Emotional symptoms and peer problems as factors independently associated with impaired quality of life in adolescents with chronic diseases: a cross-sectional multivariable analysis

Background Adolescents with chronic diseases are vulnerable to mental-emotional problems that may accompany reduced quality of life (QoL). However, evidence identifying which psychosocial domains are independently associated with impaired QoL in this population remains limited. Objective To examine whether mental-emotional problems, assessed with two complementary screening instruments, are independently associated with impaired quality of life among adolescents with chronic diseases. Methods This cross-sectional study analysed retrospectively collected data from 273 adolescents aged 10–18 years with chronic diseases admitted to the paediatric inpatient wards of Dr. Hasan Sadikin General Hospital, Bandung, a tertiary referral centre, between October 2024 and March 2025. Mental-emotional problems were screened using the Pediatric Symptom Checklist-17 (PSC-17) and the Strengths and Difficulties Questionnaire (SDQ), and QoL was measured using the Pediatric Quality of Life Inventory (PedsQL™ 4.0 Generic Core Scales). Associations were examined using chi-square or Fisher’s exact tests, followed by multivariable logistic regression for each PedsQL domain, adjusted for age group, sex, nutritional status and primary diagnostic category. Because the two instruments assess overlapping constructs, they were never entered into the same model. Collinearity was assessed formally, and sensitivity analyses used an alternative exposure definition and Firth penalised likelihood. Results Emotional symptoms and peer problems were the most prevalent SDQ domains (13.2% each). QoL impairment was most pronounced in the school domain (80.6%), followed by physical (66.3%), emotional (50.9%) and social functioning (35.5%). After adjustment, SDQ emotional symptoms were independently associated with impaired physical (adjusted odds ratio [AOR] 2.89; 95% CI 1.11–7.47), emotional (AOR 2.95; 95% CI 1.21–7.23) and social QoL (AOR 3.00; 95% CI 1.32–6.80), and SDQ peer problems with impaired emotional (AOR 5.19; 95% CI 1.95–13.80), social (AOR 4.28; 95% CI 1.82–10.05) and school QoL (AOR 10.47; 95% CI 1.38–79.64). Modelled separately, PSC-17 internalizing symptoms were also independently associated with impaired emotional (AOR 5.89; 95% CI 2.16–16.07) and social QoL (AOR 6.73; 95% CI 2.78–16.30), and the PSC-17 total score with impaired social QoL (AOR 12.24; 95% CI 2.52–59.39). Entering both instruments in one model attenuated each of them, which accounts for the apparent divergence between the questionnaires. Undernutrition and female sex were independently associated with impaired physical QoL. Conclusion Emotional and peer-related difficulties were independently associated with impaired quality of life across several domains. Both screening instruments identified affected adolescents when each was modelled appropriately; neither is redundant, but they should not be adjusted for one another. Because the design is cross-sectional, these findings identify correlates rather than causes and cannot establish the direction of the associations.