Our study showed that the highest prevalence of low QoL among adolescents was observed in psychological well-being and school environment dimensions, whereas school environment was assessed as the lowest out of all the KIDSCREEN-52 dimensions.
In these dimensions, more than 50% adolescents assessed their QoL as low.
The study indicated that sex and level of education were significant predictors of QoL. Girls were more likely to report lower QoL than boys in the majority of KIDSCREEN-52 dimensions (physical well-being, psychological well-being, self-perception, autonomy, parent relation and home life, financial resources). This result was confirmed in the other studies, both conducted in the Polish population (Magiera A. et al., 2017; Mazur J. et al., 2008), and in different countries (Gaitán-López D.F. et al., 2017; Gaspar et al., 2009; Griffiths et al., 2017; Meade & Dowswell, 2016; Michel et al., 2009; Solveig Petersen et al., 2012; Svedberg et al., 2013). In the Polish study among adolescents from junior high school in Kraków using KIDSCREEN-27, the authors also indicated that girls assessed their QoL lower than boys in terms of physical and psychological well-being, autonomy and relations with parents (Magiera A. et al., 2017), whereas a study conducted in Poland among the 8–18 years old (the Polish part of KIDSCREEN project) showed that girls reported lower QoL than boys in physical well-being, moods and emotions, self-perception, autonomy dimensions (Mazur J. et al., 2008). These results are also supported by global studies using the KIDSCREEN-52 instrument, in which boys scored QoL higher than girls in the majority of dimensions, in particular in psychological well-being, moods and emotions (Gaspar et al., 2009; Meade & Dowswell, 2015, 2016; Svedberg et al., 2013; Viira & Koka, 2012; Villalonga-Olives et al., 2010).
Lower quality of life among girls might be explained by biological and psychological emotional differences between girls and boys. Biological differences such as earlier puberty and brain development can underpin explanations of lower quality of life in girls (Bisegger C. et al., 2005; Patton & Viner, 2007). Girls experience all the changes in body (for example the first menstrual period, increasing outer body fat) and psyche more negatively than boys (Solveig Petersen et al., 2012; Svedberg et al., 2013). It might lead to a negative body image (Friedlander S.L. et al., 2003). Adolescent girls are less disposed to physical activity than adolescent boys, girls prefer passive leisure time. Gaspar et al. suggested that boys achieve higher QoL than girls in physical well-being dimension probably due to the physical activity with friends such as collective games and other activities in their free time (Gaspar et al., 2009). Girls are marked by lower self-assessment, more frequent depressive symptoms and negative emotions than boys. Additionally, girls are less satisfied with their life (Friedlander S.L. et al., 2003; S Petersen et al., 2013; Svedberg et al., 2013), so it might explain their poorer QoL in psychological well-being and self-perception dimensions. Lower QoL in the context of autonomy and relation with parents might be explained by the discrepancy between the sense of autonomy of adolescents and the parental control, which is associated with lower level of well-being. Piko and Hamvai suggested that girls report parental monitoring more often than boys, which is related to lower life satisfaction (Piko & Hamvai, 2010). In our study girls experienced poorer QoL in financial resources dimension. It might be associated with the fact that girls feel financial deficit in family more strongly than boys, they do not have enough pocket money for spending (Duda M., 2016).
Being students in the 3rd grade of junior high school and the 2nd grade of upper secondary school was related to higher odds of low QoL in adolescents (in dimensions relating to physical and psychological well-being, moods and emotions, self-perception and relations with peers and school). It can be suggested that younger pupils assess their QoL higher than the older ones. Similar observation was found in the previous studies (Gaspar et al., 2009; Meade & Dowswell, 2015). It can be related to the fact that older adolescents encounter more and more difficult challenges concerning the increasing requirements in school, which may impair QoL among youth.
Our findings also demonstrate that variables concerning general health, such as being dissatisfied with appearance, health status, being absent at school due to illness episodes seldom or often were significant predictors of QoL in adolescents. The subjective sense of satisfaction with body and appearance is an important factor affecting the quality of life in teenagers (Hogan, MJ, Strasburger, 2009). The contemporary model of an ideal body promoted by the mass media affects the social expectations of youth and may be a source of dissatisfaction with own body (Holsen, I, Kraft, P, Røysamb, 2001). Griffits et al. found that the reduction in the level of quality of life associated with dissatisfaction with body was equally pronounced in girls and boys.
It concerned the reduction of the quality of life in physical and psychosocial dimensions (Griffiths et al., 2017). In our study, adolescents who reported dissatisfaction with health status had higher odds of low QoL. In an American study, the authors indicated that if adolescents reported ‘fair or poor’ health or an increasing number of poor physical health days, the risk of dissatisfaction with life increased (Zullig et al., 2005). Moreover, experiencing illness episodes and absence at school for this reason may reduce the QoL of adolescents due to worse physical well-being as well as possible difficulties in catching up with the school material. Garcia-Moya et al. showed that absence at school, backlogs in school material may reduce the QoL in youth and, as a result, may impair their health status (Garcia-Moya I. et al., 2013).
Our study also found that socio-economic variables affected the QoL in adolescents. We found that primary/vocational father’s/caregiver’s educational level, not receiving pocket money, bad material standing of the family, bad relations with at least one parent/caregiver, feeling uncomfortable at home significantly decreased the QoL among youth.
Von Rueden et al. found that wealthiness of the family and the level of parents' education have a significant impact on the QoL in childhood and adolescence, whereby the family's wealthiness was a stronger predictor of the quality of life. Among the children, primary or secondary parent’s educational level was related to lower QoL concerning physical, psychological well-being, moods and emotions, social acceptance and financial resources. Among the adolescents, educational level of parents was an important predictor in physical well-being dimension. Children from families with low or medium financial resources had higher odds of poor QoL in the following dimensions: physical well-being, parent relations and home life and financial resources in comparison to their peers from the wealthier families. In adolescents, low or middle financial resources in family were a risk factor for low QoL in all KIDSCREEN-52 dimensions. Lower financial resources in a family may also suggest that a teenager does not receive any pocket money from parents/caregivers (Rueden et al., 2006). Good relations with parents/caregivers and as a consequence a feeling of comfort at home are also important predictors of QoL, so the lack of closer relations render that a teenager does not feel comfortable at home, which may reduce QoL. Piko and Hamvai found that parents and relations with them play a key role in the achievement of well-being among adolescents, especially joint meals, talking about problems with parents (Piko & Hamvai, 2010).
We also confirmed that spending more than 3 hours on social media per week, low level of physical activity, not spending free time with friends besides school significantly increased the odds of low QoL in adolescents.
Frequent use of electronic media may be associated with poorer behavior, health status, and QoL in adolescents. A relationship between the time spent using the computer and on the Internet and mental discomfort was observed (Mathers M. et al., 2009). Intensive use of social media may be associated with more frequent psychosocial problems (e.g. anxiety and depression, abnormal thinking) (Lou et al., 2012; Pantic et al., 2012). Furthermore, frequent use of social media may be related to low physical activity. Studies indicate that low level of physical activity is related to poorer QoL in physical fitness, emotions, general health domains (Chen X. et al., 2005), whereas higher level of physical activity is related to higher QoL (Motamed-Gorji N. et al., 2019; Muros et al., 2017). This may be explained by the fact that regular physical activity improves psychological well-being, so consequently it may improve the QoL.
Relations with peers are a very important element of adolescents’ life, which significantly affects the QoL of young people. Moreover, Piko and Hamvai showed that helpful friends and relations with them was an important predictor of well-being in girls, increasing the QoL among them (Piko & Hamvai, 2010).
The international survey – HBSC (Health Behavior in School-aged Children) conducted in Poland in 2010 among students of the 1st and the 3rd grade of junior high schools relevant to the relations with friends and their QoL showed that better relations with friends were significantly associated with a higher QoL of students from junior high schools, however this relationship was more clearly visible in boys. Lack of friendly relationships may lead to a reduction in QoL as well as increase the intensity of emotional and social problems among adolescents (Małkowska-Szkutnik A., 2012).
Knowledge about predictors of QoL among youth is especially important for preventive medicine and public health, but it is also important for specialists, teachers, psychologists and other who meet and work with adolescents. Knowledge about predictors of QoL can help in the identification of reasons of low QoL and development of preventive actions for this age group.
Schools also should provide opportunities to improve adolescents’ QoL. Health promotion and intervention programs that aim to strengthen psychosocial well-being, especially self-image, should be developed for adolescents (Haraldstad et al., 2011).
Limitations and strengths of the present study
The present study has some disadvantages. Firstly, our study is cross-sectional, so it does not enable the assessment of the causality between the potential determinants of QoL and low QoL. Then, it should be considered that despite the fact that information about the study was given to parents during periodical teacher-parent meetings, we did not receive any information (either approval or refusal to participate) from 33% of the adolescents. It should be also emphasized that there were restrictions concerning the respondent’s error (respondent gave a reply contrary to the state of facts).
Some strengths should be mentioned as well. The QoL of adolescents was assessed using the KIDSCREEN-52 questionnaire prepared as a multinational instrument and validated both internationally and in Poland. In addition, the sample size was big enough to receive the reliable estimates and ensure that the results were representative of adolescents in the southern part of Poland. This study provides information about the potential determinants of quality of life of the adolescent population. According to our knowledge, the present study is the first of this kind in Poland and in the Małopolska region.