Profile of subjective quality of life and its correlates in a nation-wide sample of high school students in an Arab setting using the WHOQOL-Bref

BMC Psychiatry

Jude U Ohaeri²  Ghenaim A Al-Fayez¹ 

[1] Department of Psychiatry, Faculty of Medicine, Kuwait University, Kuwait;Department of Psychiatry, Psychological Medicine Hospital, Gamal Abdul Naser Road, P.O. Box 4081, Safat, Kuwait

关键词: parents;    age;    gender;    Arab;    students;    Quality of life;   

Others  :  1124565
DOI  :  10.1186/1471-244X-11-71

 received in 2010-11-25, accepted in 2011-04-25,  发布年份 2011

【 摘 要 】

Background

The upsurge of interest in the quality of life (QOL) of children is in line with the 1989 Convention on the Rights of the Child, which stressed the child's right to adequate circumstances for physical, mental, and social development. The study's objectives were to: (i) highlight how satisfied Kuwaiti high school students were with life circumstances as in the WHOQOL-Bref; (ii) assess the prevalence of at risk status for impaired QOL and establish the QOL domain normative values; and (iii) examine the relationship of QOL with personal, parental, and socio-environmental factors.

Method

A nation-wide sample of students in senior classes in government high schools (N = 4467, 48.6% boys; aged 14-23 years) completed questionnaires that included the WHOQOL-Bref.

Results

Using Cummins' norm of 70% - 80%, we found that, as a group, they barely achieved the well-being threshold score for physical health (70%), social relations (72.8%), environment (70.8%) and general facet (70.2%), but not for psychological health (61.9%). These scores were lower than those reported from other countries. Using the recommended cut-off of <1SD of population mean, the prevalence of at risk status for impaired QOL was 12.9% - 18.8% (population age-adjusted: 15.9% - 21.1%). In all domains, boys had significantly higher QOL than girls, mediated by anxiety/depression; while the younger ones had significantly higher QOL (p < 0.001), mediated by difficulty with studies and social relations. Although poorer QOL was significantly associated with parental divorce and father's low socio-economic status, the most important predictors of poorer QOL were perception of poor emotional relationship between the parents, poor self-esteem and difficulty with studies.

Conclusion

Poorer QOL seemed to reflect a circumstance of social disadvantage and poor psychosocial well-being in which girls fared worse than boys. The findings indicate that programs that address parental harmony and school programs that promote study-friendly atmospheres could help to improve psychosocial well-being. The application of QOL as a school population health measure may facilitate risk assessment and the tracking of health status.

【 授权许可】

   
2011 Al-Fayez and Ohaeri; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Pal DK: Quality of life assessment in children: a review of conceptual and methodological issues in multidimensional health status measures. J Epidemiol Community Health 1996, 50:391-396.
• [2]Center for Human Rights, United Nations: Convention on the Rights of the Child. Geneva: United Nations; 1989.
• [3]Vingilis ER, Wade TJ, Seeley JS: Predictors of adolescent self-rated health. Analysis of the National Population Health Survey. Can J Public Health 2002, 93:193-197.
• [4]Varni JW, Burwinkle TM, Seid M: The PedsQL™ 4.0 as a school population health measure: feasibility, reliability and validity. Qual Life Res 2006, 15:203-215.
• [5]Simon AE, Chan KS, Forrest CB: Assessment of children's health-related quality of life in the United States with a multidimensional index. Pediatrics 2008, 121:e118-e126.
• [6]Kim HK, Viner-Brown SI, Garcia J: Children's mental health and family functioning in Rhode Island. Pediatrics 2007, 119:S22-S28.
• [7]Pantzer K, Rajmil L, Tebe C, Codina F, Serra-Sutton V, Ferrer M, Ravens-Sieberer U, Simeoni M-C, Alonso J: Health-related quality of life in immigrants and native school aged adolescents in Spain. J Epidemiol Community Health 2006, 60:694-698.
• [8]Mansour ME, Kotagal U, Rose B, Ho M, Brewer D, Roy-Chaudhury A, Hornung RW, Wade TJ, DeWitt TG: Health-related quality of life in urban elementary school children. Pediatrics 2003, 111:1372-1381.
• [9]Felder-Puig R, Baumgartner M, Topf R, Gadner H, Formann AK: Health-related quality of life in Austrian elementary school children. Med Care 2008, 46:432-439.
• [10]Gkoltsiou K, Dimitrakaki C, Tzavara C, Papaevangelou V, Varni JW, Tountas Y: Measuring health-related quality of life in Greek children: psychometric properties of the Greek version of the Pediatric Quality of Life Inventory(TM) 4.0 Generic Core Scales. Qual Life Res 2008, 17:299-305.
• [11]Collier J, MacKinlay D, Phillips D: Norm values for the Generic Children's Quality of Life measure from a large school-based sample. Qual Life Res 2000, 9:617-623.
• [12]Kook SH, Varni JW: Validation of the Korean version of the pediatric quality of life inventory 4.0 (PedsQL) generic core scales in school children and adolescents using the Rasch model. Health Qual Life Outcomes 2008, 6:41. BioMed Central Full Text
• [13]Jirojanakul P, Skevington SM, Hudson J: Predicting young children's quality of life. Soc Sci Med 2003, 57:1277-1288.
• [14]Chen X, Origasa H, Ichida F, Kamibeppu K, Varni JW: Reliability and validity of the Pediatric Quality of Life Inventory (PedsQL) Short Form 15 Generic Core Scales in Japan. Qual Life Res 2007, 16:1239-1249.
• [15]Klatchoian DA, Len CA, Terreri MT, Silva M, Itamoto C, Ciconelli RM, Varni JW, Hilário MO: Quality of life of children and adolescents from São Paulo: reliability and validity of the Brazilian version of the Pediatric Quality of Life Inventory version 4.0 Generic Core Scales. J Pediatr (Rio J) 2008, 84:308-315.
• [16]Amiri P, Ardekani ME, Jalali-Farahani S, Hosseinpanah F, Varni JW, Ghofranipour F, Montazeri A, Azizi F: Reliability and validity of the Iranian version of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales in adolescents. Qual Life Res 2010.
• [17]Abdel-Khalek AM: Quality of life, subjective well-being and religiosity in Muslim college students. Qual Life Res 2010.
• [18]Matza LS, Swensen AR, Flood EM, Secnik K, Leidy NK: Assessment of health-related quality of life in children: a review of conceptual, methodological, and regulatory issues. Value Health 2004, 7:79-92.
• [19]Frisen A: Measuring health-related quality of life in adolescence. Acta Paediatr 2007, 96:963-968.
• [20]Schlarmann JG, Metzing-Blau S, Schnep W: The use of health-related quality of life in children and adolescents as an outcome criterion to evaluate family oriented support for young carers in Germany: an integrative review of the literature. BMC Public Health 2008, 8:414. BioMed Central Full Text
• [21]Ravens-Sieberer U, Erhart M, Wille N, Wetzel R, Nickel J, Bullinger M: Generic health-related quality-of-life assessment in children and adolescents: methodological considerations. Pharmacoeconomics 2006, 24:1199-1220.
• [22]De Civita M, Regier D, Alamgir AH, Anis AH, Fitzgerald MJ, Marra CA: Evaluating health-related quality-of-life studies in paediatric populations: some conceptual, methodological and developmental considerations and recent applications. Pharmacoeconomics 2005, 23:659-685.
• [23]Coons SJ, Rao S, Keininger DL, Hays RD: A comparative review of generic quality of life instruments. Pharmacoeconomics 2000, 17:13-35.
• [24]Davis E, Waters E, Mackinnon A, Reddihough D, Graham HK, Mehmet-Radji O, Boyd R: Paediatric quality of life instruments: a review of the impact of the conceptual framework on outcomes. Dev Med Child Neurol 2006, 48:311-318.
• [25]Skevington SM, Lofty M, O'Connell KA: The World Health Organization's WHOQOL-Bref quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004, 13:299-310.
• [26]Leplege A, Hunt S: The problem of quality of life in medicine. JAMA 1997, 278:47-50.
• [27]Cummins RA: Moving from the quality of life concept to a theory. J Intellectual Disability Res 2005, 49:699-706.
• [28]Cummins RA, Lau ALD, Stokes M: HRQOL and subjective well-being: non-complimentary forms of outcome measurement. Expert Rev Pharmacoeconomics Outcomes Res 2004, 4:413-420.
• [29]Moons P, Budts W, De Geest S: Critique on the conceptualisation of quality of life: a review and evaluation of different conceptual approaches. International J Nurs Stud 2006, 43:891-901.
• [30]Varni JW, Burwinkle TM, Seid M, Skarr D: The PedsQL™ 4.0 as a pediatric population health measure: feasibility, reliability and validity. Amb Pediatr 2003, 3:329-341.
• [31]Ohaeri JU, Awadalla AW, Gado OM: Subjective quality of life in a nationwide sample of Kuwaiti subjects using the short version of the WHO quality of life instrument. Soc Psychiatry Psychiatr Epidemiol 2009, 44:693-701.
• [32]Wille N, Bettge S, Wittchen H-U, Ravens-Sieberger U, the BELLA study group: How impaired are children and adolescents by mental health problems? Results of the BELLA study. Eur Child Adolesc Psychiatry 2008, Suppl 1(17):42-51.
• [33]Varni JW, Burwinkle TM, Lane MM: Health-related quality of life measurement in pediatric clinical practice: an appraisal and precept for future research and application. Health Qual Outcomes 2005., 3(34)
• [34]Katschnig H: How useful is the concept of quality of life in psychiatry? In Quality of life in mental disorders. Edited by Katschnig H, Freeman H, Sartorius N. John Wiley & Sons Ltd, West Sussex, England; 2006:6.
• [35]Ohaeri JU, Awadalla AW, El-Abassi AH, Jacob A: Confirmatory factor analytical study of the WHOQOL-Bref: experience with Sudanese general population and psychiatric samples. BMC Med Res Methodol 2007, 7:37. BioMed Central Full Text
• [36]Ohaeri JU, Awadalla AW: The reliability and validity of the short version of the WHO Quality of Life Instrument in an Arab general population. Ann Saudi Med 2009, 29:98-104.
• [37]Warner R: The emics and etics of quality of life assessment. Soc Psychiatry Psychiatr Epidemiol 1999, 34:117-121.
• [38]Laaksonen C, Aromaa M, Heinonen OJ, Koivusilta L, Koski P, Suominen S, Vahlberg T, Salanterä S: Health related quality of life in 10-year-old schoolchildren. Qual Life Res 2008, 17:1049-1054.
• [39]Kiss E, Baji I, Mayer L, Skultéti D, Benák I, Vetró A: Validity and psychometric properties of a quality of life questionnaire in a Hungarian child and adolescent population. Psychiatr Hung 2007, 22:33-42.
• [40]Upton P, Eiser C, Cheung I, Hutchings HA, Jenney M, Maddocks A, Russell IT, Williams JG: Measurement properties of the UK-English version of the Pediatric Quality of Life Inventory 4.0 (PedsQL) generic core scales. Health Qual Life Outcomes 2005, 3:22. BioMed Central Full Text
• [41]Engelen V, Haentjens MM, Detmar SB, Koopman HM, Grootenhuis MA: Health related quality of life of Dutch children: psychometric properties of the PedsQL in the Netherlands. BMC Pediatr 2009, 9:68. BioMed Central Full Text
• [42]Case A, Paxson C: Children's health and social mobility. Future Child 2006, 16:151-173.
• [43]Svavarsdottir EK, Orlygsdottir B: Health-related quality of life in Icelandic school children. Scand J Caring Sci 2006, 20:209-215.
• [44]Spurrier NJ, Sawyer MG, Clark JJ, Baghurst P: Socio-economic differentials in the health-related quality of life of Australian children: results of a national study. Aust N Z J Public Health 2003, 27:27-33.
• [45]Bramlett MD, Blumberg SJ: Family structure and children's physical and mental health. Health Aff (Millwood) 2007, 26:549-558.
• [46]Ahrons CR: Family ties after divorce: long-term implications for children. Fam Process 2007, 46:53-65.
• [47]Zhao X, Zhang Q, Shan Y, Zhang H, Guo L: A study on the influence factors for social adaptive behavior of children. Hua Xi Yi Ke Da Xue Xue Bao 2002, 33:259-261.
• [48]Kauffman JM, Hallahan DP, Ball DW: Parents' predictions of their children's perceptions of family relations. J Pers Assess 1975, 39:228-235.
• [49]Seid M, Varni JW, Cummings L, Schonlau M: The impact of realized access to care on health-related quality of life: a two-year prospective cohort study of children in the California State Children's Health Insurance Program. J Pediatr 2006, 149:354-361.
• [50]King MT, Fayers PM: Making quality-of-life results more meaningful for clinicians. Lancet 2008, 371(9614):709-710.
• [51]Sloan JA, Frost MH, Berzon R, Dueck A, Guyatt G, Moinpour C, Sprangers M, Ferrans C, Cella D: Clinical Significance Consensus Meeting Group. The clinical significance of quality of life assessments in oncology: a summary for clinicians. Support Care Cancer 2006, 14:988-998.
• [52]Cummins RA: On the trail of the gold standard for subjective well-being. Soc Indicators Res 1995, 35:179-200.
• [53]Schwimmer JB, Burwinkle TM, Varni JM: Health-Related Quality of Life of Severely Obese Children and Adolescents. JAMA 2003, 289:1813-1819.
• [54]Gandek B, Ware JE: Methods for validating and norming translations of health status questionnaires: The IQOLA project approach. J Clin Epidemiol 1998, 51:953-959.
• [55]Graham P, Stevenson J, Flynn D: A new measure of health-related quality of life for children: preliminary findings. Psychol Health 1997, 12:655-665.
• [56]Olusina AK, Ohaeri JU: Subjective quality of life of recently discharged Nigerian psychiatric patients. Soc Psychiatry Psychiatr Epidemiol 2003, 38:707-714.
• [57]Bobak M, Pikhart H, Hertzman C, Rose R, Marmot M: Socioeconomic factors, perceived control and self-reported health in Russia. A cross-sectional survey. Soc Sci Med 1998, 47:269-279.
• [58]Diener E: Subjective well-being: The science of happiness and a proposal for a national index. Am Psychologist 2000, 55:34-43.
• [59]WHO: WHOQOL User Manual. World Health Organization, Program on Mental Health, Geneva, Switzerland. 1998.
• [60]Briere J: Trauma Symptom Checklist for Children. Florida: Psychological Assessment Resources, Inc; 1996.
• [61]Rosenberg M: Society and the adolescent self-image. Princeton: Princeton University Press; 1965.
• [62]Van Steen K, Curran D, Kramer J, Molenberghs G, Van Vreckem A, Bottomley A, Sylvester R: Multicollinearity in prognostic factor analyses using the EORTC QLQ-C30: identification and impact on model selection. Statistics Med 2002, 21:3865-3884.
• [63]Al-Turkait FA, Ohaeri JU: Psychopathological status, behavior problems, and family adjustment of Kuwaiti children whose fathers were involved in the first gulf war. Child Adolesc Psychiatry Ment Health 2008, 2(1):12. BioMed Central Full Text
• [64]Al-Turkait FA, Ohaeri JU: Dimensional and hierarchical models of depression using the Beck Depression Inventory-II in an Arab college student sample. BMC Psychiatry 2010, 10:60. BioMed Central Full Text
• [65]Abdel-Khalek AM, Lester D: Anxiety in Kuwaiti and American college students. Psychol Rep 2006, 99:512-514.
• [66]Abdel-Khalek AM, Lester D: Death anxiety as related to somatic symptoms in two cultures. Psychol Rep 2009, 105:409-410.
• [67]Kenny C: Does development make you happy?. Subjective well being in developing countries. Soc Indicators Res 2005, 73:199-219.
• [68]Stewart K: Dimensions of well being in EU Regions: Do GDP and unemployment tell us all we need to know? Soc Indicators Res 2005, 73:221-246.
• [69]El-Islam FM: Mental illness in Kuwait and Qatar. In Al-Junun Mental illness in the Islamic world. Edited by Al-Issa I. Madison: International University Press; 2000:121-137.
• [70]Abdel-Khalek AM: Age and sex differences for anxiety in relation to family size, birth order, and religiosity among Kuwaiti adolescents. Psychol Rep 2002, 90(3 Pt 1):1031-6.
• [71]Enns MWI, Cox BJ, Clara I: Parental bonding and adult psychopathology: results from the US National comorbidity survey. Psychol Med 2002, 32:997-1008.
• [72]George C: A representational perspective of child abuse and prevention: internal working models of attachment and caregiving. Child Abuse Negl 1996, 20:411-424.
• [73]Eisenberg ME, Ackard DM, Resnick MD: Protective factors and suicide risk in adolescents with a history of sexual abuse. J Ped 2007, 151:482-487.
• [74]Supranowicz P: Parents' unemployment, selected life conditions, adolescents' well-being and perceived health. Przegl Epidemiol 2005, 59:773-780.
• [75]"School-Wide Positive Behavioral Interventions and Supports" [http://www.pbis.org/] webcite