Gender Differences for the Associations among Housework, Self-Stigma, and Psychiatric Symptoms among Community Severe Mental Disorder Patients

Purpose: Previous studies have suggested housework might reduce self-stigma and psychiatric symptoms, but it had not been validated in severe mental illness (SMI) patients. Considering gender differences, we examined the relationship between housework, self-stigma, and psychiatric symptoms to link family, social, and disease factors, aiding rehabilitation from a "life-oriented" perspective, promoting patients from "passive treatment" to "active life reconstruction". Patients and methods: We collected 486 questionnaires from SMI patients in Shandong, China (210 men, 276 women, 124 in 0-40 age group, 244 in 41-64 age group, and 118 in 65 or older age group). Brief Psychiatric Rating Scale, Self-Stigma Scale for Chronic Illness 8-item version were used to measure psychiatric symptoms and self-stigma. Housework and demographic-variables were collected through a questionnaire complied by our research group. Linear regression explicit the relationship between the study variables, based on which a mediation analysis is established to verify the internal mechanism which controls confounding variables (age, religion, marriage, education, occupation, labor capacity, living alone, liability, chronic disease, disease status). Results: Most participants did housework for less than 1 hour, with men more likely than women (76.2% vs 56.2%). Housework reduced psychiatric symptoms in both genders (men: beta = -5.563 (95% CI = -9.513, -1.613), P <0.01, and women: beta = -4.088 (95% CI = -7.706, -0.469), P <0.01). However, housework only lowered self-stigma in women (beta = -2.322 (95% CI = -3.922, -0.723), P <0.01). Self-stigma fully mediated the housework and psychiatric symptoms (indirect effect = -2.228, 95% CI = -4.046, -0.716). Conclusion: Housework alleviated psychiatric symptoms in both genders, but only reduced the self-stigma of disease in women, suggesting its potential as a modifiable rehabilitation intervention. Limitation: The cross-sectional design precludes causal inferences, self-reported data may introduce recall bias, the Shandong-based sample limits generalizability, unmeasured confounders (eg, medications, comorbidities) warrant further study, and the small sample size may reduce statistical power.