Health services - Research lines Jordi Alonso

Trajectories of perceived health and use of health care services in a Spanish population sample of children and adolescents 8 to 18 years old. Study of the parent/tutors (KIDSCREEN)

Research Team: Alonso J, Villalonga E, Valderas JM, Ferrer M, Vilagut G, Forrest CB, Ravens-Sieberer U, Ridley AW.

Coordinated study between Agència d’Avaluació de Tecnologia i Recerca Mèdiques i Institut Municipal d’Investigació Mècica (coordinator: Luís Rajmil).

Summary: The general objective of the study is to characterize trajectories of perceived health (TPH) and the use of health services (UHS) among Spanish children and adolescents from a 24 months monitoring, taking into account family, social and proxy (parents) factors. The specific objectives are to analyze the association between proxy self-perceived health, proxy mental health, UHS and health outcomes. To study risk factors that influence child mental health. To compare the predictive influence of the children’s responses with the proxy ones and to analyze adolescent risk factors and their association with perceived health and UHS. The study is a prospective cohort. Re-interviews by postal questionnaires to the Spanish sample of children and adolescents aged 8-18 years of the Kidscreen project (n=926) were carried out during the year 2003. The following indicators related with the children sample were analyzed: TPH (Kidscreen), mental health questionnaire (SDQ), UHS, life events (CLES), and health related behaviours of children. From tutors and parents, the following indicators related were analyzed: Assessment of perceived health (SF-12), mental health (CIDI) and UHS. Analysis: Repeated measure regression models and GEE (generalized estimated equations) to determine the health trajectories, for every Kidscreen dimensions. Multivariate models –logistic, linear regression and general additive models, depending on the dependant variable- will be adjusted, stratified by declared morbidity, under-aged mental health and proxy mental health controlling for health and sociodemographic factors. Structural equation modelling to study risk factors related with mental health in children and the relation between stressful life events and psychosomatic complaints. Methodologic results: The CLES (Coddington Life Events Scales for children) have been adapted into Spanish with good validity and reliability results. A pilot study of the validity of the psychiatric interview CIDI has been expanded and the results are in process. Substantive results: It has been observed that HRQoL decrement in older ages. Also, parental mental health and stressful life events are the most important risk factors that affect children mental health. The experience of stressful life events can decrement quality of life, but to cope with stress changes depending on gender. In our sample, girls are less affected.

Status: Dietary habits, obesity and its relation with health related quality of life are now under study. In the same population, the relationship between life events, and psychosomatic complaints taking into account possible mediators like social, human and financial capital is under study. Finally, changes on mental health in children and the use of health services are also under study.

Key Words: Children, adolescents, health related quality of life, mental health, stressful life events, KIDSCREEN.

Funding: Instituto de Salud Carlos III (Red IRYSS G03/202) and Fondo de Investigación Sanitaria (PI042504 and PI042315).