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Effect on Health-related Quality of Life of changes in mental health in children and adolescents

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      BackgroundThe objective of the study was to assess the effect of changes in mental health status on health-related quality of life (HRQOL) in children and adolescents aged 8 - 18 years.MethodsA representative sample of Spanish children and adolescents aged 8-18 years completed the self-administered KIDSCREEN-52 questionnaire at baseline and after 3 years. Mental health status was measured using the Strengths and Difficulties Questionnaire (SDQ). Changes on SDQ scores over time were used to classify respondents in one of 3 categories (improved, stable, worsened). Data was also collected on gender, undesirable life events, and family socio-economic status. Changes in HRQOL were evaluated using effect sizes (ES). A multivariate analysis was performed to identify predictors of poor HRQOL at follow-up.ResultsResponse rate at follow-up was 54% (n = 454). HRQOL deteriorated in all groups on most KIDSCREEN dimensions. Respondents who worsened on the SDQ showed the greatest deterioration, particularly on Psychological well-being (ES = -0.81). Factors most strongly associated with a decrease in HRQOL scores were undesirable life events and worsening SDQ score.ConclusionsChanges in mental health status affect children and adolescents' HRQOL. Improvements in mental health status protect against poorer HRQOL while a worsening in mental health status is a risk factor for poorer HRQOL.

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      Most cited references 26

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      Psychometric properties of the strengths and difficulties questionnaire.

      To describe the psychometric properties of the Strengths and Difficulties Questionnaire (SDQ), a brief measure of the prosocial behavior and psychopathology of 3-16-year-olds that can be completed by parents, teachers, or youths. A nationwide epidemiological sample of 10,438 British 5-15-year-olds obtained SDQs from 96% of parents, 70% of teachers, and 91% of 11-15-year-olds. Blind to the SDQ findings, all subjects were also assigned DSM-IVdiagnoses based on a clinical review of detailed interview measures. The predicted five-factor structure (emotional, conduct, hyperactivity-inattention, peer, prosocial) was confirmed. Internalizing and externalizing scales were relatively "uncontaminated" by one another. Reliability was generally satisfactory, whether judged by internal consistency (mean Cronbach a: .73), cross-informant correlation (mean: 0.34), or retest stability after 4 to 6 months (mean: 0.62). SDQ scores above the 90th percentile predicted a substantially raised probability of independently diagnosed psychiatric disorders (mean odds ratio: 15.7 for parent scales, 15.2 for teacher scales, 6.2 for youth scales). The reliability and validity of the SDQ make it a useful brief measure of the adjustment and psychopathology of children and adolescents.
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        Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample.

        Child psychiatric disorders are common and treatable, but often go undetected and therefore remain untreated. To assess the Strengths and Difficulties Questionnaire (SDQ) as a potential means for improving the detection of child psychiatric disorders in the community. SDQ predictions and independent psychiatric diagnoses were compared in a community sample of 7984 5- to 15-year-olds from the 1999 British Child Mental Health Survey. Multi-informant (parents, teachers, older children) SDQs identified individuals with a psychiatric diagnosis with a specificity of 94.6% (95% Cl 94.1-95.1%) and a sensitivity of 63.3% (59.7-66.9%). The questionnaires identified over 70% of individuals with conduct, hyperactivity, depressive and some anxiety disorders, but under 50% of individuals with specific phobias, separation anxiety and eating disorders. Sensitivity was substantially poorer with single-informant rather than multi-informant SDQs. Community screening programmes based on multi-informant SDQs could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.
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          The Strengths and Difficulties Questionnaire (SDQ)--further evidence for its reliability and validity in a community sample of Dutch children and adolescents.

          This study was a first attempt to examine the psychometric properties of the Strengths and Difficulties Questionnaire (SDQ) in Dutch youths. A large sample of normal children and adolescents ( N = 562) and their parents completed the SDQ along with a number of other psychopathology measures. Factor analysis of the SDQ yielded five factors that were in keeping with the hypothesised subscales of hyperactivity-inattention, emotional symptoms, peer problems, conduct problems, and prosocial behaviour. Furthermore, internal consistency, test-retest stability, and parent-youth agreement of the various SDQ scales were acceptable. Finally, the concurrent validity of the SDQ was good: that is, its scores correlated in a theoretically meaningful way with other measures of psychopathology. It can be concluded that the psychometric properties of the parent- and self-report version of the SDQ were satisfactory in this Dutch community sample. Moreover, the current data provide further support for the utility of the SDQ as an index of psychopathological symptoms in youths.

            Author and article information

            [1 ]Catalan Agency for Health Technology Assessment and Research (CAHTA), Roc Boronat 81-95 2nd Floor, Barcelona 08005, Spain
            [2 ]Health Services Research Unit, Institut Municipal d'Investigació Mèdica (IMIM-hospital del mar), Dr Aiguader 88, Barcelona 08003, Spain
            [3 ]CIBER en Epidemiología y Salud Pública (CIBERESP), Dr Aiguader 88, Barcelona 08003, Spain
            [4 ]National Primary Care Research and Development Centre and NIHR School for Primary Care Research, University of Manchester, Williamson Building Oxford Road, Manchester M13 9PL, UK
            Health Qual Life Outcomes
            Health and Quality of Life Outcomes
            BioMed Central
            23 December 2009
            : 7
            : 103
            Copyright ©2009 Rajmil et al; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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