Factors Predicting Quality-of-Life Difficulty among Early Adolescent Students in Bangkok: A Secondary Analysis

Abstract

Introduction Quality of life is a critical outcome indicator in both school health nursing and adolescent nursing. Urban students, particularly those in Bangkok, face multiple pressures related to academic demands, sleep and rest, family, and social contexts, all of which may be associated with difficulties in quality of life. Previous projects have examined health behaviors and quality of life among adolescents in Bangkok; however, the primary studies reported only prevalence and bivariate associations. The present secondary data analysis was therefore conducted to investigate predictors of quality-of-life difficulties among early adolescents in Bangkok, utilizing data from the main project and guided by the conceptual framework of stress and coping. The findings are intended to inform strategies to improve the quality of life of early adolescents in Bangkok. Objective The objective of this study was to examine the jointly predictive ability of risk factors (sleep related daytime dysfunction, emotional distress, and strengths and difficulties) and protective factors (health behavior, perceived social support, self-esteem, and general self-efficacy) in explaining quality-of-life difficulties among early adolescent students in Bangkok.

Design This research employed a cross-sectional design through predictive secondary data analysis.

Methodology The study sample comprised 1,614 students in Bangkok, ranging from Grade 4 in primary school to Grade 9 in lower secondary school, drawn from the main project. Data collection in the primary study utilized a series of standardized instruments, including: a personal information questionnaire; a quality-of-life questionnaire encompassing domains of health and activities, emotional well-being, social relationships, and learning; the Adolescent Lifestyle Questionnaire (ALQ); the Sleep-Related Daytime Dysfunction scale (SRDD); the Multidimensional Scale of Perceived Social Support (MSPSS); the Rosenberg Self-Esteem Scale (RSES); the General Self-Efficacy scale (GSE); the Depression Anxiety Stress Scale (DASS); and the Strengths and Difficulties Questionnaire (SDQ). Data were analyzed using descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA), Pearson’s correlation analysis, and multiple regression analysis with the Enter method. 

Results The participants had a mean age of 12.44 years (SD = 1.76). The proportion of males (50.1%) was nearly equal to that of females (49.9%). More than half of the students were enrolled in lower secondary school (Grades 7–9) (52.7%). Fathers and mothers most frequently attained education at the bachelor’s level or higher (38.0% and 39.3%, respectively). Results from the multiple regression analysis indicated that the seven predictors together explained 32.7% of the variance in quality-of-life difficulties (R² = .327, adjusted R² = .324, F = 111.36, p < .001). Emotional distress emerged as the strongest predictor (β = .381, p < .001), followed by strengths and difficulties (β = .184, p < .001), self-efficacy (β = -.181, p < .001), sleep-related daytime dysfunction (β = .063, p = .005), self-esteem (β = .063, p = .003), and perceived social support (β = −.055, p = .024). Health behavior was not a significant predictor (β = -.034, p = .190). 

Recommendation Given that emotional distress was identified as the strongest predictor of quality-of-life difficulties, school health nurses should prioritize the development of programs that emphasize mental health care and the empowerment of students. Such programs should integrate systematic assessment of students’ strengths and difficulties, alongside interventions that address emotional well-being, sleep hygiene, self-esteem, and social support. By adopting a comprehensive and integrative approach, school health nurses can help reduce quality-of-life difficulties and foster more effective learning within the school environment.