Mental health-related quality of life and associated factors among people living with severe mental illness in southwestern Uganda

Abstract

Severe mental illness (SMI), including schizophrenia, bipolar disorder, and major depressive disorder, adversely affects multiple dimensions of quality of life, limiting individuals' ability to participate in everyday activities and maintain meaningful social and occupational roles. Globally, nearly one in seven people live with a mental disorder, and approximately 24.2% of Ugandan adults have at least one mental disorder. However, evidence on factors associated with mental health-related quality of life (MHQoL) among people living with SMI in Uganda remains limited. This study examined factors associated with MHQoL among adults living with SMI. A cross-sectional study was conducted among 422 adults with schizophrenia, bipolar disorder, or major depressive disorder attending the outpatient psychiatry clinic at Mbarara Regional Referral Hospital between May and June 2024. MHQoL was assessed using the Mental Health-related Quality of Life questionnaire. Sociodemographic, clinical, and psychosocial factors were measured using validated instruments. Bivariate and multivariable linear regression analyses identified factors associated with MHQoL. Higher medication adherence (b = 0.96; 95% CI: 0.10–1.83), family support (b = 0.13; 95% CI: 0.05–0.22), friend support (b = 0.05; 95% CI: 0.004–0.10), religiosity (b = 0.13; 95% CI: 0.003–0.26), and stigma resistance (b = 0.16; 95% CI: 0.02–0.29) were independently associated with better MHQoL. Social withdrawal (b = −0.13; 95% CI: −0.26 to −0.004) and stereotype endorsement (b = −0.14; 95% CI: −0.26 to −0.02) were associated with poorer MHQoL. Greater perceived social support, religiosity, and stigma resistance were associated with better MHQoL, whereas social withdrawal and stereotype endorsement were associated with poorer MHQoL among people living with SMI. These findings highlight the importance of addressing psychosocial factors alongside pharmacological treatment. Longitudinal and intervention studies are needed to determine whether targeting these factors improves MHQoL. •Social and cultural factors play a central role in MHQoL among people with SMI.•Family support and religious engagement may protect mental health quality of life.•Addressing stigma may improve quality of life alongside clinical care.