Quality of Life Research

, Volume 26, Issue 10, pp 2717–2727 | Cite as

Predictors of health-related quality of life in maltreated children and adolescents

  • Sabine Weber
  • Andreas Jud
  • Markus A. Landolt
  • Lutz Goldbeck
Article

Abstract

Purpose

Research on the consequences of child maltreatment has primarily focused on behavior and mental health; the children’s overall well-being has not received the same attention. A number of studies have investigated health-related quality of life (HRQoL) among victims of child maltreatment, but there is still a lack of knowledge about predictors of HRQoL in maltreated children and adolescents. This study seeks to bridge the gap by drawing data from the German multi-site study Child Abuse and Neglect Case-Management (CANMANAGE).

Methods

Parents or caregivers of 350 children and adolescents completed a proxy version of the Kidscreen-10-Index, a multidimensional instrument measuring child HRQoL. An additional 249 children age 8 years and older completed a self-report version. Multiple regression analyses were performed to identify potential predictors for both self- and proxy-rated HRQoL.

Results

Comparisons with the reference group revealed a significantly lower mean proxy-rated HRQoL, the self-rated HRQoL of the study sample was not significantly impaired. Predictors of impaired self-reported HRQoL were older age, self-reported posttraumatic stress symptoms (PTSS), and self-reported emotional and behavioral symptoms. Predictors of impaired proxy-reported HRQoL again were older age, self-reported PTSS, and emotional and behavioral symptoms in the child/adolescent, as reported by the caregiver, as well as low socioeconomic status. Multivariate analysis explained 20% and 38% of the variability in self-reported and proxy-rated HRQoL, respectively.

Conclusions

It is important to treat PTSS and emotional and behavioral symptoms in maltreated children, as these two phenomena are strong cross-sectional predictors of a child’s HRQoL. Trauma-focused cognitive behavioral therapies are one possible option to address the needs of such children.

Keywords

Health-related quality of life Child maltreatment Predictors Regression analysis 

References

  1. 1.
    Stoltenborgh, M., Bakermans-Kranenburg, M. J., Alink, L. R. A., & van IJzendoorn, M. H. (2015). The prevalence of child maltreatment across the globe: review of a series of meta-analyses. Child Abus Rev, 24, 37–50. doi:10.1002/car.2353.CrossRefGoogle Scholar
  2. 2.
    Edwards, V. J., Holden, G. W., Anda, R. F., & Felitti, V. J. (2003). Experiencing multiple forms of childhood maltreatment and adult mental health: results from the adverse childhood experiences (ACE) study. Am J Psychiatry, 160, 1453–1460.CrossRefPubMedGoogle Scholar
  3. 3.
    Dube, S. R., Felitti, V. J., Dong, M., et al. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics, 111, 564–572. doi:10.1542/peds.111.3.564.CrossRefPubMedGoogle Scholar
  4. 4.
    Hillis, S. D., Anda, R. F., Felitti, V. J., & Marchbanks, P. A. (2001). Adverse childhood experiences and sexual risk behaviors in women: a retrospective cohort study. Family Plan Perspect. doi:10.2307/2673783.Google Scholar
  5. 5.
    Bullinger, M. (2014). The concept of quality of life in medicine: Its history and current relevance [Das Konzept der Lebensqualität in der Medizin-Entwicklung und heutiger Stellenwert]. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 108, 97–103. doi:10.1016/j.zefq.2014.02.006.CrossRefPubMedGoogle Scholar
  6. 6.
    Aaronson, N. K., Meyerowitz, B. E., Bard, M., et al. (1991). Quality-of-life research in oncology—past achievements and future priorities. Cancer, 67, 839–843. doi:10.1002/1097-0142(19910201)67:3+<839:Aid-Cncr2820671415>3.0.Co;2-0.CrossRefPubMedGoogle Scholar
  7. 7.
    Kalantar-Zadeh, K., Kopple, J. D., Block, G., & Humphreys, M. H. (2001). Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol, 12, 2797–2806.PubMedGoogle Scholar
  8. 8.
    Li, C.-L., Chang, H.-Y., Hsu, C.-C., et al. (2013). Joint predictability of health related quality of life and leisure time physical activity on mortality risk in people with diabetes. BMC Publ Health, 13, 67. doi:10.1186/1471-2458-13-67.CrossRefGoogle Scholar
  9. 9.
    Zuluaga, M. C., Guallar-Castillón, P., López-García, E., et al. (2010). Generic and disease-specific quality of life as a predictor of long-term mortality in heart failure. Eur J Heart Fail, 12, 1372–1378. doi:10.1093/eurjhf/hfq163.CrossRefPubMedGoogle Scholar
  10. 10.
    Sehlen, S., Marten-Mittag, B., Herschbach, P., et al. (2012). Health-related quality of life supersedes other psychosocial predictors of long-term survival in cancer patients undergoing radiotherapy. Acta Oncol, 51, 1020–1028. doi:10.3109/0284186X.2012.683879.CrossRefPubMedGoogle Scholar
  11. 11.
    Ul-Haq, Z., Mackay, D. F., & Pell, J. P. (2014). Association between physical and mental health-related quality of life and adverse outcomes; a retrospective cohort study of 5272 Scottish adults. BMC Public Health, 14, 1197. doi:10.1186/1471-2458-14-1197.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Weber, S., Jud, A., & Landolt, M. A. (2015). Quality of life in maltreated children and adult survivors of child maltreatment: a systematic review. Qual Life Res, 25, 237–255. doi:10.1007/s11136-015-1085-5.CrossRefPubMedGoogle Scholar
  13. 13.
    Jud, A., Landolt, M. A., Tatalias, A., et al. (2013). Health-related quality of life in the aftermath of child maltreatment: follow-up study of a hospital sample. Qual Life Res, 22, 1361–1369. doi:10.1007/s11136-012-0262-z.CrossRefPubMedGoogle Scholar
  14. 14.
    Greger, H. K., Myhre, A. K., Lydersen, S., & Jozefiak, T. (2016). Child maltreatment and quality of life: a study of adolescents in residential care. Health Qual Life Outcomes, 14, 1. doi:10.1186/s12955-016-0479-6.CrossRefGoogle Scholar
  15. 15.
    Landolt, M. A. (2003). Die Bewältigung akuter Psychotraumata im Kindesalter. Praxis der Kinderpsychol Kinderpsychiatr, 52, 71–87.Google Scholar
  16. 16.
    Lazarus, R. S. (1974). Psychological stress and coping in adaptation and illness. Int J Psychiatry Med, 5, 321–333. doi:10.2190/T43T-84P3-QDUR-7RTP.CrossRefPubMedGoogle Scholar
  17. 17.
    Landolt, M. A. (2012). Psychotraumatologie des Kindesalters: Grundlagen, Diagnostik und Interventionen. Göttingen: Hogrefe Verlag.Google Scholar
  18. 18.
    Afifi, T. O., Enns, M. W., Cox, B. J., et al. (2007). Child abuse and health-related quality of life in adulthood. J Nerv Mental Dis, 195, 797–804. doi:10.1097/NMD.0b013e3181567fdd.CrossRefGoogle Scholar
  19. 19.
    Agorastos, A., Pittman, J. O. E., Angkaw, A. C., et al. (2014). The cumulative effect of different childhood trauma types on self-reported symptoms of adult male depression and PTSD, substance abuse and health-related quality of life in a large active-duty military cohort. Journal of Psychiatric Research, 58, 46–54. doi:10.1016/j.jpsychires.2014.07.014.CrossRefPubMedGoogle Scholar
  20. 20.
    Corso, P. S., Edwards, V. J., Fang, X. M., & Mercy, J. A. (2008). Health-related quality of life among adults who experienced maltreatment during childhood. Am J Public Health, 98, 1094–1100. doi:10.2105/Ajph.2007.119826.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Evren, C., Sar, V., Dalbudak, E., et al. (2011). Lifetime PTSD and quality of life among alcohol-dependent men: Impact of childhood emotional abuse and dissociation. Psychiatry Res, 186, 85–90. doi:10.1016/j.psychres.2010.07.004.CrossRefPubMedGoogle Scholar
  22. 22.
    Witt, A., Münzer, A., Ganser, H. G., et al. (2016). Experience by children and adolescents of more than one type of maltreatment: association of different classes of maltreatment profiles with clinical outcome variables. Child Abus Negl, 57, 1–11. doi:10.1016/j.chiabu.2016.05.001.CrossRefGoogle Scholar
  23. 23.
    Fenn, H. H., Bauer, M. S., Alshuler, L., et al. (2005). Medical comorbidity and health-related quality of life in bipolar disorder across the adult age span. J Affect Disord, 86, 47–60. doi:10.1016/j.jad.2004.12.006.CrossRefPubMedGoogle Scholar
  24. 24.
    Johnco, C. J., Salloum, A., Lewin, A. B., et al. (2015). The impact of comorbidity profiles on clinical and psychosocial functioning in childhood anxiety disorders. Psychiatry Res, 229, 237–244. doi:10.1016/j.psychres.2015.07.027.CrossRefPubMedGoogle Scholar
  25. 25.
    Franco, X., Saavedra, L. M., & Silverman, W. K. (2007). External validation of comorbid patterns of anxiety disorders in children and adolescents. J Anxiety Disord, 21, 717–729. doi:10.1016/j.janxdis.2006.10.002.CrossRefPubMedGoogle Scholar
  26. 26.
    Rajmil, L., Palacio-Vieira, J. A., Herdman, M., et al. (2009). Effect on health-related quality of life of changes in mental health in children and adolescents. Health Qual Life Outcomes, 7, 103. doi:10.1186/1477-7525-7-103.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    de Vries, A. P. J., Kassam-Adams, N., Cnaan, A., et al. (1999). Looking beyond the physical injury: posttraumatic stress disorder in children and parents after pediatric traffic injury. Pediatrics, 104, 1293–1299. doi:10.1542/peds.104.6.1293.CrossRefPubMedGoogle Scholar
  28. 28.
    Morris, A., Gabert-Quillen, C., & Delahanty, D. L. (2012). The association between parent PTSD/depression symptoms and child PTSD symptoms: a meta-analysis. J Pediatr Psychol, 37, 1076–1088. doi:10.1093/jpepsy/jss091.CrossRefPubMedGoogle Scholar
  29. 29.
    Stuber, M. L., Kazak, A. E., Meeske, K., et al. (1997). Predictors of posttraumatic stress symptoms in childhood cancer survivors. Pediatrics, 100, 958–964. doi:10.1542/peds.100.6.958.CrossRefPubMedGoogle Scholar
  30. 30.
    Mielck, A., Vogelmann, M., & Leidl, R. (2014). Health-related quality of life and socioeconomic status: inequalities among adults with a chronic disease. Health Qual Life Outcomes, 12, 58. doi:10.1186/1477-7525-12-58.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Villalonga-Olives, E., von Steinbüchel, N., Witte, C., et al. (2014). Health related quality of life of immigrant children: towards a new pattern in Germany? BMC Public Health, 14, 790. doi:10.1186/1471-2458-14-790.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Flink, I. J. E., Beirens, T. M. J., Looman, C., et al. (2013). Health-related quality of life of infants from ethnic minority groups: the Generation R Study. Qual Life Res, 22, 653–664. doi:10.1007/s11136-012-0184-9.CrossRefPubMedGoogle Scholar
  33. 33.
    Puder, J., Pinto, A. M., Bonvin, A., et al. (2013). Health-related quality of life in migrant preschool children. BMC Public Health, 13, 384. doi:10.1186/1471-2458-13-384.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Witt, A., Münzer, A., Ganser, H. G., et al. (2016). Data on maltreatment profiles and psychopathology in children and adolescents. Data Brief, 8, 1352–1356. doi:10.1016/j.dib.2016.07.056.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Lindström, B., & Eriksson, B. (1993). Social pediatrics. Sozial- und Präventivmedizin SPM, 38, 83–89. doi:10.1007/BF01318465.CrossRefGoogle Scholar
  36. 36.
    Sabaz, M., Cairns, D. R., Lawson, J. A., et al. (2001). The health-related quality of life of children with refractory epilepsy: a comparison of those with and without intellectual disability. Epilepsia, 42, 621–628. doi:10.1046/j.1528-1157.2001.25200.x.CrossRefPubMedGoogle Scholar
  37. 37.
    Goldbeck, L., Schmitz, T. G., Besier, T., et al. (2007). Life satisfaction decreases during adolescence. Qual Life Res, 16, 969–979. doi:10.1007/s11136-007-9205-5.CrossRefPubMedGoogle Scholar
  38. 38.
    Michel, G., Bisegger, C., Fuhr, D. C., & Abel, T. (2009). Age and gender differences in health-related quality of life of children and adolescents in Europe: a multilevel analysis. Qual Life Res, 18, 1147–1157. doi:10.1007/s11136-009-9538-3.CrossRefPubMedGoogle Scholar
  39. 39.
    Ravens-Sieberer, U., Erhart, M., Rajmil, L., et al. (2010). Reliability, construct and criterion validity of the KIDSCREEN-10 score: a short measure for children and adolescents’ well-being and health-related quality of life. Qual Life Res, 19, 1487–1500. doi:10.1007/s11136-010-9706-5.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Grip, K. K., Almqvist, K., Axberg, U., & Broberg, A. G. (2014). Perceived quality of life and health complaints in children exposed to intimate partner violence. J Fam Violence, 29, 681–692. doi:10.1007/s10896-014-9622-5.CrossRefGoogle Scholar
  41. 41.
    Jernbro C, Tindberg Y, Lucas S, Janson S (2015). Quality of life among Swedish school children who experienced multitype child maltreatment. Acta Paediatr (Oslo, Norway: 1992) 104:320–5. doi:10.1111/apa.12873
  42. 42.
    Ravens-Sieberer U, The KIDSCREEN Groupe Europe. (2006). The Kidscreen questionnaires: quality of life questionnaires for children and adolescents; Handbook. Lengerich: Pabst Science Publ.Google Scholar
  43. 43.
    Finkelhor, D., Hamby, S. L., Ormrod, R. K., & Turner, H. A. (2005). The Juvenile victimization questionnaire: reliability, validity, and national norms. Child Abus Negl, 29, 383–412. doi:10.1016/j.chiabu.2004.11.001.CrossRefGoogle Scholar
  44. 44.
    Hamby, S. L., Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2004). The juvenile victimization questionnaire (JVQ): Administration and scoring manual. Durham: Crimes Against Children Research Center.Google Scholar
  45. 45.
    Finkelhor, D., Ormrod, R. K., Turner, H. A., & Hamby, S. L. (2005). The victimization of children and youth: a comprehensive, national survey. Child Maltreatment, 10, 5–25. doi:10.1177/1077559504271287.CrossRefPubMedGoogle Scholar
  46. 46.
    Steinberg, A. M., Brymer, M. J., Decker, K. B., & Pynoos, R. S. (2004). The University of California at Los Angeles post-traumatic stress disorder reaction index. Curr Psychiatry Rep, 6, 96–100. doi:10.1007/s11920-004-0048-2.CrossRefPubMedGoogle Scholar
  47. 47.
    Steinberg, A. M., Brymer, M. J., Kim, S., et al. (2013). Psychometric properties of the UCLA PTSD reaction index: part I. J Trauma Stress, 26, 1–9. doi:10.1002/jts.21780.CrossRefPubMedGoogle Scholar
  48. 48.
    Hofbeck B (2010). Psychometrische Eigenschaften der deutschen Version des UCLA PTSD Reaction Index.[Unveröffentlichte Diplomarbeit]. München: Ludwig-Maximilians-Universität MünchenGoogle Scholar
  49. 49.
    Delmo C, Weiffenbach O, Gabriel M, Poustka F (2000). Kiddie-SADS present and lifetime version (K-SADS-PL). Auflage der deutschen Forschungsversion. Frankfurt am Main: Klinik für Psychiatrie und Psychotherapie des Kindes-und Jugendalters der Universität FrankfurtGoogle Scholar
  50. 50.
    Goodman, R. (1997). The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry Allied Discip, 38, 581–586. doi:10.1111/j.1469-7610.1997.tb01545.x.CrossRefGoogle Scholar
  51. 51.
    Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry, 40, 1337–1345. doi:10.1097/00004583-200111000-00015.CrossRefPubMedGoogle Scholar
  52. 52.
    Cohen, J. A., & Mannarino, A. P. (1996). A treatment outcome study for sexually abused preschool children: initial findings. J Am Acad Child Adolesc Psychiatry, 35, 42–50. doi:10.1097/00004583-199601000-00011.CrossRefPubMedGoogle Scholar
  53. 53.
    Cohen, J. A., & Mannarino, A. P. (1996). Factors that mediate treatment outcome of sexually abused preschool children. J Am Acad Child Adolesc Psychiatry, 35, 1402–1410. doi:10.1097/00004583-199610000-00028.CrossRefPubMedGoogle Scholar
  54. 54.
    Cohen, J. A., & Mannarino, A. P. (2000). Predictors of treatment outcome in sexually abused children. Child Abus Negl, 24, 983–994. doi:10.1016/S0145-2134(00)00153-8.CrossRefGoogle Scholar
  55. 55.
    Löwe B, Spitzer RL, Zipfel S, Herzog W (2002). PHQ-D. Gesundheitsfragebogen fuer Patienten [German version of the patient health questionnaire]. Pfizer, KarlsruheGoogle Scholar
  56. 56.
    Gräfe, K., Zipfel, S., Herzog, W., & Löwe, B. (2004). Screening psychischer Störungen mit dem “Gesundheitsfragebogen für Patienten (PHQ-D)“. Diagnostica, 50, 171–181.CrossRefGoogle Scholar
  57. 57.
    Foa, E. B. (1995). Manual for the posttraumatic stress diagnostic scale (PDS). Minneapolis: National Computer Systems.Google Scholar
  58. 58.
    Griesel, D., Wessa, M., & Flor, H. (2006). Psychometric qualities of the German version of the posttraumatic diagnostic scale (PTDS). Psychol Assess, 18, 262. doi:10.1037/1040-3590.18.3.262.CrossRefPubMedGoogle Scholar
  59. 59.
    Ravens-Sieberer, U., & Kurth, B.-M. (2008). The mental health module (BELLA study) within the German health interview and examination survey of children and adolescents (KiGGS): study design and methods. Eur Child Adolesc Psychiatry, 17(Suppl 1), 10–21. doi:10.1007/s00787-008-1002-3.CrossRefPubMedGoogle Scholar
  60. 60.
    Wagner, G. G., Frick, J. R., & Schupp, J. (2007). The German socio-economic panel study (SOEP)-evolution, scope and enhancements. Schmollers Jahrb, 127, 139–169. doi:10.2139/ssrn.1028709.Google Scholar
  61. 61.
    The Organisation for Economic Co-operation and Development (OECD) (2008). Growing unequal?: Income distribution and poverty in OECD countries. http://www.oecd.org/els/soc/growingunequalincomedistributionandpovertyinoecdcountries.htm.
  62. 62.
    The Organisation for Economic Co-operation and Development (OECD) (2011). Divided we stand—Why inequality keeps rising. http://www.oecd.org/els/soc/dividedwestandwhy.
  63. 63.
    IBM (2013). IBM SPSS Statistics for Windows, Version 22.0Google Scholar
  64. 64.
    Field, A. (2009). Discovering statistics using SPSS. London: Sage Publications Ltd.Google Scholar
  65. 65.
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Erlbaum Associates.Google Scholar
  66. 66.
    Upton, P., Lawford, J., & Eiser, C. (2008). Parent-child agreement across child health-related quality of life instruments: a review of the literature. Qual Life Res, 17, 895–913. doi:10.1007/s11136-008-9350-5.CrossRefPubMedGoogle Scholar
  67. 67.
    Clark, D. B., & Kirisci, L. (1996). Posttraumatic stress disorder, depression, alcohol use disorders and quality of life in adolescents. Anxiety, 2, 226–233. doi:10.1002/(SICI)1522-7154(1996)2:5<226::AID-ANXI4>3.0.CO;2-K.CrossRefPubMedGoogle Scholar
  68. 68.
    Warshaw, M. G., Fierman, E., Pratt, L., et al. (1993). Quality of life and dissociation in anxiety disorder patients with histories of trauma or PTSD. Am J Psychiatry, 150, 1512–1516. doi:10.1176/ajp.150.10.1512.CrossRefPubMedGoogle Scholar
  69. 69.
    Zatzick, D. F., Marmar, C. R., Weiss, D. S., et al. (1997). Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry, 154, 1690–1695. doi:10.1176/ajp.154.12.1690.CrossRefPubMedGoogle Scholar
  70. 70.
    Olatunji, B. O., Cisler, J. M., & Tolin, D. F. (2007). Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev, 27, 572–581. doi:10.1016/j.cpr.2007.01.015.CrossRefPubMedGoogle Scholar
  71. 71.
    Morina, N., Koerssen, R., & Pollet, T. V. (2016). Interventions for children and adolescents with posttraumatic stress disorder: a meta-analysis of comparative outcome studies. Clin Psychol Rev, 47, 41–54. doi:10.1016/j.cpr.2016.05.006.CrossRefPubMedGoogle Scholar
  72. 72.
    Wilkins, A. J., O’Callaghan, M. J., Najman, J. M., et al. (2004). Early childhood factors influencing health-related quality of life in adolescents at 13 years. J Paediatr Child Health, 40, 102–109.CrossRefPubMedGoogle Scholar
  73. 73.
    Richards, M. M., Bowers, M. J., Lazicki, T., et al. (2007). Caregiver involvement in the intensive mental health program: influence on changes in child functioning. J Child Family Stud, 17, 241–252. doi:10.1007/s10826-007-9163-0.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Sabine Weber
    • 1
  • Andreas Jud
    • 1
    • 2
  • Markus A. Landolt
    • 3
    • 4
  • Lutz Goldbeck
    • 5
  1. 1.Child Protection GroupUniversity Children’s Hospital ZurichZurichSwitzerland
  2. 2.School of Social WorkLucerne University of Applied Sciences and ArtsLucerneSwitzerland
  3. 3.Department of Psychosomatics and PsychiatryUniversity Children’s Hospital ZurichZurichSwitzerland
  4. 4.Division of Child and Adolescent Health Psychology, Department of PsychologyUniversity of ZurichZurichSwitzerland
  5. 5.Department of Child and Adolescent Psychiatry/Psychotherapy, Medical CentreUniversity of UlmUlmGermany

Personalised recommendations