25 Clinical and personal recovery, a meta-analysis hand and personal recovery, hope, and empowerment, on the other hand, were investigated separately. In addition to the analyses of overall symptom severity, separate analyses were conducted for positive, negative and affective symptoms and general functioning, if possible. The presence of heterogeneity was evaluated by calculating the I2 metric, i.e. the percentage of between-study variance due to systematic heterogeneity rather than chance (38). Data-analysis was performed with SPSS version 23 (39). Figures were plotted using Comprehensive Meta-analysis software (40). Heterogeneity was further explored by evaluating the effect of moderator variables. We were interested if estimated study quality as assessed with the AHRQ would affect reported effect sizes and/or cause heterogeneity. Furthermore, we planned to include age and illness duration or stage of illness as moderators. However, because the information was missing on these variables in a substantial part of the studies (table 1), only age could be added to the model. Meta-regression analyses were performed using SPSS 23 software, with macros provided by Lipsey and Wilson (33). Publication bias was examined by computing Rosenthal’s fail safe N and a funnel plot, which displays effect sizes plotted against the standard errors (35, 41). Data points on the funnel plot are ideally evenly distributed around the mean effect size, with asymmetry suggesting a publication bias. RESULTS Study selection Figure 1 shows the flow chart of the process of selecting relevant articles. The literature search resulted in 5191 publications, of which 3617 remained after removal of duplicates. A total of 178 publications were selected on the basis of title and abstract. Eventually, 35 studies from the literature search were included. By reviewing the references of the included publications, we found an additional 2 relevant articles (25, 42). Within the total of 37 included publications, 22 addressed overall personal recovery, 19 hope and 7 empowerment. No relevant articles were found concerning connectedness. See table 1 for study characteristics. Results of the meta-analysis Clinical and personal recovery The meta-analysis that investigated the relationship between overall symptom severity and overall personal recovery in patients with schizophrenia spectrum disorders included 20 studies, with a total of 3994 participants, most of which were male (70.4%) and outpatients. The mean age was 42.4, with an age range from 28.0 2
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