An Asian study on clinical and psychological factors associated with personal recovery in people with psychosis

Abstract

Background Despite the rising recognition of personal recovery, there is a lack of research on personal recovery in individuals with psychosis in Singapore. This study aims to evaluate the psychometric properties of the QPR-15 using the CHIME personal recovery framework and to examine its associations with clinical recovery factors. Methods Sixty-six stable outpatients were recruited and assessed at two time points approximately 2 weeks apart. Convergent validity was examined through Spearman correlations with scores on CHIME-related psychological factors: connectedness (Ryff subscale- positive relations with others), hope (Herth Hope Index- abbreviated), identity (Ryff subscale- self-acceptance, Internalized Stigma of Mental Illness- Brief), meaning (World Health Organization Quality of Life Assessment-Brief Form), empowerment (Empowerment Scale). Pearson’s correlation was used to examine the test-retest reliability, while Cronbach’s alpha was used to examine internal consistency. The initial factor structure was evaluated via principal component analysis, Velicer’s minimum average partial (MAP) criteria, parallel analysis, and a scree plot. Spearman correlations and hierarchical multiple linear regression (controlling for age and gender) were employed to examine the association of clinical (symptoms and functioning) and psychological factors with the QPR-15. Results The QPR-15 demonstrated convergent validity with all CHIME-related psychological factors (r s ranged from 0.472 to 0.687). Internal consistency was excellent (Cronbach’s alpha = 0.934), and test-retest reliability was adequate (r = 0.708). Initial factor structure evaluations revealed a one-factor model. Correlations of clinical factors with the QPR-15 were mostly low (r s ranged from − 0.105 to − 0.544) but significant, except for depressive symptoms (CDSS: r s = − 0.529 to − 0.544), while correlations were moderate for psychological factors. Clinical factors significantly explained 28.3–31.8% of the variance of the QPR-15. Adding psychological factors significantly increased the model variance at baseline (∆ adjusted R 2 = 0.369, F change < 0.001) and at time point 2 (∆ adjusted R 2 = 0.208, F change < 0.001). Conclusion Our results provide preliminary evidence that the QPR-15 has adequate psychometric properties in Singapore and encompasses the CHIME personal recovery framework. In addition, our results suggest that clinical recovery and personal recovery are not substitutes for each other but rather are complementary, thereby promoting a more holistic evaluation of recovery in people with psychosis. Implications are discussed. Electronic supplementary material The online version of this article (10.1186/s12888-019-2238-9) contains supplementary material, which is available to author...

Exploring mediators of the recovery process over time among mental health service users, using a mixed model regression analysis based on cluster RCT data

“…This is noteworthy, since these variables were not based on the service users’ self-reports but were rated by research assistants. Symptom reduction is generally regarded as clinical recovery, but earlier research has also highlighted that it can be important for personal recovery, though decreased symptoms are not the primary focus for the overall personal recovery journey [ 8 ]. As this is in line with our findings, it could be warranted for future research to explore further the relationship between clinical and personal recovery.…”

“…Using the QPR [ 34 ] to measure recovery in this study can be seen as a strength, since it aligns well with CHIME, one of the most-used frameworks for personal recovery in mental health services today [ 10 ]. Research shows that the QPR incorporates all the concepts in the CHIME framework [ 8 , 44 ]. Some limitations need to be acknowledged, however.…”

“…clinical recovery) does not necessarily result in higher personal recovery [ 6 , 7 ]. Lim et al [ 8 ] suggest that since it is a subjective view from the people themselves, personal recovery offers a more holistic definition of the recovery concept. They contend that personal recovery be the primary focus when evaluating recovery in mental health services, although clinical recovery may also be considered as a supplement [ 8 ].…”

Personal Recovery in People With a Psychotic Disorder: A Systematic Review and Meta-Analysis of Associated Factors

“…Unsurprisingly, considering the overlap, the associations between PR-scale total scores and the CHIME dimensions were medium to large. This overlap is confirmed by the fact that some studies investigated PR-scale total scores in relation to CHIME dimensions in order to assess the convergent validity of a PR measure ( 21 , 25 , 30 , 31 , 40 , 41 , 49 ).…”

Psychological factors in personal and clinical recovery in bipolar disorder

“…For instance, a recent longitudinal study exploring psychological predictors of PR found that less negative beliefs about self and hopelessness along with higher self-esteem were stronger predictors of PR than psychotic symptoms or functioning (Law et al, 2016). Other research has focused on factors incorporated in the CHIME model, such as hope in relation to PR in psychosis (Lim et al, 2019). However, based upon the model these factors are components of PR as opposed to psychological correlates/predictors of PR (Leamy et al, 2011).…”