Determinants of personal recovery: a mediation analysis 179 Discussion The research question of this study was: What is the association of changes over time in the illness self-management skills of people with SMI on changes in personal recovery, and to what degree is this association mediated by changes in clinical and functional recovery? Congruent with the formulated hypothesis, the results showed that improvement in self-reported overall illness self-management capabilities was associated with the improvement of overall personal recovery in two ways: (1) directly, and (2) indirectly via improvements in clinical and functional recovery. The results suggest that illness (self-) management is an important direct determinant of personal recovery, while the indirect effects of illness management mediated by clinical recovery and functional recovery, are less profound. These results also suggest that improvement in clinical and functional recovery might not be a prerequisite for improvement in personal recovery. Our results on the association between illness management and personal recovery are supported by previous findings. An earlier study showed that the selfmanagement of people with SMI had a significant effect compared with control on subjective recovery measures such as hope and empowerment at follow-up, and on self-rated recovery both at end of treatment and at follow-up (3). Hope and empowerment are both components of the CHIME conceptual framework of personal recovery (20). Moreover, these results were consistent with previous indications, that for predicting personal recovery, the ability to cope with symptoms appeared more relevant than the symptoms themselves (10). Previous studies have proposed explanations for a close connection between illness self-management and personal recovery (5). Long periods with serious symptoms, relapses, and stresses can affect one’s sense of well-being. Therefore, better symptom management is required to develop hope for the future and provide more opportunities to work on personal recovery goals (5). Helpful in learning to cope with symptoms is teaching patients basic facts concerning their mental illness and working together on relapse prevention planning (5, 42). Taking more control of their own lives promotes empowerment and rebuilding a positive sense of identity (5, 43). Learning illness management also entails gaining social support, including peer support, and greater involvement with family members. This may contribute to a sense of connectedness (5, 43). This also applies to working towards meaningful activities. All mentioned components of illness self-management are measured with the IMR scale. All mentioned components of personal recovery are included in the CHIME conceptual framework.
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