Disability, health-related quality of life, and self-concept change in people with multiple sclerosis: A moderated mediation

•Disability is a key contributor to self-concept change for people with MS. However, it is unclear what other psychosocial factors might contribute to this association.•This study reports on a model that shows that health-related quality of life partially mediates the relationship between disability and self-concept change.•Domains of health-related quality of life that may be considered ‘behaviourally informed’ appear to contribute more to this relationship than other domains.•Relationship satisfaction does not moderate the mediation effect of health-related quality of life on the relationship between disability and self-concept change.•These key factors may be the focus of future interventions that aim to improve self-concept change following MS diagnosis. Disability is a key factor related to self-concept change following a Multiple Sclerosis (MS) diagnosis. Psychosocial factors (e.g., social integration, marital support) are also associated with changing self-concept in people with MS (pwMS). What remains unclear however, is whether psychosocial factors account for the relationship between disability and self-concept change. The current study aimed to investigate the potential mediation effect of Health-Related Quality of Life (HRQoL) on the relationship between disability and self-concept change in pwMS, and whether relationship satisfaction is a moderator of the mediated relationship. Nine hundred and ninety-five pwMS (79.5 % female; Age M = 59.72 years, SD = 11.15) completed measures of disability, HRQoL, and self-concept change. Of these participants, seven hundred and twenty-six pwMS who indicated they were currently in a relationship also completed a measure of relationship satisfaction. A moderated mediation (conditional process) analysis indicated that the relationship between disability and self-concept change was partially mediated by HRQoL. A further parallel mediation found that across the eight subdomains of HRQoL, only participants’ reported levels of ‘relationships’ and ‘coping’ significantly mediated the relationship between disability and self-concept change. However, for those participants in a relationship, relationship satisfaction did not moderate any mediation effects. The findings highlight the role that perceptions of HRQoL in some domains may have in explaining the relationship between disability and self-concept change. Further research is needed to explicate the causal direction of these relationships through longitudinal stu