Clinical, Functional, and Personal Recovery in Schizophrenia

In individuals with schizophrenia and other severe mental illnesses, coping may be a determinant of all 3 types of recovery, including clinical, functional, and personal recovery. In contrast, social support appears to be a determinant of functional recovery. The current cross-sectional study, which was conducted in The Netherlands, used baseline data from 187 outpatients who had participated in the randomized controlled trial on Illness Management and Recovery (IMR). Results of the analysis were published in the journal PLoS One.

The investigators sought to evaluate the relationships among insight, medication adherence, addiction, coping, and social support, all of which are components of IMR, as determinants of clinical, functional, and personal recovery in patients with severe mental illnesses, including schizophrenia. A total of 187 outpatient participants were enrolled in the current study. The researchers used structural equation modeling to depict the pathways between degrees of insight, medication adherence, addiction, coping, and social support, along with the degree of clinical, functional, and personal recovery. Additionally, they analyzed whether clinical recovery mediated functional recovery and personal recovery.

In this study, coping was evaluated with the use of the client-rated Coping Self-Efficacy Scale, which comprises 26 items that are rated on a scale of 0 to 10. Clinical recovery was operationalized as the score on the client-rated Brief Symptom Inventory, in which a total of 53 items are rated on a scale of 0 to 4. Functional recovery was operationalized as the score on the Social Functioning Scale, which is a self-administered questionnaire that comprises 76 items with a variety of response formats. Personal recovery was operationalized as the score on the Mental Health Recovery Measure, which includes a total of 30 items that are rated on a scale of 0 to 4.

Results based on the final model demonstrated that coping was linked to clinical, functional, and personal recovery. The direct associations between coping and functional and personal recovery were stronger than were the indirect associations through clinical recovery. Structural equation modeling demonstrated a significant but weak direct pathway between social support and functional recovery; however, no significant pathways were shown between either social support and clinical or personal recovery, or between insight, addiction, medication adherence, and any type of recovery.

Limitations of the current study include that, although coping and personal recovery are different concepts, there may be some overlap in these notions. Moreover, the generalizability of these study results is limited in scope.

The investigators concluded that clinical recovery does not appear to be a prerequisite for either functional or personal recovery. Although the results of this study suggest the relevance of improved coping skills and of enhanced social support among patients with severe mental illnesses, they only partially reinforce the conceptual framework of IMR.

Reference

Roosenschoon B-J, Kamperman AM, Deen ML, van Weeghel J, Mulder CL. Determinants of clinical, functional and personal recovery for people with schizophrenia and other severe mental illnesses: a cross-sectional analysis. PLoS One. 2019;14(9):e0222378.