Examining spirituality, psychological inflexibility, and hopelessness in schizophrenia: A mediation nursing study

Individuals with schizophrenia frequently experience psychological inflexibility and hopelessness, which negatively impact their mental health and quality of life. Spirituality has been suggested as a potential protective factor in mental illness, yet its role in the context of psychological inflexibility and hopelessness in schizophrenia remains underexplored.

This study aimed to examine the relationships among spirituality, psychological inflexibility, and hopelessness in individuals with schizophrenia, and to assess whether psychological inflexibility mediates the association between spirituality and hopelessness.

A cross-sectional study was conducted with 226 participants diagnosed with schizophrenia from three psychiatric hospitals in Egypt. Participants completed validated Arabic versions of the Beck Hopelessness Scale, Daily Spiritual Experience Scale, and Acceptance and Action Questionnaire-II. Mediation analysis was performed using Hayes' PROCESS Macro (Model 4), with 5000 bootstrap samples and 90% confidence intervals.

Spirituality was negatively correlated with both psychological inflexibility (r = -0.576, p < 0.001) and hopelessness (r = -0.431, p < 0.001). Psychological inflexibility was positively correlated with hopelessness (r = 0.442, p < 0.001). Mediation analysis revealed that psychological inflexibility partially mediated the relationship between spirituality and hopelessness (indirect effect β = -0.167, 90% CI: -0.283 to -0.075).

Spirituality may protect against hopelessness in schizophrenia, but its effect is weakened by psychological inflexibility. Interventions that enhance both spirituality and psychological flexibility may improve mental health outcomes in this population.