116 Chapter 6 Social interaction is associated with personal recovery in patients and siblings. Possibly, initiatives to support social interaction may lead to better personal recovery. In patients, promoting social interactions, for instance by peer support, individual placement and support (IPS), wellness recovery action planning, and recovery colleges could promote personal recovery (47-49). Future research might take a closer look at which particular components of social support are most important for personal recovery. One can imagine that reducing (self) stigma, promoting openness about illness and efforts to maintain existing social contacts can also help. The fact that illness-related factors, especially in patients, show less predictive value for personal recovery, supports the statement of Anthony (1993) that personal recovery transcends illness. As found in earlier research, this suggests that focusing on illness-related factors might not be the key to personal recovery of patients (16). Nevertheless, it is apparent that treating symptoms is important, especially affective symptoms, and to a lesser extent psychotic symptoms, but a strict focus on symptom reduction only might not result in improving personal recovery (47). Strengths and limitations Strengths of the current study include the relatively large sample size, the fact that not only patients, but also siblings and healthy controls participated, and the multitude of self-report measures that highlights the individual experience of recovery. We need to acknowledge some limitations. Personal recovery was measured only at one time point, even though it has been defined by many as an active process with different recovery stages (7, 8, 13). Having a score of how recovery may change over time is therefore more useful than a single measurement. The current cross-sectional design also precludes causal inferences. From our findings it is unclear whether promoting coping styles and social interaction or treatment of affective symptoms facilitate personal recovery, or the other way around. Longitudinal evaluation is needed to clarify causal interrelations. Furthermore, in the current research the Social Functioning Scale (SFS) (31) was used to determine to what extent participants are undertaking social and occupational activities. To gain more insight in which specific factors of support contribute most, one could use more detailed measures for informal support (i.e. for family, partner and religious support) and formal support (professional relationship and support and work support) (50). Although we were able to explain a substantial part of the variation in personal recovery of patients, siblings and healthy controls, still 50-60% of the variance of personal recovery is not explained by the factors mentioned above. More research is needed to find which other factors are important.
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