Mental health of young people in Australia

4 Health-related quality of life

Page last updated: October 2000

The survey used the concept of health-related quality of life (HRQL) to assess the degree of disability associated with child and adolescent mental health problems. This concept employs people's subjective evaluations of their own physical, psychological and social functioning rather than assessments by clinicians or assessments based on biomedical parameters. For children, assessments of HRQL were based on reports from parents. For adolescents, assessments were based on reports from both parents and the adolescents themselves.

The assessment of the HRQL of children and adolescents was derived from the Child Health Questionnaire (CHQ) (Landgraf et al., 1996), which was completed by the parents of children and adolescents aged 6 to 17 years. The questionnaire assesses three broad aspects of the lives of children and adolescents:

  1. child or adolescent HRQL, including physical activities, pain and discomfort, limitations in peer and school activities, and self-esteem;

  2. family functioning, including family activities and family cohesion; and

  3. parental HRQL, including perceived loss of time for personal needs and parental concern or worry about children's or adolescents' problems.
On each of the scales that comprise these three domains, scores range from 0 to 100, with lower scores indicating a less favourable quality of life. Full details of the individual scales and the meaning of high and low scores are provided in appendix B.

For the purpose of presenting results in this section, children and adolescents were grouped into one of four problem levels on the basis of their score on the Total Problems scale of the Child Behaviour Checklist. These classified children and adolescents as having low, moderate, high or very high levels of emotional and behavioural problems (figure 4.1). Those who scored in the lowest 50% of the range of scores reported on the Total Problems scale were defined as having a low level of problems; those in the 50–75% range were defined as having a moderate level of problems; those in the 75–90% range were defined as having a high level of problems; and those who scored in the top 10% of the scoring range were defined as having a very high level of problems.

The relationship between scores on the CHQ and the number of emotional and behavioural problems experienced by children and adolescents is shown in figure 4.2, figure 4.3 and figure 4.4. Each figure consists of a line graph or bar chart that shows the average score on each CHQ scale for children and adolescents in each of the four problem levels.

The health-related quality of life of children and adolescents
Summary
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Figure 4.1 Problem level categories for children and adolescents as rated on the Total Problems Scale of the Child Behaviour Checklist

Refer to the following text for a text equivalent of Figure 4.1 Problem level categories for children and adolescents as rated on the Total Problems Scale of the Child Behaviour Checklist

Text version of Figure 4.1

The figure shows a bell curve of increasing number of emotional and behavioural problems. The four problem level categories are:
  • Low - in the 0 to 50% range
  • Moderate - in the 50 to 75% range
  • High - in the 75 to 90% range
  • Very high - in the 90-100% range

The health-related quality of life of children and adolescents

Children and adolescents with more emotional and behavioural problems to have a lower HRQL score than those with fewer problems (figure 4.2). The differences between those with different levels of problems were smaller in areas more relevant to physical health (e.g., physical activities, pain and discomfort, and limitations in school work or activities with friends due to physical health). However, children and adolescents with more emotional and behavioural problems had substantially worse self-esteem and greater limitations in school and peer activities related to emotional and behavioural problems than did children with fewer problems (figure 4.2).

Children and adolescents with more emotional and behavioural problems lived in less cohesive families and were perceived by their parents to have a larger impact on family activities than those with fewer problems (figure 4.3). Parents of young people with more problems were more concerned and worried about the health of their children or adolescents than were the parents of those with fewer problems (figure 4.4). In addition, pare1001100nts of children and adolescents with more problems experienced greater limitation in the time available for their personal needs than did the parents of those with fewer problems.
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Figure 4.2 Health-related quality of life of children and adolescents

Refer to the following text for a text equivalent of Figure 4.2 Health-related quality of life of children and adolescents

Text version of Figure 4.2

Figures in this description are approximate as they have been read from the graph.

The figure shows the the average CHQ score (higher is better HRQL, lower is worse HRQL) for children and adolescents at different levels of emotional and behavioural problems (low, moderate, high and very high). The average scores are presented in the following table.
Low level
of problems
Moderate level
of problems
High level
of problems
Very high level
of problems
Physcial activities
96
94
92
90
Pain & discomfort
91
86
83
80
School/friends - physical limitations
96
95
93
89
School/friends - emotional & behavioural limitations
97
96
92
77
Self-esteem
86
81
75
65

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Figure 4.3 Family functioning of children and adolescents

Refer to the following text for a text equivalent of Figure 4.3 Family functioning of children and adolescents

Text version of Figure 4.3

Figures in this description are approximate as they have been read from the graph.

The figure shows the the average CHQ score (higher is better functioning, lower is worse functioning) for children and adolescents at different levels of emotional and behavioural problems (low, moderate, high and very high). The average scores are presented in the following table.
Low level
of problems
Moderate level
of problems
High level
of problems
Very high level
of problems
Family activities
95
88
79
65
Family cohesion
82
75
68
61
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Figure 4.4 Perceived impact of child and adolescent mental health problems on parents


Refer to the following text for a text equivalent of Figure 4.4 Perceived impact of child and adolescent mental health problems on parents

Text version of Figure 4.4

Figures in this description are approximate as they have been read from the graph.

The figure shows the the average CHQ score (higher is less impact, lower is greater impact) for children and adolescents at different levels of emotional and behavioural problems (low, moderate, high and very high). The average scores are presented in the following table.
Low level
of problems
Moderate level
of problems
High level
of problems
Very high level
of problems
Emotional impact
91
81
71
60
Time impact
95
92
85
74
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Summary

The results in this chapter address the third question of the survey: What is the degree of disability associated with mental health problems? There were two key findings. First, children and adolescents with more emotional and behavioural problems had more difficulties than their peers in many other areas of their lives. For example, they had lower self-esteem and experienced more difficulty in peer and school activities. Parents believed that the problems of these children impeded family activities and reduced the time that the parents had for their personal needs.

Second, it appears that other difficulties were not restricted to children and adolescents with the highest level of problems. Rather, as children and adolescents experience an increasing number of emotional and behavioural problems, they also experience increasing difficulties in several other areas. It appears that there is no natural point at which children and adolescents with lower levels of emotional and behavioural problems cease to have difficulties in other areas. Instead, as the number of problems increases, so does the frequency of difficulties in other areas. We know little about the longer-term adjustment of children and adolescents with mental health problems who have varying levels of difficulties in these other areas. This information is essential to identify which children and adolescents are in greatest need of help for their problems.

Professionals need to be aware of the broad range of difficulties experienced by children and adolescents with mental health problems and of the needs that many of them have for help in other areas of their lives. In this survey, we cannot determine whether mental health problems cause these other difficulties or whether the opposite is true. For example, while it is possible that mental health problems reduce family cohesion, it is equally possible that lack of family cohesion gives rise to mental health problems. Regardless, the results highlight the importance of providing broadly-based help for those with mental health problems, including help for parents and families. The cooperation of the health, education and family welfare sectors will be essential to address these issues.