Service satisfaction and perceived social support mediate the effect of internalised stigma on quality of life of people with mental illness: mediation analysis

When people with mental illnesses internalise stigma, their quality of life (QoL) can be compromised. However, previous studies in sub-Saharan countries, including Ethiopia, have not examined the relationship between internalised stigma and QoL, nor how factors such as service satisfaction and perceived social support might mediate this relationship. In this study using a mediation analysis model we explore the possible mediating role of service satisfaction and perceived social support in the relationship between internalised stigma and QoL among people with mental illness attending psychiatry outpatient clinics. Six hundred thirty-eight patients diagnosed with mental illness were interviewed by psychiatry nurses with a questionnaire that measured QoL, internalised stigma, service satisfaction, and perceived social support. A maximum likelihood model was used to examine the mediating effect of service satisfaction and perceived social support on the association between internalised stigma and QoL. We used Amos-28 to perform mediation analysis to accommodate latent and endogenous mediating variables within the same model. Service satisfaction and perceived social support mediated the relationship between internalised stigma and QoL. Structural equation modelling showed a significant correlation between internalised stigma and QoL (B = -1.093; 95% CI -1.692, -0.653). The hypothetical model indicated that internalised stigma was indirectly related to QoL through service satisfaction and social support (B = 0.13, 95% CI 0.066, 0.199), (B = -0.09; 95% CI -0.141, -0.040) respectively. All domains of QoL had a negative association with internalised stigma directly, indirectly and in total effect. Social support had a positive significant association for all domains of QoL except for psychological domains and service satisfaction had a negative association with all domains of QoL. These findings suggest that the QoL of people with mental illness was associated with internalised stigma, service satisfaction, and perceived social support; and identified the mediating effect of service satisfaction and perceived social support in the association between internalised stigma and QoL. This suggests the importance of integrating intervention techniques to target service satisfaction and perceived social support into the QoL improvement program of individuals with internalised stigma.