Determinants of personal recovery: a mediation analysis 171 Based on these results, we wondered whether the found changes in illness selfmanagement might be related to the found changes in personal recovery. If this were the case, we wondered whether this association could be (partially) mediated by changes in clinical and functional recovery. Rationales for applying those two mediators in the present analysis were: First, in the proposed working of IMR, clinical recovery was a mediator between illness management on the one hand and personal and functional recovery on the other (4). Second, in an earlier review and meta-analysis, illness management appeared to enhance functional recovery (3). Third, in two other earlier reviews and metaanalyses functional recovery was associated with personal recovery (15, 22). Therefore, the research question arose as to whether functional recovery, as well as clinical recovery, might be a mediator that could explain the relationship between illness management and personal recovery. Therefore, on the basis of the working of IMR suggested in the conceptual framework (4), the results of our RCT (11), and the results of three reviews and meta-analyses, in this study, we were interested to explore to what degree changes in time in overall illness self-management might be associated with changes in personal recovery. Furthermore, we wanted to identify whether these associations might be (partly) mediated by changes in clinical or functional recovery. This research question might be important for future studies to consider which interventions are relevant to improve personal recovery. In this study, mediation analysis was performed to investigate the indirect and direct relations. Earlier studies have indicated the importance of improvements in personal recovery for people with SMI, including self-perceived growth and leading a satisfactory life despite the presence of persistent symptoms (8, 11, 18, 23, 24). Therefore, examining personal recovery as an outcome of interventions in people with SMI is considered increasingly relevant (15, 22, 25, 26). This led us to the following research question: What is the association of changes over time in illness self-management skills on changes in personal recovery, and to what degree is this association mediated by changes in clinical and functional recovery?
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