Protective factors for mental health of children and adolescents--empirical results validating a concept

In Public Health, an outlook developed emphasising the importance of assets and protective factors in addition to stress and risk factors. The study aimed at the development of a brief, multidimensional questionnaire to assess protective factors for the mental health of children and adolescents. This questionnaire was to be tested as a self-report survey instrument. In a random sample consisting of 883 children and adolescents aged 11 to 17 years scales already validated in empirical research as well as questions newly developed from aspects of protective factors identified in the literature were applied in a written questionnaire. Three dimensions, covering social, personal and family assets, could be identified from the items by factor analysis. The resulting scales for the assessment of protective factors were analysed for their psychometric characteristics. Mental health and health-related quality of life served as validation criteria. The protective factors proved to significantly influence these outcomes in regression analyses, showing a proportion of explained variance of up to 53 %. The child and adolescent self-report measure presented is apt to give a picture of protective factors for mental health representing the three dimensions of social, personal, and family assets.     

Quality of life—evaluation criteria for children with chronic conditions in medical care

Health-related quality of life denotes the patients’ perception of well-being and function in physical, emotional, mental, social, and everyday life areas. In medicine, it is frequently used as an outcome criterion to evaluate the quality and effect of different therapies. It is also frequently used in epidemiological studies, as well as health economic research. Approaches to assess the quality of life include patients’ self-report versus report by other persons, multidimensional versus unidimensional assessment of well-being and function, as well as the use of generic versus disease-specific methods. In the past 20 years, a multitude of instruments to assess health-related quality of life has been developed, mostly for adults, complying with psychometric standards concerning the reliability, validity, and sensitivity of the scales. The current paper describes challenges to the assessment of the quality of life in children and adolescents, introduces widely used generic measures, and focuses on the application of these measures in the research context by using examples from a German prospective study in pediatric rehabilitation and an international project to develop a set of quality of life instruments for children with chronic conditions. The quality of life area has developed to be a major innovation also in public health. In terms of including the perspective of children and adolescents, efforts directed at assessments have increased recently, but much needs to be done to include these measures in epidemiological and clinical studies.     

Assessment of psychological health and quality of life with The Child and Adolescent Health Survey

The National Health Survey for Children and Adolescents plans to collect data on the health status of children and adolescents in the 0-17 years age bracket which can be used for the generalisation and implementation of measures. In this context, assessment of mental and subjective health, in addition to collection of data concerning somatic health, is of great importance in a survey on the health status of children and adolescents in Germany. The proportion of children and adolescents afflicted by--in part long lasting--mental health problems and disorders is considerable. Subjective impairment due to somatic, psychological or social factors result in a reduced quality of life. Last but not least, personal, familial, and social assets of children and adolescents are relevant as protective factors for their mental and subjective health. Experiences and results from the pilot test of the survey demonstrate that the instruments selected for assessing mental health problems (SDQ), health related quality of life (KINDL), and assets (a combination of various scales) are appropriate for epidemiological purposes. They may supply valuable data to estimate the prevalence of mental health problems and psychiatric disorders, to identify risk groups needing intervention, and to describe the subjective health of children and adolescents in Germany.     

Measuring and Valuing Health Benefits for Economic Evaluation in Adolescence: An Assessment of the Practicality and Validity of the Child Health Utility 9D in the Australian Adolescent Population

ObjectivesThe Child Health Utility 9D (CHU9D) is a new generic preference-based measure of health-related quality of life developed for children aged 7 to 11 years. There is increasing interest in its potential for application in adolescents, and previous research has demonstrated that it shows good construct validity here. This article further examines its practicality and validity in adolescents by comparing it with KIDSCREEN-10, a short generic measure for assessing children and adolescents’ health-related quality of life and well-being.MethodsA Web-based survey, including the CHU9D, a general health question, questions on the presence of long-standing illness, disability, or medical conditions, sociodemographic variables, and KIDSCREEN-10, was administered to 961 consenting adolescents. The practicality and face and construct validity of the CHU9D were examined, and the CHU9D and KIDSCREEN-10 were compared in terms of their coverage, correlations between dimensions, and overall scores.ResultsBoth measures demonstrated good practicality and validity. The strongest degree of correlation was found with the only dimension in common for the CHU9D and KIDSCREEN (sad). The lowest correlations were found between all the CHU9D dimensions and the “have you had enough time for yourself” dimension of KIDSCREEN-10.ConclusionsThe findings from this study provide further support for the practicality and validity of the application of the CHU9D in the economic evaluation of adolescent health care and public health programs. Further research to test the psychometric performance of the CHU9D in more diverse clinical samples of adolescents is desirable including tests of reliability.     

吉林省留守青少年生活事件与健康素质关系研究

目的 分析留守青少年生活事件和健康素质的现状,明确生活事件和健康素质的关系,为制定留守青少年健康素质提升策略提供科学依据。 方法 采用青少年生活事件多维评定问卷、青少年亚健康多维评定问卷对825名留守青少年进行问卷调查。 结果 留守青少年的主要生活事件来源于家庭生活、健康成长和学校生活。留守青少年的健康素质与性别、居住地、是否独生子女、父亲学历、监护人学历、父母与子女的联系频率、亲子关系、师生关系、伙伴关系、学习成绩等因素有关。留守青少年生活事件与健康素质及其各维度呈显著正相关,生活事件中的健康成长维度、亲子关系、伙伴关系对留守青少年健康素质有显著影响(P＜0.001)。 结论 留守青少年的健康素质受其面临的生活事件的影响,故应着力培养青少年应对来自各种生活事件及其压力的能力。     

Socioeconomic determinants of health related quality of life in childhood and adolescence: results from a European study

STUDY OBJECTIVE: The objective of this study was to investigate the impact of two different socioeconomic status (SES) measures on child and adolescent self reported health related quality of life (HRQoL). The European KIDSCREEN project aims at simultaneous developing, testing, and implementing a generic HRQoL instrument. DESIGN AND SETTING: The pilot version of the questionnaire was applied in school surveys to students from 8 to 18 years of age, as well as to their parents, together with such determinants of health status as two SES indicators, the parental educational status and the number of material goods in the family (FAS, family affluence scale). PARTICIPANTS: Students from seven European countries: 754 children (39.8%; mean: 9.8 years), and 1142 adolescents (60.2 %; mean: 14.1 years), as well as their respective parents. MAIN RESULTS: In children, a higher parental educational status was found to have a significant positive impact on the KIDSCREEN dimensions: physical wellbeing, psychological wellbeing, moods and emotions, bullying and perceived financial resources. Increased risk of low HRQoL was detected for adolescents in connection with their physical wellbeing. Family wealth plays a part for children's physical wellbeing, parent relations and home life, and perceived financial resources. For adolescents, family wealth furthermore predicts HRQoL on all KIDSCREEN dimensions. CONCLUSIONS: There is evidence to suggest that exposure to low parental educational status may result in a decreased HRQoL in childhood, whereas reduced access to material (and thereby social) resources may lead to a lower HRQoL especially in adolescence.     

A sociodental approach to assessing children's oral health needs: integrating an oral health-related quality of life (OHRQoL) measure into oral health service planning

OBJECTIVE: We adopted a sociodental approach to assess the real dental needs of Thai primary school children, and integrated an oral health-related quality of life measure (OHRQoL) into oral health service planning. We then compared the results of this sociodental assessment with standard estimates of a child's oral health needs. METHODS: We developed a new model of sociodental needs assessment and used it to assess the level of impact that various oral health conditions have on the everyday lives of school children. We then carried out a cross-sectional study of all grade-6 children (11-12 years old) in Suphan-buri Province, Thailand. We examined the sample (n = 1034) to assess the children's oral health and then we interviewed each child individually to assess what impact any dental conditions he or she may have on their quality of life. This assessment was done using an OHRQoL indicator, the Child Oral Impacts on Daily Performances index (child-OIDP). We integrated the results obtained using this indicator with those estimates obtained using more traditional, standard clinical methods, in order to generate a clearer picture of exactly which non-progressive dental conditions really needed treatment. These results take into account the impact those conditions have on the overall well-being of children and their ability to function normally and unimpeded. We were then able to prioritize their dental needs according to the severity of disruption caused in their daily lives. FINDINGS: Using standard or "normative" estimates of dental health care needs, the children's need was 98.8%. This level of need decreased signifi cantly to 39.5% when adopting the sociodental approach (P <0.001). Overall, per 100 children with a standard or normative need for dental treatment, only 40 had a sociodental need for treatment when taking into account the impact their condition has on their everyday lives. Children thus identifi ed as requiring treatment were further categorized according to the severity of impact their condition had: 7.2% had severe, 10.3% moderate and 22.0% had minor impacts on OHRQoL. CONCLUSIONS: There was a marked difference between the standard normative and the sociodental needs assessment approach, with the latter approach showing a 60% lower assessment of dental health care needs in Thai 11-12-year-old children. Different levels of "impacts" on daily life can be used to prioritize children with needs.     

Assessing psychosocial well-being of adolescents: a systematic review of measuring instruments

Background The paradigm shift from the clinically deficit‐oriented approach to that of educationally strength‐based model in assessing adolescents' psychosocial well‐being has brought about a recent increase in school‐based health promotion and prevention initiatives. This prompted this systematic review of measuring instruments designed to assess psychosocial well‐being of children and adolescents. Methods Using electronic databases on Academic Search Premier, MEDLINE, PROQUEST, PsycINFO, CINAHL Plus and Psychosocial and Health Instrument, a systematic review of literature of measuring instruments was conducted from their inception to December 2009 using the keywords of child, emotion, assessment, scale and measure. Measuring instruments from selected articles were critically appraised using a predetermined set of quality indicators which guided the rating of the psychometric properties of the instruments into grades of A, B, and C. The constructs of psychosocial well‐being from the measuring instruments were categorized into themes. Results Twenty‐nine out of the 908 articles met the inclusion criteria. Seventeen instruments identified from the selected articles were examined using preset quality indicators. In construct building, the themes identified from the strength‐based instruments distinguished the construct of psychosocial well‐being primarily into the dimensions of personal emotional competency and social functioning. In the ratings of psychometric properties, one instrument was rated 5A, five rated 4A and four rated 3A. For reliability testing, eight measures received grade A when their intraclass correlation is higher than 0.7; whereas only two instruments reported sensitivity and none investigated responsiveness. Conclusions Strength‐based measures focusing on social emotional behavioural outcomes open up a possibility to link up assessment with promotion of psychosocial well‐being, away from clinical settings and into adolescents' homes, schools and community. Future research should focus more on investigating the sensitivity and responsiveness of measuring instruments using longitudinal design in efficacy studies to assess change in adolescents' psychosocial status over extended time.     

Family cohesion and psychopathological symptoms in pediatric obesity: Is there an indirect effect?

The prevalence of pediatric obesity is increasing worldwide, which is particularly concerning given its negative impact on adjustment (e.g., quality of life, psychopathological symptoms) and physical health (e.g., high blood pressure, cardiovascular problems). It is important to understand the factors that may improve children’s/adolescents’ adjustment to overweight/obesity. This study aims to assess the indirect effect of family cohesion on children’s/adolescents’ internalizing/externalizing symptoms through body esteem and social life. The sample comprises 182 treatment-seeking children/adolescents with overweight/obesity and their mothers. Mothers completed a measure of family cohesion (Family Environment Scale), and children/adolescents completed measures of body esteem, social life (Impact of Weight on Quality of Life-Kids), and internalizing/externalizing symptoms (Strengths and Difficulties Questionnaire). Path analyses indicated a significant indirect effect between family cohesion and internalizing symptoms through children’s/adolescents’ body esteem and social life. Higher levels of family cohesion were linked to higher levels of body esteem, which were linked to higher levels of social life that, in turn, were associated with lower levels of internalizing symptoms. The results suggest the importance of body esteem and social life in explaining the link between family cohesion and children’s/adolescents’ internalizing symptoms. The results also suggest that belonging to a more cohesive family may improve the mental health of children/adolescents with overweight/obesity.     

Versorgungsbedarf chronisch kranker Kinder und Jugendlicher

Using data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), we studied the association between chronic health conditions and specific health care needs among children and adolescents in Germany. A chronic health condition was defined based on standardized parent questionnaires and computer-assisted parent interviews regarding any lasting illness or health problem, congenital malformation or officially recognized disability. As part of the parent questionnaire, the validated German version of the Children with Special Health Care Needs (CSHCN) screener was used to assess special health care needs. Overall, 38.7% of the study population had at least one chronic health condition, as compared to 73.0% of children and adolescents who were identified as having specific health care needs. Only 25.8% of children and adolescents with chronic health conditions were found to have any special health care needs. However, this proportion varied considerably according to the type of health condition. Overall 3.7% of study participants screened positive for special health care needs, while no specific chronic health condition was reported by their parents. In multiple logistic regression analyses, factors independently associated with the absence of perceived health care needs among children and adolescents with chronic health conditions included female gender, migration background, a lower socioeconomic status, residence in former West Germany, a lower number of concomitant health problems, and the absence of behavioural problems. The identification of special health care needs among children and adolescents without any reported chronic health condition was determined by male gender, having no migration background, and evidence of behavioural problems. Further analyses are necessary to elucidate the relationship between chronic health conditions and health care needs among children and adolescents. These need to focus on specific health conditions and should include additional information on health-related quality of life, health care services use, and psychosocial resources.     

Factors influencing health-related quality of life of thalassaemic Jordanian children

Purpose To assess the health‐related quality of life (HRQoL) of Jordanian children with thalassaemia, identify differences in HRQoL according to socio‐demographic and clinical characteristics of participants, and identify factors influencing HRQoL of thalassaemic children in Jordan. Methods The Pediatric Quality of Life Inventory and socio‐demographic and clinical data forms were used to collect data from a convenience sample of 128 thalassaemic children and 83 healthy children between the ages of 8 to 18 years. Thalassaemic children were recruited from two thalassaemia units during their blood transfusion and treatment visits. Healthy children were recruited from four public schools. Results Thalassaemic children had significantly lower HRQoL mean scores in all dimensions compared with their healthy counterparts. The lowest mean scores for thalassaemic children were reported for the school functioning and the physical functioning domains (46.71 ± 21.14 and 54.19 ± 15.10), respectively. Regression analysis showed that disease complications and family history of thalassaemia explained 8.5% of the variance in the total HRQoL. Conclusion This study highlights the negative impact of thalassaemia on the quality of life of children, especially in terms of physical well‐being and school achievement. Healthcare providers, counsellors and school teachers have very important roles in helping these children to overcome these problems and enhance their quality of life.     

Family-Centered Preventive Intervention Science: Toward Benefits to Larger Populations of Children,Youth, and Families

The field of family-centered preventive intervention science is well poised to seize an opportunity for larger-scale intervention implementation and greater public health impact. This opportunity has been created by earlier research in the areas of epidemiology, developmental etiology, and intervention outcome research. Both earlier and current research define a number of key tasks required to meet the many challenges involved in scaling-up for greater impact. Illustrations of how these tasks can be addressed are provided in articles on programs of family-centered research with infants, children, and adolescents. Each article in this special issue treats one or more tasks that concern (a) expansion of the set of rigorously evaluated, theory-driven interventions that have potential to reach large numbers of children, youth, and families; (b) effective strategies for family recruitment and retention; (c) cultural sensitivity of interventions; (d) application of a developmental life course perspective; (e) strategies for linking higher-risk population subgroups with potentially beneficial services; (f) improved diffusion mechanisms for sustained, quality delivery; and (g) policy making informed by research, including economic analysis. A summary of how articles address these tasks concludes with a discussion of the importance of futher strengthening a public service orientation in prevention science.     

Quality of life in early adolescence: A sixteendimensional health-related measure (16D)

While data on the health-related quality of life (HRQOL) of adults are accumulating, very little is known about the HRQOL—and especially the perceived HRQOL—of children. In our study we introduced a 16-dimensional, generic self-assessment measure of HRQOL (16D) for early adolescents, and demonstrated its use with four populations of children aged 12–15: (1) 239 normal schoolchildren, (2) patients waiting for organ transplantation (n=5), (3) patients with genetic skeletal dysplasias (n=19), and (4) patients with epilepsy (n=32). The HRQOL profiles of the patients differed significantly according to the diagnosis, giving support to its construct validity. The reliability of the measure was high: its repeatability coefficient was 91%. The quality of life ratings of the healthy boys and their parents differed on the dimensions of distress, vitality, speech, mental function, and discomfort and symptoms (p<0.05). In addition, there were significant differences in the health-related valuations between the girls, boys and their parents. We conclude that the assessment of quality of life of adolescents should be based on data collected from the adolescents themselves. Further, the 16D is so far the only generic HRQOL measure designed specifically for this purpose. It is capable of differentiating the HRQOL of healthy adolescents as well as patients with various diagnoses. Our experience also indicates that it is easy to use, yet it seems comprehensive, reliable, and valid.Supported in part by the Foundation for Economic Education (J.R.) and the Paulo Foundation.     

Children's understanding of health and illness concepts: a preventive health perspective

The present study examined beliefs about health and illness among a sample of 101 healthy children and young adolescents, from 8 to 14 years old. Respondents were administered a series of open- and closed-ended interview questions and were asked to draw a picture of a sick person. Various dimensions of health and illness were examined, including definition, concern, susceptibility, and locus of control. Several agelinked differences along these dimensions were found. Younger children were more concerned about their health and maintained a more external health locus of control, yet tended to rate their health more positively than older respondents. Younger children also tended to define illness from a more concrete, present-oriented, and symptom-specific, perspective. No effects of gender, self-reported illness experience, or family illness experience were found. Implications for the design of preventive health interventions and for future research are discussed.     

Health-related quality of life of children and adolescents with chronic illness – a two year prospective study

The aim of this study was to compare the self-reported health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF) with the HRQL of a large community sample, to assess the extent to which the HRQL of the children and adolescents with chronic illness changes over time, and to examine the consistency of changes in different HRQL domains. One hundred and twenty three young people aged 10-16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Children rated their HRQL using the Child Health Questionnaire (CHQ) and three disease-specific measures at baseline, 6, 12, 18 and 24 months post-baseline. In several areas, the HRQL of children with chronic illness was significantly worse than that of children in the community sample. Over the 2 years of the study, although children with asthma and diabetes did not report significant changes in CHQ scores rating their physical health, they reported significant improvements in scores rating the extent to which health problems interfered with physical and family activities. CHQ scores describing their physical health reported by children with CF declined significantly but there was no significant change in scores rating interference with physical and family activities.     

先天性心脏病术后患儿生活质量的研究现状

先天性心脏病(简称先心病)的发病率近年来居高不下,成为婴幼儿死亡及致残的主要原因.外科手术和介入手术治疗的发展,使至少85%的先心病患儿存活到成年期,越来越多的先天性心脏病患儿被治愈或带病生存至终身.随着人们对健康观念的转变,生活质量即患儿对其目前生命状况的认知和满意程度,已逐渐成为评估儿童身心健康的重要指标.因此关注先心病术后患儿的生活质量对患儿术后恢复健康具有重要意义.目前我国对先心病术后患儿生活质量现状缺乏长期随访观察,使得研究结果不够深入和全面.该文主要阐述了先心病术后患儿生活质量的研究现状,按照WHO生活质量研究组提出的生理功能、外表、心理功能、家庭社会关系、心理社会状况和生活环境这6个方面来阐述,为后期改善先心病术后患儿生活质量提供依据.     

Gesundheitsbezogene Lebensqualität bei Kindern und Jugendlichen in Deutschland

In recent years, there has been a change in the health and disease spectrum among children and adolescents, with an increase in mental health problems and a shift from acute to chronic illness. In this phase, the health-related quality of life (HRQoL) has increased in importance as a dimension of subjective health. The aim of this study is to describe the HRQoL of children and adolescents measured with the internationally standardized screening instrument KIDSCREEN-10. In the follow-up of the KiGGS study in 2009-2012 (KiGGS Wave 1), 2,567 parents of children aged 7–10 years and 4,878 adolescents aged 11 years or older completed the KIDSCREEN-10 questionnaire. In all, 94% of parents of 7- to 10-year-old girls and boys estimate the HRQoL of their children to be “very good” or “good.” Of the 11- to 17-year-old adolescents, 96?% report their HRQoL as “very good” or “good.” Somatic diseases and pain as well as mental health problems and a low social status are included in the HRQoL in only a limited way. Potential differences in HRQoL by social status were not confirmed in multivariate models. The HRQoL of the examined children and adolescents is predominantly very good or good. Interventions to improve the HRQoL of children and adolescents with diseases and psychopathological problems are necessary, regardless of their social status.     

Lebensqualität von jungen Patienten mit Hämophilie in Europa

Haemophilia, an inherited x-linked bleeding disorder, is a rare disease with comparable prevalence worldwide, which leads to early disability if untreated, and which, if treated via substitution of blood clotting factor, is associated with high treatment costs. Recent research has focused on bio-psychosocial consequences of treatment from the patient's perspective, in order to identify new treatment approaches, to quantify the patient benefit, and to compare haemophilia care across countries. For this, generic and disease-specific instruments have been developed and are currently being used in studies. The present paper describes clinical aspects of haemophilia as well as the assessment of quality of life and proceeds to introduce two recent studies on quality of life of children and adolescents with haemophilia in Europe. The HAEMO-QoL study investigated the quality of life of 339 children with haemophilia age 4 and above from six European countries. A total of 1,424 patients from 21 European countries participated in the ESCHQoL study, among these were 444 children aged 4 and above years. In both studies clinical data, information about health care and psychosocial determinants such as coping, life satisfaction and social support were assessed. Significant differences in quality of life between countries were found. Psychosocial determinants were associated with quality of life. Current analyses suggest that important determinants for quality of life are availability of factor concentrate from the clinical side and social support from the psychosocial side. The difference in quality of life across countries is a future major health-political challenge.     

Assessing needs for youth health promotion

Children and adolescents recently have become a group targeted for health promotion efforts. It is argued that early behavioral intervention will alter patterns of behavior that might place young people at increased risk for chronic diseases later in life. The Minnesota Heart Health Program is a longitudinal, community-based research and demonstration project to improve cardiovascular health in three north central communities. Reductions in cigarette smoking, improved eating and exercise patterns, and hypertension management are targeted objectives. To design educational interventions for children and adolescents in these areas as part of this program, a behavioral needs assessment was conducted in the communities prior to program implementation. This needs assessment focused on existing behavior patterns, skills related to the targeted behaviors, and environmental influences. This article describes that needs assessment, the results from two of the communities, differences due to gender and age of student, and the implications of the results for designing intervention activities for children and adolescents.     

Health‐related quality of life in children with myelomeningocele: a systematic review of the literature

Myelomeningocele (MMC) is the most complex congenital birth defect compatible with life. To provide the best health care for children with MMC, clinicians and researchers have to understand health and functional status of their patients as well as factors influencing their quality of life (QOL). The objective is to review studies that assess health‐related quality of life (HRQOL) and determinants of HRQOL in children with MMC. The data sources include MEDLINE, along with reference lists of relevant reviews and included articles. Study eligibility criteria are quantitative studies that assess HRQOL using validated HRQOL instrument. Participants include children aged 0–18 years with diagnosis of MMC or spina bifida. Risk of bias was assessed using the Hayden system for non‐randomized studies. Narrative synthesis and tables of results of HRQOL studies were conducted. Children with MMC have decreased HRQOL compared with normative population. Physical HRQOL is the most exposed aspect of QOL, while discrepancies in psychosocial domains vary by study. Many determinants of QOL have been found, and it is still not clear which determinant can be described as the strongest predictor. Psychosocial factors are the most consistent determinants of HRQOL.Heterogeneous study sample size, study designs, determinant and outcomes measures limited synthesis of findings. The HRQOL in children with MMC is complex and mediated by a number of associated medical problems, together with a variety of psychosocial and environmental factors. Future research is needed (a) on the relation between complex medical problems, functional independence, parent's and clinician's expectation and HRQOL in children and (b) to assess the differences in HRQOL by social environment and healthcare system.