Effect of a Positive Psychology Expressive Writing on Stigma, Hope, Coping Style, and Quality of Life in Hospitalized Female Patients with Schizophrenia: A Randomized, Controlled Trial

Abstract

Purpose. Schizophrenia accounts for more than 50% of psychiatric inpatients, and its special manifestations and recurring illnesses not only bring great harm to patients and their families but also pose great challenges to social security and management. Schizophrenia is associated with the most severe stigma of all mental illnesses. This stigma seriously affects the psychological functioning and quality of life of people with schizophrenia. Female patients’ experiences with stigma tend to be more severe than those of male patients and their self-denial and discrimination may be more serious. As expressive writing is a relatively simple, brief intervention that may serve as a useful and cost-effective alternative intervention or adjunct to other treatments, it is important to assess its effectiveness for female patients with schizophrenia. In this study, we explored the effect of a positive psychology expressive writing intervention on stigma, hope, coping style, and quality of life in hospitalized female patients with schizophrenia. Methods. This randomized controlled trial investigated the psychophysiological benefits of a positive psychology expressive writing (PPEW) in 54 schizophrenia patients recruited from the psychiatry department of a tertiary psychiatric hospital in Nanjing, China. Patients were randomized into the experimental group (n = 27) and control group (n = 27). The experimental group participated in the positive psychology expressive writing for 2 weeks, while the control group received routine psychiatric care. As outcome measures, all patients completed the Personal Information Form, Perceived Devaluation-Discrimination (PDD), Simplified Coping Style Questionnaire (SCSQ), Herth Hope Index Scale (HHIS), and Quality of Life Scale for Schizophrenia (SQLS). Results. There were significant differences in PDD, SCSQ, HHIS, and SQLS pretest to posttest scores between the experimental and control groups shown by the per protocol (PP) and intent-to-treat (ITT) analysis ( P  < 0.05). PPEW decreased the level of stigma and improved hope, coping style, and quality of life among patients with schizophrenia. Conclusion. These findings highlight the benefits of including positive psychology expressive writing (PPEW) in daily psychological treatment of patients with schizophrenia to promote their rehabilitation and improve their quality of life.