Peer-reviewed article

Children's Internalizing Symptoms and Well-Being: The Role of Parental Anxiety and Health-Related Quality of Life.

Georgousopoulou V, Manomenidis G, Serdari A · 6 Jul 2026

Abstract

Background Children's health-related quality of life (HRQoL) has been associated with both individual and family-related factors, including internalizing symptoms and parental psychological well-being. Although previous research has highlighted the role of parental mental health, evidence from non-clinical community samples remains limited, particularly when parent-proxy reports are used. Methods A cross-sectional study was conducted among 242 parents of children aged 8-12 years in Northern Greece. Parents completed proxy measures of children's HRQoL and internalizing symptoms, as well as self-reported measures of their own HRQoL and anxiety. Nonparametric tests were used for bivariate analyses, and multiple linear regression was applied to identify independent predictors of children's HRQoL. Results Higher parental mental HRQoL was positively associated with children's HRQoL (ρ = 0.213, p = 0.031), while parental anxiety (trait anxiety: ρ = -0.204, p = 0.004; state anxiety: ρ = -0.314, p < 0.001) and parent-reported child internalizing symptoms (depression: ρ = -0.369, p < 0.001; anxiety: ρ = -0.322, p < 0.001) were negatively associated with HRQoL; however, in the multivariable model, only parental mental HRQoL (B = 0.344, p = 0.020) and parental education (B = -2.944, p = 0.044) remained significantly associated with parent-proxy child HRQoL, explaining 29.2% of the variance in children's HRQoL (R2 = 0.292). Conclusions The findings suggest that parent-proxy child HRQoL is associated with parental psychosocial functioning in this community-based sample. Parental mental HRQoL was the strongest independent correlate of parent-proxy child HRQoL. However, given the exclusive use of parent-proxy reports and the convenience-based sample, these findings should be interpreted cautiously, as shared method variance, rater-related effects, and limited generalizability may have contributed to the observed associations. Further multi-informant and longitudinal studies conducted in more diverse populations are warranted.