68 Chapter 4 of negative symptoms (global, apathy and anhedonia) over a period of two years was associated with an increase of personal recovery in patients with first episode psychosis. Psychotic symptoms were not associated with personal recovery (18). In a recent large study over one year in patients with schizophrenia-spectrum disorders Dubreucq et al. showed that clinical recovery and personal recovery predicted each other (baseline personal recovery for stable clinical recovery at one year; baseline clinical recovery for stable personal recovery at one year) with mediating effects of depression, psychosocial function, and quality of life (19). All above mentioned studies were performed in patients with psychosis, while patients with other SMI diagnoses also experience long-term complaints and, in many countries, receive treatment in the same settings (e.g. community teams) as patients with psychosis. Severe mental illness (SMI) has different definitions worldwide, but it represents patients with prolonged illness and need for long-term treatment (usually more than two years), who experience severe social, occupational or school dysfunctioning, regardless of a specific diagnosis (20, 21). Especially for SMI patients, the concept of recovery has become an important focus for mental healthcare in recent decades (22, 23). The aims of the current longitudinal study are to investigate in SMI patients: 1. The association between change in symptom severity and change in personal recovery over the course of three years 2. The association between change in severity of various symptom domains and change in personal recovery over the course of three years 3. The association between baseline severity of various symptom domains and change in personal recovery over the course of three years. Hypotheses: Based on earlier findings, we expect that: 1. The association between change in symptom severity and change in personal recovery is modest. 2. Change in depression/anxiety symptoms will be more strongly associated with change in personal recovery than change in other symptom domains of psychosis. 3. Of all symptom domains, the severity of affective symptoms is associated with change in personal recovery over time.
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