Mediating role of self-esteem and hope in predicting quality of life among forensic psychiatric patients with homicide offenses

BACKGROUND: Understanding the psychological factors that influence the quality of life among patients with forensic psychiatric disorders admitted to inpatient care units is of principal importance in enhancing their well-being and rehabilitation outcomes. This study investigates hope as a mediator in the relationship between self-esteem and quality of life in this unique population. METHODS: This study was conducted among male forensic psychiatric inpatients admitted following homicide offenses at the forensic ward of Razi Psychiatric Hospital. A total of 58 participants were selected using census method. Data collection involved administering Rosenberg's Self-Esteem Scale, Snyder's Adult Hope Scale, and the World Health Organization Quality of Life-BREF questionnaire. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS-26), including correlation analysis, univariable regression analysis, multivariable regression analysis, and mediation analysis. RESULTS: In a simple regression model, Self-esteem positively associated with quality of life (coef. = 12.9, p <.001). Hope also positively linked to quality of life (coef. = 6.1, p <.001). Self-esteem positively associated with hope (coef. = 1.9, p <.001). Hope mediated the relationship between self-esteem and quality of life, including general health, physical health, mental health, social relationships, and environmental factors. The indirect effect of self-esteem on quality of life through hope was significant (11.2, 95% CI: 5.2 to 17.7), while the direct effect was non-significant (1.7, 95% CI: -5.1 to 8.5). 47% of the quality of life score variance was explained by self-esteem and hope. CONCLUSION: Both self-esteem and hope are significant predictors of quality of life in this population, with hope playing a mediating role in the relationship between self-esteem and various aspects of well-being. Interventions targeting self-esteem and fostering hope may prove beneficial in enhancing the overall quality of life for these patients.