The effectiveness of psychosocial interventions designed to improve health-related quality of life (HRQOL) amongst asthmatic children and their families: a systematic review

Purpose

Asthmatic children are at risk of compromised health-related quality of life (HRQOL) compared with their healthy peers. This systematic review reports the range and effectiveness of psychosocial interventions designed to improve HRQOL amongst asthmatic children, adolescents, and their families.

Method

Data sources included The Cochrane Airways Group Trials Register of trials, PubMed database, and reference lists from review articles.

Results

Eighteen studies of psychosocial interventions were identified. Interventions were designed to improve HRQOL amongst a range of psychosocial, health care, school-related and clinical outcomes, and were delivered in numerous settings and formats. Four studies reported that interventions were effective for significant improvements in child overall HRQOL scores. These include asthma education (n?=?2), asthma education plus problem solving (n?=?1), and art therapy (n?=?1).

Conclusions

Most interventions focussed on the delivery of asthma education to children, with the purpose of improving knowledge about asthma and disease management. There is limited evidence to suggest that interventions currently available are effective for significantly improving HRQOL amongst asthmatic children, adolescents, and their families. Most interventions lacked a theoretical basis and did not focus on family functioning variables. Multi-component interventions that incorporate asthma education along with strategies to assist families with implementing behaviour change towards improved asthma management are required. Future interventions should also attempt to address the wider context of family functioning likely to contribute to the family??s ability to engage in successful asthma management in order to improve HRQOL.     

Health-related quality of life in rural children living in four European countries: the GABRIEL study

Objective

Measuring children’s health-related quality of life (HRQOL) is of growing importance given increasing chronic diseases. By integrating HRQOL questions into the European GABRIEL study, we assessed differences in HRQOL between rural farm and non-farm children from Germany, Austria, Switzerland and Poland to relate it to common childhood health problems and to compare it to a representative, mostly urban German population sample (KIGGS).

Methods

The parents of 10,400 school-aged children answered comprehensive questionnaires including health-related questions and the KINDL-R questions assessing HRQOL.

Results

Austrian children reported highest KINDL-R scores (mean: 80.9; 95 % CI [80.4, 81.4]) and Polish children the lowest (74.5; [73.9, 75.0]). Farm children reported higher KINDL-R scores than non-farm children (p = 0.002). Significantly lower scores were observed in children with allergic diseases (p < 0.001), with sleeping difficulties (p < 0.001) and in overweight children (p = 0.04). The German GABRIEL sample reported higher mean scores (age 7–10 years: 80.1, [79.9, 80.4]; age 11–13 years: 77.1, [74.9, 79.2]) compared to the urban KIGGS study (age 7–10 years: 79.0, [78.7–79.3]; age 11–13 years: 75.1 [74.6–75.6]). Socio-demographic or health-related factors could not explain differences in HRQOL between countries.

Conclusions

Future increases in chronic diseases may negatively impact children’s HRQOL.     

Prevalence of negative life events and chronic adversities in European pre- and primary-school children: results from the IDEFICS study

Background

Children are not always recognized as being susceptible to stress, although childhood stressors may originate from multiple events in their everyday surroundings with negative effects on children’s health.

Methods

As there is a lack of large-scale, European prevalence data on childhood adversities, this study presents the prevalence of (1) negative life events and (2) familial and social adversities in 4637 European pre- and primary-school children (4–11 years old), using a parentally-reported questionnaire embedded in the IDEFICS project (‘Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS’).

Results

The following findings were observed: (1) Certain adversities occur only rarely, while others are very regular (i.e. parental divorce); (2) A large percentage of children is shielded from stressors, while a small group of children is exposed to multiple, accumulating adversities; (3) The prevalence of childhood adversity is influenced by geographical location (e.g. north versus south), age group and sex; (4) Childhood adversities are associated and co-occur, resulting in potential cumulative childhood stress.

Conclusions

This study demonstrated the importance of not only studying traumatic events but also of focusing on the early familial and social environment in childhood stress research and indicated the importance of recording or monitoring childhood adversities.

     

Executive function as a mediator in the link between single or complex trauma and posttraumatic stress in children and adolescents

Purpose

In this study, we examined whether there is a mediating role of executive function (EF) in the relationship between trauma exposure and posttraumatic stress in youth.

Methods

Children and adolescents exposed to trauma were recruited at an academic center for child psychiatry in The Netherlands. The total sample consisted of 119 children from 9 to 17 years old (M?=?13.65, SD?=?2.45). Based on retrospective life event information, the sample was divided into three groups: a single trauma group (n?=?41), a complex trauma group (n?=?38), and a control group that was not exposed to traumatic events (n?=?40).

Results

Our findings revealed that youth exposed to complex trauma had more deficits in EF compared to youth in the single trauma and control groups. EF was found to partly mediate posttraumatic stress symptoms for youth exposed to complex trauma, but not for youth exposed to single trauma. Youth exposed to complex trauma showed more deficits in EF, which was in turn associated with higher levels of posttraumatic stress symptoms.

Conclusions

Our findings provide partial support for the role of EF in mediating posttraumatic stress outcomes for youth exposed to complex trauma. This points to the important role of EF in the etiology and treatment of complexly traumatized youth.

     

Lifetime traumatic events,health-related quality of life,and satisfaction with life in older adults

Purposes

The aims were to assess the association between lifetime traumatic events and post-traumatic stress syndrome (PTSS) and health-related quality of life (HRQOL) and satisfaction with life stratified by gender among a community-dwelling sample of older adults.

Methods

Data used came from the ESA-Services study (2011–2013) and included a large convenience sample of 1811 older adults. Traumatic events were measured using a list of 14 events. PTSS was measured using the Impact of Event Scale-Revised. HRQOL and life satisfaction were measured with the EQ-5D-3L and the Satisfaction With Life Scale. Multivariate regression analyses were used to assess the association between traumatic events, PTSS, and quality of life.

Results

Respondents had a mean age of 73.90 years (SD: 6.13, range 65–97). Our results showed that exposure to violence (OR 4.88, CI 2.72–8.77), an accident (OR 2.33, CI 1.29–4.22), and sexual abuse (OR 2.26 CI 1.17–4.37) was associated with PTSS only in women. No traumatic event was associated only in men. The interaction between gender and exposure to violence and life-threatening disease of a close one was significant. Experiencing violence (β = ?0.04, p < 0.01), a natural disaster (β = ?0.04, p = 0.02), a life-threatening disease (β = ?0.04, p < 0.01), and sexual abuse (β = ?0.04, p < 0.01) were associated with a lower HRQOL only in women. No traumatic event was associated in men. Interactions between event and gender were significant for natural disaster, life-threatening disease of a close one, sexual abuse, and other type of traumatic events. A life-threatening disease (β = ?0.90, p < 0.01) was associated with a reduced life satisfaction only in men and the exposure of violence (β = ?1.18, p < 0.01) was associated with lower life satisfaction in women.

Conclusion

Our study could help healthcare professionals to identify and monitor traumatic events that are at higher risk to be associated with PTSS and a lower quality of life for older men and women.

     

H.U.B city steps: methods and early findings from a community-based participatory research trial to reduce blood pressure among african americans

Background

Although lifestyle interventions targeting multiple lifestyle behaviors are more effective in preventing unhealthy weight gain and chronic diseases than intervening on a single behavior, few studies have compared individual and combined effects of diet and/or exercise interventions on health-related quality of life (HRQOL). In addition, the mechanisms of how these lifestyle interventions affect HRQOL are unknown. The primary aim of this study was to examine the individual and combined effects of dietary weight loss and/or exercise interventions on HRQOL and psychosocial factors (depression, anxiety, stress, social support). The secondary aim was to investigate predictors of changes in HRQOL.

Methods

This study was a randomized controlled trial. Overweight/obese postmenopausal women were randomly assigned to 12 months of dietary weight loss (n = 118), moderate-to-vigorous aerobic exercise (225 minutes/week, n = 117), combined diet and exercise (n = 117), or control (n = 87). Demographic, health and anthropometric information, aerobic fitness, HRQOL (SF-36), stress (Perceived Stress Scale), depression [Brief Symptom Inventory (BSI)-18], anxiety (BSI-18) and social support (Medical Outcome Study Social Support Survey) were assessed at baseline and 12 months. The 12-month changes in HRQOL and psychosocial factors were compared using analysis of covariance, adjusting for baseline scores. Multiple regression was used to assess predictors of changes in HRQOL.

Results

Twelve-month changes in HRQOL and psychosocial factors differed by intervention group. The combined diet + exercise group improved 4 aspects of HRQOL (physical functioning, role-physical, vitality, and mental health), and stress (p ≤ 0.01 vs. controls). The diet group increased vitality score (p < 0.01 vs. control), while HRQOL did not change differently in the exercise group compared with controls. However, regardless of intervention group, weight loss predicted increased physical functioning, role-physical, vitality, and mental health, while increased aerobic fitness predicted improved physical functioning. Positive changes in depression, stress, and social support were independently associated with increased HRQOL, after adjusting for changes in weight and aerobic fitness.

Conclusions

A combined diet and exercise intervention has positive effects on HRQOL and psychological health, which may be greater than that from exercise or diet alone. Improvements in weight, aerobic fitness and psychosocial factors may mediate intervention effects on HRQOL.     

The associations among economic hardship, caregiver psychological distress, disease activity, and health-related quality of life in children with juvenile idiopathic arthritis

Purpose

To examine the associations among caregiver perceived economic hardship, psychological distress, children??s disease activity, and health-related quality of life (HRQOL) in children with juvenile idiopathic arthritis (JIA).

Methods

Caregivers of 182 children with JIA (ages 2?C18) attending the rheumatology clinics at the Montreal Children??s Hospital and the British Columbia??s Children Hospital completed a series of questionnaires on perceived financial hardship, caregiver psychological distress, and children??s HRQOL at baseline, 6 and 12?months. Clinical information such as disease activity was obtained from medical charts. Statistical models were used to look at the significance of several factors of interest while controlling for possible confounders.

Results

Higher caregiver perceived economic hardship [(???=?0.03, 95% CI?=?0.005, 0.06), P?=?0.02], psychological distress [(???=?0.02, 95% CI?=?0.006, 0.03), P?=?0.004], and higher children??s disease activity [(???=?0.11, 95% CI?=?0.07, 0.15), P?Conclusions Findings suggest that caregiver financial hardship and psychological distress as well as children??s disease activity may impact children??s HRQOL. By providing psychological help to parents, offering information regarding financial resources in the community and by ensuring disease control, especially when the disease is severe, health providers may improve children??s health outcomes.     

Impact of care at foster homes on the health-related quality of life of HIV-infected children and adolescents: a cross-sectional study from India

Purpose

To assess the impact of care at foster homes on the health-related quality of life (HRQOL) of children living with HIV (CLHIV), attending a referral ART Centre, and to compare their HRQOL with children living in their own homes.

Methods

A cross-sectional study was conducted in 144 CLHIV between 5 and 18 years of age, attending a referral ART Centre in South India to assess their HRQOL using the standard PedsQL? 4.0 questionnaire. Data were then analysed to compare the HRQOL of children living in foster homes to those children living in their own homes. The child report and the parent proxy-report on the child’s HRQOL were also compared to see for any differences in their perspectives.

Results

56.25% CLHIV were brought up in different foster homes. In the child’s self-report, the mean HRQOL was higher for children living in foster homes [physical score (76.54?±?12.40), psychosocial score (71.41?±?12.40) and total score (73.20?±?11.13)] when compared to children living in their own homes [physical score (75.09?±?14.76), psychosocial score (70.60?±?13.48) and total score (72.17?±?12.00)]. There was no statistically significant difference in the HRQOL between these two groups (p?>?0.05). In the parent proxy-report also, there was no statistically significant difference in the HRQOL in all the three scores. The child self-report depicted a significantly higher HRQOL in all the domains compared to the parent proxy-report (p?<?0.05).

Conclusions

HRQOL of children living in foster homes is at par with the quality of life enjoyed by children living in their own homes. Foster care manages to provide a reasonable HRQOL in CLHIV, and has become an inseparable component of quality health care delivery for these children.

     

Development of a vision-targeted health-related quality of life item measure

Purpose

To develop a vision-targeted health-related quality of life (HRQOL) measure for the NIH Toolbox for the Assessment of Neurological and Behavioral Function.

Methods

We conducted a review of existing vision-targeted HRQOL surveys and identified color vision, low luminance vision, distance vision, general vision, near vision, ocular symptoms, psychosocial well-being, and role performance domains. Items in existing survey instruments were sorted into these domains. We selected non-redundant items and revised them to improve clarity and to limit the number of different response options. We conducted 10 cognitive interviews to evaluate the items. Finally, we revised the items and administered them to 819 individuals to calibrate the items and estimate the measure’s reliability and validity.

Results

The field test provided support for the 53-item vision-targeted HRQOL measure encompassing 6 domains: color vision, distance vision, near vision, ocular symptoms, psychosocial well-being, and role performance. The domain scores had high levels of reliability (coefficient alphas ranged from 0.848 to 0.940). Validity was supported by high correlations between National Eye Institute Visual Function Questionnaire scales and the new-vision-targeted scales (highest values were 0.771 between psychosocial well-being and mental health, and 0.729 between role performance and role difficulties), and by lower mean scores in those groups self-reporting eye disease (F statistic with p < 0.01 for all comparisons except cataract with ocular symptoms, psychosocial well-being, and role performance scales).

Conclusions

This vision-targeted HRQOL measure provides a basis for comprehensive assessment of the impact of eye diseases and treatments on daily functioning and well-being in adults.     

Health-related quality of life in fathers of children with or without developmental disability: the mediating effect of parental stress

Purpose

The aims of this study were to compare parental stress and health-related quality of life (HRQOL) between Taiwanese fathers of children with and without developmental disabilities (DDs) and to examine the mediating effect of parental stress on the association between having a child with DD and paternal HRQOL within Chinese culture.

Method

This cross-sectional, prospective, unmatched case–control study included 206 fathers of children with DDs and 207 fathers of healthy children. HRQOL was assessed by the SF-36 short-form questionnaire, and parental stress was assessed by the Chinese version Parental Stress Scale.

Results

Fathers of children with DDs experienced poorer mental and physical HRQOL and higher parental stress than fathers of healthy children. Parental stress acted as a complete mediator for paternal physical HRQOL, while parental stress had a partial mediating effect on the relationship between having a child with DD and paternal mental HRQOL. Having a child with DD also directly affected paternal mental HRQOL.

Conclusions

Fathers of children with DDs should be monitored for parental stress and HRQOL, and interventions should be provided to empower them with the knowledge and skills to reduce their stress and to enhance their HRQOL.     

Helping Children Exposed to War and Violence: Perspectives from an International Work Group on Interventions for Youth and Families

Background

This paper outlines conclusions from a three-day workgroup hosting the eight authors as well as others with expertise in the evaluation and treatment of youth exposed to war and violence.

Objective

The purpose of this meeting was to bring multiple perspectives together to identify components that comprise effective psychosocial interventions for child victims of war and community violence across cultures. The meeting also sought to identify gaps in the existing treatment approaches.

Method

In the meeting, personal experiences and previous research were discussed to develop a wide-ranging intervention approach, determine a cohesive definition for “indirect” exposure, and identify successful methods of intervention delivery for youth exposed to acts of war and violence.

Results and Conclusions

Key components of intervention for youth exposed to war/violence, important outcome measures, and cultural differences that may influence effective intervention were identified. A clearer definition of “indirect” exposure was also developed. Finally, a nine-phase model was developed to provide guidelines for establishing partnerships between trauma teams and other organizations or schools to implement and disseminate treatment for this population.     

Health-related quality of life in mothers of children with epilepsy: 10 years after diagnosis

Purpose

Epilepsy in childhood extends far beyond seizures and affects child and parental well-being. The long-term impact of childhood-onset epilepsy on parental well-being is unknown. This study assessed health-related quality of life (HRQOL) in mothers 10 years after their child’s diagnosis of epilepsy.

Methods

Data come from the Health-Related Quality of Life in Children with Epilepsy Study, a multicenter prospective cohort study of children with newly diagnosed epilepsy. Mothers completed a mailed questionnaire at the 10-year follow-up, which included the Short-Form Health Survey (SF-12-v2) to evaluate the physical and mental health components of their HRQOL. Block-wise linear regressions identified child/epilepsy, maternal/family, and maternal psychosocial factors associated with mothers’ HRQOL.

Results

A total of 159 mothers participated in this study (46% of the sample assessed at baseline). At follow-up, 69% of youth had been seizure free for the past 5 years. Mothers scored similarly to population norms (mean: 50, SD: 10) on the mental health subscale (mean: 49.5, SD: 9.3) and significantly better on the physical health subscale (mean: 53.0, SD: 7.6). Better family resources were associated with higher (better) scores on the physical health subscale (B?=?0.20; 95% CI 0.03, 0.36). Better family functioning (B?=?0.34; 95% CI 0.06, 0.62), fewer maternal depressive symptoms (B?=?0.33; 95% CI 0.20, 0.47), and perception of less stress (B?=?0.70; 95% CI 0.52, 0.88) were associated with higher (better) scores on the mental health subscale.

Conclusion

Ten years after the diagnosis of epilepsy in children, the HRQOL of mothers was similar to reports from women in the general population. This study identified factors contributing to better maternal HRQOL and highlights the importance of family environment over epilepsy-related variables.

     

Mental health literacy and attitudes in a Swedish community sample – Investigating the role of personal experience of mental health care

Background

The role of social and family environments in the development of mental health problems among children and youth has been widely investigated. However, the degree to which parental working conditions may impact on developmental psychopathology has not been thoroughly studied.

Methods

We conducted a case-control study of several mental health outcomes of 19,833 children of sawmill workers and their association with parental work stress, parental socio-demographic characteristics, and paternal mental health.

Results

Multivariate analysis conducted with four distinct age groups (children, adolescents, young adults, and adults) revealed that anxiety based and depressive disorders were associated with paternal work stress in all age groups and that work stress was more strongly associated with alcohol and drug related disorders in adulthood than it was in adolescence and young adulthood.

Conclusion

This study provides support to the tenet that being exposed to paternal work stress during childhood can have long lasting effects on the mental health of individuals.     

The association between cumulative adversity and mental health: considering dose and primary focus of adversity

Purpose

The study addressed the dose?Cresponse model in the association of cumulative adversity with mental health.

Method

Data of 1,725 participants aged 50+ were drawn from the Israeli component of the Survey of Health, Ageing, and Retirement in Europe. Measures included an inventory of potentially traumatic events, distress (lifetime depression, depressive symptoms), and well-being (quality of life, optimism/hope).

Results

The maximal effect of cumulative trauma emerged in the contrast between 0?C2 and 3+ events, where the higher number of events related to higher distress but also to higher well-being. While self-oriented adversity revealed no, or negative, association with well-being, other-oriented adversity revealed a positive association.

Conclusions

The study suggests an experiential dose of cumulative adversity leading to a co-activation of distress and well-being. The source of this co-activation seems to be other-oriented adversity.     

Assessing the Impact of Violence and War on Youth in Low- and Middle-Income Countries

Background

Research is needed to understand the effects of violence and armed conflict in low- and middle-income countries, though there are logistical and ethical concerns that should be taken prior to study design.

Objective

This paper provides commentary on some of the challenges inherent in conducting research with youth affected by war in low- and middle-income countries.

Method

A practical discussion of the need of psychosocial research with youth from low-and middle-income countries, determining priorities for research on violence using a mental health needs assessment, and the importance of service linked to research in low-resource countries.

Results and Conclusion

Understanding the practical and ethical concerns of conducting research for youth exposed to violence and armed conflict can assist in producing studies that are powerful tools to advocate for those affected by trauma in low- and middle-income countries.     

Parental divorce and adult longevity

Objective

Life course research has established associations between adverse childhood events and later life health. We examine the relationship of experiencing parental divorce before the age of 16 and survival across 34 years of adulthood.

Methods

Analysis of panel data from a USA-based survey of 6,928 adults residing in Alameda County, California in 1965. Cox regression was used to examine associations between parental divorce and longevity.

Results

Controlling for age, race/ethnicity, gender, and childhood socioeconomic position, respondents who recalled a parental divorce during childhood had increased risk of mortality compared to those with no separation. The association was stronger for premature mortality and deaths due to cardiovascular disease. Divorce in childhood was also associated with lowered adult education, fewer social network ties, more depression, and worse health practices. These factors appeared to explain the association with longevity.

Conclusion

Parental divorce in childhood is associated with lowered well-being in adulthood and long-term survival. Early prevention and health promotion efforts may be warranted for children who experience parental divorce or discord as a means of supporting enhanced trajectories of health and well-being.     

Health-related quality of life of Spanish children with cystic fibrosis

Purpose

To investigate (1) the contributions of sex, age, nutritional status- and physical-fitness-related variables on health-related quality of life (HRQOL) in Spanish children with cystic fibrosis, and (2) the agreement on HRQOL between children and their parents.

Methods

In 28 children aged 6?C17?years, body mass index percentile, percentage body fat, physical activity, pulmonary function, cardiorespiratory fitness, functional mobility, and dynamic muscle strength were determined using objective measures. HRQOL was measured using the revised version of the cystic fibrosis questionnaire. Simple and multiple linear regression analyses were performed to determine the variables associated with HRQOL. To assess the agreement on HRQOL between children and parents, intra-class correlation coefficients (ICCs) were calculated.

Results

Girls reported worse emotional functioning, a higher treatment burden, and more respiratory problems than boys. Greater functional mobility appeared associated with a less favourable body image and more eating disturbances. Agreement on HRQOL between children and parents was good to excellent, except for the domain of treatment burden.

Conclusions

Sex and age were stronger predictors of HRQOL than nutritional status- or physical-fitness-related variables. Children reported a lower treatment burden than their parents perceived them to have.     

PTSD, depression and anxiety among former abductees in Northern Uganda

Background

The population in Northern Uganda has been exposed to extreme levels of traumatic stress and thousands abducted forcibly became rebel combatants.

Methods

Using structured interviews, the prevalence and severity of posttraumatic stress disorder (PTSD), depression and anxiety was assessed in 72 former abducted adults, 62 of them being former child soldiers.

Results

As retrospective reports of exposure to traumatic stress increased, anxiety and PTSD occurrence increased (r = .45). 49% of respondents were diagnosed with PTSD, 70% presented with symptoms of depression, and 59% with those of anxiety. In a multiple linear regression analysis four factors could best explain the development of PTSD symptoms: male respondents (sex) living in an IDP-Camp (location) with a kinship murdered in the war (family members killed in the war) and having experienced a high number of traumatic events (number of traumatic events) were more likely to develop symptoms of PTSD than others. In disagreement to a simple dose-response-effect though, we also observed a negative correlation between the time spent with the rebels and the PTSD symptom level.

Conclusions

Former abductees continue to suffer from severe mental ill-health. Adaptation to the living condition of rebels, however, may lower trauma-related mental suffering.     

Socioeconomic inequalities in mental health and health-related quality of life (HRQOL) in children and adolescents from 11 European countries

Objectives

To assess the presence and magnitude of social inequalities in mental health and health-related quality of life (HRQOL) in the population aged 8–18 years in 11 European countries.

Methods

Cross-sectional surveys were carried out in representative samples of children/adolescents (8–18 years) from the participating countries of the KIDSCREEN project. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), and HRQOL by means of the KIDSCREEN-10. Socioeconomic status (SES) was assessed using the Family Affluence Scale and parental level of education. The association between health outcomes and SES was analyzed with the regression-based relative index of inequalities (RII) and population attributable risk.

Results

A total of 16,210 parent–child pairs were included. The SDQ showed inequalities in mental health according to family level of education in all countries (RII = 1.45; 1.37–1.53). The RII for HRQOL was 2.15 (1.79–2.59) in the whole sample, with less consistent results by age and country.

Conclusions

Socioeconomic inequalities in mental health were consistently found across Europe. Future research should clarify the causes of these inequalities and define initiatives which prevent them continuing into adulthood.     

Assessment of health-related quality of life 6 years after childhood cochlear implantation

Purpose

To examine the impact of cochlear implant (CI) intervention on health-related quality of life (HRQOL) assessed by both self- and parent-reported measures.

Methods

In this national study of children implanted between ages 6 months and 5 years, HRQOL of 129 children 6-year post-CI was compared to 62 internal study (NH1) and 185 external (NH2) samples of hearing children frequency-matched to the CI group on sociodemographic variables. HRQOL ratings of children and their parents in each group, measured using the Child Health and Illness Profile-Child Edition, were compared, and their associations with the Family Stress Scale were investigated.

Results

CI children reported overall and domain-specific HRQOL that was comparable to both NH1 and NH2 peers. CI parents reported worse child scores than NH1 parents in Achievement, Resilience, and Global score (p’s < 0.01) but similar or better scores than socioeconomically comparable NH2 parents. Higher family stress was negatively associated with all parent-reported HRQOL outcomes (p’s < 0.01). Parent–child correlations in HRQOL global scores trended higher in CI recipients (r = 0.50) than NH1 (r = 0.42) and NH2 (r = 0.35) controls.

Conclusions

CI recipients report HRQOL comparable to NH peers. These results, from both child and parent perspective, lend support to the effectiveness of CI intervention in mitigating the impact of early childhood deafness. Family stress was associated with worse HRQOL, underscoring a potential therapeutic target. Parent–child agreement in HRQOL scores was higher for CI families than NH families, which may reflect higher caregiver insight and involvement related to the CI intervention.