35 Clinical and personal recovery, a meta-analysis Figure 4: Meta-analysis of the association between symptom severity and empowerment. DISCUSSION Main findings To our knowledge, this is the first meta-analysis investigating the relationship between clinical and personal recovery. Results show that there is only a small to medium negative correlation between symptom severity and personal recovery in patients with schizophrenia spectrum disorders. This also is the case for the relationship between symptom severity and hope and empowerment, 2 important categories of personal recovery processes (13). No studies have been found considering the relationship between symptom severity and connectedness, the third category of personal recovery. When subdomains of clinical recovery are taken into consideration, it becomes apparent that affective symptoms show a medium strength correlation with personal recovery and hope. Positive and negative symptoms demonstrate a small to medium association with personal recovery and hope. Moreover, only a small positive association was found between general functioning, as measured with the GAF, and personal recovery. Previous studies on the relationship of clinical outcome with subjective quality of life, a concept related to personal recovery, show a similar modest correlation and also strengthen the importance of affective symptoms within this association (75, 76). In the current meta-analysis, heterogeneity of the studies was substantial. Furthermore, a tendency of a moderating effect of age was found in meta-regression analyses: the younger the patient, the higher the negative correlation between symptom severity and personal recovery. Lastly, the sensitivity analysis suggests that the risk of publication bias is low. Implications Implications for clinical practice Given the small to medium association between overall symptom severity and personal recovery, explicit attention for personal recovery within treatment could better fit the needs of patients. Besides that, our findings suggest that current 2
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