS

The FMP was effective in fostering improved outcomes among enrolled parents that received the FMP compared to parents in the control group. Healthcare providers, especially nurses that work with parents of children with ALL, can easily offer the FMP to parents to help foster optimal family management, family QOL, and child QOL.

Relationship between bullying with depressive symptoms and health-related quality of life among Brazilian high school students from Southern Brazil

The aim is to analyze the associations of bullying victimization and perpetration with depressive symptoms and health-related quality of life (HRQoL) in a sample of Brazilian high school adolescents. Adolescents (n=852, 50.2% female, mean age: 16.4 years) answered a questionnaire about depressive symptoms drawn from the Center for Epidemiologic Studies Depression Scale. HRQoL was measured using the Kidscreen-10 Index, and bullying-related information was extracted from two different questions (victims and perpetrators). Multilevel logistic regression models were used. Adolescent victims of bullying had higher levels of depressive symptoms and a lower perception of HRQoL than those who were not victims. On the other hand, an inverse relationship was found for perpetrators of bullying compared to those who were not perpetrators. Adolescents' health-related impacts varied according to their role in bullying situations.

Health-related quality of life and its association with socioeconomic status and mental health in 5- to 7-year-old children: a cross-sectional study

PURPOSE

Assessing socioeconomic status (SES), mental health, and health-related quality of life (HRQoL) in young children is crucial for making informed health care decisions and identifying areas of intervention. The present study aimed to investigate potential associations between SES, mental health, and HRQoL in 5-7-year-old children.

METHOD

The present study included mother-reported health assessments for 621 children aged 5-7 years in Grade 1 collected between 2019 and 2023 as part of the Starting Right™ project. Online questionnaires were used to support public health nurses in assessing children's health status. HRQoL (KIDSCREEN-27, 5 subscales) and mental health [Strength and Difficulties Questionnaire (SDQ), 4 subscales] were assessed. Sociodemographic characteristics, sex, maternal education, and income were obtained from Statistics Norway. The data were analyzed using multiple robust regression.

RESULTS

Mother-reported mean scores for the KIDSCREEN-27 were within the normal range compared with European norms (8-11 years). However, for each KIDSCREEN-27 dimension, there were individuals whose mothers reported scores that were substantially lower than average. Having mental health problems, defined as being in the 80th and 90th percentiles of the SDQ Total problem score, was associated with 2.1-10.7-point lower KIDSCREEN-27 scores (p < 0.001-0.021), which was most noticeable in the KIDSCREEN-27 school environment subscale. Weak but significant positive associations were found between SES and HRQoL.

CONCLUSION

Our results provide important insights into the associations between SES, mental health, and HRQoL in young children. Given the strong association between mental health problems and HRQoL in Grade 1 children, the assessment of both is essential, so that early interventions, an improved caring environment, and nurturing support can be initiated.

Instruments for the assessment of quality of life in children and adolescents with Down syndrome: a scoping review

The construct of quality of life (QoL) includes aspects of health and well-being of people. Down syndrome [DS] or trisomy 21 is one of the most common congenital anomalies. DS is characterized by motor and cognitive alterations that affect health and QOL of both the child and caregiver.In pediatrics, there are various instruments to assess Health-Related Quality of Life (HRQoL) and QoL. The advantage of these instruments is that they can be implemented in any type of disease and population in general. However, they may have certain disadvantages, such as the difficulty in evaluating specific aspects of each disease or condition related to Down syndrome. The aim of this study was to identify 1: instruments used to assess quality of life in children with Down syndrome. 2: psychometrics properties of instruments validated in children with Down syndrome to assess quality of life. Methods A Scoping review was conducted to identify instruments used in children and adolescents with Down syndrome, and a second systematic searched psychometric properties of these instruments. The electronic databases PubMed, Embase, Epistemonikos and other sources were explored with a search strategy that included keywords such as "Down syndrome," "Quality of life" or "Life Quality," "Health-Related Quality of Life" and psychometrics properties. The quality of the included studies was evaluated using the COSMIN (Based Standards for the Selection of Health Measurement Instruments) methodology. Results Twenty-seven studies were selected that used twelve instruments to evaluate quality of life in children or adolescents with Down syndrome. Two of the twelve evaluated quality of life and ten health-related quality of life. In the second search, ten studies reported the psychometric properties of six instruments evaluated in minors with Down Syndrome. Conclusion There is limited information available regarding the psychometric properties of instruments used to assess quality of life, particularly health-related quality of life. Commonly employed instruments in this area include the PedsQL 4.0 and KIDSCREEN. Notably, while the PedsQL 4.0 lacks specific evaluation in children with DS, data from KIDSCREEN assessments are inconsistently reported. Rigorous evaluation of the performance of Kidslife and Kidslife Down in clinical settings is necessary, or the development of new instruments tailored for children with DS is warranted to comprehensively assess quality of life in clinical settings.

Risk and protective factors associated with health-related quality of life in children and adolescents with ADHD in Germany - Findings from the consortium project INTEGRATE-ADHD

Background

The health-related quality of life (HRQoL) of individuals living with Attention-deficit/hyperactivity disorder (ADHD) is known to be impaired. Identifying factors that influence HRQoL can provide important information for the development of prevention and intervention programmes for affected children and adolescents. The aim of the present study was to investigate health care-related and psychosocial risk and protective factors for HRQoL in children and adolescents with an administrative ADHD diagnosis.

Methods

In the consortium project INTEGRATE-ADHD, n = 4,809 parents of children and adolescents aged 7 to 17 years participated in an online survey between October 2021 and August 2022 and answered questions regarding HRQoL (KIDSCREEN-27), health care utilisation, and psychosocial risk and protective factors. Multiple linear regression analyses were conducted to assess the association between these factors and the five HRQoL dimensions of the KIDSCREEN-27.

Results

Findings indicate that parental psychopathology and parental burden were risk factors for lower HRQoL in children and adolescents with ADHD. Further, a positive association was found between the five HRQoL dimensions and the psychosocial factors family climate and social support, indicating that these are protective factors.

Conclusions

The results highlight the importance of prevention and intervention programmes for individuals with ADHD that consider parental mental health and aim to strengthen resources such as the availability of good family climate and social support.

A Pilot Study of a Family Management Program for Parents of Children with Acute Lymphoblastic Leukemia

OBJECTIVES

The aim of this completed pilot study was to evaluate the feasibility of implementing a family management program (FMP) for parents of children with acute lymphoblastic leukemia (ALL).

DATA SOURCES

A convenience sample of 11 parents of preschool-aged children with ALL were recruited from an ambulatory chemotherapy-care clinic at a tertiary hospital in Thailand. Participants received three FMP sessions over 3 weeks. The FMP is based on two established family programs (ie, FMP-style framework and building on family strengths) and reviewed literature. The following measures were used to evaluate parents' responses at baseline, postintervention, and follow-up: Family Management Measure, Beach-Center Family Quality-of-Life Scale, and Pediatric Quality of Life Inventory. Data were analyzed using one-way repeated-measures analysis of variance.

CONCLUSION

The study results provide promising evidence that the FMP is feasible and improves family management and quality of life for parents of enrolled children with ALL.

IMPLICATIONS FOR NURSING PRACTICE

Educating pediatric oncology nurses and other healthcare professionals to replicate the FMP may help to provide better family management, and child quality of life support to future parents and other family members of young children diagnosed with ALL. This support should focus on educating parents about the potential effects of caring for a child with ALL on the family and fostering positive relationships within the family and offering guidance on effective family communications and decision-making processes.

Healthy diets positively associated with health-related quality of life in children and adolescents from low socioeconomic areas: Findings from the Greek Food Aid Program, DIATROFI

OBJECTIVES

To assess the relationship of diet with health-related quality of life (HRQoL) in vulnerable children and adolescents.

METHODS

Data included 6583 children and adolescents (aged 3-18 years old) from the Greek Food-Aid DIATROFI Program in the 2015 to 2016 and 2017 to 2018 school years. HRQoL was measured with the Pediatric Quality of Life Inventory questionnaire and diet with food frequency questionnaires. The healthy plant-based diet index (hPDI), animal score, and dietary patterns were investigated.

RESULTS

The hPDI and animal score were associated with good HRQoL (odds ratio [OR] [95% confidence interval], 10-unit increase: ORhPDI = 1.28 [1.05, 1.57], ORanimal = 1.51 [1.14, 2.00]) and physical (ORanimal = 1.62 [1.23, 2.13]), emotional (ORhPDI = 1.30 [1.07, 1.58], ORanimal = 1.41 [1.08, 1.85]) and school function (ORhPDI = 1.32 [1.09, 1.59], ORanimal = 1.46 [1.12, 1.89]). Dietary patterns of fruits, raw vegetables, and cheese were associated with good HRQoL (OR of 1-unit increase: 1.22 [1.13, 1.32]), and physical OR = 1.18 [1.09, 1.27]) and emotional function (OR = 1.09 [1.02, 1.18]). Starchy foods and sweetened beverages were associated with poor HRQoL (OR = 0.75 [0.63, 0.90]), and emotional (OR = 0.80 [0.68, 0.95]) and school function (OR = 0.72 [0.61, 0.85]).

CONCLUSION

Healthy diets and dietary patterns were positively associated with the HRQoL of vulnerable children and adolescents, which may offer opportunities for prevention.

Quality of Life of Children with Short Bowel Syndrome from Patients' and Parents' Points of View

Despite limited research, existing studies using generic quality of life (QOL) tools indicate decreased physical health and compromised emotional functioning in children with IF. This study investigates QOL in children with short bowel syndrome (SBS) and its determinants. The study included 57 pediatric patients with SBS treated at Mannheim's University Hospital between 1998 and 2014. To evaluate QOL, the KINDL questionnaire was used. Three age-specific questionnaire variants were employed, and parental proxy reports were collected. Most patients underwent intestinal lengthening procedures, with varying primary diagnoses. A comparison with healthy children from the patient's perspective revealed no difference but from the parent's perspective showed lower QOL in SBS patients, especially regarding physical and mental well-being. QOL varied with age, with 7-10-year-olds reporting the lowest scores. Several factors, including independence from parenteral nutrition and the presence of a complete colon, positively influenced QOL. The independence of parenteral nutrition and the presence of a complete colon positively influenced QOL. The Bianchi technique for intestinal lengthening has also shown promise but needs further research. The observation sample in this study is too small to generalize about the whole population of SBS patients. However, this study shows that many health and treatment factors affect QOL, and a large multicenter study is necessary. Our findings underline the importance of appropriate psychological support for children with SBS and their families.

A systematic review on the relationship between the built environment and children's quality of life

BACKGROUND

Evidence of the effects of the built environment on children has mainly focused on disease outcomes; however, quality of life (QoL) has gained increasing attention as an important health and policy endpoint itself. Research on built environment effects on children's QoL could inform public health programs and urban planning and design.

OBJECTIVE

We aimed to review and synthesize the evidence of the relationship between built environment features and children's QoL.

METHODS

Five research databases were searched for quantitative peer-reviewed studies on children between 2 and 18 years, published in English or German between January 2010 and August 2023. Only primary research was considered. Included studies (n = 17) were coded and methodologically assessed with the Joanna Briggs Critical Appraisal Checklists, and relevant data were extracted, analyzed, and synthesized, using the following built environment framework: (1) neighborhood green and blue space, (2) neighborhood infrastructure, and (3) neighborhood perception.

RESULTS

Green space was positively associated with children's QoL. Infrastructure yielded inconclusive results across all measured aspects. Overall neighborhood satisfaction was positively correlated with higher QoL but results on perceived environmental safety were mixed.

CONCLUSIONS

Most studies are correlational, making it difficult to infer causality. While the positive findings of green space on QoL are consistent, specific features of the built environment show inconsistent results. Overall perception of the built environment, such as neighborhood satisfaction, also shows more robust results compared to perceptions of specific features of the built environment. Due to the heterogeneity of both built environment and QoL measures, consistent measures of both concepts will help advance this area of research.

A systematic review on the relationship between the built environment and children's quality of life

Background

Evidence of the effects of the built environment on children has mainly focused on disease outcomes; however, quality of life (QoL) has gained increasing attention as an important health and policy endpoint itself. Research on built environment effects on children's QoL could inform public health programs and urban planning and design.

Objective

We aimed to review and synthesize the evidence of the relationship between built environment features and children's QoL.

Methods

Five research databases were searched for quantitative peer-reviewed studies on children between 2-18 years, published in English or German between 2010-2021. Only primary research was considered. Included studies (n=17) were coded and methodologically assessed with the Joanna Briggs Critical Appraisal Checklists, and relevant data were extracted, analyzed, and synthesized, using the following built environment thematic framework: 1) neighborhood natural environment, 2) neighborhood infrastructure, and 3) neighborhood perception.

Results

Green space was positively associated with children's QoL. Infrastructure yielded inconclusive results across all measured aspects. Overall neighborhood satisfaction was positively correlated with higher QoL but results on perceived environmental safety were mixed.

Conclusions

Most studies are correlational, making it difficult to infer causality. While the positive findings of green space on QoL are consistent, specific features of the built environment show inconsistent results. Overall perception of the built environment, such as neighborhood satisfaction, also shows more robust results compared to perceptions of specific features of the built environment. Due to the heterogeneity of both built environment and QoL measures, consistent definitions of both concepts will help advance this area of research.

Health-Related Quality of Life in Childhood and Adolescence: The Interrelation with Level of Adherence to Mediterranean Diet and Dietary Trajectories: Highlights from the DIATROFI Program (2021-2022)

Children's dietary habits can have a key role in contributing to an improvement in their Health-Related Quality of Life (HRQoL). This study aims to assess the connection between Mediterranean diet adherence and HRQoL in a sample of Greek students, utilizing data from the DIATROFI program. The parents of 3774 students (mean age 7.8 (2.6) years) reported their children's HRQoL and level of adherence to the Mediterranean dietary pattern at the beginning and end of the 2021-2022 school year. At baseline, most students' adherence was characterized as moderate (55.2%) or high (25.1%). Students with moderate or high adherence tο the Mediterranean diet were less likely to report a total HRQoL below the median at baseline (OR = 0.56, 95%CI = 0.44, 0.70), along with all its dimensions (physical, emotional, social, and school functions). A one-unit improvement in KIDMED score _{(beginning-end of schoolyear)} was associated with the likelihood of an improvement in total HRQoL _{(beginning-end of schoolyear)} (OR = 1.09, 95%CI = 1.02, 1.17), emotional (OR = 1.09, 95%CI = 1.02, 1.17), and social functions (OR = 1.13, 95%CI = 1.05, 1.22), but not with physical and school functions. The health benefits of the Mediterranean diet in children may not be limited to disease prevention but also extend to their overall wellbeing.

Adolescents' polycystic ovary syndrome health-related quality of life questionnaire (APQ-20): development and psychometric properties

Several health-related quality of life (HRQOL) questionnaires for adults with polycystic ovary syndrome (PCOS) have been developed so far. However, an adolescent-specific HRQOL questionnaire for PCOS patients is still lacking. Hence, this study aimed to develop and validate a questionnaire to assess HRQOL in adolescents with PCOS. This mixed-method study was conducted in Tehran, Iran, from 2018 to 2020. The qualitative phase was conducted on 18 target participants, and in the quantitative phase, exploratory factor analysis (EFA) was performed on 200 adolescents with PCOS and confirmatory factor analyses (CFA) on the other 200 ones. The item-developing process was finalized with 77 questions. Concerning the optimum cutoff of content validity ratio, content validity index, kappa statistic coefficient, and item impact score, a draft with 55 items was finalized. Then, piloting scale was performed on 40 participants and considering the interitem correlation < 0.3, fifteen items were excluded. Based on the EFA, 20 items in six components (emotion and mood, loss of attractiveness due to the hirsutism, loss of attractiveness due to the acne, self-care, support, and menstrual cycle problem) that explain 60.3% of the variance were extracted. The CFA with acceptable values of goodness-of-fit statistics supports this construct validity. Results of reliability, floor, and ceiling effect were acceptable.  Conclusion: Our study showed that the short questionnaire of APQ-20 is valid and reliable for assessment of the HRQOL of adolescents with PCOS. Further studies are needed to assess the feasibility and reliability of APQ-20 for assessing the HRQOL of adolescents with PCOS. It constitutes a significant step forward in the measurement of HRQOL of adolescents with PCOS. What is Known: • There is no disease-specific questionnaire for assessment of the health-related quality of life (HRQOL) of adolescents with polycystic ovary syndrome (PCOS). What is New: • The short questionnaire of APQ-20 is easy to use, valid, and reliable for the assessment of the HRQOL of adolescents with PCOS. • APQ-20 constitutes a significant step forward in the measurement of HRQOL of adolescents with PCOS.

[Relationship Between Social Integration, Global Self-Esteem, and Physical and Mental Health in a Representative German Sample]

INTRODUCTION

Beyond participation as a civil right, social participation has already been considered from legal, ethical, socio-psychological and political perspectives as an important component of the self- and external evaluation of a person as a valuable member of a society. Thus, social psychological studies frequently showed the importance of the sense of belonging as a central psychological component of social participation for both personal and social self-esteem. From a medical-psychological perspective, the association of global self-esteem and self-efficacy with health is well established. However, it is an open question whether social participation is directly related to psychological and physical well-being or whether this relationship is mediated via global self-esteem.

MATERIAL AND METHODS

Based on a nationwide representative survey in Germany (N=2.531; age 14-93, M=48.58; 55.4% women), the variables social participation (KsT-5), global self-esteem (SISE), and physical and mental health (EQ5D) were measured using standardized questionnaires to examine a potential mediation.

RESULTS

As expected, significant positive correlations between social participation, global self-esteem and physical and mental health were found with medium ranged effect sizes. However, global self-esteem only partially mediated the association between social participation and health, i. e. a direct significant association between social participation and health could be proven.

DISCUSSION

The results underline the direct relevance of social participation for physical and mental health. This opens a hitherto hardly used perspective for health promotion in interaction with socio-political challenges in the topics of integration, inclusion and the sense of belonging.

Use of KIDSCREEN health-related quality of life instruments in the general population of children and adolescents: a scoping review

PURPOSE

Subjectively assessing health related quality of life (HRQoL) in children and adolescents is increasingly important in the public health field. One valid and widely used generic HRQoL instrument is the KIDSCREEN questionnaire. The aim of this study was to map all studies using KIDSCREEN instruments in the general population of children and adolescents aged 6-18 years.

METHODS

A scoping review was conducted. The search strategy was formulated according to the Preferred Reporting Items for Systematic Reviews and Scoping Reviews guidelines. The databases Cinahl, socINDEX, Medline, Embase, APA Psychinfo, Scopus, and Eric were searched in October 2021.

RESULTS

In total, 1365 papers were eligible for screening, 1031 were excluded and 334 reports were read in full. 252 reports were included. KIDSCREEN studies in the general population was predominantly conducted in Europe (n = 211). Most studies (n = 179) had a cross sectional design, while few experimental studies (n = 24) were found. The three KIDSCREEN versions comprising of 10, 27 and 52 items, were equally distributed between studies. The self-reported version (n = 225) of the KIDSCREEN instrument was more prevalent than the proxy version, while few studies discussed a cut point. Study contexts reflected international trends of public health challenges, commonly including mental- and psychosocial health, physical activity, socioeconomic status, and obesity.

CONCLUSION

KIDSCREEN is widely used in cross sectional studies assessing common public health challenges. Experimental and longitudinal assessments, possibly including relevant cut offs remain mainly unexplored and are recommended for future research.

A Tool for Assessing the Quality of Life of Adolescents in Youth Care: Psychometric Properties of the QOLYSS

Quality of life (QOL) has gained increased interest as a critical pathway to better understanding the lives and circumstances of children and adolescents in both the general population and among specific populations. Yet, QOL assessment among youngsters in youth care services remains a highly under-researched topic. This study examines the suitability and psychometric properties of a new QOL self-report scale for adolescents between 12 and 18 years old in youth care: the Quality of Life in Youth Services Scale (QOLYSS). The provisional version of the QOLYSS was pre-tested in a sample of 28 adolescents in youth care to examine its applicability and feasibility. Next, a comprehensive evaluation of the psychometric properties of the field-test version was conducted in a sample of 271 adolescents in youth care in Flanders, Belgium (M = 15.43, SD = 1.73). Classical item and factor analyses were carried out per subscale, (test-retest) reliability and item-discriminant validity of the subscales were examined, convergent validity was explored, and confirmatory factor analysis was used to examine the goodness-of-fit of different measurement models. Reliability measures of the scale are satisfactory, results are indicative of convergent validity, and confirmatory factor analysis provides evidence for the eight correlated factors model. Future lines of research concerning the ongoing development and application of the QOLYSS are discussed.

COVID-19-related future anxiety is associated with the health-related quality of life in school-aged children and adolescents-A cross-sectional study

Background

Over the course of the COVID-19 pandemic, previous studies have shown that the physical as well as the mental health of children and adolescents significantly deteriorated. Future anxiety caused by the COVID-19 pandemic and its associations with quality of life has not previously been examined in school children.

Methods

As part of a cross-sectional web-based survey at schools in Mecklenburg-Western Pomerania, Germany, two years after the outbreak of the pandemic, school children were asked about COVID-19-related future anxiety using the German epidemic-related Dark Future Scale for children (eDFS-K). Health-related quality of life (HRQoL) was assessed using the self-reported KIDSCREEN-10. The eDFS-K was psychometrically analyzed (internal consistency and confirmatory factor analysis) and thereafter examined as a predictor of HRQoL in a general linear regression model.

Results

A total of N = 840 8-18-year-old children and adolescents were included in the analysis. The eDFS-K demonstrated adequate internal consistency reliability (Cronbach's α = 0.77), and the confirmatory factor analysis further supported the one-factor structure of the four-item scale with an acceptable model fit. Over 43% of students were found to have low HRQoL. In addition, 47% of the students sometimes to often reported COVID-19-related fears about the future. Children with COVID-19-related future anxiety had significantly lower HRQoL (B = - 0.94, p < 0.001). Other predictors of lower HRQoL were older age (B = - 0.63, p < 0.001), and female (B = - 3.12, p < 0.001) and diverse (B = - 6.82, p < 0.001) gender.

Conclusion

Two years after the outbreak of the pandemic, school-aged children continue to exhibit low HRQoL, which is further exacerbated in the presence of COVID-19-related future anxiety. Intervention programs with an increased focus on mental health also addressing future anxiety should be provided.

The Potential Impact of COVID-19 on Health-Related Quality of Life in Children and Adolescents: A Systematic Review

This was a systematic review of studies examining the effect of COVID-19 on the health-related quality of life (HRQoL) of children and adolescents. The review was conducted by examining the current literature and analyzing up-to-date evidence. The studies were extracted from three major databases (CINAHL Complete, MEDLINE, and Web of Science) and analyzed. Studies on children and adolescents whose HRQoL has been affected by COVID-19 were included based on the eligibility criteria. Ultimately, eight studies met these criteria. The evidence of the selected studies was analyzed; the research design, age categories, respondents, evaluation tools, gender differences, and variability before and during COVID-19 were systematically reviewed. This review found differences in these groups regarding oral symptoms, functional limitations, emotional well-being, and social well-being. Furthermore, this review highlighted the relative paucity of studies that comprehensively investigate the latest evidence of changes in the HRQoL of children and adolescents due to COVID-19 in preparation for the post-COVID era.

Cochlear implant-specific risks should be considered, when assessing the quality of life of children and adolescents with hearing loss and cochlear implants-not just cochlear implant-specific benefits-Perspective

Cochlear implants (CIs) are electronic medical devices that enable hearing in cases where traditional hearing aids are of minimal or no use. Quality of life (QoL) studies of children and adolescents with a CI have so far focused on the CI-specific benefits. However, the CI-specific risks listed by the U.S. Food and Drug Administration have not yet been considered. From this list, medical and device-related complications, lifelong dependency on the implanted device, and neurosecurity risks (CI technology is an interface technology) may be particularly relevant for young CI users. Medical and device-related complications can cause physical discomfort (e.g., fever, pain), as well as functioning problems (e.g., in speech discrimination, social behavior, and mood). In the worst case, reimplantation is required. Clinical experience shows that these complications are perceived as a burden for young CI users. Furthermore, many young patients are worried about possible complications. Additionally, CIs can be at least a temporary burden when children, typically at the age of 8-9 years, realize that they need the CI for life, or when they become peer victims because of their CI. Concerning neurosecurity risks, it is still unknown how young CI recipients perceive them. In summary, CI-specific risks can be perceived as a burden by young CI users that impairs their QoL. Therefore, they should not be ignored. There is an urgent need for studies on this topic, which would not only be important for professionals and parents, but also for the design of CI-specific QoL instruments.

Large Improvements in Health-Related Quality of Life and Physical Fitness during Multidisciplinary Inpatient Rehabilitation for Pediatric Cancer Survivors

Rehabilitation is a key element in improving health-related quality of life (HRQOL) for pediatric cancer survivors. The aim of this study was to present data from a multidisciplinary inpatient rehabilitation treatment. Children took part in a four-week multidisciplinary family-oriented inpatient rehabilitation. A total of 236 children (>5−21 years) and 478 parents routinely completed electronic patient-reported outcomes (ePROs), performance-based assessments, and clinician-rated assessments before (T1) and at the end (T2) of rehabilitation. HRQOL was assessed with the PedsQL generic core and PedsQL cancer module. Data were analyzed using repeated measures analysis of variance (ANOVA). Statistically significant improvements with medium to large effect sizes were observed for most HRQOL scales (η2 = 0.09−0.31), as well as performance-based and clinician-rated assessments for physical activity and functional status (η2 > 0.28). Agreement between children’s PROs and parents’ proxy ratings was lower before (rICC = 0.72) than after (rICC = 0.86) rehabilitation. While the concordance between children and parents’ assessment of changes during rehab was low to moderate (r = 0.19−0.59), the use of the performance score led to substantially increased scores (r = 0.29−0.68). The results of this naturalistic observational study thus highlight the benefits of multidisciplinary pediatric inpatient rehabilitation for childhood cancer survivors. The use of the performance score is recommended in this field.

Anthropometric, Lifestyle Characteristics, Adherence to the Mediterranean Diet, and COVID-19 Have a High Impact on the Greek Adolescents' Health-Related Quality of Life

OBJECTIVE

The study aimed at analyzing the relationship between anthropometric characteristics, lifestyle, and dietary habits, as well as the burden of the pandemic on the health-related quality of life among Greek pupils.

RESEARCH METHODS AND PROCEDURES

On the whole, 2088 adolescents aged 12-18 years from Attica, Greece, were enlisted in this school-based cross-sectional study that took place in May-December 2021. Health-related quality of life was estimated through the KIDSCREEN-27 questionnaire, adherence to the Mediterranean diet-through the KIDMED test. For the empirical and econometric analyses, the Mann-Whitney U and Kruskal-Wallis means comparison tests were utilized; multiple linear regression was used accordingly.

RESULTS

The present study provides evidence to the fact that boys, younger adolescents, adolescents living with both parents and with highly educated mothers had a better health-related quality of life. Concerning their eating practices, positive predictors were consuming a better-quality breakfast, having all five meals daily, consuming lunch and dinner with parents, and higher adherence to the Mediterranean diet. Moreover, sufficient night sleep time, fewer hours spent on screen viewing, more frequent walks, and having hobbies were linked to the health-related quality of life with a positive sign. In contrast, negative predictors were higher body mass index and everyday life difficulties due to the COVID-19 pandemic crisis.

CONCLUSIONS

Greek adolescents' anthropometric characteristics, BMI, lifestyle and sedentary habits, eating habits, and adherence to the Mediterranean diet were significantly related to their perceived health-related quality of life during the pandemic.

Quality of Life in Children and Adolescents with Stickler Syndrome in Spain

Objective: To describe the quality of life and daily functioning of Spanish children and adolescents living with Stickler syndrome (SS) and to estimate the prevalence of associated disease features in a representative sample. Methods: A cross-sectional study of children and adolescents with SS were recruited via telephone calls through the Spanish SS Association. All participants underwent a structured clinical interview and filled in questionnaires reporting their quality of life (EuroQol-5D, TSK-11, CHAQ and PedsQoL). The prevalence of the main features associated with the syndrome and the mean scores of the questionnaires were estimated with 95% confidence intervals (95% CI). Results: The recruited sample included 26 persons who were mainly children (mean age 10.4 ± 4.5 (SD) range: 5–14) and male (65.4%). The prevalence estimates of SS features were as follows: the presence of moderate pain (52%), hearing loss 67% (95% CI: 54.8 to 91.3) and myopia 96% (95% CI: 87.2 to 104.4). The mean scores of the QoL indices were as follows: 22.4 (95% CI: 19.2 to 25.5) (±7.5) for TSK-11; 76.2 (95% CI: 68.8 to 83.6) (±17.1) for PedsQoL, 0.8 (95% CI: 0.7 to 0.9) (±0.3) for EQ-5D and 0.61 (95% CI: 0.24 to 1.0) (±0.9) for the cHAQ functional index. Conclusions: Our results confirmed a high variability in syndrome-related manifestations, with a large prevalence of visual and hearing deficits, pain and maxillofacial alterations. These findings may facilitate the detection of the most prevalent problems in this population, which could be a target to be addressed during the treatment of children and adolescents with SS.

Heterogeneity of quality of life in young people attending primary mental health services

AIMS

The utility of quality of life (QoL) as an outcome measure in youth-specific primary mental health care settings has yet to be determined. We aimed to determine: (i) whether heterogeneity on individual items of a QoL measure could be used to identify distinct groups of help-seeking young people; and (ii) the validity of these groups based on having clinically meaningful differences in demographic and clinical characteristics.

METHODS

Young people, at their first presentation to one of five primary mental health services, completed a range of questionnaires, including the Assessment of Quality of Life-6 dimensions adolescent version (AQoL-6D). Latent class analysis (LCA) and multivariate multinomial logistic regression were used to define classes based on AQoL-6D and determine demographic and clinical characteristics associated with class membership.

RESULTS

1107 young people (12-25 years) participated. Four groups were identified: (i) no-to-mild impairment in QoL; (ii) moderate impairment across dimensions but especially mental health and coping; (iii) moderate impairment across dimensions but especially on the pain dimension; and (iv) poor QoL across all dimensions along with a greater likelihood of complex and severe clinical presentations. Differences between groups were observed with respect to demographic and clinical features.

CONCLUSIONS

Adding multi-attribute utility instruments such as the AQoL-6D to routine data collection in mental health services might generate insights into the care needs of young people beyond reducing psychological distress and promoting symptom recovery. In young people with impairments across all QoL dimensions, the need for a holistic and personalised approach to treatment and recovery is heightened.

The effects of living and learning conditions on the health-related quality of life of children and adolescents during the COVID-19 lockdown in the French Grand Est region

INTRODUCTION

COVID-19 lockdown measures resulted in children and adolescents staying and learning at home. This study investigated health-related quality of life (HRQoL) and its associated factors among youth during the first lockdown.

METHODS

A cross-sectional study was conducted among 8- to 18-year-olds from the French Grand Est region. Sociodemographic data and information on living and learning conditions were collected using an online survey. HRQoL was assessed using the KIDSCREEN-27. Multiple regression analysis was performed to explore factors related to low HRQoL in each dimension.

RESULTS

In total, 471 children from 341 households were included. Difficulties isolating at home were associated with low HRQoL in the psychological well-being (OR = 2.2, 95% CI: 1.2-4.0) and parent relations and autonomy (OR = 2.1, 95% CI: 1.2-3.8) dimensions. Conflicts with dwelling occupants were related to increased ORs in the psychological well-being (OR = 2.9, 95% CI: 1.9-4.6), parent relations and autonomy (OR = 2.2, 95% CI: 1.4-3.4) and school environment (OR = 2.4, 95% CI: 1.5-3.7) dimensions. Living in an apartment (OR = 1.8, 95% CI: 1.1-3.1), never leaving home (OR = 2.6, 95% CI: 1.2-5.9), having indoor noise at home (OR = 2.3, 95% CI: 1.2-4.6), and having a parent with high anxiety (OR = 1.8, 95% CI: 1.1-3.1) were associated with low HRQoL in the social support and peers dimension. Children working less than 1 h/day on schoolwork had an increased OR of 3.5 (95% CI: 1.4-9.0) in the school environment dimension.

CONCLUSION

Living and learning conditions were associated with low HRQoL among children and adolescents during the COVID-19 lockdown. Prevention and intervention programs are needed to support youth by facilitating their interactions and improving their coping and to prepare for future waves.

Relation of parenting child abuse based on attachment styles, parenting styles, and parental addictions

The purpose of this study was to complete the cycle of recognizing these relationships. In this regard, the effect of parenting styles, attachment styles, and the mediating variable of addiction was investigated on child abuse (CA). Multi-stage random sampling and sample size were selected based on the sample size estimation software (510 people) and according to the 20% probability of a drop in the number of subjects, 530 people (265 boys and 265 girls) and 1060 parents were selected. The available method was selected from a sample of 530 people who were selected based on the Addiction Severity Index (ASI) and answered Baumrind's Parenting Styles Questionnaire (PSQ), Childhood Trauma Questionnaire (CTQ), and Adult Attachment Scale (AAS). Data were assessed by analysis of variance, mediator analysis, and path analysis. The results showed that differences in parenting styles cause differences in their attachment styles. The results supported only the relationship between the two components of parental affection and control with the attachment avoidance index, and no relationship was observed between these components and the anxiety index. Perceived emotional abuse, mediates the relationship between parental parenting components and the child attachment avoidance index. Finally, it was achieved to a model that shows how the two factors of affection and control simultaneously affect the avoidance index, mediated by parental addiction.

Tools to study the severity of itch in 8- to 17-year-old children: Validation of TweenItchyQoL and ItchyQuant

BACKGROUND/OBJECTIVES

Validated pruritus-specific quality of life and self-reported severity instruments exist primarily for adults. Clinical trials to develop therapeutics for children with chronic pruritus are hampered by the paucity of appropriate outcome measures. To address this gap, we aimed to develop validated instruments to measure itch-specific quality of life and self-reported severity in children.

METHODS

We conducted in-depth, open-ended interviews of itchy children and generated concepts to develop TweenItchyQoL. We administered TweenItchyQoL, ItchyQuant, a cartoon-annotated self-reported pruritus severity numeric rating scale (NRS), and a non-cartoon NRS to 175 itchy children aged 8-17 years. We analyzed the data for feasibility, preference, reliability, construct validity, and responsiveness.

RESULTS

Average completion time was 4.8 minutes for TweenItchyQoL and 33 seconds for ItchyQuant. The majority of patients either preferred ItchyQuant or found no difference between ItchyQuant and the NRS. Cronbach's alpha for TweenItchyQoL total and subscales ranged from 0.84 to 0.95. Test-retest reliability coefficients were ≥0.7 for TweenItchyQoL and 0.4 for ItchyQuant. A 3-dimensional bifactor model was most appropriate (RMSEA = 0.048) on the confirmatory factor analyses. As a function of those reporting worsening, improvement, or no change at their final visit, TweenItchyQoL and ItchyQuant scores in those cohorts changed as expected.

CONCLUSIONS

This new set of validated and feasible instruments shows promise to quantify itch severity and QoL impact in older children.

Pruritus assessment tools for 6 to 7-year-old children: KidsItchyQoL and ItchyQuant

BACKGROUND/OBJECTIVES

Measures of pruritus severity and quality of life (QoL) are necessary for the development of therapeutics for children with chronic pruritus. In children, questionnaires need to be developed for specific age groups given the differences in cognitive levels. In this study, we aimed to develop tools to assess QoL and pruritus severity in children 6 to 7-years-old with chronic pruritus.

METHODS

Based on open interviews with children, we developed a cartoon-annotated QoL instrument, KidsItchyQoL, and validated an existing pruritus severity instrument, ItchyQuant, that measures pruritus impact and severity for the preceding week. Both instruments were administered to 100 children aged 6-7 years with chronic pruritus. The data were analyzed for reliability, reproducibility, construct validity, and responsiveness.

RESULTS

We found the 14-item KidsItchyQoL to be reliable (Cronbach's α = 0.846) and reproducible (intraclass correlation coefficient (ICC) = 0.66) as was the ItchyQuant (ICC = 0.47). With respect to construct validity, examination of eigenvalues of the inter-item polychoric correlation matrix suggested three dominant factors. A subsequent confirmatory factor analysis suggested that a 3-dimensional simple structure model with correlated factors provided a reasonable data representation. The responsiveness of KidsItchyQoL and ItchyQuant (P = .005, GLM procedure) were demonstrated with scores changing as expected with the self-reported change of itch severity.

CONCLUSIONS

These results demonstrate promise for a new set of reliable research tools to assess QoL and pruritus severity in children 6 to 7 years of age.

Sleep problems, internalizing and externalizing symptoms, and domains of health-related quality of life: bidirectional associations from early childhood to early adolescence

STUDY OBJECTIVES

To examine longitudinal, bidirectional associations among behavioral sleep problems, internalizing and externalizing symptoms, and domains of health-related quality of life (HRQoL) from early childhood to adolescence in a population sample of Australian children.

METHOD

Data were drawn from the Longitudinal Study of Australian Children, a national prospective cohort study with 4983 children participating in the Kindergarten cohort. Data were collected when children were aged 4-5, 6-7, 8-9, 10-11, and 12-13 years. At each study wave, the primary parent (97% mothers) reported on behavioral child sleep problems, internalizing and externalizing symptoms, and HRQoL domains (psychosocial and physical). Cross-lagged structural equation models were used to evaluate bidirectional associations.

RESULTS

At nearly every age, behavioral sleep problems were associated with worse subsequent psychosocial and physical HRQoL. Despite bidirectional associations between mental health and HRQoL at many waves, HRQoL domains more strongly predicted later internalizing symptoms, while externalizing symptoms more strongly predicted later HRQoL. Many of the bidirectional associations among sleep, mental health, and HRQoL were found earlier in childhood.

CONCLUSIONS

Behavioral sleep problems may forecast later HRQoL psychosocial and physical impairments. Attending to both sleep problems and HRQoL could prevent the progression of internalizing conditions, while a focus on externalizing concerns could prevent the worsening of these symptoms, sleep problems, and HRQoL, particularly during the transition to school.

Health-Related Quality of Life in Children with Developmental Disorders

Purpose of Review

(1) To give an overview of what is currently known about health-related quality of life (HRQoL) in three common and co-occurring developmental disorders: attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASD), and developmental coordination disorder (DCD), and (2) to provide directions for future research.

Recent Findings

HRQoL is compromised in all three developmental disorders, affecting various domains of HRQoL. However, some domains are more affected than others depending on the nature of the core deficits of the disorder. Overall, parents’ rate HRQoL of their children lower than the children themselves. Children with ASD and ADHD with co-occurring disorders have lower HRQoL compared to those with singular disorders. Future studies in DCD are needed to investigate the effect of co-occurring disorder in this population.

Summary

Children with developmental disorders have lower HRQoL than typically developing children. Future research should focus on the effects of co-occurring disorders on HRQoL and on protective factors that may increase HRQoL. HRQoL should be a part of clinical assessment, as it reveals the areas in life children are struggling with that could be targeted during intervention.

Evaluating quality of life and well-being at the intersection of dementia care and creative engagement

Increasingly, art and design projects are used in dementia care settings to support the well-being of people living with dementia. However, the way well-being is defined and evaluated varies significantly in reporting. This study briefly examines the development of the concept of well-being and how it is intertwined with concepts of health and quality of life. It presents a scoping review of studies that use art and design to support the well-being of people living with dementia. We examined the characteristics and methodologies of the studies, how well-being is understood and operationalized, and how the outcomes are reported. The aim of this study was to understand whether there is any consistency in how well-being and related terminology are understood, the methodologies used, how projects are evaluated, the assessment tools used, and in what outcomes and implications are discussed. Results showed well-being and related terminology are used to reference the social, physical, states of mind and feelings, and in opposition to identified deficits. There was no consistent approach to how arts engagement for well-being in the dementia care space is carried out and evaluated. However, this study suggests that this is not necessarily problematic across arts engagement activities for well-being, providing the use of terminology and approaches, and means of evaluation are consistent and retain integrity within the design of individual projects. It suggests that well-designed projects provide frameworks that are able to take into account the many variables in relation to art and creativity and dementia care, and can offer transferability.

Economic Evaluations of Mental Health Programs for Children and Adolescents in the United States: A Systematic Review

The United States (US) spent 201 billion dollars on mental health-related concerns in 2016, ranking mental illness as the leading cause of disability and the single largest source of economic burden worldwide. With mental health-related treatment costs and economic burden only projected to rise, there is an increasing need for cost-inclusive evaluations of mental health interventions in the US. This systematic review evaluated the intervention characteristics and the quality of 9 economic evaluation studies (e.g., cost-effectiveness, cost-benefit) of youth mental health services conducted in the US from 2003 to 2019. Existing evaluations suggest that certain mental health interventions for youth, among the few that have been formally evaluated, may be cost-effective and cost-beneficial. However, intervention characteristics were generally homogenous, a majority of studies did not adhere to the standard of economic evaluations of the CHEERS checklist, and outcome measures were not consistently clinically useful, limiting the utility of such youth mental health economic evaluations to policymakers. By adhering to standards of economic evaluations and diversifying the characteristics of interventions subject to economic evaluations, intervention researchers can increase confidence in conclusions about which youth mental health interventions are cost-effective or cost-beneficial and more meaningfully inform evidence-based mental health policy.

Acceptability of the health-related quality of life instrument EQ-5D-Y-5L among patients in child and adolescent psychiatric inpatient care

Aim

The generic EuroQol 5 Dimensions Youth 5 Level (EQ‐5D‐Y‐5L) measures health‐related quality of life among children from 8 years. Respondents report their health on five dimensions with five severity levels and rate their overall health on a visual analogue scale (EQ VAS). The aim of the study was to explore acceptability of the EQ‐5D‐Y‐5L instrument among patients in child and adolescent psychiatric inpatient care.

Methods

A convenience sample of patients within a psychiatric inpatient care clinic in Region Stockholm, Sweden, was used. Follow‐up questions were answered directly after filling in the EQ‐5D‐Y‐5L. Conventional qualitative content analysis was chosen to analyse the open‐ended questions on how they perceived answering the instrument.

Results

In total, 52 patients (83% girls), mean age 15.4 years (range 13‐17), were included. Three themes emerged: generic content of the EQ‐5D‐Y‐5L descriptive system; design and wording of the EQ‐5D‐Y‐5L descriptive system and the EQ VAS; self‐reporting health with the EQ‐5D‐Y‐5L descriptive system and the EQ VAS.

Conclusion

The inclusion of physical health dimensions was perceived as positive, but some patients considered the descriptive system too generic. The results indicate that these patients in general could self‐report their health in a meaningful way with the EQ‐5D‐Y‐5L instrument.

Development and initial validation of self-report measures of general health, preoperative anxiety, and postoperative pain in young children using computer-administered animation

BACKGROUND

For young children, existing measures of children's health-related quality of life must be parent-reported or interviewer-administered for those who cannot read or complete measures independently. Parents' and childrens' reports about the child's health have been shown to disagree.

AIMS

(a) To test the reliability and validity of an animated, computer-administered Child Health Rating Inventories (CHRIS2.0) among children aged 4-12 undergoing surgery; and (b) to develop and test two CHRIS measures of preoperative anxiety and postoperative pain management.

METHODS

We conducted a longitudinal cohort study of a diverse group of 542 children aged 4-12 undergoing surgery. We compared the CHRIS measures to Pediatric Quality of Life Inventory (PedsQL), the Functional Disabilities Inventory (FDI), State-Trait Anxiety Inventory for children (STAI-CH), and the Parent Postoperative Pain Measure (PPPM).

RESULTS

Factor analyses supported the construct validity of the 12-item general physical health and the 8-item mental health CHRIS scales, as well as a composite 20-item scale, and the CHRIS preoperative anxiety and postoperative pain scales. Internal consistency reliability for all CHRIS scales exceeded the standard for group comparisons (Cronbach's α ≥0.70). The CHRIS general health composite was significantly correlated with composite PedsQL and FDI (r = 0.28, P < .001 and r = 0.43, P < .001, respectively). The CHRIS peri-operative anxiety measure was significantly correlated with the STAI-CH (r = 0.44, P < .001), as was the CHRIS postoperative pain scale with the PPPM (r = 0.52, P < .001).

CONCLUSIONS

The CHRIS measures were reliable and valid in this diverse sample of young children (4-12). Because CHRIS measures are self-administered, scored in real time, and run on multiple different platforms, this approach provides a feasible method for the collection of health-related quality of life in young children and those with limited literacy. Our data indicate that this approach is psychometrically sound and has the potential for adding the child's voice to pediatric outcomes.

Change in quality of life and self-esteem in a randomized controlled CBT study for anxious and sad children: can targeting anxious and depressive symptoms improve functional domains in schoolchildren?

BACKGROUND

Quality of life and self-esteem are functional domains that may suffer when having mental problems. In this study, we examined the change in quality of life and self-esteem when targeting anxious and depressive symptoms in school children (8-12 years) using a CBT-based transdiagnostic intervention called EMOTION, Kids Coping with anxiety and depression. The aim of this study was to investigate quality of life and self-esteem in children with elevated levels of anxious and depressive symptoms, and further if the EMOTION intervention could influence these important functional domains.

METHODS

The study had a clustered randomized design (cRCT), where N = 795 children recruited from 36 schools participated. The children were included based on self-reports of anxious and depressive symptoms. Schools were the unit of randomization and were assigned to intervention or control condition. Children in the intervention condition received the 10-week EMOTION intervention. Mixed effects models were used to take account of the possible clustering of data. Separate models were estimated for the dependent variables.

RESULTS

Children with elevated levels of anxious and depressive symptoms reported lower levels of quality of life and self-esteem compared to normative samples, with girls and older children reporting the lowest levels. For both genders and older children, a large and significant increase in quality of life and self-esteem was found among the children who received the intervention compared to the children in the control condition. Children in the intervention group reporting both anxious and depressive symptoms showed a significantly larger increase in both quality of life and self-esteem compared to the controls. Reductions in quality of life and self-esteem were partially mediated by reductions in symptoms of anxiety and depression.

CONCLUSIONS

Participating in an intervention targeting emotional symptoms may have a positive effect on quality of life and self-esteem in addition to reducing anxious and depressive symptoms. Improved quality of life may increase the child's satisfaction and subjective perception of wellbeing. As low self-esteem may lead to anxious and depressive symptoms, improving this functional domain in children may make them more robust dealing with future emotional challenges. Trial registration NCT02340637, retrospectively registered.

Impact of Pacemakers and Implantable Cardioverter Defibrillators on the Psychosocial Functioning of Paediatric Patients

Although implanted cardiac devices improve patients' physical health, long-term psychosocial effects especially in the paediatric population are still unknown. The aim of this study was to evaluate the psychosocial effects of cardiac devices in a paediatric population.Pediatric Quality of Life Questionnaire (PedsQoL) was used to evaluate life quality, Connor-Davidson Resilience Scale was used to evaluate resilience and Brief Symptom Inventory was used to evaluate psychiatric symptoms in a paediatric population with cardiac devices.Seventy-one patients were enrolled in the study. Fifty of them (70.5%) had a cardiac pacemaker and 21 of them (29.5%) had implantable cardioverter defibrillator. When compared to the control group both implantable cardioverter defibrillator and pacemaker using patients had lower quality of life (79.5 ± 12.4 versus 86.7 ± 12.1, p = 0.001) but no difference was observed in resilience and psychological pathologies. Age, gender, family size, and education level had no effect on quality of life. Implantable cardioverter defibrillator bearing patients had higher levels of anxiety than pacemaker patients (0.58 versus 0.30 p = 0.045), and implantable cardioverter defibrillator patients who had received shock in the last year had higher levels of somatisation than the group that did not receive device shock (0.17 versus 0.44 p = 0.022).In conclusion study showed that cardiac devices have negative effects on the psychosocial health of children. Cardiologist working with these patients should be aware of these pathologies and monitor not only physical health but also psychosocial health too.

Efficacy of the 'Children in Disaster: Evaluation and Recovery (CIDER)' Protocol for Traumatized Adolescents in Korea

BACKGROUND

We aimed to evaluate the feasibility of trauma-focused group therapy in adolescents exposed to traumatic events in Korea.

METHODS

We recruited 22 adolescents (mean age, 16 years; standard deviation, 1.43; range, 13-18 years). Children in Disaster: Evaluation and Recovery (CIDER) V1.0 is a trauma-focused group therapy comprising eight 50-minute-long sessions. The effectiveness of the intervention was evaluated using the Korean version of the Children's Response to Traumatic Events Scale-Revised (K-CRTES-R), the Beck Depression Inventory (BDI), the State Anxiety Inventory for Children (SAIC), and the Pediatric Quality of Life Inventory (PedsQL). The data were analyzed by the Wilcoxon signed-rank test.

RESULTS

A significant improvement was revealed in trauma-related symptom scores (Z = -2.85, P < 0.01), depressive symptom scores (Z = -2.35, P < 0.05) and quality of life scores (Z = -3.08, P < 0.01). Additionally, a marginally significant improvement was found in anxiety symptom scores (Z = -1.90, P = 0.058).

CONCLUSION

CIDER is a potentially effective intervention for adolescents exposed to traumatic events. Larger controlled trials are needed.

TRIAL REGISTRATION

Clinical Research Information Service Identifier: KCT0004681.

Assessing quality of life in psychosocial and mental health disorders in children: a comprehensive overview and appraisal of generic health related quality of life measures

BACKGROUND

Mental health problems often arise in childhood and adolescence and can have detrimental effects on people's quality of life (QoL). Therefore, it is of great importance for clinicians, policymakers and researchers to adequately measure QoL in children. With this review, we aim to provide an overview of existing generic measures of QoL suitable for economic evaluations in children with mental health problems.

METHODS

First, we undertook a meta-review of QoL instruments in which we identified all relevant instruments. Next, we performed a systematic review of the psychometric properties of the identified instruments. Lastly, the results were summarized in a decision tree.

RESULTS

This review provides an overview of these 22 generic instruments available to measure QoL in children with psychosocial and or mental health problems and their psychometric properties. A systematic search into the psychometric quality of these instruments found 195 suitable papers, of which 30 assessed psychometric quality in child and adolescent mental health.

CONCLUSIONS

We found that none of the instruments was perfect for use in economic evaluation of child and adolescent mental health care as all instruments had disadvantages, ranging from lack of psychometric research, no proxy version, not being suitable for young children, no age-specific value set for children under 18, to insufficient focus on relevant domains (e.g. social and emotional domains).

EQ-5D-Y-5L as a patient-reported outcome measure in psychiatric inpatient care for children and adolescents - a cross-sectional study

Background

Psychiatric disorders have a major individual and societal impact. Until now, the association between health-related quality of life and physical disorders has been far more investigated than the association with psychiatric disorders. Patient-reported outcome measures makes it possible to capture the patient perspective to improve treatments and evaluate treatment outcomes. The aim of this study is to measure health-related quality of life with the EQ-5D-Y-5L among patients in child and adolescent psychiatric inpatient care and to test the instrument’s psychometric properties in terms of feasibility and construct validity.

Methods

Data were collected at the child and adolescent psychiatric inpatient facility in Region Stockholm. A questionnaire including the EQ-5D-Y-5L instrument, the Strengths and Difficulties Questionnaire with an impact supplement and a self-rated health question, was administered for self-completion using paper and pencil, with an interviewer present. The Chi-square test was used to investigate differences in proportion of reported problems in the EQ-5D-Y-5L dimensions and the Mann-Whitney U test was used for differences in mean EQ VAS scores. Feasibility was assessed by investigating proportion of missing and ambiguous answers and Spearman’s and Pearson’s correlation were used to examine construct validity.

Results

In total 52 adolescents participated in the study and the majority were girls. The most common diagnosis at admission was depressive episode/recurrent depressive disorder. All participants reported problems on at least one dimension. Most problems were reported in the dimension ‘feeling worried, sad or unhappy’, where 64% reported severe or extreme problems. Mean EQ VAS score was 29.2. Feasibility was supported and construct validity indicated as some of the hypothesised correlations between the EQ-5D-Y-5 L and the Strengths and Difficulties Questionnaire were found, however, for ‘doing usual activities’ and ‘having pain or discomfort’ the correlations were weaker than hypothesised.

Conclusions

This is the first study where the newly developed EQ-5D-Y-5L instrument has been used in psychiatric inpatient care for youth. Participants reported problems in all severity levels in most of the EQ-5D-Y-5L dimensions; mean EQ VAS score was considerably low. Feasibility of the EQ-5D-Y-5L was supported, however other psychometric properties need to be further tested in a larger sample.

Predictive factors for changes in quality of life among children and adolescents in youth welfare institutions

PURPOSE

Children and adolescents living in youth welfare institutions often have a below average quality of life (QoL), for reasons that include developmental difficulties, history of traumatic experiences, and mental disorders. Youth welfare measures are needed that would have a positive impact, but there is a lack of longitudinal research on which measures are most effective. This study investigated what factors are associated with an improvement in QoL during residential stay.

METHODS

Residents of youth care facilities in Switzerland and their professional caregivers completed questionnaires that addressed QoL, psychopathology, and experience of traumatic events at two time points. In addition, information regarding mental disorders was obtained through structured clinical interviews. Analyses were conducted on the data obtained from 204 respondents aged 11-18 years. Comparisons with a school sample were conducted.

RESULTS

Compared to a school sample, a majority of participants rated their QoL equal, whereas their caregivers rated it as lower. Factors predictive of a poorer QoL were high levels of internalizing and externalizing psychopathology, presence of co-morbidities, and female gender. At the second assessment, the caregivers reported a small improvement, which was associated with reductions in both internalizing and externalizing psychopathology.

CONCLUSIONS

The finding that a reduction in severity of psychopathology may result in an improvement in QoL underlines the importance of providing professional support for mentally ill residents of youth welfare institutions. Further research is needed to determine the causality of this association.

Restricted Speech Recognition in Noise and Quality of Life of Hearing-Impaired Children and Adolescents With Cochlear Implants - Need for Studies Addressing This Topic With Valid Pediatric Quality of Life Instruments

Cochlear implants (CI) support the development of oral language in hearing-impaired children. However, even with CI, speech recognition in noise (SRiN) is limited. This raised the question, whether these restrictions are related to the quality of life (QoL) of children and adolescents with CI and how SRiN and QoL are related to each other. As a result of a systematic literature research only three studies were found, indicating positive moderating effects between SRiN and QoL of young CI users. Thirty studies addressed the quality of life of children and adolescents with CI. Following the criteria of the World Health Organization (WHO) for pediatric health related quality of life HRQoL (1994) only a minority used validated child centered and age appropriate QoL instruments. Moreover, despite the consensus that usually children and adolescents are the most prominent informants of their own QoL (parent-reports complement the information of the children) only a minority of investigators used self-reports. Restricted SRiN may be a burden for the QoL of children and adolescents with CI. Up to now the CI community does not seem to have focused on a possible impairment of QoL in young CI users. Further studies addressing this topic are urgently needed, which is also relevant for parents, clinicians, therapists, teachers, and policy makers. Additionally investigators should use valid pediatric QoL instruments. Most of the young CI users are able to inform about their quality of life themselves.

Socioeconomic Inequalities in Quality of Life in Iranian Children and Adolescents: The Weight Disorder Survey of the CASPIAN-IV Study

BACKGROUND

We aimed to determine the association between socioeconomic status (SES) and health-related quality of life (HRQOL) in a representative sample of Iranian children and adolescents.

STUDY DESIGN

A cross-sectional study.

METHODS

In this nationwide school-based study, 6-18-yr-old students were selected via multistage cluster random sampling method from 30 provinces of Iran in 2011-2012. SES of each participant was determined using the categories of the Progress International Reading Literacy Study (PIRLS) for Iran and the Principle Component Analysis (PCA) method. The students' HRQL was evaluated using the Persian version of the Pediatric Quality of Life Inventory (PedsQL™ 4.0TM 4.0) Generic Core Scales. The level of physical activity was evaluated using the physical activity questionnaire for adolescents. The association between SES and HRQL was evaluated using multiple linear regression analysis.

RESULTS

Overall, 23043 students were enrolled. The mean of total PedsQL™ score, school function, and psychosocial subscales was significantly different between different categories of SES (P<0.001). The differences in total population and among girls were between low and middle categories and low and high categories, but in boys, the difference was between low and high categories. There was a significant association between SES and school functioning, psychosocial function, and total score of HRQOL. Moderate and high SES had higher score compared to low SES group [β=1.0(0.5-1.6) for Moderate SES/Low SES and β=1.6(1.0-2.2) for High SES/Low SES].

CONCLUSION

SES is in positive association with HRQOL of Iranian schoolchildren, mainly due to its impact on school function. HRQOL could be improved by elimination of the socio-economic inequalities especially in the field of school function.

Self-Esteem as a Potential Mediator of the Association Between Social Integration, Mental Well-Being, and Physical Well-Being

Previous research points to a significant impact of social integration and self-esteem on well-being. The present study examined whether self-esteem constitutes one pathway from social integration in the classroom to mental and physical well-being of students and accordingly serves as a mediator. Therefore, 163 students (mean age: 12.98 years, age range: 9-17 years, 57.9% male) of three German secondary schools were examined regarding their experience of social integration, self-esteem, and mental as well as physical well-being. Results revealed that self-esteem mediated the effect of social integration on mental and physical well-being. This finding elucidates one pathway from social integration to well-being and points to the importance of improving both self-esteem and social integration for the promotion of well-being among adolescents.

CAPMH health-related quality of life among adolescent psychiatric outpatients: a 12-month follow-up study among 12-14-year-old Finnish boys and girls

BACKGROUND

Little is known about adolescents' perceptions about their health-related quality of life (HRQoL) in the course of routine adolescent psychiatric treatment. The aim of this 1-year follow-up study was to investigate HRQoL and changes in it among youths receiving adolescent psychiatric outpatient treatment.

METHODS

The study comprised 158 girls and 82 boys aged 12-14 years from 10 psychiatric outpatient clinics in one Finnish hospital district. Same-aged population controls (210 girls and 162 boys) were randomly collected from comprehensive schools. HRQoL was measured using the 16D instrument. The questionnaire was self-administered when the adolescents entered the polyclinics (= baseline), after a treatment period of 6 months, and after 12 months.

RESULTS

The mean age of respondents was 13.8 years (SD 0.63). At baseline, the mean HRQoL score of both female and male outpatients was significantly lower than that of population controls (p < 0.001). HRQoL of female patients was significantly worse than that of male patients (p < 0.001). In girls, HRQoL improved continuously during the 12-month follow-up, yet it remained worse than that of female population controls. Among boys, HRQoL was substantially better at the 6-month follow-up than at baseline, but this positive development was no longer seen at the 12-month follow-up.

CONCLUSIONS

From the perspective of HRQoL, girls seem to benefit more than boys from adolescent psychiatric outpatient treatment. Possible explanations for this finding are discussed.

Health-related quality-of-life model in adolescents with different body composition

The purpose of the present study was to develop and evaluate a causal model of health-related quality of life (HRQoL) in adolescents with different body composition. The participants were 209 adolescents (107 women and 102 men) ranging from 10 to 15 years of age. A model based on that proposed by Wilson and Cleary (JAMA 273(1):59-65, 1995) was elaborated. The body composition of the participants was analyzed. They were asked to complete a battery of questionnaires composed of the following factors: biological status (BS; included body mass index and weight), symptomatic psychological status (SPS; included the variables of drive for thinness and food concerns), functional status (FS; composed of physical activity, food consumption estimation, and socioeconomic status), and HRQoL, which included the dimensions of psychological well-being, autonomy and relationship with parents, social support and peers, and the academic environment. Structural equation modeling produced a model, which obtained an adequate fit for the prediction of HRQoL (χ²(38) = 51.88, p = .07; NNFI = 0.97, CFI = 0.98, GFI = 0.95, and RMSEA = 0.04). The main outcome demonstrated the indirect effect of BS (0.44) and SPS (- 0.45) as well as a direct effect of FS (0.21) on HRQoL. In addition, a second path was observed, BS has an indirect effect on FS (0.34) and FS on HRQoL (0.21). These results provide empirical support for the evaluated model.Level of evidence: Level V, Descriptive study.

Health-Related Quality of Life and Psychological Adjustment of Children and Adolescents with Pacemakers and Implantable Cardioverter Defibrillators: A Systematic Review

The absence of cardiac symptoms, the improved exercise tolerance and the increased life expectancy are the advantages of a successful cardiac device therapy. Nevertheless, the fact of a lifelong device dependency, the inherent possibility of device malfunction and the progression of the underlying heart disease may impact the health-related quality of life (HRQoL) and the psychological adjustment of these individuals. To date, an overview of findings on these topics is lacking. The objective of this study was to evaluate and summarize the current evidence on generic and disease-specific HRQoL and psychological adjustment in paediatric patients with a pacemaker (PM) or an implantable cardioverter defibrillator (ICD). A systematic literature search was conducted using relevant databases and predefined keywords. Study selection was conducted based on predefined inclusion criteria. Fourteen studies were selected which were of varying methodological quality. Overall, the studies indicated that PM/ICD patients themselves and their parents scored lower than healthy controls on generic HRQoL scales and reported similar disease-related HRQoL as patients with severe forms of congenital heart disease. Regarding psychological adjustment outcome, PM recipients and norms were not significantly different with respect to anxiety and depression symptoms, while ICD patients showed more signs of anxiety than depression. HRQoL and psychological health should be considered when setting therapy goals and evaluating medical treatment success. This approach allows an early intervention in patients at risk of maladaptation, which is especially important in the young patient undergoing crucial developmental stages.