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. 2024 Oct 29;24(1):2986.
doi: 10.1186/s12889-024-20393-0.

Psychosocial factors mediate social inequalities in health-related quality of life among children and adolescents

Viviane Richard  1   2 , Elsa Lorthe  1   3 , Roxane Dumont  1   2 , Andrea Loizeau  1 , Hélène Baysson  1 , Stephanie Schrempft  1 , María-Eugenia Zaballa  1 , Julien Lamour  1 , Rémy P Barbe  4 , Klara M Posfay-Barbe  5 , Idris Guessous  2   6 , Silvia Stringhini  7   8   9
Affiliations

Psychosocial factors mediate social inequalities in health-related quality of life among children and adolescents

Viviane Richard et al. BMC Public Health. .

Abstract

Background: The present analysis aimed to assess the mediating role of psychosocial and behavioural factors in socio-economic inequalities in health-related quality of life (HRQoL) among children and adolescents.

Methods: Cross-sectional data was drawn from the randomly selected SEROCoV-KIDS cohort study in Geneva, Switzerland. Associations of socio-economic conditions (parents' highest education, household financial situation) with HRQoL, psychosocial (parent-child relationship, school difficulties, friends, extracurricular activities) and behavioural factors (screen time, physical activity, green spaces time, sleep duration), along with associations of psychosocial and behavioural factors with HRQoL, were evaluated with generalized estimating equations. Counterfactual mediation analyses were conducted to test pathways linking socio-economic conditions to HRQoL.

Results: Of 965 children and 816 adolescents, those with disadvantaged financial circumstances were more likely to have a poor HRQoL (adjusted Odds Ratio [aOR]: 3.80; 95% confidence interval [CI]: 1.96-7.36 and aOR: 3.66; 95%CI: 2.06-6.52, respectively). Psychosocial characteristics mediated 25% (95%CI: 5-70%) and 40% (95%CI: 18-63%) of financial disparities in HRQoL among children and adolescents, respectively. Health behaviours were weakly patterned by socio-economic conditions and did not contribute to financial differences in HRQoL.

Conclusions: These findings provide empirical evidence for mechanisms explaining socio-economic disparities in child HRQoL and could inform interventions aimed to tackle health inequalities.

Keywords: Health behaviours; Health-related quality of life; Mediation; Psychosocial; Socio-economic inequalities.

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Conflict of interest statement

KPB is a member of the Advisory Boards for pneumococcal vaccine and varicella vaccine at MSD. The other authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Directed acyclic graph (DAG) of the association between socio-economic conditions, psychosocial factors, health behaviours and health indicator. Dashed lines indicate confounding pathways. Age, sex and migration background are considered to be covariates of all associations; arrows are not drawn for readability. DAG of the models with psychosocial and behavioural mediators only are presented in Supplementary Figs. 2 and 3, respectively
Fig. 2
Fig. 2
Mediation of psychosocial risk factors and health behaviours in the association between household financial situation and health-related quality of life among children (6–11 years old) and adolescents (12–17 years old). PM: proportion of the total effect mediated by the indirect effect of psychosocial and/or behavioural factors. Results are from logistic marginal structural models adjusted for age, sex and migration background, as well as for chronic condition and parental mental health as mediator—outcome confounders affected by the exposure
See this image and copyright information in PMC

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