Objectives: Emotional disclosure has been widely publicized as having beneficial effects on physical and psychological health. A full systematic review was undertaken, with standard health technology appraisal methods, with the aim to assess the effects of emotional disclosure on healthy participants and those with pre-existing morbidity, particularly on longer-term physical health, performance, and psychological outcomes.

Methods: Randomized controlled trials of emotional disclosure were obtained from database searches (Medline (1966–2003), Embase (1980–2003), Cochrane Library (2002, issue 4), Web of Science (1981–2003), Cinahl (1982–2003), and Theses (March 2003), Internet sites (including Professor J.W. Pennebaker's home pages), and personal contacts. Quality was assessed qualitatively and by Jadad score. Meta-analysis was conducted, using Revman 4.1 software, where more than two trials reported the same outcome.

Results: Sixty-one trials were found meeting the inclusion criteria. Most had less than 100 participants and the median Jadad score was 0. A wide variety of physical, physiological, immunological, performance, and psychological outcomes were measured, but fewer were reported. There was no clear improvement for emotional disclosure compared with controls in objectively measured physical health and most other outcomes assessed.

Conclusions: The opinion that this intervention is beneficial needs to be reassessed in light of the totality of evidence available.

Recent research with adults by Pennebaker and his colleagues has found that emotional disclosure through writing about stressful events appears to have significant benefits in terms of psychological and physical health outcomes. This report describes a controlled trial of emotional disclosure, adapted for school children, with the major hypothesis that the repeated description of negative events will have beneficial effects on measures of mental health, attendance, and school performance. The sample consisted of children aged 8–13 years from four schools, a primary and a secondary school both from a suburban and an inner-city area. Children were randomly assigned to one of three conditions: writing about negative events, writing about nonemotional events, and a non-writing control group. Children in all groups were seen four times during a single week and were then followed up after 2 months with measures of health and school performance. The intervention was well received by both schools and children, and the scripts written by the emotional and nonemotional writing groups differed in content in the predicted ways. Contrary to expectation, there was little evidence of a specific effect of emotional disclosure, and several possible reasons for this are discussed. Nevertheless, there was a general reduction in symptom measures, indicating that children may have benefited from their involvement in the study. Although there are several possible explanations for our findings, they indicate that it is both feasible and potentially valuable to give children opportunities to engage in discussion about sources of stress and their reactions to them.