Chronic conditions and adolescent psychosocial functioning: the moderating role of demographics

Background: This study investigated the differences in psychosocial functioning between adolescents with and without chronic conditions and examined the moderating influence of demographic characteristics. Methods: We conducted a cross-sectional study using nationally representative data from the Dutch Health Behavior in School-aged Children (HBSC) survey in 2017, which included 8,182 adolescents (aged 11–16 years), of whom 407 reported a chronic condition. Psychosocial functioning was assessed using ten indicators across three domains: wellbeing (life satisfaction, self-rated health, psychosomatic complaints, and mental health problems), social environment (sources of support and schoolwork pressure), and lifestyle (sleep problems, physical exercise, substance use, social media, and gaming). We examined differences in psychosocial functioning between adolescents with and without a chronic condition and assessed the potential moderating effects of demographic characteristics (gender, age, socioeconomic status, family structure, and migration background) on this association. Results: Across almost all indicators, adolescents with chronic conditions reported significantly lower levels of psychosocial functioning than those without chronic conditions. The effect sizes were medium to large for wellbeing indicators, and small to medium for the social environment and lifestyle indicators. For several wellbeing and social environment indicators, differences between adolescents with and without a chronic condition were more pronounced for females, older adolescents, and those from lower socioeconomic backgrounds. The differences in family support were greater among adolescents who did not live with both parents. Conclusions: Adolescents with self-reported chronic conditions experienced substantially lower levels of psychosocial functioning than those without. This highlights the need for monitoring and preventive interventions targeting specific groups to improve psychosocial functioning.