Factors influencing health-related quality of life in adolescent girls: a path analysis using a multi-mediation model

Hyunjeong Shin, Songi Jeon, Inhae Cho

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Background: Recent studies have reported gender differences in adolescents’ health-related quality of life (HRQOL), with females scoring significantly lower than males. Researchers have identified the female puberty process as one of the causes of the differences in HRQOL between male and female adolescents. This study examines mechanisms of how social support, dietary habits, sleep quality, and depression contribute to predicting HRQOL in relation to menstrual health among adolescent girls. Methods: A cross-sectional study was conducted with 295 students recruited from middle and high schools in Korea using a self-report questionnaire. A multi-mediation model was constructed based on previous literature and tested using path analysis with AMOS, version 21.0. Results: The study results showed that menstrual health, social support, sleep quality, dietary habits, and depression had significant effects on HRQOL. Both sleep quality and depression had significant direct effects on menstrual health. Dietary habits, social support, sleep quality, and depression had significant indirect effects on HRQOL, mediated through menstrual health. According to serial mediation analysis, the path from social support to HRQOL via dietary habits → sleep quality → depression → menstrual health → HRQOL was significant. However, mediation models including the path of dietary habits → depression were not supported. The study variables explained 57% of the total variance for HRQOL. Conclusions: The findings suggest menstrual health is an important factor that mediates the effects of eating, sleeping, psychological health, and social support on HRQOL. Early complaints about sleep disorders and depressive symptoms with poor dietary habits could be an ominous sign for adolescent girls at high risk of menstrual problems and lower HRQOL. Empirical evidence from this study suggests the need to develop and test interventions addressing multiple modifiable behavioral and psychosocial factors to improve HRQOL in adolescent girls. Interventions or supportive systems that aim to improve eating habits and sleep quality thereby achieving a healthier lifestyle need to be developed and incorporated into school health services.

Original languageEnglish
Article number50
JournalHealth and Quality of Life Outcomes
Issue number1
Publication statusPublished - 2022 Dec

Bibliographical note

Funding Information:
This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. NRF-2014R1A1A3049965), the grant funded by Korea University (No. K1515741), and the grant funded by the Nursing Research Institute of Korea University.

Publisher Copyright:
© 2022, The Author(s).


  • Adolescent
  • Depression
  • Dietary habits
  • Menstruation
  • Quality of life
  • Sleep
  • Social support

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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