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

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Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

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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Authors and Affiliations

  1. Department of Rehabilitation and Counselor Education, The University of Iowa, N346 Lindquist Center, Iowa City, IA, 52242, USA

    Jennifer Sánchez & Mileidy Crespo-Jones

  2. Iowa Consortium for Substance Abuse Research and Evaluation, The University of Iowa, 2662 Crosspark Road, Coralville, IA, 52241, USA

    Jennifer Sánchez

  3. I-SERVE (Iowa-Support, Education, and Resources for Veterans and Enlisted), The University of Iowa, N122 Lindquist Center, Iowa City, IA, 52242, USA

    Jennifer Sánchez

  4. Department of Educational Foundations and Counseling, Hunter College, City University of New York, 695 Park Avenue, Room W1123, New York, NY, 10065, USA

    Veronica Muller

  5. Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, 431 Education Building, 1000 Bascom Mall, Madison, WI, 53706, USA

    Fong Chan & Kanako Iwanaga

  6. Department of Rehabilitation and Health Services, University of North Texas, 218 Chilton Hall, 410 Avenue C, Denton, TX, 76203, USA

    Jessica M. Brooks & Wei-Mo Tu

  7. Department of Rehabilitation Sciences, The University of Texas at El Paso, 101 Campbell Building, 500 West University Avenue, El Paso, TX, 79968, USA

    Emre Umucu

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  1. Jennifer Sánchez
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Correspondence to Jennifer Sánchez.

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Sánchez, J., Muller, V., Chan, F. et al. Personal and environmental contextual factors as mediators between functional disability and quality of life in adults with serious mental illness: a cross-sectional analysis. Qual Life Res 28, 441–450 (2019). https://doi.org/10.1007/s11136-018-2006-1

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