title: Stigmatization predicts psychological adjustment and quality of life in children and adolescents with a facial difference.
abstract: OBJECTIVE
  This cross-sectional study assessed psychological adjustment and health-related quality of life (HRQOL) in children and adolescents with congenital or acquired facial differences and identified potential predictors of adjustment.
  
  
  METHODS
  Data were obtained from 88 children, ages 9 months to 16 years, by means of parent questionnaires (n = 86) and standardized interviews with children ≥7 years old (n = 31). Evaluation measures included the Child Behavior Checklist (CBCL), KIDSCREEN-27, TNO-AZL Preschool Quality of Life Questionnaire (TAPQOL), and Perceived Stigmatization Questionnaire.
  
  
  RESULTS
  Psychological adjustment, as measured by the CBCL, was within norms. Parent-reported HRQOL was good in preschool children. Parent- and self-reported HRQOL of participants 7-16 years old was impaired in several dimensions, including psychological well-being. Psychological adjustment (especially internalizing behavior problems) and HRQOL were predicted primarily by perceived stigmatization.
  
  
  CONCLUSIONS
  Identification of stigma experiences and appropriate support may be crucial to enhancing psychological adjustment and quality of life in children with facial disfigurement.
authors.affiliation: Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Ornella
authors.initials: O
authors.lastname: Masnari
authors.forename: Clemens
authors.initials: C
authors.lastname: Schiestl
authors.forename: Jochen
authors.initials: J
authors.lastname: Rössler
authors.forename: Stefanie K
authors.initials: SK
authors.lastname: Gütlein
authors.forename: Kathrin
authors.initials: K
authors.lastname: Neuhaus
authors.forename: Lisa
authors.initials: L
authors.lastname: Weibel
authors.forename: Martin
authors.initials: M
authors.lastname: Meuli
authors.forename: Markus A
authors.initials: MA
authors.lastname: Landolt
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002056:Burns / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005145:Face; D005260:Female; D018324:Hemangioma, Capillary / Q000523:psychology; D006801:Humans; D007223:Infant; D008297:Male; D009508:Nevus, Pigmented / Q000151:congenital / Q000523:psychology; D010290:Parents / Q000523:psychology; D019339:Port-Wine Stain / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D012878:Skin Neoplasms / Q000523:psychology; D012917:Social Adjustment; D013240:Stereotyping; D011795:Surveys and Questionnaires