161 General discussion resilience, social support, socio-demographic and illness-related variables on the other hand, of patients, their siblings and controls. It appeared that the schema of positive self was significantly and independently associated with personal recovery in all three groups. Pro-active action taking also showed this trend. Social functioning significantly contributed to explained variance of personal recovery in patients and siblings. Regarding illness-related factors, depressive symptoms were associated with personal recovery in both patients and siblings, whereas (subclinical) positive symptoms were only associated with personal recovery in siblings and not in patients. So, patients and non-patients share supportive factors of personal recovery, especially in the domain of resilience. In the recent meta-analysis of Franco-Rubio et al. resilience was also the variable most strongly associated with recovery in patients with schizophrenia spectrum disorders (5). The importance of self-esteem and healthy coping has been replicated in several studies in patients, mentioned in chapter 6 (7, 37-41). Maas et al. found more recently that self-esteem predicted personal recovery beyond the effects of clinical and functional recovery in patients with first-episode psychosis (42). Psychological factors related to resilience have been shown to also impact personal recovery (43). There is, for instance, a negative link between neuroticism (a susceptibility to negative affect and psychological distress, i.e. inadequate coping) and personal recovery and subjective well-being (44, 45). Also insecure anxious and avoidant attachment is associated with worse personal recovery outcomes in patients with psychosis (46). Resilience and recovery show overlap with the concept of post-traumatic growth (47). Social functioning in our study contributed to personal recovery in patients and siblings. Especially in qualitative studies, the importance of social support is mentioned by patients (48, 49), but in some quantitative studies these factors show only small correlations with personal recovery (2, 7). Leendertse et al. argue that this might have to do with a difference between quantity and quality of social interactions and between patient-rated and clinician-rated measures (44). Finally, regarding symptom severity, again, the impact of depressive symptoms on personal recovery is shown in the GROUP-study. As discussed in chapter 6, a possible explanation of the impact of affective and positive symptoms on personal recovery in siblings is that they might perceive subclinical expressions as more alarming given the illness of their sibling. Perspective matters in recovery Chapter 7 described a qualitative study into the views of persons with severe mental illness, family and mental health professionals on collaboration during recovery. Two central themes emerged: attributing roles and interacting within the triad. Attributing 8
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