Abstract
Purpose
Health-related quality of life (HRQoL) may be helpful in identifying children at risk of developing adjustment problems. Few studies have focused on HRQoL among children of ill or substance abusing parents despite their considerable risk status. In the present study, we used the KIDSCREEN-27 to assess self-reported HRQoL in children and adolescents living in families with parental illness, or substance dependence. First, we tested whether the factor structure of the KIDSCREEN-27 was replicated in this population of children. Next, we examined differences in HRQoL according to age, gender, and type of parental illness. Finally, we compared levels of HRQoL in our sample to a normative reference population.
Method
Two hundred and forty-six children and adolescents aged 8–17 years and their ill parents participated. The construct validity of the KIDSCREEN-27 questionnaire was examined by confirmatory factor analysis (CFA). T-tests and ANOVA were used to test differences in HRQoL levels according to age, gender, and parental patient groups, and for comparisons with reference population.
Results
The KIDSCREEN-27 fit the theoretical five-factor model of HRQoL reasonably well. Boys and younger children reported significantly greater well-being on physical well-being, psychological well-being, and peers and social support, compared to girls and older children. Younger children also reported significantly greater well-being at school than did older children. There were no significant differences in HRQoL between groups of children living with different type of parental illness. The children in our sample reported their physical well-being significantly lower than the reference population.
Conclusion
The KIDSCREEN-27 questionnaire appears to work satisfactorily among children of ill or substance abusing parents.
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References
Barkmann, C., Romer, G., Watson, M., Schulte-Markwort, M. (2007). Parental physical illness as a risk for psychosocial maladjustment in children and adolescents: Epidemiological findings from a national survey in Germany. Psychosomatics: Journal of Consultation Liaison Psychiatry, 48, 476–481.
Berg-Nielsen, T. S., & Wichstrom, L. (2012). The mental health of preschoolers in a Norwegian population-based study when their parents have symptoms of borderline, antisocial, and narcissistic personality disorders: At the mercy of unpredictability. Child and Adolescent Psychiatry and Mental Health, 6, 19.
Bogosian, A., Moss-Morris, R., & Hadwin, J. (2010). Psychosocial adjustment in children and adolescents with a parent with multiple sclerosis: A systematic review. Clinical Rehabilitation, 24, 789–801.
Christoffersen, M. N., & Soothill, K. (2003). The long-term consequences of parental alcohol abuse: A cohort study of children in Denmark. Journal of Substance Abuse Treatment, 25, 107–116.
Connell, A. M., & Goodman, S. H. (2002). The association between psychopathology in fathers versus mothers and children’s internalizing and externalizing behavior problems: A meta-analysis. Psychological Bulletin, 128, 746–773.
Diareme, S., Tsiantis, J., Kolaitis, G., Ferentinos, S., Tsalamanios, E., Paliokosta, E., et al. (2006). Emotional and behavioural difficulties in children of parents with multiple sclerosis: A controlled study in Greece. European Child & Adolescent Psychiatry, 15, 309–318.
Evans, S., Keenan, T. R., & Shipton, E. A. (2007). Psychosocial adjustment and physical health of children living with maternal chronic pain. Journal of Paediatrics and Child Health, 43, 262–270.
Jeppesen, E., Bjelland, I., Fossa, S. D., Loge, J. H., Sorebo, O., & Dahl, A. A. (2014). Does a parental history of cancer moderate the associations between impaired health status in parents and psychosocial problems in teenagers: A HUNT study. Cancer Medicine, 3, 919–926.
Kelley, M. L., & Fals-Stewart, W. (2004). Psychiatric disorders of children living with drug-abusing, alcohol-abusing, and non-substance-abusing fathers. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 621–628.
Krattenmacher, T., Kuhne, F., Halverscheid, S., Wiegand-Grefe, S., Bergelt, C., Romer, G., et al. (2014). A comparison of the emotional and behavioral problems of children of patients with cancer or a mental disorder and their association with parental quality of life. Journal of Psychosomatic Research, 76, 213–220.
Osborne, C., & Berger, L. M. (2009). Parental substance abuse and child well-being: A consideration of parents’ gender and coresidence. Journal of Family Issues, 30, 341–370.
Ramchandani, P., & Psychogiou, L. (2009). Paternal psychiatric disorders and children’s psychosocial development. The Lancet, 374, 646–653.
Razaz, N., Nourian, R., Marrie, R. A., Boyce, W. T., & Tremlett, H. (2014). Children and adolescents adjustment to parental multiple sclerosis: A systematic review. BMC Neurology, 14, 107.
Sieh, D., Meijer, A., Oort, F., Visser-Meily, J., & Van der Leij, D. (2010). Problem behavior in children of chronically ill parents: A meta-analysis. Clinical Child and Family Psychology Review, 13, 384–397.
Visser, A., Huizinga, G. A., Hoekstra, H. J., Van Der Graaf, W. T., Klip, E. C., Pras, E., et al. (2005). Emotional and behavioural functioning of children of a parent diagnosed with cancer: A cross-informant perspective. Psychooncology, 14, 746–758.
The KIDSCREEN Group Europe. (2006). The KIDSCREEN Questionnaires—Quality of life questionnaires for children and adolescents. Handbook. Lengerich: Pabst Science Publishers.
Coker, T. R., Elliott, M. N., Wallander, J. L., Cuccaro, P., Grunbaum, J. A., Corona, R., et al. (2011). Association of family stressful life-change events and health-related quality of life in fifth-grade children. Archives of Pediatrics and Adolescent Medicine, 165, 354–359.
Krattenmacher, T., Kuhne, F., Ernst, J., Bergelt, C., Romer, G., & Moller, B. (2012). Parental cancer: Factors associated with children’s psychosocial adjustment-A systematic review. Journal of Psychosomatic Research, 72, 344–356.
Mayo, N. E. (2015). Dictionary of Quality of Life and Health Outcomes Measurement. 1st ed. International Society for Quality of Life Research, 3.
Bot, M., de Leeuw den Bouter, B., & Adriaanse, M. (2011). Prevalence of psychosocial problems in Dutch children aged 8–12 years and its association with risk factors and quality of life. Epidemiology and Psychiatric Sciences, 20, 357–365.
Ravens-Sieberer, U., Auquier, P., Erhart, M., Gosch, A., Rajmil, L., Bruil, J., et al. (2007). The KIDSCREEN-27 quality of life measure for children and adolescents: Psychometric results from a cross-cultural survey in 13 European countries. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 16, 1347–1356.
Ravens-Sieberer, U., Erhart, M., Gosch, A., & Wille, N. (2008). Mental health of children and adolescents in 12 European countries—Results from the European KIDSCREEN Study. Clinical Psychology & Psychotherapy, 15, 154–163.
Wallander, J. L., & Koot, H. M. (2016). Quality of life in children: A critical examination of concepts, approaches, issues, and future directions. Clinical Psychology Review, 45, 131–143.
Sun, R. C. F., & Shek, D. T. L. (2013). Longitudinal influences of positive youth development and life satisfaction on problem behaviour among adolescents in Hong Kong. Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, 114(3), 1171–1197.
Berra, S., Tebe, C., Esandi, M. E., & Carignano, C. (2013). Reliability and validity of the KIDSCREEN-52 questionnaire to measure health related quality of life in the 8 to 18 year-old Argentinean population. Archivos Argentinos de Pediatria, 111, 29–35.
Palacio-Vieira, J., Villalonga-Olives, E., Valderas, J., Espallargues, M., Herdman, M., Berra, S., et al. (2008). Changes in health-related quality of life (HRQoL) in a population-based sample of children and adolescents after 3 years of follow-up. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 17, 1207–1215.
World Health Organization. Health statistics and information systems; WHOQOL: Measuring quality of life. Retrieved from http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/.
Wallander, J. L., Schmitt, M., & Koot, H. M. (2001). Quality of life measurement in children and adolescents: Issues, instruments, and applications. Journal of Clinical Psychology, 57, 571–585.
Detmar, S., Bruil, J., Ravens-Sieberer, U., Gosch, A., & Bisegger, C. (2006). The use of focus groups in the development of the KIDSCREEN HRQL questionnaire. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 15, 1345–1353.
Robitail, S., Ravens-Sieberer, U., Simeoni, M.-C., Rajmil, L., Bruil, J., Power, M., et al. (2007). Testing the structural and cross-cultural validity of the KIDSCREEN-27 Quality of Life Questionnaire. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 16, 1335–1345.
Gotze, H., Ernst, J., Brahler, E., Romer, G., & von Klitzing, K. (2015). Predictors of quality of life of cancer patients, their children, and partners. Psychooncology, 24, 787–795.
Giannakopoulos, G., Dimitrakaki, C., Pedeli, X., Kolaitis, G., Rotsika, V., Ravens-Sieberer, U., et al. (2009). Adolescents’ wellbeing and functioning: relationships with parents’ subjective general physical and mental health. Health and Quality of Life Outcomes, 7, 100.
Cavallo, F., Zambon, A., Borraccino, A., Raven-Sieberer, U., Torsheim, T., & Lemma, P. (2006). Girls growing through adolescence have a higher risk of poor health. Quality of Life Research, 15, 1577–1585.
Meade, T., & Dowswell, E. (2015). Health-related quality of life in a sample of Australian adolescents: Gender and age comparison. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation. https://doi.org/10.1007/s11136-015-1033-4.
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. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 18, 1147–1157.
Bisegger, C., Cloetta, B., von Rueden, U., Abel, T., & Ravens-Sieberer, U. (2005). Health-related quality of life: gender differences in childhood and adolescence. Soz Praventivmed, 50, 281–291.
Kuhne, F., Krattenmacher, T., Bergelt, C., Ernst, J. C., Flechtner, H. H., Fuhrer, D., et al. (2012). Parental palliative cancer: Psychosocial adjustment and health-related quality of life in adolescents participating in a German family counselling service. BMC Palliative Care, 11, 21.
Morley, D., Selai, C., Schrag, A., Jahanshahi, M., & Thompson, A. (2011). Adolescent and adult children of parents with Parkinson’s Disease: Incorporating their needs in clinical guidelines. Parkinson’s Disease. https://doi.org/10.4061/2011/951874.
Dittrich, K., Fuchs, A., Bermpohl, F., Meyer, J., Führer, D., Reichl, C., et al. (2018). Effects of maternal history of depression and early life maltreatment on children’s health-related quality of life. Journal of Affect Disordorders, 1, 280–288.
Comiskey, C. M., Milnes, J., & Daly, M. (2017). Parents who use drugs: The well-being of parent and child dyads among people receiving harm reduction interventions for opiate use. Journal of Substance Use, 22, 206–210
Dam, K., & Hall, E. O. (2016). Navigating in an unpredictable daily life: A metasynthesis on children’s experiences living with a parent with severe mental illness. Scandinavian Journal of Caring Sciences. https://doi.org/10.1111/scs.12285.
Tebes, J., Kaufman, J., Adnopoz, J., & Racusin, G. (2001). Resilience and family psychosocial processes among children of parents with serious mental disorders. Journal of Child and Family Studies, 10(1), 115–136.
Berg-Nielsen, T. S., Vikan, A., & Dahl, A. A. (2002). Parenting related to child and parental psychopathology: A descriptive review of the literature. Clinical Child Psychology and Psychiatry, 7, 529–552.
Johnson, J. G., Cohen, P., Kasen, S., Ehrensaft, M. K., & Crawford, T. N. (2006). Associations of parental personality disorders and axis I disorders with childrearing behavior. Psychiatry: Interpersonal and Biological Processes, 69, 336–350.
Laulik, S., Chou, S., Browne, K. D., & Allam, J. (2013). The link between personality disorder and parenting behaviors: A systematic review. Aggression and Violent Behavior, 18, 644–655.
Stein, A., Ramchandani, P., Murray, L. (2008). Impact of parental psychiatric disorder and physical illness. In M. Rutter, D. Bishop, D. Pine, S. Scott, J. Stevenson, E. Taylor, & A. Thapar (Eds.), Rutter’s child and adolescent psychiatry (5th ed., pp 407–420) xv, 1230 pp. London: Wiley. (Reprinted 2010).
Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: From theory to practice. Social Work in Public Health, 28, 194–205.
Europe, T. K. G. (2006). The KIDSCREEN questionnaires: Quality of life questionnaires for children and adolescents. Lengerich: Pabst Science Publishers.
Ruud, T. B. B., Faugli, A., Amlund Hagen, K., Hellmann, A., Hilsen, M., Kallander, E. K., et al. (2015). Barn som pårørende—-Resultater fra en multisenterstudie. Lørenskog: Akershus universitetssykehus HF.
Andersen, J. R., Natvig, G. K., Haraldstad, K., Skrede, T., Aadland, E., & Resaland, G. K. (2016). Psychometric properties of the Norwegian version of the Kidscreen-27 questionnaire. Health and Quality of Life Outcomes, 14, 58.
Munthén, L. K. (1998–2015). MBO: Mplus User’s Guide. Seventh edition. Los Angeles, CA: Munthén & Munthén.
Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit Measures. Methods of psychological research online, 8, 23–74.
Ogden, T., & Hagen, K. A. (2014). Adolescent mental health: Prevention and intervention. New York: Taylor & Francis Group.
Benjet, C., & Hernandez-Guzman, L. (2001). Gender differences in psychological well-being of Mexican early adolescents. Adolescence, 36, 47–65.
Kayed, N. S., Jozefiak, T., Rimehaug, T., Tjelflaat, T., Brubakk, A. M., & Wickstrom, L. (2015). Resultater fra forskningsprosjektet psykisk helse hos barn og unge i barnevernsinstitusjoner. Trondheim: Norwegian University of Science and Technology.
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This study was funded by the Research Council of Norway (ID: 213477).
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All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Regional Committee on Medical and Health Research Ethics, South-East (ID: 2012/1176).
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Hagen, K.A., Hilsen, M., Kallander, E.K. et al. Health-related quality of life (HRQoL) in children of ill or substance abusing parents: examining factor structure and sub-group differences. Qual Life Res 28, 1063–1073 (2019). https://doi.org/10.1007/s11136-018-2067-1
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DOI: https://doi.org/10.1007/s11136-018-2067-1