158 Chapter 8 GENERAL DISCUSSION The aim of the current thesis was to better understand the relationship between clinical and personal recovery in patients with psychosis and other severe mental illnesses (SMI). Cross-sectional relationship between clinical and personal recovery The results of the systematic review and meta-analysis of 37 studies, described in chapter 2, show that there is only a small to medium negative correlation between symptom severity and personal recovery in patients with schizophrenia spectrum disorders (r = −.21). This is also the case for the relationship between symptom severity and hope and empowerment, two important subcategories of personal recovery. Regarding the symptom domains, we found that affective symptoms show a larger association (r = −.34) with personal recovery, than positive (r = −.20) or negative (r = −.24) symptoms. In accordance, in our own study at Mentrum, described in chapter 3, we also observed that affective symptoms are important for personal recovery, explaining 35.1% of the variance of overall personal recovery of patients with different severe mental illnesses. A small significant positive effect was found in the meta-analysis for the association between general functioning and personal recovery (r = .21). These findings are in line with several other studies that have been published recently. Ponce-Correa et al. found a small weighted average association (- .18) between symptom remission and personal recovery in patients with schizophrenia in their meta-analysis. Also the correlation of .26 between functional and personal recovery is comparable to our earlier findings (1). Leendertse et al. published a systematic review and meta-analysis with factors associated with personal recovery of patients with psychotic disorders. They found a medium negative association between affective symptoms with personal recovery (r = − .44), and also only small negative correlations with positive, negative and general symptoms (2). Best et al. replicated the finding that affective symptoms were most strongly associated with personal recovery, accounting for 30% of the variance in patients with psychosis. They also found that positive symptoms were not significantly related to personal recovery (3). Skar-Fröding et al. also described the link between lower levels of depression and better personal recovery (4). Franco-Rubio et al. did a review of 14 meta-analyses of factors associated with recovery in schizophrenia and also state that less severe affective symptoms were related to greater personal recovery (5). Castelein et al. used a least absolute shrinkage and selection operator (LASSO) regression analysis to identify factors strongest associated with clinical, societal and personal recovery in people with psychosis with a long duration of illness. Depressive mood was again one of the factors associated with personal recovery (6).
RkJQdWJsaXNoZXIy MTk4NDMw