53 Affective symptoms and personal recovery Measures Brief Psychiatric Rating Scale-Expanded version (BPRS-E) To assess clinical recovery, defined as experienced and observed symptom severity, the BPRS-E was used (25). This is a 24-item symptom rating scale. 14 items are scored based on answers of the patient, whereas 10 items are scored based on observations of the interviewer. BPRS-E items are rated on a Likert scale ranging from 1, not present, to 7, extremely severe. The total score ranges from 24 to 168. Higher scores represent greater symptom severity. In the analysis we used the subscales as proposed by Ruggeri et al., namely positive symptoms (5 items), negative symptoms (7 items), depression/anxiety (affective, 6 items) and manic excitement/ disorganization (8 items). The internal consistency of the four component scales (Chronbach’s alpha) ranged from 0.69 to 0.74 (26). Mental Health Recovery Measure (MHRM) The MHRM was used to assess personal recovery (27). The concepts of connectedness, hope, identity, meaning and empowerment are represented in the items of the MHRM (28). The MHRM is a self-report questionnaire. Items are rated on a 5-point Likert scale ranging from 1, strongly disagree, to 5, strongly agree. Higher MHRM scores indicate higher self-reported levels of recovery. Based on factor analysis of the Dutch version of the MHRM three subscales have been defined: selfempowerment (13 items), learning and new potentials (15 items) and spirituality (2 items). Self-empowerment contains for instance self-esteem, self-efficacy and optimism and control over the future. Being positive about possibilities to learn and opportunities for new potentials are part of the second subscale. Spirituality is about how faith and spirituality help people to recover. A mean total score for all completed items is calculated. The score then again ranges from 1 to 5. The Dutch version of the MHRM has a Cronbach’s alpha that ranges from 0.86 to 0.94 (29). Data analysis Data-analysis was performed with SPSS version 23 (30). Spearman correlation coefficients were calculated between domains of clinical recovery assessed with the BPRS-E and personal recovery measured with the MHRM. Linear regression analyses were used to assess the additive predictive value of specific BPRS-E symptom domains on personal recovery. Age, gender, diagnosis, country of origin, housing status, neighbourhood, marital status, legal status and treatment status were assessed as potential confounders. RESULTS Sample characteristics Characteristics of the 105 participants are shown in table 1. The average age of participants was 48.94 (SD= 10.12, range 22-71). Slightly more men (54.3%) than 3
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