WHAT IS KNOWN ABOUT THE SUBJECT?: Psychotic symptoms and depression are common problems in people diagnosed with schizophrenia. Psychological flexibility is a skill that facilitates coping with difficulties. There is limited research on the role of psychological flexibility in the relationship between psychotic symptoms and depression in people diagnosed with schizophrenia. WHAT DOES THE ARTICLE ADD TO EXISTING KNOWLEDGE?: This article investigates the role of psychological flexibility in the link between psychotic symptom severity and depression in people diagnosed with schizophrenia. The article shows that psychological flexibility partially mediates the relationship between psychotic symptom severity and depression. The article suggests that interventions aimed at improving psychological flexibility may be beneficial in reducing depressive symptoms in people diagnosed with schizophrenia. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should consider psychotic symptom severity and psychological flexibility when assessing and intervening for depressive symptoms in people diagnosed with schizophrenia. Mental health nurses should receive training to improve psychological flexibility and pass this skill on to their patients. Mental health nurses should continue to research the effectiveness and outcomes of interventions aimed at improving psychological flexibility.

Abstract: INTRODUCTION: Psychological flexibility may help people diagnosed with schizophrenia (PWS) cope with their psychotic symptoms and reduce their depressive symptoms, but the mechanism of this effect is unclear.

Aim: To investigate whether psychological flexibility mediates the relationship between psychotic symptom severity and depression in PWS.

Method: A cross-sectional study was conducted, in which a total of 111 PWS were assessed with DSM-5 Clinician-Rated Dimensions of Psychosis Symptom Severity, Calgary Depression Scale for Schizophrenia and Acceptance and Action Questionnaire. Data analysis was performed using SPSS 25 and PROCESS macro.

Results: Significant correlations were found between psychotic symptoms, depression and psychological flexibility. Psychological flexibility partially mediated the relationship between psychotic symptom severity and depression.

Discussion: Psychological flexibility could weaken the impact of psychotic symptom severity on depression in PWS. Higher psychotic symptoms were associated with lower psychological flexibility and higher depression.

Implications for practice: Interventions to improve psychological flexibility may prevent depressive symptoms in PWS. Psychiatric nurses can use psychological flexibility as a goal for evaluation and intervention.