Factors associated with health-related quality of life in people with severe mental illness: Results from a multicountry study in South Asia

BackgroundHealth-related quality of life (HRQoL) is a multidimensional measure of well- being encompassing physical, psychological, and social domains. Individuals with severe mental illness (SMI) experience substantial HRQoL challenges, particularly in low- and middle- income countries (LMICs) where healthcare disparities persist. This study examines sociodemographic, economic, and health-related factors associated with HRQoL in people with SMI across Bangladesh, India, and Pakistan. MethodsA cross-sectional study was conducted as part of the IMPACT survey, recruiting 3,989 participants with SMI. HRQoL was assessed using the EQ-5D-5L tool, covering mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Logistic regression models explored associations between HRQoL and demographic, socioeconomic, and health factors, including BMI and smoking status. ResultsHRQoL varied significantly by sociodemographic and geographic factors. Participants from India had lower odds of HRQoL difficulties than those in Pakistan and Bangladesh. Higher income and education were linked to better HRQoL, while female gender, underweight status, unemployment, and smoking were associated with significantly worse outcomes. For instance, underweight individuals had 1.30 times higher odds (95% CI=0.98- 1.73, p=0.072) of mobility problems, while smokers had 1.34 times higher odds (95% CI=1.13- 1.59, p<0.001) of self-care difficulties. Women reported worse HRQoL than men. ConclusionAddressing income disparities, promoting education, supporting employment, and reducing smoking prevalence is essential to improve HRQoL in people with SMI in South Asia. Targeted interventions that consider geographical and demographic contexts can enhance quality of life in people attending mental health facilities in LMICs.