The Impact of Trait Mindfulness on Quality of Life in Patients With Bipolar Disorder: The Serial Mediating Role of Emotion Dysregulation and Depressive/Manic Symptoms

Background: To explore the impact of trait mindfulness on the quality of life (QoL) in patients with bipolar disorder (BD) and to examine the serial mediating roles of emotion dysregulation and depressive/manic symptoms.

Methods: A cross-sectional study based on previous medical record data was conducted. Clinical records and scale data of 256 patients with BD who received outpatient or inpatient care at Xiamen Xianyue Hospital (Xiamen Mental Health Center) between June 2022 and June 2024 were extracted, all of whom carried a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) confirmed diagnosis. All scale assessments had been completed at the time of the index clinical visit, including the Five Facet Mindfulness Questionnaire (FFMQ), the Difficulties in Emotion Regulation Scale (DERS), the Self-Rating Depression Scale (SDS), the Bech-Rafaelsen Mania Scale (BRMS), and the Brief Quality of Life in Bipolar Disorder scale (Brief QoL.BD). Age, sex, bipolar subtype,illness duration,current mood state, and current pharmacological treatment were entered as covariates. Two separate serial mediation models (one with depressive symptoms and one with manic symptoms as the second-stage mediator) were tested using regression-based mediation analysis with bias-corrected bootstrapping (5000 resamples) under the PROCESS framework (Model 6).

Results: Correlation analysis showed that trait mindfulness in patients with BD was significantly and positively correlated with QoL (r = 0.472, p < 0.001), and significantly and negatively correlated with emotion dysregulation (r =–0.523, p < 0.001), depressive symptoms (r =–0.457, p < 0.001), and manic symptoms (r =–0.406, p< 0.001). Serial mediation analysis revealed that the indirect effect of trait mindfulness on QoL through emotion dysregulation and depressive symptoms was 0.086 (95% CI [0.047, 0.132]), with a model explanatory power (adjusted R2 ) of 0.385. The indirect effect through emotion dysregulation and manic symptoms was 0.052 (95% CI [0.016, 0.091]), with a model explanatory power (adjusted R2) of 0.307.

Conclusions: In this cross-sectional study based on previous medical record data, emotion dysregulation together with mood symptoms jointly served as a serial mediating chain linking trait mindfulness to QoL in patients with BD, and the depression-related chain conveyed a stronger mediating effect than the mania-related chain. Above findings suggest that a higher level of trait mindfulness may be associated with better QoL through enhanced emotion regulation and milder depressive/manic symptoms, with the depressive pathway being the most salient. The direction of these pathways still needs further verification by prospective designs.