Personal and environmental contextual factors as mediators between functional disability and quality of life in adults with serious mental illness: a cross-sectional analysis.

Abstract

To examine personal and environmental contextual factors as mediators of functional disability on quality of life (QOL) in a sample of individuals with serious mental illness (SMI). A cross-sectional analysis of 194 individuals with SMI (major depressive disorder = 38.1%; bipolar disorder = 35.6%; schizophrenia spectrum disorder = 25.8%) recruited from four psychosocial rehabilitation clubhouses was undertaken to test a multiple regression model assuming that personal (i.e., resilience, social competence, and disability acceptance) contextual factors and environmental (i.e., family support, support from friends, and support from significant others) contextual factors would mediate the relationship of functional disability on QOL. The bootstrap test for multiple mediators was then used to test for the significance of the indirect effects functional disability on QOL through the mediators. In the simple regression model, functional disability had a strong relationship with QOL; however, after introducing the potential mediators, its effect was significantly reduced indicating partial mediation effects. The final regression model yielded a large effect, accounting for 44% of the variance in QOL. Controlling for all other potential mediating factors, social competence, disability acceptance, family support, and support from friends were found to partially mediate the relationship between functional disability and QOL. Bias-corrected bootstrap procedure results further supported the mediation model. The findings from the study provide good support for the inclusion of person-environment contextual factors in conceptualizing the relationship between functional disability and QOL for individuals with SMI.