title: Examination of a theoretical model for oral health-related quality of life among youths with cleft.
abstract: OBJECTIVE
  We evaluated relationships among physical and psychological indicators and oral health-related quality of life (OHRQOL) in youths with cleft.
  
  
  METHODS
  We recruited youths aged 7 to 18 years with cleft palate (n = 282) or cleft lip and palate (n = 918) and their caregivers into a 5-year observational investigation at 6 US treatment centers from 2009 to 2011. At baseline, youths completed surveys to assess psychological status. After clinical evaluation, 433 youths received a recommendation for surgery. We developed structural models from the baseline data incorporating age, gender, race, and cleft diagnosis to examine direct relationships between depressive symptoms and, in separate models, self-concept and sense of mastery and OHRQOL. Subsequent models examined the possible mediating effect of surgical recommendation.
  
  
  RESULTS
  Depressive symptoms were negatively and self-concept and self-efficacy were positively associated with OHRQOL. Surgical recommendation appeared to mediate the effect of psychological well-being, but not depression, on OHRQOL, even after adjustment for cleft diagnosis. In some models, individual-level characteristics were significant.
  
  
  CONCLUSIONS
  Path analyses support the theoretical model and underscore the importance of examining positive psychosocial characteristics such as resiliency and self-concept in this patient population.
authors.affiliation: Hillary L. Broder and Lacey Sischo are with the Department of Comprehensive Care, College of Dentistry, New York University, NY. Maureen Wilson-Genderson is with the Department of Social and Behavioral Health, Virginia Commonwealth University Medical Center, Richmond.
authors.forename: Hillary L
authors.initials: HL
authors.lastname: Broder
authors.forename: Maureen
authors.initials: M
authors.lastname: Wilson-Genderson
authors.forename: Lacey
authors.initials: L
authors.lastname: Sischo
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002972:Cleft Palate / Q000453:epidemiology / Q000523:psychology*; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009909:Oral Health; D011788:Quality of Life; D044469:Racial Groups; D012649:Self Concept; D012737:Sex Factors