HRQoL impact of stressful life events in children beginning primary school: results of a prospective study in Poland

Abstract

Purpose: To evaluate the relationship between recent stressful life events (SLEs), stress-related symptoms (SRSs), and health-related quality of life (HRQoL) in children beginning primary school.

Methods: A community-based sample of 6- to 8-year-old children (176 boys and 175 girls at baseline) participated in a prospective longitudinal study with three waves of data collection and 1-year interval between subsequent surveys, conducted in the Wielkopolska Province, Poland. Main exposures included nine recent stressful life events and psychosomatic and behavioural symptoms related to stress (SRSs), both self-reported by children. The outcome was total HRQoL assessed by a Polish version of the PedsQL™ 4.0 (Pediatric Quality of Life Inventory) Generic Core Scales questionnaire, 5- to 7-year-old version. To evaluate the relationship between total HRQoL and predictor variables, a latent growth curve (LGC) model using multiple group design (boys and girls) with three waves and two time-varying covariates, the SLEs and SRSs, was applied.

Results: An unconditional multi-group LGC model revealed that the total HRQoL changed over time in a linear trajectory. After incorporating to the model, two time-varying covariates, SLEs and SRSs, the first predictor for HRQoL was only significant at the last wave in girls and at two subsequent waves, except for baseline, in boys. The second predictor revealed significant negative impacts on HRQoL over the entire period of time in both boys and girls suggesting that the pathway underlying the association of SLEs with HRQoL may be mediated by SRSs. Mean values of HRQoL at each time points did not show gender differences.

Conclusions: The findings of the present study may help to develop and implement a health and safety protection training programmes addressed to parents, caregivers, and practitioners to make children's lives easier.

Keywords: LGC model; Stress-related symptoms; Stressful life events; Total HRQoL; Young children.

Fig. 1

Effects of childhood stress on health problems later in life. Modified after Underdown [10], Middlebrooks and Audage [11], Marin et al. [12]

Fig. 2

Conceptual framework for the present study on health-related quality of life in the early primary school-age children 6–8 years

Fig. 3

Unconditional LGC model depicting linear growth of the HRQoL over time in the early primary school children aged from 6 to 8 years

Fig. 4

LGC model of the HRQoL trajectory over time in the early primary school children aged from 6 to 8 years with time-varying predictors: stressful life events (SLEs) and stress-related somatic and behavioural symptoms (SRSs)