Optimism and Pessimism in Children with Cancer and Healthy Children: Confirmatory Factor Analysis of the Youth Life Orientation Test and Relations with Health-Related Quality of Life

Objective To test the measurement equivalence of the Youth Life Orientation Test (YLOT) in children with cancer (N = 199) and healthy controls (N = 108), and to examine optimism and pessimism as predictors of children's health-related quality of life (HRQL). Methods Confirmatory factor analysis (CFA) was conducted to establish the two factor structure of the YLOT and to test for metric invariance. Results A two-factor structure for the YLOT was confirmed and found to be stable across our study groups. There were no differences in mean levels of optimism and pessimism between cancer patients and controls after controlling for race/ethnicity. Higher optimism was associated with lower self-reports of pain and better emotional/behavioral functioning, whereas pessimism was related to poorer mental health and general behavior, and greater impact on the family. Conclusions Optimism and pessimism appear to be differentially related to certain aspects of children's HRQL, and should be investigated separately in relation to these outcomes.