Quality of Life Research

, Volume 28, Issue 2, pp 441–450 | Cite as

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

  • Jennifer SánchezEmail author
  • Veronica Muller
  • Fong Chan
  • Jessica M. Brooks
  • Kanako Iwanaga
  • Wei-Mo Tu
  • Emre Umucu
  • Mileidy Crespo-Jones



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.


Serious mental illness Person–environment contextual factors Social competence Disability acceptance Social support 



The work for this manuscript was funded, in part, by the Rehabilitation Research and Training Center on Evidence-Based Practice in Vocational Rehabilitation (RRTC-EBP VR) at the University of Wisconsin-Madison and the University of Wisconsin-Stout with funding provided by the U.S. Department of Health and Human Services, National Institute on Disability, Independent Living, and Rehabilitation Research (H133B100034; PI Fong Chan) and by the Psychosocial Rehabilitation and Health-and-Related Disparities Research Lab (PsyR HaRD), Department of Rehabilitation and Counselor Education, College of Education, The University of Iowa (COE4724; PI Jennifer Sánchez). The ideas, opinions, and conclusions expressed, however, are those of the authors and do not represent recommendations, endorsements, or policies of the sponsors. The sponsors had no involvement in the study design, data collection, or write up.


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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Rehabilitation and Counselor EducationThe University of IowaIowa CityUSA
  2. 2.Iowa Consortium for Substance Abuse Research and EvaluationThe University of IowaCoralvilleUSA
  3. 3.I-SERVE (Iowa-Support, Education, and Resources for Veterans and Enlisted)The University of IowaIowa CityUSA
  4. 4.Department of Educational Foundations and Counseling, Hunter CollegeCity University of New YorkNew YorkUSA
  5. 5.Department of Rehabilitation Psychology and Special EducationUniversity of Wisconsin-MadisonMadisonUSA
  6. 6.Department of Rehabilitation and Health ServicesUniversity of North TexasDentonUSA
  7. 7.Department of Rehabilitation SciencesThe University of Texas at El PasoEl PasoUSA

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