Background: The upsurge of interest in the quality of life (QOL) of children is in line with the 1989 Convention on the Rights of the Child, which stressed the child's right to adequate circumstances for physical, mental, and social development. The study's objectives were to: (i) highlight how satisfied Kuwaiti high school students were with life circumstances as in the WHOQOL-Bref; (ii) assess the prevalence of at risk status for impaired QOL and establish the QOL domain normative values; and (iii) examine the relationship of QOL with personal, parental, and socio-environmental factors.
Method: A nation-wide sample of students in senior classes in government high schools (N = 4467, 48.6% boys; aged 14-23 years) completed questionnaires that included the WHOQOL-Bref.
Results: Using Cummins' norm of 70% - 80%, we found that, as a group, they barely achieved the well-being threshold score for physical health (70%), social relations (72.8%), environment (70.8%) and general facet (70.2%), but not for psychological health (61.9%). These scores were lower than those reported from other countries. Using the recommended cut-off of <1SD of population mean, the prevalence of at risk status for impaired QOL was 12.9% - 18.8% (population age-adjusted: 15.9% - 21.1%). In all domains, boys had significantly higher QOL than girls, mediated by anxiety/depression; while the younger ones had significantly higher QOL (p < 0.001), mediated by difficulty with studies and social relations. Although poorer QOL was significantly associated with parental divorce and father's low socio-economic status, the most important predictors of poorer QOL were perception of poor emotional relationship between the parents, poor self-esteem and difficulty with studies.
Conclusion: Poorer QOL seemed to reflect a circumstance of social disadvantage and poor psychosocial well-being in which girls fared worse than boys. The findings indicate that programs that address parental harmony and school programs that promote study-friendly atmospheres could help to improve psychosocial well-being. The application of QOL as a school population health measure may facilitate risk assessment and the tracking of health status.
Pal DK. Quality of life assessment in children: a review of conceptual and methodological issues in multidimensional health status measures. J Epidemiol Community Health. 1996;50:391–396. doi: 10.1136/jech.50.4.391. - DOI - PMC - PubMed
Center for Human Rights; United Nations. Convention on the Rights of the Child. Geneva: United Nations; 1989.
Vingilis ER, Wade TJ, Seeley JS. Predictors of adolescent self-rated health. Analysis of the National Population Health Survey. Can J Public Health. 2002;93:193–197. - PMC - PubMed
Varni JW, Burwinkle TM, Seid M. The PedsQL™ 4.0 as a school population health measure: feasibility, reliability and validity. Qual Life Res. 2006;15:203–215. doi: 10.1007/s11136-005-1388-z. - DOI - PubMed
Simon AE, Chan KS, Forrest CB. Assessment of children's health-related quality of life in the United States with a multidimensional index. Pediatrics. 2008;121:e118–e126. doi: 10.1542/peds.2007-0480. - DOI - PubMed
Kim HK, Viner-Brown SI, Garcia J. Children's mental health and family functioning in Rhode Island. Pediatrics. 2007;119:S22–S28. doi: 10.1542/peds.2006-2089E. - DOI - PubMed
Pantzer K, Rajmil L, Tebe C, Codina F, Serra-Sutton V, Ferrer M, Ravens-Sieberer U, Simeoni M-C, Alonso J. Health-related quality of life in immigrants and native school aged adolescents in Spain. J Epidemiol Community Health. 2006;60:694–698. doi: 10.1136/jech.2005.044073. - DOI - PMC - PubMed
Mansour ME, Kotagal U, Rose B, Ho M, Brewer D, Roy-Chaudhury A, Hornung RW, Wade TJ, DeWitt TG. Health-related quality of life in urban elementary school children. Pediatrics. 2003;111:1372–1381. doi: 10.1542/peds.111.6.1372. - DOI - PubMed
Felder-Puig R, Baumgartner M, Topf R, Gadner H, Formann AK. Health-related quality of life in Austrian elementary school children. Med Care. 2008;46:432–439. doi: 10.1097/MLR.0b013e3181648e95. - DOI - PubMed
Gkoltsiou K, Dimitrakaki C, Tzavara C, Papaevangelou V, Varni JW, Tountas Y. Measuring health-related quality of life in Greek children: psychometric properties of the Greek version of the Pediatric Quality of Life Inventory(TM) 4.0 Generic Core Scales. Qual Life Res. 2008;17:299–305. doi: 10.1007/s11136-007-9294-1. - DOI - PubMed
Collier J, MacKinlay D, Phillips D. Norm values for the Generic Children's Quality of Life measure from a large school-based sample. Qual Life Res. 2000;9:617–623. doi: 10.1023/A:1008915700210. - DOI - PubMed
Kook SH, Varni JW. Validation of the Korean version of the pediatric quality of life inventory 4.0 (PedsQL) generic core scales in school children and adolescents using the Rasch model. Health Qual Life Outcomes. 2008;6:41. doi: 10.1186/1477-7525-6-41. - DOI - PMC - PubMed
Jirojanakul P, Skevington SM, Hudson J. Predicting young children's quality of life. Soc Sci Med. 2003;57:1277–1288. doi: 10.1016/S0277-9536(02)00507-5. - DOI - PubMed
Chen X, Origasa H, Ichida F, Kamibeppu K, Varni JW. Reliability and validity of the Pediatric Quality of Life Inventory (PedsQL) Short Form 15 Generic Core Scales in Japan. Qual Life Res. 2007;16:1239–1249. doi: 10.1007/s11136-007-9230-4. - DOI - PubMed
Klatchoian DA, Len CA, Terreri MT, Silva M, Itamoto C, Ciconelli RM, Varni JW, Hilário MO. Quality of life of children and adolescents from São Paulo: reliability and validity of the Brazilian version of the Pediatric Quality of Life Inventory version 4.0 Generic Core Scales. J Pediatr (Rio J) 2008;84:308–315. - PubMed
Amiri P, Ardekani ME, Jalali-Farahani S, Hosseinpanah F, Varni JW, Ghofranipour F, Montazeri A, Azizi F. Reliability and validity of the Iranian version of the Pediatric Quality of Life Inventory 4.0 Generic Core Scales in adolescents. Qual Life Res. 2010. - PubMed
Abdel-Khalek AM. Quality of life, subjective well-being and religiosity in Muslim college students. Qual Life Res. 2010. - PubMed
Matza LS, Swensen AR, Flood EM, Secnik K, Leidy NK. Assessment of health-related quality of life in children: a review of conceptual, methodological, and regulatory issues. Value Health. 2004;7:79–92. doi: 10.1111/j.1524-4733.2004.71273.x. - DOI - PubMed
Frisen A. Measuring health-related quality of life in adolescence. Acta Paediatr. 2007;96:963–968. doi: 10.1111/j.1651-2227.2007.00333.x. - DOI - PubMed
Schlarmann JG, Metzing-Blau S, Schnep W. The use of health-related quality of life in children and adolescents as an outcome criterion to evaluate family oriented support for young carers in Germany: an integrative review of the literature. BMC Public Health. 2008;8:414. doi: 10.1186/1471-2458-8-414. - DOI - PMC - PubMed
Ravens-Sieberer U, Erhart M, Wille N, Wetzel R, Nickel J, Bullinger M. Generic health-related quality-of-life assessment in children and adolescents: methodological considerations. Pharmacoeconomics. 2006;24:1199–1220. doi: 10.2165/00019053-200624120-00005. - DOI - PubMed
De Civita M, Regier D, Alamgir AH, Anis AH, Fitzgerald MJ, Marra CA. Evaluating health-related quality-of-life studies in paediatric populations: some conceptual, methodological and developmental considerations and recent applications. Pharmacoeconomics. 2005;23:659–685. doi: 10.2165/00019053-200523070-00003. - DOI - PubMed
Coons SJ, Rao S, Keininger DL, Hays RD. A comparative review of generic quality of life instruments. Pharmacoeconomics. 2000;17:13–35. doi: 10.2165/00019053-200017010-00002. - DOI - PubMed
Davis E, Waters E, Mackinnon A, Reddihough D, Graham HK, Mehmet-Radji O, Boyd R. Paediatric quality of life instruments: a review of the impact of the conceptual framework on outcomes. Dev Med Child Neurol. 2006;48:311–318. doi: 10.1017/S0012162206000673. - DOI - PubMed
Skevington SM, Lofty M, O'Connell KA. The World Health Organization's WHOQOL-Bref quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13:299–310. - PubMed
Leplege A, Hunt S. The problem of quality of life in medicine. JAMA. 1997;278:47–50. doi: 10.1001/jama.278.1.47. - DOI - PubMed
Cummins RA. Moving from the quality of life concept to a theory. J Intellectual Disability Res. 2005;49:699–706. doi: 10.1111/j.1365-2788.2005.00738.x. - DOI - PubMed
Cummins RA, Lau ALD, Stokes M. HRQOL and subjective well-being: non-complimentary forms of outcome measurement. Expert Rev Pharmacoeconomics Outcomes Res. 2004;4:413–420. doi: 10.1586/14737167.4.4.413. - DOI - PubMed
Moons P, Budts W, De Geest S. Critique on the conceptualisation of quality of life: a review and evaluation of different conceptual approaches. International J Nurs Stud. 2006;43:891–901. doi: 10.1016/j.ijnurstu.2006.03.015. - DOI - PubMed
Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL™ 4.0 as a pediatric population health measure: feasibility, reliability and validity. Amb Pediatr. 2003;3:329–341. doi: 10.1367/1539-4409(2003)003<0329:TPAAPP>2.0.CO;2. - DOI - PubMed
Ohaeri JU, Awadalla AW, Gado OM. Subjective quality of life in a nationwide sample of Kuwaiti subjects using the short version of the WHO quality of life instrument. Soc Psychiatry Psychiatr Epidemiol. 2009;44:693–701. doi: 10.1007/s00127-008-0477-z. - DOI - PubMed
Wille N, Bettge S, Wittchen H-U, Ravens-Sieberger U. the BELLA study group. How impaired are children and adolescents by mental health problems? Results of the BELLA study. Eur Child Adolesc Psychiatry. 2008;Suppl 1(17):42–51. - PMC - PubMed
Varni JW, Burwinkle TM, Lane MM. Health-related quality of life measurement in pediatric clinical practice: an appraisal and precept for future research and application. Health Qual Outcomes. 2005;3(34) - PMC - PubMed
Katschnig H. In: Quality of life in mental disorders. Katschnig H, Freeman H, Sartorius N, editor. John Wiley & Sons Ltd, West Sussex, England; 2006. How useful is the concept of quality of life in psychiatry? p. 6.
Ohaeri JU, Awadalla AW, El-Abassi AH, Jacob A. Confirmatory factor analytical study of the WHOQOL-Bref: experience with Sudanese general population and psychiatric samples. BMC Med Res Methodol. 2007;7:37. doi: 10.1186/1471-2288-7-37. - DOI - PMC - PubMed
Ohaeri JU, Awadalla AW. The reliability and validity of the short version of the WHO Quality of Life Instrument in an Arab general population. Ann Saudi Med. 2009;29:98–104. doi: 10.4103/0256-4947.51790. - DOI - PMC - PubMed
Warner R. The emics and etics of quality of life assessment. Soc Psychiatry Psychiatr Epidemiol. 1999;34:117–121. doi: 10.1007/s001270050121. - DOI - PubMed
Laaksonen C, Aromaa M, Heinonen OJ, Koivusilta L, Koski P, Suominen S, Vahlberg T, Salanterä S. Health related quality of life in 10-year-old schoolchildren. Qual Life Res. 2008;17:1049–1054. doi: 10.1007/s11136-008-9388-4. - DOI - PubMed
Kiss E, Baji I, Mayer L, Skultéti D, Benák I, Vetró A. Validity and psychometric properties of a quality of life questionnaire in a Hungarian child and adolescent population. Psychiatr Hung. 2007;22:33–42. - PubMed
Upton P, Eiser C, Cheung I, Hutchings HA, Jenney M, Maddocks A, Russell IT, Williams JG. Measurement properties of the UK-English version of the Pediatric Quality of Life Inventory 4.0 (PedsQL) generic core scales. Health Qual Life Outcomes. 2005;3:22. doi: 10.1186/1477-7525-3-22. - DOI - PMC - PubMed
Engelen V, Haentjens MM, Detmar SB, Koopman HM, Grootenhuis MA. Health related quality of life of Dutch children: psychometric properties of the PedsQL in the Netherlands. BMC Pediatr. 2009;9:68. doi: 10.1186/1471-2431-9-68. - DOI - PMC - PubMed
Case A, Paxson C. Children's health and social mobility. Future Child. 2006;16:151–173. doi: 10.1353/foc.2006.0014. - DOI - PubMed
Svavarsdottir EK, Orlygsdottir B. Health-related quality of life in Icelandic school children. Scand J Caring Sci. 2006;20:209–215. doi: 10.1111/j.1471-6712.2006.00397.x. - DOI - PubMed
Spurrier NJ, Sawyer MG, Clark JJ, Baghurst P. Socio-economic differentials in the health-related quality of life of Australian children: results of a national study. Aust N Z J Public Health. 2003;27:27–33. doi: 10.1111/j.1467-842X.2003.tb00376.x. - DOI - PubMed
Bramlett MD, Blumberg SJ. Family structure and children's physical and mental health. Health Aff (Millwood) 2007;26:549–558. doi: 10.1377/hlthaff.26.2.549. - DOI - PubMed
Ahrons CR. Family ties after divorce: long-term implications for children. Fam Process. 2007;46:53–65. doi: 10.1111/j.1545-5300.2006.00191.x. - DOI - PubMed
Zhao X, Zhang Q, Shan Y, Zhang H, Guo L. A study on the influence factors for social adaptive behavior of children. Hua Xi Yi Ke Da Xue Xue Bao. 2002;33:259–261. - PubMed
Kauffman JM, Hallahan DP, Ball DW. Parents' predictions of their children's perceptions of family relations. J Pers Assess. 1975;39:228–235. doi: 10.1207/s15327752jpa3903_3. - DOI - PubMed
Seid M, Varni JW, Cummings L, Schonlau M. The impact of realized access to care on health-related quality of life: a two-year prospective cohort study of children in the California State Children's Health Insurance Program. J Pediatr. 2006;149:354–361. doi: 10.1016/j.jpeds.2006.04.024. - DOI - PubMed
King MT, Fayers PM. Making quality-of-life results more meaningful for clinicians. Lancet. 2008;371(9614):709–710. doi: 10.1016/S0140-6736(08)60324-4. - DOI - PubMed
Sloan JA, Frost MH, Berzon R, Dueck A, Guyatt G, Moinpour C, Sprangers M, Ferrans C, Cella D. Clinical Significance Consensus Meeting Group. The clinical significance of quality of life assessments in oncology: a summary for clinicians. Support Care Cancer. 2006;14:988–998. doi: 10.1007/s00520-006-0085-y. - DOI - PubMed
Cummins RA. On the trail of the gold standard for subjective well-being. Soc Indicators Res. 1995;35:179–200. doi: 10.1007/BF01079026. - DOI
Schwimmer JB, Burwinkle TM, Varni JM. Health-Related Quality of Life of Severely Obese Children and Adolescents. JAMA. 2003;289:1813–1819. doi: 10.1001/jama.289.14.1813. - DOI - PubMed
Gandek B, Ware JE. Methods for validating and norming translations of health status questionnaires: The IQOLA project approach. J Clin Epidemiol. 1998;51:953–959. doi: 10.1016/S0895-4356(98)00086-9. - DOI - PubMed
Graham P, Stevenson J, Flynn D. A new measure of health-related quality of life for children: preliminary findings. Psychol Health. 1997;12:655–665. doi: 10.1080/08870449708407412. - DOI
Olusina AK, Ohaeri JU. Subjective quality of life of recently discharged Nigerian psychiatric patients. Soc Psychiatry Psychiatr Epidemiol. 2003;38:707–714. doi: 10.1007/s00127-003-0691-7. - DOI - PubMed
Bobak M, Pikhart H, Hertzman C, Rose R, Marmot M. Socioeconomic factors, perceived control and self-reported health in Russia. A cross-sectional survey. Soc Sci Med. 1998;47:269–279. doi: 10.1016/S0277-9536(98)00095-1. - DOI - PubMed
Diener E. Subjective well-being: The science of happiness and a proposal for a national index. Am Psychologist. 2000;55:34–43. - PubMed
WHO. WHOQOL User Manual. World Health Organization, Program on Mental Health, Geneva, Switzerland. 1998.
Briere J. Trauma Symptom Checklist for Children. Florida: Psychological Assessment Resources, Inc; 1996.
Rosenberg M. Society and the adolescent self-image. Princeton: Princeton University Press; 1965.
Van Steen K, Curran D, Kramer J, Molenberghs G, Van Vreckem A, Bottomley A, Sylvester R. Multicollinearity in prognostic factor analyses using the EORTC QLQ-C30: identification and impact on model selection. Statistics Med. 2002;21:3865–3884. doi: 10.1002/sim.1358. - DOI - PubMed
Al-Turkait FA, Ohaeri JU. Psychopathological status, behavior problems, and family adjustment of Kuwaiti children whose fathers were involved in the first gulf war. Child Adolesc Psychiatry Ment Health. 2008;2(1):12. doi: 10.1186/1753-2000-2-12. - DOI - PMC - PubMed
Al-Turkait FA, Ohaeri JU. Dimensional and hierarchical models of depression using the Beck Depression Inventory-II in an Arab college student sample. BMC Psychiatry. 2010;10:60. doi: 10.1186/1471-244X-10-60. - DOI - PMC - PubMed
Abdel-Khalek AM, Lester D. Anxiety in Kuwaiti and American college students. Psychol Rep. 2006;99:512–514. - PubMed
Abdel-Khalek AM, Lester D. Death anxiety as related to somatic symptoms in two cultures. Psychol Rep. 2009;105:409–410. doi: 10.2466/pr0.105.2.409-410. - DOI - PubMed
Kenny C. Does development make you happy?. Subjective well being in developing countries. Soc Indicators Res. 2005;73:199–219. doi: 10.1007/s11205-004-0986-4. - DOI
Stewart K. Dimensions of well being in EU Regions: Do GDP and unemployment tell us all we need to know? Soc Indicators Res. 2005;73:221–246. doi: 10.1007/s11205-005-2922-7. - DOI
El-Islam FM. In: Al-Junun Mental illness in the Islamic world. Al-Issa I, editor. Madison: International University Press; 2000. Mental illness in Kuwait and Qatar; pp. 121–137.
Abdel-Khalek AM. Age and sex differences for anxiety in relation to family size, birth order, and religiosity among Kuwaiti adolescents. Psychol Rep. 2002;90(3 Pt 1):1031–6. - PubMed
Enns MWI, Cox BJ, Clara I. Parental bonding and adult psychopathology: results from the US National comorbidity survey. Psychol Med. 2002;32:997–1008. doi: 10.1017/S0033291702005937. - DOI - PubMed
George C. A representational perspective of child abuse and prevention: internal working models of attachment and caregiving. Child Abuse Negl. 1996;20:411–424. doi: 10.1016/0145-2134(96)00016-6. - DOI - PubMed
Eisenberg ME, Ackard DM, Resnick MD. Protective factors and suicide risk in adolescents with a history of sexual abuse. J Ped. 2007;151:482–487. doi: 10.1016/j.jpeds.2007.04.033. - DOI - PubMed
Supranowicz P. Parents' unemployment, selected life conditions, adolescents' well-being and perceived health. Przegl Epidemiol. 2005;59:773–780. - PubMed
"School-Wide Positive Behavioral Interventions and Supports". http://www.pbis.org/