26 Chapter 2 to 54.3. One study did not report on gender and age (43). Individual sample sizes ranged from 25 to 825. Most studies reported on chronic patients, only one study specifically investigated early psychosis patients (44). The heterogeneity across studies was substantial (I2 = 75.8, 95% CI = 62.7-84.3) (45). Random effect meta-analysis of the relationship between overall symptom severity and personal recovery revealed a significant mean weighted correlation coefficient of r = -.21 (95% CI = -0.27 to -0.14, P < .001) (supplementary table 2). This implies that patients with higher severity of overall psychopathology reported slightly lower personal recovery. Figure 2 shows the forest plot of effect sizes and 95% confidence intervals, as well as z and P values, which provide an indication of the statistical significance of the association. Of the 20 studies, the majority reported on the association between personal recovery and different symptom domains: positive symptoms (k = 17, n = 3319), negative symptoms (k = 15, n = 2442), affective symptoms (k = 12, n = 2442). In addition to the association between personal recovery and overall psychopathology, we performed separate meta-analyses for all of these domains. The meta-analyses of positive and affective symptoms included one additional study, which only reported data on the association between these symptoms domains and personal recovery (46). One additional study only reported on the association between personal recovery and the GAF (47) resulting in 8 studies which reported on the association with general functioning (n = 1938). Again, heterogeneity was substantial across studies assessing positive symptoms (I2 = 74.8, 95% CI = 59.3-84.3), negative symptoms (I2 = 76.7, 95% CI = 61.8-85.8), and affective symptoms (I2 = 84.5, 95% CI = 74.4-90.6). Random effect meta-analyses revealed a significant negative mean weighted effect size for positive symptoms r = -.20 (95% CI = -0.27 to -0.12, P < .001), negative symptoms r = -.24 (95% CI = -0.33 to -0.15 P < .001) and affective symptoms r = -.34 (95% CI = -0.44 to -0.24, P < .001). A small significant positive effect size was found for the association with general functioning r = .21 (95% CI = -0.09 to 0.32, P < .001) (supplementary table 2). Meta-regression analysis We conducted a meta-regression analysis to evaluate if age or study quality potentially explained differences in reported effect sizes among studies and caused heterogeneity. A nonsignificant tendency for age to correlate with the effect size (B = .010, SE = .005, P = .056) was found and no effect for study quality. Together they only explained 14.5% of the variation between studies. Furthermore, no significant moderation effects were found in meta-regression analyses conducted for the different symptom domains. Differences in age and study quality explained 27.6% of the variation observed in the association with positive symptoms, 6.2% for negative symptoms, and 29.8% for affective symptoms.
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