Determinants of health-related quality of life in healthy children and adolescents during the COVID-19 pandemic: results from a prospective longitudinal cohort study

PurposeUnderstanding health-related quality of life (HRQOL) in children and adolescents, during a pandemic and afterwards, aids in understanding how circumstances in their lives impact their well-being. We aimed to identify determinants of HRQOL from a broad range of biological, psychological and social factors in a large longitudinal population-based sample. MethodsData was taken from a longitudinal sample (n = 1843) of children and adolescents enrolled in the prospective school-based cohort study Ciao Corona in Switzerland. The primary outcome was HRQOL, assessed using the KINDL total score and its subscales (each from 0, worst, to 100, best). Potential determinants, including biological (physical activity, screen time, sleep, etc), psychological (sadness, anxiousness, stress) and social (nationality, parents education, etc) factors, were assessed in 2020 and 2021, and HRQOL in 2022. Determinants were identified in a data-driven manner using recursive partitioning to define homogeneous subgroups, stratified by school level. ResultsMedian KINDL total score in the empirically identified subgroups ranged from 68 to 83 in primary school children and from 69 to 82 in adolescents in secondary school. The psychological factors sadness, anxiousness and stress in 2021 were identified as the most important determinants of HRQOL in both primary and secondary school children. Other factors, such as physical activity, screen time, chronic health conditions or nationality, were determinants only in individual subscales. ConclusionRecent mental health, more than biological, physical or social factors, played a key role in determining HRQOL in children and adolescents during pandemic times. Public health strategies to improve mental health may therefore be effective in improving HRQOL in this age group. What is knownO_LIAssessing health-related quality of life (HRQOL) in children and adolescents aids in under- standing how life circumstances impact their well-being. C_LIO_LIHRQOL is a complex construct, involving biological, psychological and social factors. Factors driving HRQOL in children and adolescents are not often studied in longitudinal population-based samples. C_LI What is newO_LIMental health (stress, anxiousness, sadness) played a key role in determining HRQOL during the coronavirus pandemic, more than biological or social factors. C_LIO_LIPublic health strategies to improve mental health may be effective in improving HRQOL in children. C_LI