Recovery from serious mental illness: examining traditional clinical and psychosocial factors

The aim of the current study was to advance the current understanding of recovery from serious mental illness (SMI) by examining the construct and some of the associated factors. The study used the consumer-driven notion of recovery describing a personal process of overcoming SMI. SMI was defined as an enduring psychiatric, emotional, or dual diagnosis that has a serious impact on a person’s quality of life, functioning ability, and health. The dependent variables were recovery and functional disability. An assessment of functioning is often used to assess outcomes, and was used in the study to compare findings with recovery. The current study examined a selection of psychosocial variables alongside some of the more traditional clinical variables used in the SMI research literature and treatment. Psychosocial factors were drawn from an attachment framework (i.e., attachment style, schemas, and coping style). Clinical predictors were selected from more traditional clinical outcome research in the SMI literature (i.e., medication adherence, substance use, severity of illness, and functional disability). The study was a cross-sectional design using a quantitative measure of recovery (the Recovery Assessment Scale; Giffort, Schmook, Woody, Vollendorf, & Gervain, 1995). One hundred and fifty-four participants were recruited from Mind Australia, a non-government psychiatric rehabilitation service. Participants completed a questionnaire at the recruitment sites and relevant information was also collected from the participant’s case files and support staff. Hierarchical regression found that an active coping style and low negative evaluations of self were the strongest unique predictors of recovery. Structural equation modeling showed a series of interactions between psychosocial variables and recovery involving attachment anxiety and avoidance, self-schemas, and active coping. Of the clinical variables, the number of hospitalisations and degree of medication adherence had the strongest relationships with recovery, but demonstrated smaller magnitude associations relative to the psychosocial variables. While research and clinical practice continually strive to maximise outcomes for those with an SMI, the current findings suggest that interventions targeting psychosocial variables (particularly those relating to active coping and self-views) would make a significant contribution to recovery, over and above the contribution of traditional clinical programs that target medication adherence and substance use. This in no way suggests that clinical variables are not important; rather, that an excessive focus on traditional clinical variables may occur at the expense of psychosocial variables which are amenable to psychosocial interventions. Furthermore, the use of subjective measures of recovery in research can provide unique information that is not always accessible using measures based solely on symptoms. The study’s findings have important implications for research, clinical practice, and policy.