Background Abdominal wall hernia (AWH) affects mental health and mental health questions are frequently included within Patient-Reported Outcome Measures (PROMS) for this patient population. However, these questions have not been informed by the subjective lived experiences of mental health in AWH patients. This study is the first to qualitatively examine how AWH affects patients’ mental health. Methods Fifteen patients were interviewed from a purposive sample of AWH patients until no new themes emerged. Interviews explored patient thoughts and experiences of AWH and mental health. Data were examined using Interpretative Phenomenological Analysis (IPA). Results Three key themes pertaining to mental health were identified: “psychological and emotional distress”, “identity disruption” and “coping mechanisms and support systems”. Conclusion Our findings illustrate that AWH is a pathology that can have a significant detrimental impact on people’s mental health. This impact has implications for patient care and can be treated and managed through better psychological support. This support may positively affect AWH patient’s experience and outcomes in terms of quality of life. This paper provides recommendations for improved AWH patient care in regard to mental health. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-022-02699-3.

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