Advertisement

Quality of Life Research

, Volume 22, Issue 8, pp 2201–2211 | Cite as

Factor structure of the Child Health Questionnaire Parent Form-50 and predictors of health-related quality of life in children with epilepsy

  • Mark A. Ferro
  • Jeanne M. Landgraf
  • Kathy N. Speechley
Article

Abstract

Purpose

The present study investigated the higher-order summary factor structure of the Child Health Questionnaire Parent Form-50 (CHQ) in a sample of children with new-onset epilepsy. The secondary aim was to identify risk factors predicting health-related quality of life (HRQL) 24 months post-diagnosis.

Methods

Data came from the Health-related Quality of Life in Children with Epilepsy Study (HERQULES, N = 374), a multi-site study documenting HRQL among children with epilepsy from diagnosis through 24 months. Confirmatory factor analysis was used to determine goodness of fit between the original structure of the CHQ and HERQULES data. Multiple regression was used to identify risk factors at diagnosis for HRQL at 24 months.

Results

The models demonstrated good fit: baseline: CFI = 0.945; TLI = 0.941; WRMR = 1.461; RMSEA = 0.058; 24 months: CFI = 0.957; TLI = 0.954; WRMR = 1.393; RMSEA = 0.055. Factor loadings were high and no cross-loadings observed (first order: λ = 0.27–0.99, 0.24–0.98; second order: λ = 0.69–0.86, 0.54–0.92; p < 0.001 for all). Controlling for HRQL at diagnosis, predictors for better 24-month HRQL were as follows: physical health: fewer cognitive problems (p = 0.023) and parents with fewer depressive symptoms (p = 0.049); psychosocial health: older parent age (p = 0.043), fewer behavior problems (p = 0.004), and families with better functioning (p = 0.008) and fewer demands (p = 0.009).

Conclusions

The CHQ higher-order summary factor structure was replicated in a sample of children with new-onset epilepsy, and child and family risk factors at diagnosis were found to predict HRQL 24 months post-diagnosis. These findings suggest it is possible to identify at-risk children early in the illness process and provide impetus for adopting family-centered care practices.

Keywords

Children Epilepsy Factor analysis Health-related quality of life Measurement Psychometrics 

Abbreviations

AEDs

anti-epileptic drugs

CES-D

Center for Epidemiological Studies Depression Scale

CFA

Confirmatory Factor Analysis

CFI

Comparative Fit Index

CHQ

Child Health Questionnaire

Family APGAR

Family Adaptability, Partnership, Growth, Affection, and Resolve

FILE

Family Inventory of Life Events and Changes

FIRM

Family Inventory of Resources for Management

GASE

Global Assessment of Severity of Epilepsy

HERQULES

Health-related Quality of Life in Children with Epilepsy Study

HRQL

Health-related Quality of Life

RMSEA

Root Mean Square Error of Approximation

TLI

Tucker–Lewis Index

WRMR

Weighted Root Mean Square Residual

Notes

Acknowledgments

Dr. Ferro is supported by the Banting Postdoctoral Fellowship from the Canadian Institutes for Health Research. Dr. Speechley is the recipient of a Canadian Institutes for Health Research grant for HERQULES (MOP-64311).

References

  1. 1.
    Arzimanoglu, A., Guerrini, R., & Aicardi, J. (Eds.). (2004). Aicardi’s epilepsy in children (3rd ed.). Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  2. 2.
    Guerrini, R. (2006). Epilepsy in children. Lancet, 367(9509), 499–524.PubMedCrossRefGoogle Scholar
  3. 3.
    U. S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research. (2006). Guidance for industry: Patient-reported outcome measures: Use in medical product development to support labeling claims: Draft guidance. Health Qual Life Outcomes, 4, 79.Google Scholar
  4. 4.
    European Medicines Agency. (2005). Reflection paper on the regulatory guidance for the use of health-related quality of life (HRQL) measures in the evaluation of medicinal products. London: European Agency for the Evaluation of Medicinal Products.Google Scholar
  5. 5.
    International League Against Epilepsy. (1981). Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia, 22(4), 489–501.Google Scholar
  6. 6.
    International League Against Epilepsy. (1989). Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia, 30(4), 389–399.Google Scholar
  7. 7.
    Sillanpaa, M., Jalava, M., Kaleva, O., & Shinnar, S. (1998). Long-term prognosis of seizures with onset in childhood. New England Journal of Medicine, 338(24), 1715–1722.PubMedCrossRefGoogle Scholar
  8. 8.
    Camfield, C. S., & Camfield, P. R. (2007). Long-term social outcomes for children with epilepsy. Epilepsia, 48(Suppl 9), 3–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Camfield, P., & Camfield, C. (2010). Idiopathic generalized epilepsy with generalized tonic-clonic seizures (IGE-GTC): A population-based cohort with >20 year follow up for medical and social outcome. Epilepsy & Behavior, 18(1–2), 61–63.CrossRefGoogle Scholar
  10. 10.
    Ferro, M. A. (2011). A population-based study of the prevalence and sociodemographic risk factors of self-reported epilepsy among adults in the United Kingdom. Seizure, 20(10), 784–788.PubMedCrossRefGoogle Scholar
  11. 11.
    Freilinger, M., Reisel, B., Reiter, E., Zelenko, M., Hauser, E., & Seidl, R. (2006). Behavioral and emotional problems in children with epilepsy. Journal of Child Neurology, 21(11), 939–945.PubMedCrossRefGoogle Scholar
  12. 12.
    Hoie, B., Sommerfelt, K., Waaler, P. E., Alsaker, F. D., Skeidsvoll, H., & Mykletun, A. (2006). Psychosocial problems and seizure-related factors in children with epilepsy. Developmental Medicine and Child Neurology, 48(3), 213–219.PubMedCrossRefGoogle Scholar
  13. 13.
    Tse, E., Hamiwka, L., Sherman, E. M., & Wirrell, E. (2007). Social skills problems in children with epilepsy: Prevalence, nature and predictors. Epilepsy & Behavior, 11(4), 499–505.CrossRefGoogle Scholar
  14. 14.
    Williams, J. (2003). Learning and behavior in children with epilepsy. Epilepsy & Behavior, 4(2), 107–111.CrossRefGoogle Scholar
  15. 15.
    Eiser, C., & Morse, R. (2001). Quality-of-life measures in chronic diseases of childhood. Health Technology Assessment, 5(4), 1–157.PubMedGoogle Scholar
  16. 16.
    Eiser, C., & Morse, R. (2001). A review of measures of quality of life for children with chronic illness. Archives of Disease in Childhood, 84(3), 205–211.PubMedCrossRefGoogle Scholar
  17. 17.
    Landgraf, J. M., Abetz, L., & Ware Jr., J. E. (1996, 1999). Child Health Questionnaire (CHQ): A user’s manual. Boston: The Health Institute, New England Medical Center [no longer in print].Google Scholar
  18. 18.
    Baca, C. B., Vickrey, B. G., Caplan, R., Vassar, S. D., & Berg, A. T. (2011). Psychiatric and medical comorbidity and quality of life outcomes in childhood-onset epilepsy. Pediatrics, 128(6), e1532–e1543.PubMedCrossRefGoogle Scholar
  19. 19.
    Baca, C. B., Vickrey, B. G., Vassar, S. D., & Berg, A. T. (2012). Seizure recency and quality of life in adolescents with childhood-onset epilepsy. Epilepsy & Behavior, 23(1), 47–51.CrossRefGoogle Scholar
  20. 20.
    Connolly, A. M., Northcott, E., Cairns, D. R., McIntyre, J., Christie, J., Berroya, A., et al. (2006). Quality of life of children with benign rolandic epilepsy. Pediatric Neurology, 35(4), 240–245.PubMedCrossRefGoogle Scholar
  21. 21.
    Miller, V., Palermo, T. M., & Grewe, S. D. (2003). Quality of life in pediatric epilepsy: Demographic and disease-related predictors and comparison with healthy controls. Epilepsy & Behavior, 4(1), 36–42.CrossRefGoogle Scholar
  22. 22.
    Sabaz, M., Cairns, D. R., Lawson, J. A., Nheu, N., Bleasel, A. F., & Bye, A. M. (2000). Validation of a new quality of life measure for children with epilepsy. Epilepsia, 41(6), 765–774.PubMedCrossRefGoogle Scholar
  23. 23.
    Sabaz, M., Lawson, J. A., Cairns, D. R., Duchowny, M. S., Resnick, T. J., Dean, P. M., et al. (2003). Validation of the quality of life in childhood epilepsy questionnaire in American epilepsy patients. Epilepsy & Behavior, 4(6), 680–691.CrossRefGoogle Scholar
  24. 24.
    Streiner, D. L., & Norman, G. R. (2008). Health measurement scales: A practical guide to their development and use. New York: Oxford University Press.Google Scholar
  25. 25.
    Hepner, K. A., & Sechrest, L. (2002). Confirmatory factor analysis of the Child Health Questionnaire-Parent Form 50 in a predominantly minority sample. Quality of Life Research, 11(8), 763–773.PubMedCrossRefGoogle Scholar
  26. 26.
    Drotar, D., Schwartz, L., Palermo, T. M., & Burant, C. (2006). Factor structure of the child health questionnaire-parent form in pediatric populations. Journal of Pediatric Psychology, 31(2), 127–138.PubMedCrossRefGoogle Scholar
  27. 27.
    Hoare, P. (1984). Psychiatric disturbance in the families of epileptic children. Developmental Medicine and Child Neurology, 26(1), 14–19.PubMedCrossRefGoogle Scholar
  28. 28.
    Thompson, P. J., & Upton, D. (1992). The impact of chronic epilepsy on the family. Seizure, 1(1), 43–48.PubMedCrossRefGoogle Scholar
  29. 29.
    Ronen, G. M., Fayed, N., & Rosenbaum, P. L. (2011). Outcomes in pediatric neurology: A review of conceptual issues and recommendations. The 2010 Ronnie Mac Keith Lecture. Developmental Medicine and Child Neurology, 53(4), 305–312.PubMedCrossRefGoogle Scholar
  30. 30.
    Speechley, K. N., Ferro, M. A., Camfield, C. S., Huang, W., Levin, S. D., Smith, M. L., et al. (2012). Quality of life in children with new-onset epilepsy: A two-year prospective cohort study. Neurology, 79(15), 1548–1555.PubMedCrossRefGoogle Scholar
  31. 31.
    HealthActCHQ. (2008). Child Health Questionnaire scoring and interpretation manual. Cambridge: HealthActCHQ Inc. [Provided as part of a paid license only].Google Scholar
  32. 32.
    Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.CrossRefGoogle Scholar
  33. 33.
    Smilkstein, G. (1978). The family APGAR: A proposal for a family function test and its use by physicians. Journal of Family Practice, 6(6), 1231–1239.PubMedGoogle Scholar
  34. 34.
    Smilkstein, G., Ashworth, C., & Montano, D. (Eds.). (1982). Validity and reliability of the family APGAR as a test of family function. Journal of Family Practice, 15(2), 303–311.Google Scholar
  35. 35.
    McCubbin, H. I., Thompson, A. I., & McCubbin, M. A. (Eds.). (1996). FILE: Family inventory of life events and changes. In Family assessment: Resiliency, coping and adaptation. Inventories for research and practice. Madison: University of Wisconsin Publishers.Google Scholar
  36. 36.
    McCubbin, H. I., Thompson, A. I., & McCubbin, M. A. (1996). FIRM: Family inventory of resources for management. In Family assessment: Resiliency, coping and adaptation. Inventories for research and practice. Madison: University of Wisconsin Publishers.Google Scholar
  37. 37.
    Speechley, K. N., Sang, X., Levin, S., Zou, G. Y., Eliasziw, M., Smith, M. L., et al. (2008). Assessing severity of epilepsy in children: Preliminary evidence of validity and reliability of a single-item scale. Epilepsy & Behavior, 13(2), 337–342.CrossRefGoogle Scholar
  38. 38.
    Byrne, B. M. (2012). Structural equation modeling with Mplus: Basic concepts, applications, and programming. New York: Taylor & Francis Group, LLC.Google Scholar
  39. 39.
    Muthén, L. K., & Muthén, B. O. (2010). Mplus user’s guide (6th ed.). Los Angeles: Muthén & Muthén.Google Scholar
  40. 40.
    Singh, R. (2009). Does my structural model represent the real phenomenon? A review of the appropriate use of structural equation modeling (SEM) model fit indices. The Marketing Review, 9(3), 199–212.CrossRefGoogle Scholar
  41. 41.
    Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9(2), 233–255.CrossRefGoogle Scholar
  42. 42.
    Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88(3), 588–606.CrossRefGoogle Scholar
  43. 43.
    Hu, L., & Bentler, P. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3(4), 424–453.CrossRefGoogle Scholar
  44. 44.
    Yu, C. Y. (2002). Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes. Unpublished Dissertation, University of California, Los Angeles.Google Scholar
  45. 45.
    Rubin, D. B. (1987). Multiple imputation for nonresponse in surveys. New York: Wiley.CrossRefGoogle Scholar
  46. 46.
    Waters, E., Salmon, L., & Wake, M. (2000). The parent-form Child Health Questionnaire in Australia: Comparison of reliability, validity, structure, and norms. Journal of Pediatric Psychology, 25(6), 381–391.PubMedCrossRefGoogle Scholar
  47. 47.
    McCullough, N., Parkes, J., White-Koning, M., Beckung, E., & Colver, A. (2009). Reliability and validity of the Child Health Questionnaire PF-50 for European children with cerebral palsy. Journal of Pediatric Psychology, 34(1), 41–50.PubMedCrossRefGoogle Scholar
  48. 48.
    Vittinghoff, E., Glidden, D. V., Shiboski, S. C., & McCulloch, C. E. (2005). Regression methods in biostatistics. Linear, logistic, survival, and repeated measures models. New York: Springer.Google Scholar
  49. 49.
    Sherman, E. M., Slick, D. J., Connolly, M. B., & Eyrl, K. L. (2007). ADHD, neurological correlates and health-related quality of life in severe pediatric epilepsy. Epilepsia, 48(6), 1083–1091.PubMedCrossRefGoogle Scholar
  50. 50.
    Sherman, E. M., Slick, D. J., & Eyrl, K. L. (2006). Executive dysfunction is a significant predictor of poor quality of life in children with epilepsy. Epilepsia, 47(11), 1936–1942.PubMedCrossRefGoogle Scholar
  51. 51.
    Ronen, G. M., Streiner, D. L., Verhey, L. H., Lach, L., Boyle, M. H., Cunningham, C. E., et al. (2010). Disease characteristics and psychosocial factors: Explaining the expression of quality of life in childhood epilepsy. Epilepsy & Behavior, 18(1–2), 88–93.CrossRefGoogle Scholar
  52. 52.
    Ferro, M. A., Avison, W. R., Campbell, M. K., & Speechley, K. N. (2011). The impact of maternal depressive symptoms on health-related quality of life in children with epilepsy: A prospective study of family environment as mediators and moderators. Epilepsia, 52(2), 316–325.PubMedGoogle Scholar
  53. 53.
    Fastenau, P. S., Shen, J., Dunn, D. W., Perkins, S. M., Hermann, B. P., & Austin, J. K. (2004). Neuropsychological predictors of academic underachievement in pediatric epilepsy: Moderating roles of demographic, seizure, and psychosocial variables. Epilepsia, 45(10), 1261–1272.PubMedCrossRefGoogle Scholar
  54. 54.
    Rodenburg, R., Stams, G. J., Meijer, A. M., Aldenkamp, A. P., & Dekovic, M. (2005). Psychopathology in children with epilepsy: A meta-analysis. Journal of Pediatric Psychology, 30(6), 453–468.PubMedCrossRefGoogle Scholar
  55. 55.
    Austin, J. K., Perkins, S. M., Johnson, C. S., Fastenau, P. S., Byars, A. W., deGrauw, T. J., et al. (2010). Self-esteem and symptoms of depression in children with seizures: Relationships with neuropsychological functioning and family variables over time. Epilepsia, 51(10), 2074–2083.PubMedCrossRefGoogle Scholar
  56. 56.
    Smith, L., Coleman, V., & Bradshaw, M. (2002). Family-centred care. Concept, theory and practice. New York: Palgrave.Google Scholar
  57. 57.
    Law, M., Hanna, S., King, G., Hurley, P., King, S., Kertoy, M., et al. (2003). Factors affecting family-centred service delivery for children with disabilities. Child: Care, Health and Development, 29(5), 357–366.CrossRefGoogle Scholar
  58. 58.
    Ohya, Y., Williams, H., Steptoe, A., Saito, H., Iikura, Y., Anderson, R., et al. (2001). Psychosocial factors and adherence to treatment advice in childhood atopic dermatitis. The Journal of Investigative Dermatology, 117(4), 852–857.PubMedCrossRefGoogle Scholar
  59. 59.
    Brown, T. A. (2006). Confirmatory factor analysis for applied research. New York: The Guilford Press.Google Scholar
  60. 60.
    Marsh, H. W., Hau, K. T., & Wen, Z. (2004). In search of golden rules: comment on hypothesis-testing approaches to setting cutoff values for fit indices and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Structural Equation Modeling, 11(3), 320–341.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Mark A. Ferro
    • 1
  • Jeanne M. Landgraf
    • 2
  • Kathy N. Speechley
    • 3
    • 4
    • 5
  1. 1.Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child StudiesMcMaster UniversityHamiltonCanada
  2. 2.HealthActCHQ Inc.CambridgeUSA
  3. 3.Department of PaediatricsWestern UniversityLondonCanada
  4. 4.Department of Epidemiology and BiostatisticsWestern UniversityLondonCanada
  5. 5.Children’s Health Research InstituteWestern UniversityLondonCanada

Personalised recommendations