Health‑related quality of life is strongly associated with self‑efficacy, self‑esteem, loneliness, and stress in 14–15‑year‑old adolescents: a cross‑sectional study

Abstract

Background: To enhance and better understand health-related quality of life (HRQOL) in adolescents, it is important to study factors associated with HRQOL. The present study aimed to assess possible associations between sociodemographic variables, self-efcacy, self-esteem, pain, sleep, loneliness, stress and HRQOL in 14 to 15-year-old adolescents. Methods: A cross-sectional study was performed among 696 adolescents (14–15 years) in a school-based setting. Sociodemographic variables, self-efcacy, self-esteem, pain, sleep, loneliness and stress were analyzed. The variables were all assessed with well-validated instruments. HRQOL was analyzed using KIDSCREEN 27. Analyses included Chisquare, independent t-tests, Mann–Whitney U tests, linear regression analyses and hierarchical regression analyses. The results from linear regression models were expressed as standardized beta. Results: The adolescents generally reported high levels of HRQOL. However, girls scored signifcantly worse on HRQOL, self-efcacy, self-esteem, pain, sleep, loneliness and stress compared to boys. Using hierarchical regression analyses we found that Self-efcacy (beta=0.11–0.24), Self-esteem: (beta=0.12–0.21), Loneliness: (beta=−0.24 to −0.45) and Stress: (beta=−0.26 to −0.34) revealed the strongest associations with the HRQOL dimensions. Sociodemographic-, pain- and sleep related covariates were all signifcantly associated with some of the KIDSCREEN subscales, however their efect on the outcome was smaller than for the psychosocial variables listed above. Being a girl, not living with both parents, not having both parents working, being absent from school more than 4 days, having pain and having lack of enough sleep were all independently negatively associated with HRQOL. Conclusions: HRQOL is strongly associated with self-efcacy, self-esteem, loneliness and stress in 14 to 15-year-old adolescents. Our fndings indicate that positive psychosocial factors such as self-efcacy and self-esteem might play a bufer role for negative psychosocial factors (e.g. stress) in adolescents. Further, our results show that girls score signifcantly worse on factors that are associated to HRQOL compared to boys. To improve HRQOL in school-based populations of adolescents, we suggest that future interventions should aim to strengthen self-efcacy and self-esteem. We recommend gender specifc interventions.