Abstract
Objectives
The present study assessed the obese adolescents’ health-related quality of life (HRQoL) based on both adolescent-reported and maternal-reported questionnaires to clarify adolescent-related psychiatric factors, maternal psychiatric factors, and body mass index (BMI) percentile variables that independently affect the quality of life (QoL).
Methods
A total of 190 adolescents (120 females and 70 males) were included in the study. The impact of clinical and psychiatric factors on the Pediatric Quality of Life Inventory-Child Version (PedsQL-C) scores was analyzed using hierarchical linear regression methods.
Results
The final models showed that only the Revised Child Anxiety and Depression Scale-Child Version major depressive disorder scores negatively predicted the physical, psychosocial, and total health scores of the PedsQL-C. The psychosocial scores of the PedsQL-P were negatively predicted by the Strengths and Difficulties Questionnaire emotional, and Conners’ Parent Rating Scale-Revised-Short Form (CPRS-R-S) attention-deficit/hyperactivity disorder (ADHD) index scores. The PedsQL-P total scores were negatively predicted by the CPRS-R-S ADHD index scores.
Conclusions
The findings of this study indicate that the adolescents’ psychiatric symptoms and BMI percentile played a significant role in the PedsQL subscale functioning of obese adolescents compared to maternal psychiatric symptoms.
-
Research funding: None declared.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Informed consent: Informed consent was obtained from all individuals included in this study.
-
Ethical approval: The local Institutional Review Board deemed the study exempt from review.
References
1. Smith, KB, Smith, MS. Obesity statistics. Prim Care Clin Off Pract 2016;43:121–35. https://doi.org/10.1016/j.pop.2015.10.001.Search in Google Scholar PubMed
2. Xu, S, Xue, Y. Pediatric obesity: causes, symptoms, prevention and treatment (review). Exp Ther Med 2016;11:15–20. DOI: 10.3892/etm.2015.2853.10.3892/etm.2015.2853Search in Google Scholar PubMed PubMed Central
3. Aycan, Z, Baş, VN. Approach to obesity in childhood. Curr Med Res 2021;1:06–11. DOI: 10.47482/acmr.2020.1.10.47482/acmr.2020.1Search in Google Scholar
4. Avila, C, Holloway, AC, Hahn, MK, Morrison, KM, Restivo, M, Anglin, R, et al.. An overview of links between obesity and mental health. Curr Obes Rep 2015;4:303–10. DOI: 10.1007/s13679-015-0164-9.10.1007/s13679-015-0164-9Search in Google Scholar PubMed
5. Taylor, VH, Forhan, M, Vigod, SN, McIntyre, RS, Morrison, KM. The impact of obesity on quality of life. Best Pract Res Clin Endocrinol Metabol 2013;27:139–46. DOI: 10.1016/j.beem.2013.04.004.10.1016/j.beem.2013.04.004Search in Google Scholar PubMed
6. Swallen, KC, Reither, EN, Haas, SA, Meier, AM. Overweight, obesity, and health-related quality of life among adolescents: the national longitudinal study of adolescent health. Pediatrics 2005;115:340–7. DOI: 10.1542/peds.2004-0678.10.1542/peds.2004-0678Search in Google Scholar PubMed
7. Morrison, KM, Shin, S, Tarnopolsky, M, Taylor, VH. Association of depression & health related quality of life with body composition in children and youth with obesity. J Affect Disord 2015;172:18–23. DOI: 10.1016/j.jad.2014.09.014.10.1016/j.jad.2014.09.014Search in Google Scholar PubMed
8. Tsiros, MD, Olds, T, Buckley, JD, Grimshaw, P, Brennan, L, Walkley, J, et al.. Health-related quality of life in obese children and adolescents. Int J Obes 2009;33:387–400. DOI: 10.1038/ijo.2009.42.10.1038/ijo.2009.42Search in Google Scholar PubMed
9. Buttitta, M, Iliescu, C, Rousseau, A, Guerrien, A. Quality of life in overweight and obese children and adolescents: a literature review. Qual Life Res 2014;23:1117–39. DOI: 10.1007/s11136-013-0568-5.10.1007/s11136-013-0568-5Search in Google Scholar PubMed
10. Özalp Kızılay, D, Yalın Sapmaz, Ş, Şen, S, Özkan, Y, Cengiz Özyurt, B, Ersoy, B. Mental health of both child and parents plays a larger role in the health-related quality of life of obese and overweight children. J Pediatr Endocrinol Metab 2019;32:1359–67. DOI: 10.1515/jpem-2019-0401.10.1515/jpem-2019-0401Search in Google Scholar PubMed
11. Lim, CS, Espil, FM, Viana, AG, Janicke, DM. Associations between anxiety symptoms and child and family factors in pediatric obesity. J Dev Behav Pediatr 2015;36:664–72. DOI: 10.1097/DBP.0000000000000225.10.1097/DBP.0000000000000225Search in Google Scholar
12. Parks, EP, Kumanyika, S, Moore, RH, Stettler, N, Wrotniak, BH, Kazak, A. Influence of stress in parents on child obesity and related behaviors. Pediatrics 2012;130:e1096–104. DOI: 10.1542/peds.2012-0895.10.1542/peds.2012-0895Search in Google Scholar
13. Pratt, KJ, Lamson, AL, Swanson, MS, Lazorick, S, Collier, DN. The importance of assessing for depression with HRQOL in treatment seeking obese youth and their caregivers. Qual Life Res 2012;21:1367–77. DOI: 10.1007/s11136-011-0042-1.10.1007/s11136-011-0042-1Search in Google Scholar
14. Gibson, LY, Byrne, SM, Davis, EA, Blair, E, Jacoby, P, Zubrick, SR. The role of family and maternal factors in childhood obesity. Med J Aust 2007;186:591–5. DOI: 10.5694/j.1326-5377.2007.tb01061.x.10.5694/j.1326-5377.2007.tb01061.xSearch in Google Scholar
15. Zeller, MH, Modi, AC. Predictors of health-related quality of life in obese youth. Obesity 2006;14:122–30. DOI: 10.1038/oby.2006.15.10.1038/oby.2006.15Search in Google Scholar
16. Fontaine, KR, Barofsky, I. Obesity and health-related quality of life. Obes Rev 2001;2:173–82. DOI: 10.1046/j.1467-789x.2001.00032.x.10.1046/j.1467-789x.2001.00032.xSearch in Google Scholar
17. Pater, J. Quality of life and pharmacoeconomics in clinical trials. Contr Clin Trials 1996;17:548–9. DOI: 10.1016/s0197-2456(97)82191-5.10.1016/S0197-2456(97)82191-5Search in Google Scholar
18. Landolt, MA, Vollrath, M, Niggli, FK, Gnehm, HE, Sennhauser, FH. Health-related quality of life in children with newly diagnosed cancer: a one year follow-up study. Health Qual Life Outcome 2006;4:1–8. DOI: 10.1186/1477-7525-4-63.10.1186/1477-7525-4-63Search in Google Scholar PubMed PubMed Central
19. Friedlander, SL, Larkin, EK, Rosen, CL, Palermo, TM, Redline, S. Decreased quality of life associated with obesity in school-aged children. Arch Pediatr Adolesc Med 2003;157:1206–11. DOI: 10.1001/archpedi.157.12.1206.10.1001/archpedi.157.12.1206Search in Google Scholar PubMed
20. Wang, J, Sereika, SM, Styn, MA, Burke, LE. Factors associated with health-related quality of life among overweight or obese adults. J Clin Nurs 2013;22:2172–82. DOI: 10.1111/jocn.12280.10.1111/jocn.12280Search in Google Scholar PubMed PubMed Central
21. Pinhas-Hamiel, O, Singer, S, Pilpel, N, Fradkin, A, Modan, D, Reichman, B. Health-related quality of life among children and adolescents: associations with obesity. Int J Obes 2006;30:267–72. DOI: 10.1038/sj.ijo.0803107.10.1038/sj.ijo.0803107Search in Google Scholar PubMed
22. Ottova, V, Erhart, M, Rajmil, L, Dettenborn-Betz, L, Ravens-Sieberer, U. Overweight and its impact on the health-related quality of life in children and adolescents: results from the European KIDSCREEN survey. Qual Life Res 2012;21:59–69. DOI: 10.1007/s11136-011-9922-7.10.1007/s11136-011-9922-7Search in Google Scholar PubMed
23. Zeller, MH, Inge, TH, Modi, AC, Jenkins, TM, Michalsky, MP, Helmrath, M, et al.. Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient. J Pediatr 2015;166:651–9.e4. DOI: 10.1016/j.jpeds.2014.11.022.10.1016/j.jpeds.2014.11.022Search in Google Scholar PubMed PubMed Central
24. Gouveia, MJ, Frontini, R, Canavarro, MC, Moreira, H. Quality of life and psychological functioning in pediatric obesity: the role of body image dissatisfaction between girls and boys of different ages. Qual Life Res 2014;23:2629–38. DOI: 10.1007/s11136-014-0711-y.10.1007/s11136-014-0711-ySearch in Google Scholar PubMed
25. De Beer, M, Hofsteenge, GH, Koot, HM, Hirasing, RA, Delemarre-Van De Waal, HA, Gemke, RJBJ. Health-related-quality-of-life in obese adolescents is decreased and inversely related to BMI. Acta Paediatr Int J Paediatr 2007;96:710–4. DOI: 10.1111/j.1651-2227.2007.00243.x.10.1111/j.1651-2227.2007.00243.xSearch in Google Scholar PubMed
26. Wille, N, Bullinger, M, Holl, R, Hoffmeister, U, Mann, R, Goldapp, C, et al.. Health-related quality of life in overweight and obese youths: results of a multicenter study. Health Qual Life Outcome 2010;8:36. DOI: 10.1186/1477-7525-8-36.10.1186/1477-7525-8-36Search in Google Scholar PubMed PubMed Central
27. Jansen, PW, Mensah, FK, Clifford, S, Nicholson, JM, Wake, M. Bidirectional associations between overweight and health-related quality of life from 4–11 years: longitudinal study of Australian children. Int J Obes 2013;37:1307–13. DOI: 10.1038/ijo.2013.71.10.1038/ijo.2013.71Search in Google Scholar PubMed
28. Hanć, T, Cortese, S. Attention deficit/hyperactivity-disorder and obesity: a review and model of current hypotheses explaining their comorbidity. Neurosci Biobehav Rev 2018;92:16–28. DOI: 10.1016/j.neubiorev.2018.05.017.10.1016/j.neubiorev.2018.05.017Search in Google Scholar PubMed
29. Işık, Ü, Bağcı, B, Aktepe, E, Kılıç, F, Pirgon, Ö. Investigation of psychiatric comorbidity in adolescents with obesity. Turkish J Child Adolesc Ment Heal 2020;27:85–90. DOI: 10.4274/tjcamh.galenos.2020.76486.10.4274/tjcamh.galenos.2020.76486Search in Google Scholar
30. Lee, YC, Yang, HJ, Chen, VCH, Lee, WT, Teng, MJ, Lin, CH, et al.. Meta-analysis of quality of life in children and adolescents with ADHD: by both parent proxy-report and child self-report using PedsQL™. Res Dev Disabil 2016;51–52:160–72. DOI: 10.1016/j.ridd.2015.11.009.10.1016/j.ridd.2015.11.009Search in Google Scholar PubMed
31. Neyzi, O, Günöz, H, Furman, A, Bundak, R, Gökçay, G, Darendeliler, F, et al.. Weight, height, head circumference and body mass index references for Turkish children. Çocuk Sagligi ve Hast Derg 2008;51:1–14.10.4274/jcrpe.2183Search in Google Scholar
32. Varni, JW, Seid, M, Rode, CA. The PedsQL™: measurement model for the pediatric quality of life inventory. Med Care 1999;37:126–39. DOI: 10.1097/00005650-199902000-00003.10.1097/00005650-199902000-00003Search in Google Scholar
33. Çakin Memik, N, Aǧaoǧlu, B, Coşkun, A, Üneri, ÖŞ, Karakaya, I. The validity and reliability of the Turkish pediatric quality of life inventory for children 13–18 years old. Türk Psikiyatri Derg 2007;18:1–12.Search in Google Scholar
34. Gormez, V, Kılınçaslan, A, Cahid Orengul, A, Ebesutani, C, Kaya, I, Ceri, V, et al.. Psychometric properties of the Turkish version of the revised child anxiety and depression scale-child version in a clinical sample. Psychiatr Clin Psychopharmacol 2017;27:84–92. DOI: 10.1080/24750573.2017.1297494.10.1080/24750573.2017.1297494Search in Google Scholar
35. Chorpita, BF, Yim, L, Moffitt, C, Umemoto, LA, Francis, SE. Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behav Res Ther 2000;38:835–55. DOI: 10.1016/s0005-7967(99)00130-8.10.1016/S0005-7967(99)00130-8Search in Google Scholar
36. Hisli Sahin, N Use of the Beck depression inventory with Turkish University students: reliability, validity and factor Analysis. Türk Psikol Derg 1989;7:1–14.Search in Google Scholar
37. Ulusoy, M, Sahin, NH, Erkmen, H. Turkish version of the beck anxiety inventory: psychometric properties. J Cogn Psychother An Int Q 1998;12:163–72.Search in Google Scholar
38. Goodman, R, Ford, T, Sımmons, H, Gatward, R, Meltzer, H. Using the strengths and difficulties questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry 2000;177:534–9. DOI: 10.1192/bjp.177.6.534.10.1192/bjp.177.6.534Search in Google Scholar PubMed
39. Güvenir, T, Özbek, A, Baykara, B, Arkar, H, Sentürk, B, Incekas, S. Psychometrıc properties of the Turkish version of the strengths and diffıculties questionnaire (SDQ). Turk J Child Adolesc Ment Heal 2008;15:65–74.Search in Google Scholar
40. Kaner, S, Büyüköztürk, S, İşeri, E. Conners parent rating scale-revised short: Turkish standardization study. Eğitim ve Bilim 2013;38:81–97.Search in Google Scholar
41. Nigatu, YT, Reijneveld, SA, De Jonge, P, Van Rossum, E, Bültmann, U. The combined effects of obesity, abdominal obesity and major depression/anxiety on health-related quality of life: the lifelines cohort study. PLoS One 2016;11:1–15. DOI: 10.1371/journal.pone.0148871.10.1371/journal.pone.0148871Search in Google Scholar PubMed PubMed Central
42. Vetter, ML, Wadden, TA, Lavenberg, J, Moore, RH, Volger, S, Perez, JL, et al.. Relation of health-related quality of life to metabolic syndrome, obesity, depression and comorbid illnesses. Int J Obes 2011;35:1087–94. DOI: 10.1038/ijo.2010.230.10.1038/ijo.2010.230Search in Google Scholar PubMed PubMed Central
43. Zeller, MH, Roehrig, HR, Modi, AC, Daniels, SR, Inge, TH. Health-related quality of life and depressive symptoms in adolescents with extreme obesity presenting for bariatric surgery. Pediatrics 2006;117:1155–61. DOI: 10.1542/peds.2005-1141.10.1542/peds.2005-1141Search in Google Scholar PubMed
44. Luppino, FS, de Wit, LM, Bouvy, PF, Stijnen, T, Cuijpers, P, Penninx, BWJH, et al.. Overweight, obesity, and depression. Arch Gen Psychiatr 2010;67:220. DOI: 10.1001/archgenpsychiatry.2010.2.10.1001/archgenpsychiatry.2010.2Search in Google Scholar PubMed
45. Friedman, KE, Reichmann, SK, Costanzo, PR, Musante, GJ. Body image partially mediates the relationship between obesity and psychological distress. Obes Res 2002;10:33–41. DOI: 10.1038/oby.2002.5.10.1038/oby.2002.5Search in Google Scholar PubMed
46. Hilbert, A, Braehler, E, Haeuser, W, Zenger, M. Weight bias internalization, core self-evaluation, and health in overweight and obese persons. Obesity 2014;22:79–85. DOI: 10.1002/oby.20561.10.1002/oby.20561Search in Google Scholar
47. Ha, H, Han, C, Kim, B. Can obesity cause depression? A pseudo-panel analysis. J Prev Med Public Heal 2017;50:262–7. DOI: 10.3961/jpmph.17.067.10.3961/jpmph.17.067Search in Google Scholar
48. Griffiths, LJ, Parsons, TJ, Hill, AJ. Self-esteem and quality of life in obese children and adolescents: a systematic review. Int J Pediatr Obes 2010;5:282–304. DOI: 10.3109/17477160903473697.10.3109/17477160903473697Search in Google Scholar
49. Cameron, AJ, Magliano, DJ, Dunstan, DW, Zimmet, PZ, Hesketh, K, Peeters, A, et al.. A bi-directional relationship between obesity and health-related quality of life: evidence from the longitudinal AusDiab study. Int J Obes 2012;36:295–303. DOI: 10.1038/ijo.2011.103.10.1038/ijo.2011.103Search in Google Scholar
50. Gariepy, G, Wang, J, Lesage, AD, Schmitz, N. The longitudinal association from obesity to depression: results from the 12-year national population health survey. Obesity 2010;18:1033–8. DOI: 10.1038/oby.2009.333.10.1038/oby.2009.333Search in Google Scholar
51. Renzaho, A, Wooden, M, Houng, B. Associations between body mass index and health-related quality of life among Australian adults. Qual Life Res 2010;19:515–20. DOI: 10.1007/s11136-010-9610-z.10.1007/s11136-010-9610-zSearch in Google Scholar
52. Fontaine, KR, Bartlett, SJ, Barofsky, I. Health-related quality of life among obese persons seeking and not currently seeking treatment. Int J Eat Disord 2000;27:101–5. DOI: 10.1002/(SICI)1098-108X(200001)27:1<101::AID-EAT12>3.0.CO;2-D.10.1002/(SICI)1098-108X(200001)27:1<101::AID-EAT12>3.0.CO;2-DSearch in Google Scholar
53. Schwimmer, JB, Burwinkle, TM, Varni, JW. Health-related quality of life of severely obese children and adolescents. J Am Med Assoc 2003;289:1813–9. DOI: 10.1001/jama.289.14.1813.10.1001/jama.289.14.1813Search in Google Scholar
54. Laaksonen, M, Sarlio-Lähteenkorva, S, Leino-Arjas, P, Martikainen, P, Lahelma, E. Body weight and health status: importance of socioeconomic position and working conditions. Obes Res 2005;13:2169–77. DOI: 10.1038/oby.2005.269.10.1038/oby.2005.269Search in Google Scholar
55. Cortese, S, Moreira-Maia, CR, St Fleur, D, Morcillo-Peñalver, C, Rohde, LA, Faraone, SV. Association between ADHD and obesity: a systematic review and meta-analysis. Am J Psychiatr 2016;173:34–43. DOI: 10.1176/appi.ajp.2015.15020266.10.1176/appi.ajp.2015.15020266Search in Google Scholar
56. Nigg, JT, Johnstone, JM, Musser, ED, Long, HG, Willoughby, MT, Shannon, J. Attention-deficit/hyperactivity disorder (ADHD) and being overweight/obesity: new data and meta-analysis. Clin Psychol Rev 2016;43:67–79. DOI: 10.1016/j.cpr.2015.11.005.10.1016/j.cpr.2015.11.005Search in Google Scholar PubMed PubMed Central
57. Ercan, ES, Polanczyk, G, Akyol Ardıc, U, Yuce, D, Karacetın, G, Tufan, AE, et al.. The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T). Nord J Psychiatr 2019;73:132–40. DOI: 10.1080/08039488.2019.1574892.10.1080/08039488.2019.1574892Search in Google Scholar PubMed
58. Wehmeier, PM, Schacht, A, Barkley, RA. Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. J Adolesc Health 2010;46:209–17. DOI: 10.1016/j.jadohealth.2009.09.009.10.1016/j.jadohealth.2009.09.009Search in Google Scholar PubMed
59. Kalarchian, MA, Marcus, MD. Psychiatric comorbidity of childhood obesity. Int Rev Psychiatr 2012;24:241–6. DOI: 10.3109/09540261.2012.678818.10.3109/09540261.2012.678818Search in Google Scholar PubMed
60. Farhangi, MA, Emam-Alizadeh, M, Hamedi, F, Jahangiry, L. Weight self-stigma and its association with quality of life and psychological distress among overweight and obese women. Eat Weight Disord 2017;22:451–6. DOI: 10.1007/s40519-016-0288-2.10.1007/s40519-016-0288-2Search in Google Scholar PubMed
61. Puhl, R, Suh, Y. Stigma and eating and weight disorders. Curr Psychiatr Rep 2015;17:10. DOI: 10.1007/s11920-015-0552-6.10.1007/s11920-015-0552-6Search in Google Scholar PubMed
62. Juvonen, J, Lessard, LM, Schacter, HL, Suchilt, L. Emotional implications of weight stigma across middle school: the role of weight-based peer discrimination. J Clin Child Adolesc Psychol 2017;46:150–8. DOI: 10.1080/15374416.2016.1188703.10.1080/15374416.2016.1188703Search in Google Scholar PubMed PubMed Central
63. Pott, W, Albayrak, Ö, Hebebrand, J, Pauli-Pott, U. Treating childhood obesity: family background variables and the child’s success in a weight-control intervention. Int J Eat Disord 2009;42:284–9. DOI: 10.1002/eat.20655.10.1002/eat.20655Search in Google Scholar PubMed
© 2021 Walter de Gruyter GmbH, Berlin/Boston
