Abstract
PurposeTo examine the relationships between physical health problems, and borderline or clinical levels of mental health symptoms and children’s health-related quality of life (HRQoL).MethodsData were from the Longitudinal Study of Australian Children (2004–2018). Parents reported on their child’s HRQoL (PedsQL), physical health problems and mental health symptoms (Strengths and Difficulties Questionnaire, SDQ). A pooled cross-sectional analysis using linear regressions examined the relationships between physical health and clinical/borderline mental health symptoms, individually and when multi-morbid, and children’s HRQoL, and whether these relationships vary by a range of child, family and social factors.ResultsThe sample comprised 47,567 observations of children aged 4–17 years. Borderline and clinical levels of mental health symptoms were associated with significantly lower HRQoL, equal to more than two-times (10.5 points) and more than three-times (16.8 points) the clinically meaningful difference, respectively. This was a larger difference than that associated with physical health problems (4.4 points). We found a significant interaction effect between physical health problems and clinical mental health symptoms which was associated with even poorer HRQoL after accounting for the individual relationships of both problems. Mental health problems were associated with poorer HRQoL for older versus younger children; and the interaction effect was significant for boys but not girls.ConclusionFindings highlight the importance of identifying and addressing mental health symptoms in children of all ages, even if these problems do not meet formal clinical criteria. Particular attention should be paid to the mental health and HRQoL of children with physical–mental multimorbidity, who are at risk of disproportionately poorer HRQoL.
Highlights
It has been suggested that quality of life is the “universal outcome towards which all our efforts regarding children should be directed [1].” there has been a shift in focus from quantity of life years towards the quality of those years
The interaction effect was significant for boys only, meaning that boys with physical–mental multimorbidity are at particular risk of disproportionately poorer health-related quality of life (HRQoL) than boys with either mental or physical health problems alone
In line with previous research we found children with clinical levels of mental health symptoms have poorer HRQoL than children with physical health problems [9, 12,13,14], and that greater mental health problems are associated with poorer HRQoL [18,19,20]
Summary
It has been suggested that quality of life is the “universal outcome towards which all our efforts regarding children should be directed [1].” there has been a shift in focus from quantity of life years towards the quality of those years. In Australia, 60–72% of children aged 2–15 years are experiencing an ongoing health condition; commonly obesity, asthma, and eczema [3] or mental health conditions such as Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety disorders and depression [4]. These physical and mental health problems frequently co-occur [5, 6], defined as physical–mental multimorbidity [7], our understanding of the quality of life of children with physical–mental multimorbidity remains limited in comparison to our understanding in adults [6]. Fewer studies have examined HRQoL in children with mental health conditions, but results show poorer HRQoL both compared to their healthy peers [10, 11], and to those with physical health problems [9, 12,13,14]
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