Health-Related Quality of Life, Mental Health and Physical Activity in Iranian Students from Pandemic to Post-Pandemic: Intensification of Gender differences after Covid-19

Abstract

This study compared health-related quality of life (HRQOL)—including school, physical, emotional, and social
functioning—body mass index (BMI), and physical activity (PA) levels among Iranian students (aged 6–18 years)
during and after the COVID-19 pandemic, focusing on gender- and age-related differences. Two cross-sectional
studies were conducted: the first (N = 1084) during the second year of the pandemic (post-Delta wave), and the
second (N = 1602) in the post-pandemic period. Participants were selected using multistage cluster random
sampling from urban and rural schools in Tehran Province. Data were collected online via standardized
questionnaires, including the Pediatric Quality of Life Inventory (PedsQL) and the short form of the International
Physical Activity Questionnaire (IPAQ-SF).
In both studies, children reported higher HRQOL scores than adolescents, whereas adolescents had higher BMI and
PA levels. Boys generally reported higher scores than girls on several HRQOL dimensions, particularly social
functioning and mental health. The age-related pattern was broadly
consistent across both timepoints, whereas the pattern of gender differences appeared more pronounced in the post
pandemic sample. Adolescent girls generally showed the least favorable HRQOL profile, particularly in school, social,
and mental health domains. While gender differences in school functioning appeared less pronounced post
pandemic, differences in mental health persisted. During the COVID-19 crisis, age played a more decisive role in
students' well-being, reflecting developmental sensitivity.