Loneliness and health-related quality of life in Chinese adolescents: the mediating role of depressive symptoms and the moderating role of age.

Abstract

Purpose: Despite the alarming prevalence of loneliness in adolescents, few studies addressed its impact on health-related quality of life (HRQOL). This study aimed to investigate the association between loneliness and HRQOL in adolescents, as well as the mediating role of depressive symptoms and the moderating role of age in this association.

Methods: A cross-sectional study surveyed 6743 middle school adolescents, assessing loneliness with the 6-item UCLA Loneliness Scale and HRQOL through the Pediatric Quality of Life Inventory Version 4.0. Depressive symptoms were assessed by the Patient Health Questionnaire-9. Pearson correlation analysis was performed to determine the correlation among the main variables. A moderated mediation analysis was established to evaluate the mediating role of depressive symptoms and the moderating role of age in the association between loneliness and HRQOL.

Results: Of the participating adolescents, 25.0% (1687) reported experiencing high-level loneliness. The findings revealed a significant association between loneliness and lower scores across all HRQOL dimensional and summary scales. Specifically, with every additional point in loneliness scores, the HRQOL total scale scores changed by -2.06 (95% CI: -2.13 to -2.00) points. Depressive symptoms were identified as a partial mediator, with mediation effects ranging from 24.31% for social functioning to 62.50% for school functioning. Additionally, age negatively moderated the link between loneliness and depressive symptoms in above mediation model.

Conclusions: The link between loneliness and poorer HRQOL in adolescents highlighted the need to prioritize this vulnerable group. Our findings also indicated the importance of addressing depressive symptoms and age differences among lonely adolescents to preserve their HRQOL.