Skip to main content

Advertisement

SpringerLink
Log in

Health-related quality of life in children with and without physical–mental multimorbidity

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

This study examined health-related quality of life (HRQL) in children across different physical illnesses; estimated parent–child agreement on HRQL reports; compared HRQL between children with and without physical–mental multimorbidity; and tested if multimorbidity was associated with HRQL.

Methods

Children aged 6–16 years (mean = 11.1; n = 198) with one physical illness and their parents were recruited from a pediatric hospital. Physical illnesses were classified according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10, mental illnesses were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents, and HRQL was measured using the KIDSCREEN-27. Children who screened positive for ≥ 1 mental illness were classified as having physical–mental multimorbidity. χ2/t tests compared sample characteristics of children with vs. without multimorbidity; Kruskal–Wallis tests compared KIDSCREEN-27 scores across ICD-10 categories; interclass correlation coefficients estimated parent–child agreement; and multiple regression examined effects of the number of mental illnesses on HRQL.

Results

HRQL was similar across ICD-10 categories. Parent–child agreement was fair to good for all HRQL domains, regardless of multimorbidity status. Parent-reported HRQL was significantly lower for children with multimorbidity compared to norms across all domains, whereas child-reported HRQL was significantly lower for physical well-being, psychological well-being, and school environment. Number of mental illnesses was negatively associated with psychological well-being and school environment in a dose–response manner.

Conclusion

Children with physical–mental multimorbidity are vulnerable to experiencing lower HRQL, particularly for psychological well-being and school environment. Longitudinal studies documenting trajectories of HRQL and school-based interventions that target these domains of HRQL for children with multimorbidity are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Van Cleave, J., Gortmaker, S. L., & Perrin, J. M. (2010). Dynamics of obesity and chronic health conditions among children and youth. JAMA, 303(7), 623–630.

    PubMed  Google Scholar 

  2. Silva, N., Pereira, M., Otto, C., Ravens-Sieberer, U., Canavarro, M. C., & Bullinger, M. (2019). Do 8- to 18-year-old children/adolescents with chronic physical health conditions have worse health-related quality of life than their healthy peers? A meta-analysis of studies using the KIDSCREEN questionnaires. Quality of Life Research, 28(7), 1725–1750.

    PubMed  Google Scholar 

  3. Tegethoff, M., Belardi, A., Stalujanis, E., & Meinlschmidt, G. (2015). Association between mental disorders and physical diseases in adolescents from a nationally representative cohort. Psychosomatic Medicine, 77(3), 319–332.

    PubMed  Google Scholar 

  4. Butler, A., Van Lieshout, R. J., Lipman, E. L., MacMillan, H. L., Gonzalez, A., Gorter, J. W., Georgiades, K., Speechley, K. N., Boyle, M. H., & Ferro, M. A. (2018). Mental disorder in children with physical conditions: A pilot study. British Medical Journal Open, 8(1), e019011.

    Google Scholar 

  5. Fleming, M., Salim, E. E., Mackay, D. F., Henderson, A., Kinnear, D., Clark, D., King, A., McLay, J. S., Cooper, S. A., & Pell, J. P. (2020). Neurodevelopmental multimorbidity and educational outcomes of Scottish schoolchildren: A population-based record linkage cohort study. PLoS Medicine, 17(10), e1003290.

    PubMed  PubMed Central  Google Scholar 

  6. Barker, M. M., Beresford, B., Bland, M., & Fraser, L. K. (2019). Prevalence and incidence of anxiety and depression among children, adolescents, and young adults with life-limiting conditions: A systematic review and meta-analysis. JAMA Pediatrics, 173, 835–844.

    PubMed  PubMed Central  Google Scholar 

  7. Merikangas, K. R., Calkins, M. E., Burstein, M., He, J. P., Chiavacci, R., Lateef, T., Ruparel, K., Gur, R. C., Lehner, T., Hakonarson, H., & Gur, R. E. (2015). Comorbidity of physical and mental disorders in the neurodevelopmental genomics cohort study. Pediatrics, 135(4), e927-938.

    PubMed  PubMed Central  Google Scholar 

  8. Thurston, S., Paul, L., Loney, P., Wong, M., & Browne, G. (2010). The quality of life of a multidiagnosis group of special needs children: associations and costs. International Journal of Pediatrics. https://doi.org/10.1155/2010/940101

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ow, N., Appau, A., Matout, M., & Mayo, N. E. (2021). What is QOL in children and adolescents with physical disabilities? A thematic synthesis of pediatric QOL literature. Quality of Life Research, 30, 1233–1248.

    PubMed  Google Scholar 

  10. 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.

    PubMed  Google Scholar 

  11. Ravens-Sieberer, U., Erhart, M., Wille, N., Wetzel, R., Nickel, J., & Bullinger, M. (2006). Generic health-related quality-of-life assessment in children and adolescents: Methodological considerations. PharmacoEconomics, 24(12), 1199–1220.

    PubMed  Google Scholar 

  12. Ravens-Sieberer, U., Herdman, M., Devine, J., Otto, C., Bullinger, M., Rose, M., & Klasen, F. (2014). The European KIDSCREEN approach to measure quality of life and well-being in children: Development, current application, and future advances. Quality of Life Research, 23(3), 791–803.

    PubMed  Google Scholar 

  13. Bai, G., Herten, M. H., Landgraf, J. M., Korfage, I. J., & Raat, H. (2017). Childhood chronic conditions and health-related quality of life: Findings from a large population-based study. PLoS ONE, 12(6), e0178539.

    PubMed  PubMed Central  Google Scholar 

  14. Weitkamp, K., Daniels, J., Rosenthal, S., Romer, G., & Wiegand-Grefe, S. (2013). Health-related quality of life: Cross-informant agreement of father, mother, and self-report for children and adolescents in outpatient psychotherapy treatment. Child and Adolescent Mental Health, 18(2), 88–94.

    PubMed  Google Scholar 

  15. Jonsson, U., Alaie, I., Lofgren Wilteus, A., Zander, E., Marschik, P. B., Coghill, D., & Bolte, S. (2017). Annual Research Review: Quality of life and childhood mental and behavioural disorders—A critical review of the research. Journal of Child Psychology and Psychiatry, 58(4), 439–469.

    PubMed  Google Scholar 

  16. Freire, T., & Ferreira, G. (2018). Health-related quality of life of adolescents: Relations with positive and negative psychological dimensions. International Journal of Adolescence and Youth, 23(1), 11–24.

    Google Scholar 

  17. Ferro, M. A., Lipman, E. L., Van Lieshout, R. J., Boyle, M. H., Gorter, J. W., MacMillan, H. L., Gonzalez, A., & Georgiades, K. (2019). Mental-physical multimorbidity in youth: Associations with individual, family, and health service use outcomes. Child Psychiatry and Human Development, 50(3), 400–410.

    CAS  PubMed  Google Scholar 

  18. De Civita, M., Regier, D., Alamgir, A. H., Anis, A. H., Fitzgerald, M. J., & Marra, C. A. (2005). Evaluating health-related quality-of-life studies in paediatric populations: Some conceptual, methodological and developmental considerations and recent applications. PharmacoEconomics, 23(7), 659–685.

    PubMed  Google Scholar 

  19. Berman, A. H., Liu, B., Ullman, S., Jadback, I., & Engstrom, K. (2016). Children’s quality of life based on the KIDSCREEN-27: Child self-report, parent ratings and child-parent agreement in a swedish random population sample. PLoS ONE, 11(3), e0150545.

    PubMed  PubMed Central  Google Scholar 

  20. Hemmingsson, H., Olafsdottir, L. B., & Egilson, S. T. (2017). Agreements and disagreements between children and their parents in health-related assessments. Disability and Rehabilitation, 39(11), 1059–1072.

    PubMed  Google Scholar 

  21. Oltean, I. I., & Ferro, M. A. (2019). Agreement of child and parent-proxy reported health-related quality of life in children with mental disorder. Quality of Life Research, 28(3), 703–712.

    PubMed  Google Scholar 

  22. Qadeer, R. A., & Ferro, M. A. (2018). Child–parent agreement on health-related quality of life in children with newly diagnosed chronic health conditions: A longitudinal study. International Journal of Adolescence and Youth, 23(1), 99–108.

    Google Scholar 

  23. Upton, P., Lawford, J., & Eiser, C. (2008). Parent-child agreement across child health-related quality of life instruments: A review of the literature. Quality of Life Research, 17(6), 895–913.

    PubMed  Google Scholar 

  24. Pinquart, M. (2020). Health-related quality of life of young people with and without chronic conditions. Journal of Pediatric Psychology, 45(7), 780–792.

    PubMed  Google Scholar 

  25. Ravens-Sieberer, U., Auquier, P., Erhart, M., Gosch, A., Rajmil, L., Bruil, J., Power, M., Duer, W., Cloetta, B., Czemy, L., Mazur, J., Czimbalmos, A., Tountas, Y., Hagquist, C., Kilroe, J., & European, K. G. (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, 16(8), 1347–1356.

    Google Scholar 

  26. Tompke, B. K., Tang, J., Oltean, I. I., Buchan, M. C., Reaume, S. V., & Ferro, M. A. (2020). Measurement invariance of the WHODAS 2.0 across youth with and without physical or mental conditions. Assessment, 27(7), 1490–1501.

    PubMed  Google Scholar 

  27. Ferro, M. A., Lipman, E. L., Van Lieshout, R. J., Gorter, J. W., Shanahan, L., Boyle, M., Georgiades, K., & Timmons, B. (2019). Multimorbidity in children and youth across the life-course (MY LIFE): Protocol of a Canadian prospective study. British Medical Journal Open, 9(11), e034544.

    Google Scholar 

  28. Ferro, M. A., Lipman, E. L., Van Lieshout, R. J., Timmons, B., Shanahan, L., Gorter, J. W., Georgiades, K., & Boyle, M. (2021). Cohort profile: Multimorbidity in children and youth across the life-course (MY LIFE) study. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 30(2), 104–115.

    PubMed  PubMed Central  Google Scholar 

  29. Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E., Milo, K. M., Stock, S. L., & Wilkinson, B. (2010). Reliability and validity of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). Journal of Clinical Psychiatry, 71(3), 313–326.

    Google Scholar 

  30. Duncan, L., Boyle, M., Ferro, M. A., Georgiades, K., Van Lieshout, R. J., Bennett, K., Janus, M., Lipman, E., MacMillan, H., & Szatmari, P. (2018). Psychometric evaluation of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Psychological Assessment, 30(7), 916–928.

    PubMed  Google Scholar 

  31. McDonald, E., Whitney, S., Horricks, L., Lipman, E. L., & Ferro, M. A. (2021). Parent-child agreement on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Journal of the Canadian Academy of Child and Adolescent Psychiatry. In press.

  32. Reaume, S. V., & Ferro, M. A. (2019). Chronicity of mental comorbidity in children with new-onset physical illness. Child: Care, Health and Development, 45(4), 559–567.

    Google Scholar 

  33. Tompke, B. K., & Ferro, M. A. (2021). Measurement invariance and informant discrepancies of the KIDSCREEN-27 in children with mental disorder. Applied Research in Quality of Life, 16, 891–910.

    Google Scholar 

  34. Ortiz-Pinto, M. A., Ortiz-Marron, H., Rodriguez-Rodriguez, A., Casado-Sanchez, L., Cuadrado-Gamarra, J. I., & Galan, I. (2020). Parental perception of child health status and quality of life associated with overweight and obesity in early childhood. Quality of Life Research, 29(1), 163–170.

    PubMed  Google Scholar 

  35. Ellersgaard, D., Gregersen, M., Ranning, A., Haspang, T. M., Christiani, C., Hemager, N., Burton, B. K., Spang, K. S., Sondergaard, A., Greve, A., Gantriis, D., Jepsen, J. R. M., Mors, O., Plessen, K. J., Nordentoft, M., & Thorup, A. A. E. (2020). Quality of life and self-esteem in 7-year-old children with familial high risk of schizophrenia or bipolar disorder: The Danish High Risk and Resilience Study-VIA 7-a population-based cohort study. European Child and Adolescent Psychiatry, 29(6), 849–860.

    PubMed  Google Scholar 

  36. Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., Wei, R., Curtin, L. R., Roche, A. F., & Johnson, C. L. (2002). 2000 CDC growth charts for the United States: Methods and development. Vital Health Statistics, 11(246), 1–190.

    Google Scholar 

  37. Bain, S. K., & Jaspers, K. E. (2010). Kaufman Brief Intelligence Test, 2nd edition. Journal of Psychoeducational Assessment, 28(2), 167–174.

    Google Scholar 

  38. Üstün, T. B., Kostanjsek, N., Chatterji, S., & Rehm, J. (2010). Measuring health and disability: manual for WHO Disability Assessment Schedule: WHODAS 2.0. Geneva: World Health Organization.

    Google Scholar 

  39. Kimber, M., Rehm, J., & Ferro, M. A. (2015). Measurement invariance of the WHODAS 2.0 in a population-based sample of youth. PLoS ONE, 10(11), e0142385.

    PubMed  PubMed Central  Google Scholar 

  40. Canino, G. J., Fisher, P. W., Alegria, M., & Bird, H. R. (2013). Assessing child impairment in functioning in different contexts: Implications for use of services and the classification of psychiatric disorders. Open Journal of Medical Psychology, 2(1), 29–34.

    Google Scholar 

  41. Federici, S., Bracalenti, M., Meloni, F., & Luciano, J. V. (2017). World Health Organization disability assessment schedule 2.0: An international systematic review. Disability and Rehabilitation, 39(23), 2347–2380.

    PubMed  Google Scholar 

  42. McDonald, E. (2021). Psychometric properties and informant agreement of the WHODAS 2.0 in youth with mental disorder and their parents. Canada: University of Waterloo.

    Google Scholar 

  43. Cicchetti, D. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6(4), 284–290.

    Google Scholar 

  44. Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41(5), 582–592.

    PubMed  Google Scholar 

  45. Rothman, K. J. (1990). No adjustments are needed for multiple comparisons. Epidemiology, 1(1), 43–46.

    CAS  PubMed  Google Scholar 

  46. Moreira, H., Carona, C., Silva, N., Frontini, R., Bullinger, M., & Canavarro, M. C. (2013). Psychological and quality of life outcomes in pediatric populations: A parent-child perspective. Journal of Pediatrics, 163(5), 1471–1478.

    Google Scholar 

  47. Ingerski, L. M., Modi, A. C., Hood, K. K., Pai, A. L., Zeller, M., Piazza-Waggoner, C., Driscoll, K. A., Rothenberg, M. E., Franciosi, J., & Hommel, K. A. (2010). Health-related quality of life across pediatric chronic conditions. Journal of Pediatrics, 156(4), 639–644.

    Google Scholar 

  48. Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007). Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 Generic Core Scales. Health Quality Life Outcomes, 5, 43.

    Google Scholar 

  49. Georgiades, K., Duncan, L., Wang, L., Comeau, J., Boyle, M. H., & Ontario Child Health Study, T. (2019). Six-month prevalence of mental disorders and service contacts among children and youth in Ontario: Evidence from the 2014 Ontario Child Health Study. Canadian Journal of Psychiatry, 64(4), 246–255.

    Google Scholar 

  50. Ackard, D. M., Neumark-Sztainer, D., Story, M., & Perry, C. (2006). Parent-child connectedness and behavioral and emotional health among adolescents. American Journal of Preventive Medicine, 30(1), 59–66.

    PubMed  Google Scholar 

  51. Ronen, G. M., Rosenbaum, P. L., Boyle, M. H., & Streiner, D. L. (2018). Patient-reported quality of life and biopsychosocial health outcomes in pediatric epilepsy: An update for healthcare providers. Epilepsy & Behavior, 86, 19–24.

    Google Scholar 

  52. Otto, C., Haller, A. C., Klasen, F., Holling, H., Bullinger, M., Ravens-Sieberer, U., & BELLA Study Group. (2017). Risk and protective factors of health-related quality of life in children and adolescents: Results of the longitudinal BELLA study. PLoS ONE, 12(12), e0190363.

    PubMed  PubMed Central  Google Scholar 

  53. Barthel, D., Ravens-Sieberer, U., Nolte, S., Thyen, U., Klein, M., Walter, O., Meyrose, A. K., Rose, M., & Otto, C. (2018). Predictors of health-related quality of life in chronically ill children and adolescents over time. Journal of Psychosomatic Research, 109, 63–70.

    CAS  PubMed  Google Scholar 

  54. Lum, A., Wakefield, C. E., Donnan, B., Burns, M. A., Fardell, J. E., & Marshall, G. M. (2017). Understanding the school experiences of children and adolescents with serious chronic illness: A systematic meta-review. Child: Care, Health and Development, 43(5), 645–662.

    CAS  Google Scholar 

  55. Kutash, K., Duchnowski, A. J., & Lynn, N. (2006). School-based mental health: An empirical guide for decision-makers. University of South Florida.

    Google Scholar 

  56. Conroy, K., Greif Green, J., Phillips, K., Poznanski, B., Coxe, S., Kendall, P. C., & Comer, J. S. (2020). School-based accommodations and supports for anxious youth: Benchmarking reported practices against expert perspectives. Journal of Clinical Child and Adolescent Psychology, 20, 1–9.

    Google Scholar 

  57. Green, J. G., Comer, J. S., Donaldson, A. R., Elkins, R. M., Nadeau, M. S., Reid, G., & Pincus, D. B. (2017). School functioning and use of school-based accommodations by treatment-seeking anxious children. Journal of Emotional and Behavioural Disorders, 25(4), 220–232.

    Google Scholar 

  58. Dovgan, K., & Mazurek, M. O. (2019). Impact of multiple co-occurring emotional and behavioural conditions on children with autism and their families. Journal of Applied Research in Intellectual Disabilities, 32(4), 967–980.

    PubMed  Google Scholar 

  59. Finning, K., Ford, T., Moore, D. A., & Ukoumunne, O. C. (2020). Emotional disorder and absence from school: Findings from the 2004 British Child and Adolescent Mental Health Survey. European Child and Adolescent Psychiatry, 29(2), 187–198.

    PubMed  Google Scholar 

  60. Lawrence, D., Dawson, V., Houghton, S., Goodsell, B., & Sawyer, M. G. (2019). Impact of mental disorders on attendance at school. Australian Journal of Education, 63(1), 5–21.

    Google Scholar 

  61. Bravo, L., Killela, M. K., Reyes, B. L., Santos, K. M. B., Torres, V., Huang, C. C., & Jacob, E. (2020). Self-management, self-efficacy, and health-related quality of life in children with chronic illness and medical complexity. Journal of Pediatric Health Care, 34(4), 304–314.

    PubMed  PubMed Central  Google Scholar 

  62. Taylor, R. D., Oberle, E., Durlak, J. A., & Weissberg, R. P. (2017). Promoting positive youth development through school-based social and emotional learning interventions: A meta-analysis of follow-up effects. Child Development, 88(4), 1156–1171.

    PubMed  Google Scholar 

  63. Green, J. G., Levine, R. S., Oblath, R., Corriveau, K. H., Holt, M. K., & Albright, G. (2020). Pilot evaluation of preservice teacher training to improve preparedness and confidence to address student mental health. Evidence-Based Practice in Child and Adolescent Mental Health, 5(1), 42–52.

    Google Scholar 

  64. Sajobi, T. T., Speechley, K. N., Liang, Z., Goodwin, S. W., Ferro, M. A., & Wiebe, S. (2017). Response shift in parents’ assessment of health-related quality of life of children with new-onset epilepsy. Epilepsy & Behavior, 75, 97–101.

    Google Scholar 

  65. Brinksma, A., Tissing, W. J., Sulkers, E., Kamps, W. A., Roodbol, P. F., & Sanderman, R. (2014). Exploring the response shift phenomenon in childhood patients with cancer and its effect on health-related quality of life. Oncology Nursing Forum, 41(1), 48–56.

    PubMed  Google Scholar 

  66. Martire, L. M., & Helgeson, V. S. (2017). Close relationships and the management of chronic illness: Associations and interventions. American Psychologist, 72(6), 601–612.

    Google Scholar 

  67. Menrath, I., Ernst, G., Lange, K., Eisemann, N., Szczepanski, R., Staab, D., Degner, M., Thyen, U., & Modu, S. S. G. (2019). Evaluation of a generic patient education program in children with different chronic conditions. Health Education Research, 34(1), 50–61.

    PubMed  Google Scholar 

  68. Lum, A., Wakefield, C. E., Donnan, B., Burns, M. A., Fardell, J. E., Jaffe, A., Kasparian, N. A., Kennedy, S. E., Leach, S. T., Lemberg, D. A., & Marshall, G. M. (2019). School students with chronic illness have unmet academic, social, and emotional school needs. School Psychology, 34(6), 627–636.

    PubMed  Google Scholar 

  69. Kern, L., Mathur, S. R., Albrecht, S. F., Poland, S., Rozalski, M., & Skiba, R. J. (2017). The need for school-based mental health services and recommendations for implementation. School Mental Health, 9(3), 205–217.

    Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge the children, parents, and health professionals and their staff at McMaster Children’s Hospital without whose participation this study would not have been possible. We especially thank Jessica Zelman, Robyn Wojicki, and Charlene Attard for coordinating the study and Melissa Elgie and Sophie Rosen for assisting with data collection. Thank you to Serafina Abbruzzese for providing important insights related to school-based accommodations for children.

Funding

This study was funded by the Canadian Institutes of Health Research (PJT-148602). Dr. Ferro holds the Canada Research Chair in Youth Mental Health and the Early Researcher Award from the Ministry of Research, Innovation, and Science.

Author information

Authors and Affiliations

  1. School of Public Health Sciences, University of Waterloo, Waterloo, Canada

    Mark A. Ferro & Saad A. Qureshi

  2. Jacobs Center for Productive Youth Development & Department of Psychology, University of Zurich, Zurich, Switzerland

    Lilly Shanahan

  3. Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Christiane Otto & Ulrike Ravens-Sieberer

Authors
  1. Mark A. Ferro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Saad A. Qureshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lilly Shanahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christiane Otto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ulrike Ravens-Sieberer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MAF conceptualized and designed the study, coordinated and supervised data collection, supervised the analysis, and reviewed and revised the manuscript. SAQ conducted the initial analysis, drafted the initial manuscript, and reviewed and revised the manuscript. LS, CO, and URS revised the manuscript and critically reviewed it for important intellectual content. All authors approved the final manuscript.

Corresponding author

Correspondence to Mark A. Ferro.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.

Ethical approval

MY LIFE received ethical approval from the University of Waterloo Human Research Ethics Board (ORE-22183) and the Hamilton Integrated Research Ethics Board (2797).

Informed consent

All participants 16 years and older provided informed consent, children 7–15 provided assent, and children 6 and younger were consented by their parents.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferro, M.A., Qureshi, S.A., Shanahan, L. et al. Health-related quality of life in children with and without physical–mental multimorbidity. Qual Life Res 30, 3449–3461 (2021). https://doi.org/10.1007/s11136-021-02963-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-021-02963-6

Keywords

Search

Navigation