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31-07-2021 | Uitgave 12/2021

Quality of Life Research 12/2021

Health-related quality of life in children with and without physical–mental multimorbidity

Quality of Life Research > Uitgave 12/2021
Mark A. Ferro, Saad A. Qureshi, Lilly Shanahan, Christiane Otto, Ulrike Ravens-Sieberer
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This study examined health-related quality of life (HRQL) in children across different physical illnesses; estimated parent–child agreement on HRQL reports; compared HRQL between children with and without physical–mental multimorbidity; and tested if multimorbidity was associated with HRQL.


Children aged 6–16 years (mean = 11.1; n = 198) with one physical illness and their parents were recruited from a pediatric hospital. Physical illnesses were classified according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10, mental illnesses were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents, and HRQL was measured using the KIDSCREEN-27. Children who screened positive for ≥ 1 mental illness were classified as having physical–mental multimorbidity. χ2/t tests compared sample characteristics of children with vs. without multimorbidity; Kruskal–Wallis tests compared KIDSCREEN-27 scores across ICD-10 categories; interclass correlation coefficients estimated parent–child agreement; and multiple regression examined effects of the number of mental illnesses on HRQL.


HRQL was similar across ICD-10 categories. Parent–child agreement was fair to good for all HRQL domains, regardless of multimorbidity status. Parent-reported HRQL was significantly lower for children with multimorbidity compared to norms across all domains, whereas child-reported HRQL was significantly lower for physical well-being, psychological well-being, and school environment. Number of mental illnesses was negatively associated with psychological well-being and school environment in a dose–response manner.


Children with physical–mental multimorbidity are vulnerable to experiencing lower HRQL, particularly for psychological well-being and school environment. Longitudinal studies documenting trajectories of HRQL and school-based interventions that target these domains of HRQL for children with multimorbidity are warranted.

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