Health conditions and social problems in children and adolescents with epilepsy: The role of quality of life by employing the PedsQL-EM

Background: Children with epilepsy are at increased risk for reduced health-related quality of life (HRQoL), due to the combined impact of seizures, comorbidities (somatic, psychiatric, neurologic, eurodevelopmental), social limitations. However, validated tools in different languages for HRQoL in pediatric epilepsies remain limited. Aim: To explore HRQoL in children/adolescents with epilepsy, focusing on epilepsy-related factors, social difficulties, and overall well-being, after linguistic validation of the Italian Pediatric Quality of Life Inventory Epilepsy Module (PedsQL-EM). Methods: The sample included 119 participants (aged 8–18-year-old). Caregivers completed the Italian PedsQL-EM and the Italian version of the Child Behavior Checklist (CBCL) Social Problems subscale. Hierarchical multiple regression was performed to identify predictors of HRQoL, and a mediation model tested the indirect effects on the Social Problems subscale of the CBCL. Results: The Italian PedsQL-EM showed good internal consistency (ω = 0.72–.92). We found an high correlation between each domain of the PedsQL-EM, allowing to perform further analysis using a comprehensive total score. The total score strongly correlated with lower cognitive performances, neurological and psychiatric comorbidities, and was also significantly correlated with the subscale scores of the CBCL. HRQoL significantly mediated the relationship between clinical severity and social problems (indirect effect = 2.83; 95 % CI = 1.374–4.402). Conclusion: In children with epilepsy, lower cognitive abilities and neurological/psychiatric comorbidities may affect social functioning through the mediation role of HRQoL. Utilizing PedsQL-EM as a screening tool can help identify these risks early, allowing for targeted interventions. Given the high psychiatric comorbidity in these patients, integrating behavioral health services into epilepsy care could improve comprehensive assessment and treatment, enhancing overall outcomes for affected children.