74 Chapter 4 DISCUSSION In this follow-up study, we found that overall change in symptom severity explained 31.8% of the variance of change in personal recovery. So, this suggests that the major part of the variance of personal recovery cannot be explained by clinical recovery. This is in line with earlier cross-sectional research (13, 14). Change in depression/anxiety symptom severity showed the most substantial association with change in personal recovery. In previously published cross-sectional studies, the explained variance for the association between affective symptoms and personal recovery was similar, i.e. around 30% (24, 32). Besides that, only symptom severity of depression/anxiety at baseline significantly predicts positive change in personal recovery over the course of three years. The importance of affective symptoms for personal recovery was also found in earlier cross-sectional research (33-35). As stated in the introduction, earlier longitudinal studies were done in patients with a psychotic disorder, not in general SMI. Our findings of modest associations between change scores in clinical and personal recovery align with findings by Macpherson et al. (15). It was shown before that personal recovery is considered important by service users regardless of symptomatology and functioning (36). Also, another study found that the relationship between clinical and personal recovery may change over time and may be dependent on the phase of an individual’s illness (37). The association between affective symptom severity and personal recovery was also observed in other studies, either cross-sectional (24) or longitudinal (19). Especially in patients with prolonged psychosis, depressive symptoms show a negative correlation with personal recovery, which may also have to do with demoralization (37). Important personal recovery concepts, such as hope(lessness), empowerment and self-esteem show overlap with affective symptoms, such as depressed mood, apathy and anhedonia (16, 18). In addition, previous research suggests a connection between hopelessness and life satisfaction in patients with SMI (38). Another study suggests a mediation role for hope between depressive symptoms and personal recovery in patients with schizophrenia (39). The heterogeneity of the change over the course of three years of symptom severity and personal recovery for individual patients is striking. This finding corresponds with personal recovery being defined as a non-linear process of change or a struggle (6). Experience sampling with frequent measurements has been proposed as a way to prospectively gather more information on this process (40). On the other hand, being in a certain recovery state seems relatively stable over a longer period of time
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