Determinants of personal recovery: a mediation analysis 169 Introduction Patients with serious and persistent mental illnesses (SMIs) such as schizophrenia face major challenges in attaining their personal goals and fully participate in society. This is because of their recurrent symptoms, cognitive limitations, lack of social support, and social impediments such as stigma (1, 2). Psychopharmaceutical treatment can reduce the severity of symptoms and relapse. However, there is also the need for effective psychosocial interventions to provide support for patients in illness self-management. Illness self-management interventions aim to enable people to recover by equipping them with the skills and self-confidence they require to actively recognize and manage their individual health problems (3). Several illness self-management training programs have been developed including Illness Management and Recovery (IMR). The aim of IMR is to achieve progress in recovery by combining better illness management with the pursuit of personal goals (4). IMR is currently used in several countries, such as in the US, European, and Asian countries. Illness self-management concerns people’s capabilities to take care of themselves and regain control of their lives (5). This includes the ability to perform the tasks needed to manage and live successfully with the physical, social, and emotional consequences of a serious and persistent condition (3). More specifically for people with SMI, it includes the ability to reduce their susceptibility to the illness, and to effectively cope with their symptoms. For example, it is necessary to have knowledge of mental illness to be able to make informed treatment decisions along with professionals, and to have the ability to reach out for social support (5, 6). Complementary to this, a psychosocial intervention supporting illness selfmanagement includes providing psycho-education and teaching skills for informed decision making on treatment; providing cognitive-behavioral training to support behavioral tailored medication adherence; teaching social and coping skills to deal with symptoms or stress; developing a relapse prevention plan; and improving social support (3, 4). Recovery is a complex and multi-dimensional concept that has been defined in several ways (7-9). In a typology used in previous studies (10, 11), which will be used in the present study, three types of recovery can be identified, which should be considered not mutually exclusive but complementary aspects of recovery (12). The first type is clinical recovery, which concerns the degree of psychiatric symptomatology (13-15) The second type is functional recovery which can be defined as the degree of vocational and social functioning, such as acting according
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