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Loneliness As a Mediator in the Relationship Between Social Support and Quality of Life in Adults with Severe Mental Illness
Quality of life (QOL) refers to the extent to which an individual enjoys the important aspects of lives; recently, QOL has been used to measure the outcomes of mental health services. Research evidence shows that social support can facilitate QOL among adults with severe mental illness (SMI). However, the process by which social support impacts QOL is not well understood. As data has shown that lower levels of loneliness are associated with greater social support and higher QOL, this study aimed to investigate whether the relationship between perceived social support and QOL is mediated by loneliness among adults with SMI.
Methods
This study employed a cross-sectional survey design. Data were collected from members enrolled in a Clubhouse setting. The final sample size was 124 individuals after data with missing values were deleted. A social network interview methodology was used to facilitate the nomination of social network members. Social support was evaluated by summing up perceived availability of concrete, emotional and informational support. Loneliness was measured by the 20 item UCLA Loneliness Scale, Version 3 Russell, 1996). Quality of life was measured by the 24 item Quality of Life Questionnaire (Greenley, Greenberg, & Brown, 1997). A mediation analysis was performed using the Baron and Kenny (1986) causal steps approach. Two hierarchical regression analyses were performed; the exogenous variable was social support, the outcome variable was QOL, and the proposed mediating variable was loneliness. The control variable was diagnosis. Sobel’s Test of mediation (1982) was utilized to calculate the indirect effect.
Results
The total effect of social support on QOL was significant, b = 7.00, t (121) = 4.89, p ≤ .001. Social support was significantly predictive of the hypothesized mediating variable, loneliness, b = -4.26, t (122) = -5.39 p ≤ .001. When controlling for social support, loneliness was significantly predictive of QOL, b = -.96, t (120) = -6.80, p ≤ .001. The estimated direct effect of social support on QOL, controlling for loneliness, was b = 2.93, t (120) = 2.15, p ≤ .05. QOL was predicted well from social support and loneliness, with R2 = .44, F (3,121), p ≤ .001. By using the Sobel test, the indirect effect was 4.06. This was judged to be statistically significant, z = 4.22, p≤ .001. While the direct path from social support to QOL was statistically significant, the effects of social support on QOL were partially mediated by loneliness.
Conclusion and Implication
The results indicated that, among adults with SMI, greater perceived availability of social support is associated with higher QOL partially through lower loneliness. In order to enhance QOL among adults with SMI, mental health services are recommended to increase focus on both building social support as well as addressing loneliness. Future studies exploring additional potential mediators are needed to better understand the relationship between social support and quality of life.