European Journal of Pediatrics

, Volume 177, Issue 6, pp 935–943 | Cite as

The impact of coping patterns and chronic health conditions on health-related quality of life among children and adolescents

  • Sabrina Oppenheimer
  • Orit Krispin
  • Sigal Levy
  • Maayan Ozeri
  • Alan Apter
Original Article


This study examined the relationship among chronic disease, coping strategy patterns, and health-related quality of life (HRQOL) among children and adolescents. The cohort included 273 Israeli children and adolescents aged 8–18 years diagnosed with asthma, diabetes mellitus, or celiac disease. All completed the Coping with a Disease Questionnaire (CODI) and the DISABKIDS Chronic Generic Measure (DCGM-37). The outcome measures were as follows: association of the use of effective and non-effective coping strategies with type of disease; predictive value of coping patterns for health-related quality of life; a European sample was used for comparison. On k means cluster analysis, three strategy patterns (two “effective” and one “non-effective”) were associated with health-related quality of life and disease specifics. Disease predicted coping patterns, but it had a weak direct relationship to health-related quality of life. Coping patterns were the strongest predictor of health-related quality of life. These results are similar to the European DISABKIDS study, indicating cross-cultural parallels.

Conclusions: The findings highlight the power of the concept of coping patterns as opposed to coping strategies to explain HRQOL of children and adolescents with chronic disease. Both types of disease (categorical approach) and coping patterns (non-categorical approach) are relevant to predicting HRQOL.

What is Known:

• The literature on coping has widely documented the existence of individual (unique) coping strategies.

• Coping strategies are considered “useful” or “non-useful,” based on whether they increase or decrease negative outcomes caused by certain stressors, such as chronic illness.

What is New:

• Our findings suggest that youngsters can use “non-useful” strategies to reduce stress caused by chronic illness, while still maintaining higher quality of life, as long as they also apply certain “useful” strategies.

• The use of certain combinations of coping strategies, rather than single strategies, is more important to our understanding of how coping affects HRQOL of children with chronic disease.


Quality of life Coping Chronic illness Children Adolescents 



Health-related quality of life


Coping with a Disease


DISABKIDS Chronic Generic Measure


the Transactional Stress and Coping model



We thank the European DISABKIDS group for granting permission to use their measurements.

Authors’ contributions

Sabrina Oppenheimer and Orit Krispin conceived and designed the study and contributed equally to this work, Sigal Levy conducted the data analysis, Maayan Ozeri obtained data and coordinated research, and Alan Apter was consulted on study design and analysis. All authors revised and approved the final version of the manuscript.

Compliance with ethical standards

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Helsinki committee at Schneider Children’s Medical Center of Israel and the Ethics committee at the Academic College of Tel Aviv-Yafo.

Informed consent

Informed consent was obtained by parents of all participants included in the study and by all participants aged 14 and above.

Conflict of interest

All authors declare they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sabrina Oppenheimer
    • 1
  • Orit Krispin
    • 2
  • Sigal Levy
    • 1
  • Maayan Ozeri
    • 1
  • Alan Apter
    • 2
    • 3
  1. 1.School of Behavioral SciencesThe Academic College of Tel Aviv-YaffoTel Aviv-YaffoIsrael
  2. 2.Schneider Children’s Medical Center of IsraelPetach TikvaIsrael
  3. 3.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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