27 Clinical and personal recovery, a meta-analysis Sensitivity analysis Rosenthal Fail-Safe N = 913 suggests that there would need to exist more than 900 negative unpublished studies to turn the estimated significant population effectsize into a nonsignificant result. The funnel plot does not indicate publication bias (supplementary material). Clinical recovery and hope Seventeen studies were included in the meta-analysis of the relationship between overall symptom severity and hope, with one publication included twice, because it reported on 2 studies in different populations (in Austria and Japan). Three thousand ninety-nine participants were analyzed, most were male (60.1%) and outpatients. The mean age was 37.2. One study did not report on gender and age (48). The majority of studies mainly included patients with longer duration of psychosis, only 2 specifically investigated patients with early psychosis (44, 49). Heterogeneity across studies was substantial (I2 = 64.9, 95% CI = 41.2-79.0). Results showed a significant mean weighted correlation coefficient of r = -.24 (95% CI = -0.30 to -0.187 P < .001), see supplementary table 2. Figure 3 shows the forest plot of effect sizes and 95% confidence intervals for the association between overall symptom severity and hope in the included individual studies. Subsequently, meta-analyses of the 3 separate symptom domains positive symptoms (k = 12, n = 2364), negative symptoms (k = 11, n = 1539) and affective symptoms (k = 14, n = 2669) were conducted. The meta-analyses of affective symptoms included 3 additional studies, which only reported data on the association between hope and affective symptoms (50-52). Again, heterogeneity between studies included in these analyses was substantially high for positive symptoms (I2 = 77.4, 95% CI = 60.7-87.0) and affective symptoms (I2 = 81.7, 95% CI = 70.4-88.7). Results showed significant negative mean weighted effect sizes for positive symptoms r = -.14 (95% CI = -0.23 to -0.05, P = .004), negative symptoms r = - .26 (95% CI = -0.32 to -0.19 , P < .001) and affective symptoms r = -.43 (95% CI = -0.51 to -0.35, P < .001). There were not enough studies to conduct a meta-analysis of general functioning. Meta-regression analysis Meta-regression analyses, which integrated age and study quality as potential predictors of the heterogeneity between studies, showed no significant effects. Together they only explained 4.7% of the variation observed regarding overall symptom severity, 25.4% regarding positive symptoms, 9.0% in the association with negative symptoms, and 17.4% in affective symptoms. 2
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