Perceived Self-Efficacy as a Moderator of the Relationship between Life Skills and Mental Health in Pakistani Adolescents with Non-Communicable Diseases (NCDs): A Cross-Sectional Study

Abstract

Background: Adolescents diagnosed with NCDs face a dual burden of chronic physical pathology and heightened risks for emotional and behavioral problems (EBPs). According to Social Cognitive Theory, psychosocial competencies like life skills and perceived self-efficacy (PSE) are critical determinants of adaptive coping and emotional regulation in this population. This study examined the predictive utility of life skills and PSE on EBPs and evaluated the moderating influence of PSE on the relationship between life skills and psychological outcomes. Moreover, this study evaluated the construct validity of the Urdu version of the Life Skills Scale Short (LSS-S) within a clinical population of Pakistani adolescents.

Method: A purposive sampling technique was used based on a cross-sectional research design. Two hundred adolescents (n=111 female, 55.5%; n=89 male, 44.5%) aged 15–19 with diagnosed NCDs were recruited from the departments of Fauji Foundation Hospital, Rawalpindi, Pakistan. Psychometric assessments included the Life Skills Scale Short (LSS-S), the Strengths and Difficulties Questionnaire (SDQ) Youth Self-Report, and the General Self-Efficacy Scale.

Results: This study analysis indicated that higher levels of life skills were significantly associated with increased PSE and a reduction in EBPs (p < .01). Regression analysis confirmed that life skills significantly predicted fewer emotional and behavioral difficulties, explaining 40% of the variance (R² = .40, p < .001). Moderation analysis revealed a significant interaction effect (β = .004, p < .03), indicating that PSE serves as a critical buffer. Specifically, higher PSE strengthens the protective effect of life skills, leading to a more pronounced decrease in EBPs compared to those with lower self-efficacy.

Conclusions: These findings underscore the synergistic role of life skills and self-efficacy in promoting psychological resilience among adolescents with chronic illnesses. The results advocate for the integration of self-efficacy-based life skills interventions into standard clinical care to mitigate psychological distress and enhance long-term health outcomes in pediatric NCD management.