Health-related quality of life of Greek adolescents: the role of the Mediterranean diet

Purpose

Health-related quality of life (HRQOL) refers to an individual’s perception and subjective evaluation of their health and well-being within their unique cultural environment. HRQOL in relation to adherence to the Mediterranean diet (MD) in adolescents has not been adequately investigated in the past. The aim of this study was to examine the association between adherence to the Mediterranean diet and health-related quality of life in Greek adolescents.

Methods

A total of 359 students (166 boys; 193 girls), 13–16 years old, were recruited from 13 high schools in the area of Athens and the Dodecanese. Standard anthropometric measurements were taken, and obesity was assessed using the International Obesity Task Force (IOTF) cut-off points. Students completed the KIDMED index, which evaluates the degree of adherence to the MD. Perceived HRQOL was assessed by the KIDSCREEN-27 questionnaire for children and adolescents.

Results

Adherence to the MD seems to be significantly positively correlated with all the components and total score of HRQOL, in adolescents. Linear regression analysis has revealed that the level of adherence to the MD (P < 0.001), the level maternal education (P < 0.05) and the number of meals per day consumed with the family (P = 0.001) are significantly positively associated with HRQOL in adolescents.

Conclusions

Adherence to the MD positively affects important components of HRQOL in adolescents.     

Depressive symptoms,health-related quality of life,and cardiac event-free survival in patients with heart failure: a mediation analysis

Purpose

Health-related quality of life (HRQOL) and depressive symptoms both are associated with an adverse prognosis in heart failure (HF), although their associations with outcomes have been examined only in isolation. Therefore, it is unknown how HRQOL and depressive symptoms might interact in their associations with outcomes. The present study was conducted to determine whether the association between HRQOL and cardiac event-free survival is mediated by depressive symptoms in HF patients given that depressive symptoms are associated strongly with HRQOL.

Methods

A total of 209 HF patients (61 ± 11 years, 24 % female, 49 % NYHA III/IV) participated. The Minnesota Living with HF Questionnaire and the Patient Health Questionnaire-9 were used to measure HRQOL and depressive symptoms, respectively. Patients were followed for a median of 357 days to determine cardiac event-free survival.

Results

In Cox regression analysis, HRQOL [hazard ratio (HR) 1.013; 95 % confidence interval (CI) 1.001–1.026] and depressive symptoms (HR 1.075; 95 % CI 1.025–1.127) predicted cardiac event-free survival separately, controlling for demographic and clinical variables. HRQOL independently explained 38.7 % of the variance in depressive symptoms (p < 0.05; standardized β = 0.695) in a multiple regression. When HRQOL and depressive symptoms were entered in the model simultaneously, only depressive symptoms independently predicted cardiac event-free survival (HR 1.068; 95 % CI 1.001–1.139), demonstrating a mediation effect of depressive symptoms.

Conclusions

Depressive symptoms mediated the relationship between HRQOL and cardiac event-free survival. Interventions targeting HRQOL to enhance patient outcomes must also address patient depressive symptoms to be fully efficacious.     

Impact of nocturia on disease-specific quality of life for men with localized prostate cancer

Objectives

We assessed the impact of nocturia on the general and disease-specific health-related quality of life (HRQOL) for men with localized prostate cancer.

Materials and methods

A total of 620 men with prostate cancer were enrolled to our study. All of the subjects completed the questionnaires before primary treatment. We evaluated general HRQOL with the Short Form 36-Item Health Survey (SF-36). The prostate-specific HRQOL was assessed with the University of California, Los Angeles Prostate Cancer Index (PCI). Night-time urinary frequency was assessed by the seventh score of the International Prostate Symptom Score.

Results

Of the 581 men, 47 (8%) men reported no nocturia, while 189 (32%) were categorized with one void per night and 345 (59%) with two or more voids per night. Disease-specific HRQOL, including urinary function, bowel function, and sexual function, was negatively associated with increase in frequency of nocturia. The subjects who reported two or more voids per night had significantly lower scores than those of the no nocturia or one void per night group in several domains of the SF-36 and PCI. Based on the proportion odds model, age, urinary function, bowel function, and sexual function showed a strong association with frequency of nocturia.

Conclusions

We found a strong association between the frequency of nocturia and disease-specific HRQOL as well as general HRQOL. Increased severity of nocturia is negatively correlated with overall health status and HRQOL outcomes.     

Perceived medication adherence barriers mediating effects between gastrointestinal symptoms and health-related quality of life in pediatric inflammatory bowel disease

Objectives

The primary objective was to investigate the mediating effects of patient-perceived medication adherence barriers in the relationship between gastrointestinal symptoms and generic health-related quality of life (HRQOL) in adolescents with inflammatory bowel disease (IBD). The secondary objective explored patient health communication and gastrointestinal worry as additional mediators with medication adherence barriers in a serial multiple mediator model.

Methods

The Pediatric Quality of Life Inventory? Gastrointestinal Symptoms, Medicines, Communication, Gastrointestinal Worry, and Generic Core Scales were completed in a 9-site study by 172 adolescents with IBD. Gastrointestinal Symptoms Scales measuring stomach pain, constipation, or diarrhea and perceived medication adherence barriers were tested for bivariate and multivariate linear associations with HRQOL. Mediational analyses were conducted to test the hypothesized mediating effects of perceived medication adherence barriers as an intervening variable between gastrointestinal symptoms and HRQOL.

Results

The predictive effects of gastrointestinal symptoms on HRQOL were mediated in part by perceived medication adherence barriers. Patient health communication was a significant additional mediator. In predictive analytics models utilizing multiple regression analyses, demographic variables, gastrointestinal symptoms (stomach pain, constipation, or diarrhea), and perceived medication adherence barriers significantly accounted for 45, 38, and 29 percent of the variance in HRQOL (all Ps < 0.001), respectively, demonstrating large effect sizes.

Conclusions

Perceived medication adherence barriers explain in part the effects of gastrointestinal symptoms on HRQOL in adolescents with IBD. Patient health communication to healthcare providers and significant others further explain the mechanism in the relationship between gastrointestinal symptoms, perceived medication adherence barriers, and 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 mental disorders and chronic physical conditions in health-related quality of life among primary care patients: results from an epidemiological study

Purpose

To estimate the comorbidity of mental disorders with chronic physical conditions and to assess their independent and combined effects on health-related quality of life (HRQOL).

Methods

Face-to-face cross-sectional survey of adult attendants to public primary care (PC) centres from Catalonia (Spain). A total of 3,815 out of 5,402 selected patients provided data for this study. We report frequency of chronic physical conditions among participants with mental disorders and the contribution of each mental disorder and chronic physical condition to HRQOL.

Results

Chronic pain is the most frequent condition among those with mental disorders (74.54%). The effect of chronic physical conditions on HRQOL is rather minor when compared to the effect of mental disorders (especially mood disorders). However, chronic pain plays an important role in HRQOL loss.

Conclusions

Mood disorders and chronic pain negatively affect HRQOL of PC patients. Especial efforts should be made to detect and treat mental disorders and chronic pain at this level.     

Health-related quality of life and comorbidity among older women veterans in the United States

Purpose

This paper examines the predictors of quality of life among older women (≥65 years of age) veterans in the United States focusing on the effect of comorbidity on health-related quality of life (HRQOL).

Methods

Data from the National Survey of Women Veterans, a cross-sectional nationally representative population-based, stratified random sample of women veterans, were used with an analytic sample size of 1,379 older women veterans. The SF12 physical and mental composite scores (PCS and MCS) were used as outcome measures, and a weighted comorbidity index was used as a covariate.

Results

Older women veterans who are married, employed, with higher income, and higher education have better physical health (PCS). For mental health, education is positively correlated, whereas depression and posttraumatic stress disorder are negatively correlated with MCS. After adjusting for socio-demographic, mental health, and chronic health indicators, the results showed that SF12 PCS varied by VA use status for each level of Seattle Index of Comorbidity. The same pattern was not found for MCS.

Conclusion

For each level of comorbidity, VA users have worse HRQOL which might suggest that case mix adjustments comparing VA users and non-VA users must take into account more than comorbidity alone.     

Psychometric evaluation of the Cystic Fibrosis Questionnaire-Revised in a national sample

Purpose

The psychometric properties of a health-related quality of life (HRQOL) instrument, the Cystic Fibrosis Questionnaire-Revised (CFQ-R), were evaluated in a national sample of patients with cystic fibrosis (CF).

Methods

The Epidemiologic Study of CF is a national, multicenter, longitudinal cohort study containing CFQ-R and health outcomes data. Developmentally appropriate versions of the CFQ-R were available from 7,330 patients aged 6?C70?years and a proxy version from 2,728 parents of school-age children. The CFQ-R was completed during a ??stable?? or ??sick?? visit before recording health outcomes such as weight, lung function, and pulmonary exacerbations.

Results

There were few floor and ceiling effects and strong internal consistency (Cronbach alpha ??0.70) for most scales. The CFQ-R consistently discriminated between patients seen for sick-versus-well visits, and among stages of disease severity based on lung function. As predicted, women with CF reported worse HRQOL than men on scales not related to body image and weight. Strong parent?Cchild agreement was found on scales measuring observable behaviors (respiratory symptoms). Convergence between CFQ-R scales and health outcomes provided evidence of construct validity.

Conclusions

The CFQ-R demonstrated robust psychometric properties and consistent associations with health outcomes in a large national sample.     

A systematic review and meta-analysis of the impact of tuberculosis on health-related quality of life

Purpose

To summarize the impact of tuberculosis (TB) on quantitative measures on self-reported health-related quality of life (HRQOL).

Methods

We searched eight databases to retrieve all peer-reviewed publications reporting original HRQOL data for persons with TB. All retrieved abstracts were considered for full-text review if HRQOL was quantitatively assessed among subjects with TB. Full-text articles were reviewed by two independent reviewers using a standardized abstraction form to collect data on socio-demographic characteristics, questionnaire administration, and mean HRQOL scores. Meta-analyses were performed for standardized mean differences in HRQOL scores, comparing subjects treated for active TB with subjects treated for latent TB infection (LTBI), or with healthy controls, at similar time points with respect to diagnosis and/or treatment.

Results

From over 15,000 abstracts retrieved, 76 full-text articles were reviewed, which represented 28 unique cohorts (6,028 subjects) reporting HRQOL among subjects with active TB; 42 % were women and mean age was 42 years. Data on key social and behavioral determinants were limited. Within individual studies and in meta-analyses, subjects with active TB disease consistently reported worse HRQOL than concurrently evaluated subjects treated for LTBI. However, meaningful improvements in HRQOL throughout active TB treatment were reported by longitudinal studies.

Conclusions

In a variety of studies, in different settings and using different instruments, subjects with active TB consistently reported poorer HRQOL than persons treated for LTBI. Future research on HRQOL and TB should better address social and behavioral health determinants which may also affect HRQOL.     

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.

     

Patient-reported outcomes in the practice-based opportunities for weight reduction (POWER) trial

Purpose

To evaluate effects of two behavioral weight-loss interventions (in-person, remote) on health-related quality of life (HRQOL) compared to a control intervention.

Methods

Four hundred and fifty-one obese US adults with at least one cardiovascular risk factor completed five measures of HRQOL and depression: MOS SF-12 physical component summary (PCS) and mental component summary; EuroQoL-5 dimensions single index and visual analog scale; PHQ-8 depression symptoms; and PSQI sleep quality scores at baseline and 6 and 24 months after randomization. Change in each outcome was analyzed using outcome-specific mixed-effects models controlling for participant demographic characteristics.

Results

PCS-12 scores over 24 months improved more among participants in the in-person active intervention arm than among control arm participants (P < 0.05, ES = 0.21); there were no other statistically significant treatment arm differences in HRQOL change. Greater weight loss was associated with improvements in most outcomes (P < 0.05 to < 0.0001).

Conclusions

Participants in the in-person active intervention improved more in physical function HRQOL than participants in the control arm did. Greater weight loss during the study was associated with greater improvement in all PRO except for sleep quality, suggesting that weight loss is a key factor in improving HRQOL.     

Health-related quality of life and body mass index among US adolescents

Purpose

To examine the magnitude of differences in health-related quality of life (HRQOL) by body mass index (BMI) in a population-based sample of United States adolescents overall and by sex, and to provide national prevalence estimates of reported HRQOL outcomes for not only obese and overweight but also underweight adolescents.

Methods

From the 2001 through 2010 cross-sectional National Health and Nutrition Examination Surveys, we estimated the percentages of four HRQOL outcomes—self-rated health, physically unhealthy days, mentally unhealthy days, and activity limitation days—in four BMI categories—obese, overweight, normal weight, and underweight—of approximately 6,000 US adolescents aged 12–17 years. We also estimated the percentages for boys and girls separately.

Results

Substantial gaps in self-rated health exist between normal-weight adolescents and those who are obese and overweight, but not underweight. Eighteen percent (95 % CI 15–22) of obese adolescents reported fair or poor health compared to only 5 % (95 % CI 4–7) of normal-weight adolescents. Thirty-seven percent (95 % CI 33–42) of obese adolescents reported excellent or very good health, compared to 65 % (94 % CI 63–67) of normal-weight adolescents. However, all BMI groups reported similar percentages of physically unhealthy days, mentally unhealthy days, and activity limitation days. The associations between HRQOL and BMI groups did not vary by sex. Boys generally reported significantly better self-rated health and mental health than girls. Specifically, obese boys reported better self-rated health, mental health, and fewer activity limitation days than obese girls.

Conclusions

Substantially, significant differences in some domains of HRQOL are found between above normal-weight and normal-weight US adolescents. This relationship between BMI and HRQOL is robust and observed among both boys and girls.     

Factors associated with adherence to Antiretroviral Therapy (ART) among adult people living with HIV and attending their clinical care,Eastern Ethiopia

Background

To attain a successful treatment outcome, Antiretroviral Therapy (ART) treatment for people living with HIV requires more than 95 % adherence level. The adherence level varies depending on different population contexts. Thus, the objective of this study was to investigate ART adherence level among HIV positive patients attending their clinical care in public health facilities in Harar and Dire Dawa, Eastern Ethiopia.

Methods

We conducted a cross-sectional study among 626 ART attendees. Data were collected using a structured questionnaire with a face-to-face interview. ART adherence was considered when taking all antiretroviral treatment in a correctly prescribed doses at a right time (no dose missed or delayed for greater than or equal to 90 min) in the week prior to the study. Multivariable logistic analysis was applied to examine the association between the dependent and independent variables. Statistical significance was set at p-value <0.05.

Results

The level of ART adherence was 85 %. Adherence was more likely among patients of 35–44 years (AOR?=?2.39; 95 % CI?=?1.15–5.01), had monthly income of 501.00–999.00 Ethiopian Birr (ETB) (AOR?=?6.73; 95 % CI?=?2.71–16.75), no history of opportunistic infection (AOR?=?2.81; 95 % CI?=?1.47–5.36), and had good family support (AOR?=?2.61; 95 % CI?=?1.45–4.72). However, those who did not disclose their sero-status (AOR?=?0.45; 95 % CI?=?0.21–0.97) and did experience depression (AOR?=?0.36; 95 % CI?=?0.21–0.61) were less likely adherent than their counter parts.

Conclusions

The level of ART adherence was sub-optimal. Concerted and collaborative efforts through effective and efficient interventions are needed in view of the identified factors in order to improve the adherence level.

     

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.     

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.     

Physical activity, self-efficacy, and health-related quality of life in persons with multiple sclerosis: analysis of associations between individual-level changes over one year

Background

Physical activity and self-efficacy represent behavioral and psychological factors, respectively, that are compromised in persons with multiple sclerosis (MS), but might be modifiable through intervention and result in better health-related quality of life (HRQOL).

Purpose

The present study adopted a panel research design and examined the associations between individual-level changes in physical activity, self-efficacy, and HRQOL over a one-year period in persons with MS.

Method

The sample consisted of 269 persons with relapsing–remitting MS who completed the Godin Leisure-Time Questionnaire (GLTEQ), Multiple Sclerosis Self-Efficacy (MSSE) Scale, and Multiple Sclerosis Quality of Life—29 (MSIS-29) Scale on two occasions that were separated by 1 year. The data were analyzed using panel analysis in Mplus 3.0.

Results

The initial panel analysis indicated that individual-level change in physical activity was associated with individual-level change in both physical and psychological HRQOL. The subsequent panel analysis indicated that (a) individual-level change in self-efficacy for functioning with MS was associated with individual-level change in physical HRQOL, whereas individual-level change in self-efficacy for control was associated with individual-level change in psychological HRQOL; (b) individual-level change in self-efficacy for functioning with MS, but not self-efficacy for control, mediated the association between individual-level change in physical activity and physical HRQOL; and (c) individual-level change in self-efficacy for controlling MS was the strongest predictor of individual-level change in HRQOL.

Conclusion

Physical activity and self-efficacy both might be important targets of subsequent behavioral and self-management interventions for improving the HRQOL of persons with MS, although self-efficacy is seemingly more important than physical activity.     

Health-related quality of life among hemodialysis patients at El-Minia University Hospital, Egypt

Background

Hemodialysis results in significant change in daily living, physical and psychological impairments, disruption of marital, family, and social life. Health-related quality of life (HRQOL) assessment helps to plan individual treatment strategies, and determine the efficacy, quality of medical and social care provided.

Aim

The focus of the study was to assess HRQOL of hemodialysis patients attending El-Minia University Hospital dialysis unit, determine the relation between HRQOL and some sociodemograghic factors and clinical disorders and also to compare HRQOL between patients performing hemodialysis for less than and more than 5 years.

Subjects and methods

The study is a cross-sectional hospital-based study that included 170 hemodialysis patients; 81 males and 89 females, mean age 46.6?±?14.6 years. In all 59.4 % were rural residents. Data were collected by a questionnaire which included, demographic, social and medical data. Kidney Disease Quality of Life-36 (KDQOL-36) health survey was used for assessment of HRQOL.

Results

About two thirds (64 %) of the studied hemodialysis patients had physical and mental quality of life (QOL) scores below average level. HRQOL was lower in old, female, married, illiterate and non-worker hemodialysis patients. Hepatitis C positive (HCV), diabetic and anemic patients had decreased QOL scores. A longer duration of hemodialysis treatment was associated with reduced physical QOL.

Conclusion

The most important sociodemographic factors affecting HRQOL were age, sex, education, occupation and marital status. The most important clinical disorders affecting QOL were anemia, HCV infection, sleep disturbances and diabetes. Increase awareness of hemodialysis patients and their caregivers about disabilities associated with hemodialysis treatment and educational programs to decrease the problems which the patients face and to increase the QOL.     

Why is greater medication adherence associated with better outcomes

Background

Previous studies found an association of greater adherence to placebo medication with better outcomes. The present study tested whether this association was explained by any of the following factors: 1) adherence to other medications, 2) healthcare behaviors, 3) disease risk, or 4) predicted degree of adherence. Data included information on more than 800 risk factors from 27,347 subjects in two randomized controlled trials of hormone therapy in the Women's Health Initiative.

Results

Greater adherence to placebo was not associated with colon cancer but was substantially and significantly associated with several diverse outcomes: death, myocardial infarction, stroke, and breast cancer. Adherence to hormone therapy was only weakly associated with outcomes. The WHI risk factors only poorly predicted degree of adherence, R² < 4%. No underlying factors accounted for the association between placebo adherence and outcome.

Conclusion

The results suggest that adherence to placebo is a marker for important risk factors that were not measured by WHI. Once identified these risk factors may be used to increase the validity of observational studies of medical treatment by reducing unmeasured confounding.     

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.