Adolescents living with chronic diseases who show emotional symptoms or peer problems on standard screening questionnaires also report markedly worse quality of life, according to a cross-sectional study published in BMC Pediatrics. The research, based on retrospectively collected data from 273 patients aged 10 to 18 years admitted to the paediatric inpatient wards of Dr. Hasan Sadikin General Hospital in Bandung, Indonesia, between October 2024 and March 2025, set out to identify which psychosocial domains are independently associated with impaired quality of life in this vulnerable group.
The researchers screened mental-emotional problems with two complementary instruments, the Pediatric Symptom Checklist-17 (PSC-17) and the Strengths and Difficulties Questionnaire (SDQ), and measured quality of life with the Pediatric Quality of Life Inventory (PedsQL 4.0 Generic Core Scales). Associations were first examined with chi-square or Fisher’s exact tests and then with multivariable logistic regression for each PedsQL domain, adjusted for age group, sex, nutritional status and primary diagnostic category.
On the SDQ, emotional symptoms and peer problems were the most prevalent domains, each affecting 13.2 percent of the adolescents. Quality of life impairment was most pronounced in the school domain, reported by 80.6 percent of participants, followed by physical functioning at 66.3 percent, emotional functioning at 50.9 percent and social functioning at 35.5 percent.
After adjustment, SDQ emotional symptoms were independently associated with impaired physical quality of life (adjusted odds ratio 2.89; 95 percent confidence interval 1.11 to 7.47), impaired emotional quality of life (AOR 2.95; 95 percent CI 1.21 to 7.23) and impaired social quality of life (AOR 3.00; 95 percent CI 1.32 to 6.80). SDQ peer problems showed even stronger associations: with impaired emotional quality of life (AOR 5.19; 95 percent CI 1.95 to 13.80), impaired social quality of life (AOR 4.28; 95 percent CI 1.82 to 10.05) and impaired school quality of life (AOR 10.47; 95 percent CI 1.38 to 79.64), although the wide interval for the school domain reflects considerable statistical uncertainty.
When the PSC-17 was modelled separately, internalizing symptoms were independently associated with impaired emotional quality of life (AOR 5.89; 95 percent CI 2.16 to 16.07) and impaired social quality of life (AOR 6.73; 95 percent CI 2.78 to 16.30), while the PSC-17 total score was associated with impaired social quality of life (AOR 12.24; 95 percent CI 2.52 to 59.39). Because the two instruments assess overlapping constructs, they were never entered into the same model in the primary analyses; collinearity was assessed formally, and sensitivity analyses used an alternative exposure definition and Firth penalised likelihood.
When both instruments were entered into a single model, each of their associations was attenuated, which the authors say accounts for the apparent divergence between the questionnaires. Their conclusion is that both screening tools identified affected adolescents when each was modelled appropriately, that neither is redundant, but that they should not be adjusted for one another in analyses.
Beyond the psychosocial findings, the study also found that undernutrition and female sex were independently associated with impaired physical quality of life, adding clinical context to the adjusted models.
The authors are careful to stress the limits of the design. Because the study is cross-sectional and based on retrospectively collected data from a single tertiary referral centre, the findings identify correlates rather than causes and cannot establish the direction of the associations. It remains unknown whether emotional and peer difficulties drive the reduced quality of life, whether the burden of chronic disease produces those difficulties, or whether both arise from shared underlying factors.
Subject of Research: Associations between psychosocial screening measures and impaired quality of life in adolescents with chronic diseases
Article Title: Emotional symptoms and peer problems as factors independently associated with impaired quality of life in adolescents with chronic diseases: a cross-sectional multivariable analysis
Article References: Restiviona, R., Girsang, R. T., Rusmil, K., Candra, R., Dwi Putra, M. G., & Angraini, D. (2026). Emotional symptoms and peer problems as factors independently associated with impaired quality of life in adolescents with chronic diseases: a cross-sectional multivariable analysis. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07789-0
Image Credits: AI Generated
DOI: 10.1186/s12887-026-07789-0
Keywords: adolescents, chronic disease, quality of life, emotional symptoms, peer problems, PSC-17, SDQ, PedsQL, cross-sectional study, mental health screening, Indonesia, pediatrics
News Source: Harold Sullivan. (October 28, 2026). Emotional symptoms and peer problems linked to poorer quality of life in adolescents with chronic disease. Scienmag.
