69 Change in symptom severity and personal recovery METHODS Participants and procedure The characteristics of this study were also described in an earlier published article (24). The first measurement took place between September 2015 and September 2016 and the second assessment three years later (2018-2019). Patients were recruited from five Flexible Assertive Community Treatment teams (F-ACT) of Mentrum, part of Arkin Institute for Mental Health, Amsterdam, the Netherlands. F-ACT is a Dutch version of Assertive Community Treatment (ACT), aimed at treating SMI patients (25). F-ACT teams are multidisciplinary and offer two levels of care: individual case management, and ACT when there is a need for shared caseload and assertive outreach. In short, the F of F-ACT stands for a team that is flexible to temporarily intensify treatment to ACT if this is needed. All patients in the F-ACT teams meet the criteria of having a SMI (see the introduction for criteria). Further inclusion criteria were: 18 years or older, able to understand the Dutch language and to provide informed consent. Patients were recruited by posters and flyers in the waiting room. Moreover, all mental health workers were requested to ask their patients if they would be willing to participate in this research project. The original sample consisted of 105 patients (24). Of these, 90 gave permission to be contacted again for a followup interview. A trained researcher obtained informed consent and administered clinical interviews and questionnaires. Measures Brief Psychiatric Rating Scale-Expanded version (BPRS) To assess experienced and observed symptom severity, the BPRS-E was used (26). 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 (9 items). The internal consistency of the four component scales (Chronbach’s alpha) ranged from 0.69 to 0.74 (27). Mental Health Recovery Measure (MHRM) The MHRM was used to assess personal recovery (28). The concepts of connectedness, hope, identity, meaning and empowerment (CHIME, (6)) are represented in the items of the MHRM (29). 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 personal recovery. Based on factor analysis of the Dutch version of the MHRM three subscales 4
RkJQdWJsaXNoZXIy MTk4NDMw