Chapter 7 180 In the present analysis, clinical recovery as a mediator weakly affects the relationship between illness self-management and personal recovery. This is consistent with the findings of two recent meta-analyses on people with psychotic disorders. Both meta-analyses indicated a small to moderate association between clinical and personal recovery (15, 22). Moreover, previous studies confirm that clinical recovery does not necessarily appear to be a prerequisite for personal recovery (10, 15). That functional recovery could also be a mediator between illness management and personal recovery as shown in the current analysis, is a variant of the IMR framework. However, functional recovery as a mediator only weakly affects the relationship between illness self-management and personal recovery. This might have been affected by the weak association between functional and personal recovery as shown in two meta-analyses. One of these two meta-analyses showed a small positive association between general functioning, as measured by the Global Assessment of Functioning scale, and personal recovery (15). The other meta-analysis showed small positive associations between social support, work and housing, and psychosocial functioning with personal recovery (22). This study supports the relevance of self-management interventions such as IMR, which should be part of standard care for people with SMI and should be given priority in guidelines (3). Strengths This mediation analysis has a firm base (38) because the hypothesized directions of associations between the concepts examined were derived from theory (4), from previous research results by other researchers (3, 15, 22), and from ourselves (11). This might support the relevance of the present outcomes (38). Moreover, in this study, a possible different working of IMR has been suggested than that previously proposed (4). This concerns introducing functional recovery as a possible mediator between illness management and personal recovery. Two meta-analyses respectively investigated the impact of clinical and functional recovery on personal recovery, but not the impact of illness management (15, 22). A separate meta-analysis examined the impact of illness self-management (3). However, in this study, both the indirect role of clinical and functional recovery and the direct role of illness management as determinants of personal recovery were investigated.
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