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The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: a 3-year follow-up

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Abstract

Purpose

To investigate, in adolescents referred for psychiatric services, the associations of initial self-esteem and family functioning with level and change of quality of life (QoL) over a 3-year period, over and above the effect of their emotional problems.

Methods

Of 1648 eligible 13–18 years old patients attending the child and adolescent psychiatric clinic (CAP) at least once, 717 (54.8% females) were enrolled at baseline (a response rate of 43.5%). Self- and parent reports on the McMaster Family Assessment Device were obtained. Adolescents reported self-esteem on the Rosenberg Scale, and emotional problems on the Symptom Check List-5. Adolescents completed the Inventory of Life Quality in Children and Adolescents (ILC). After 3 years, 570 adolescents again completed the ILC, and for 418 adolescents parent information was available. The longitudinal analysis sample of 418 adolescents was representative of the baseline sample for age, gender, emotional problems, and QoL. We used modified growth-model analysis, adjusted for SES, age, gender and time of contact with CAP, where residual variances for ILC at baseline and follow-up were fixed to 0.

Results

A poorer family functioning at baseline, reported by parents, was significantly associated with worsening QoL during the 3 years follow-up period (p = 0.001).

Conclusions

Parents have important knowledge about their families that may reflect long-term influences on QoL development in adolescent psychiatric patients. Health care providers and policy makers should optimize treatment outcomes by addressing family functioning in adolescents with emotional problems.

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Notes

  1. We used Mplus 8 for our analysis with the following syntax:

    Model:

    intercept slope | QOLT1QOLT2; !Comment: This line defines a growth model with two time points, centered on T1

    QOLT1QOLT2= 0; !Comment: This lines fixes the residuals of the two measurements of QOL to 0

    intercept slope ON emotional_problems self_esteem family_functioning_child family_functioning_parents ses time age gender;

    !Comment: This line regresses intercept (= QOLT1) and the slope (= difference between QOLT2 and QOLT1) on the predictors and the variables we wanted to adjust the effects for.

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Funding

This study was funded by the Liaison Committee (“Kontaktutvalget”) St. Olav’s Hospital/Faculty of medicine and Health Sciences—NTNU”, “The Liaison Committee for Education, Research and Innovation in Central Norway/Central Norway Regional Health Authority (RHA)”, the “Child and Adolescent Psychiatric Department/St. Olav’s Hospital”, the “Regional Centre of Children and Adolescent Mental health”.

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Authors and Affiliations

  1. Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, MTFS, Pb. 8905, 7491, Trondheim, Norway

    Thomas Jozefiak, Hanne K. Greger & Jan L. Wallander

  2. Department of Child and Adolescent Psychiatry, St. Olavs Hospital, Elgeseter, Postboks 6810, 7433, Trondheim, Norway

    Hanne K. Greger

  3. Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands

    Hans M. Koot

  4. Department of Psychology, University of Science and Technology, Trondheim, Norway

    Christian A. Klöckner

  5. Psychological Sciences and Health Sciences Research Institute, University of California, Merced, 5200, North Lake Rd, Merced, CA, 95343, USA

    Jan L. Wallander

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  1. Thomas Jozefiak
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  2. Hanne K. Greger
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Correspondence to Thomas Jozefiak.

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Conflict of interest

The authors declare that they have no conflict of interest. The first author receives royalties from Publisher Hogrefe/Psykologiförlag Stockholm for authorship of the “Norwegian Manual—ILC QoL measure, 2012″ which was used in this study.

Informed consent

All adolescents and parents who participated gave their written informed consent. This study was approved by the Regional Committee for Medical Research Ethics in Central Norway. The procedures in this study were in accordance with the 1964 Helsinki declaration and its later amendments.

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Jozefiak, T., Greger, H.K., Koot, H.M. et al. The role of family functioning and self-esteem in the quality of life of adolescents referred for psychiatric services: a 3-year follow-up. Qual Life Res 28, 2443–2452 (2019). https://doi.org/10.1007/s11136-019-02197-7

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