Determinants of recovery: a cross-sectional analysis 87 Introduction In recent years the concept of recovery has become increasingly important, and is generating interest and optimism among various stakeholders, such as service users, providers and payers (1). Treatment success in mental healthcare for people with schizophrenia or other serious and persistent mental illnesses (SMI) is perceived more and more as progress in terms of the degree of recovery. However, recovery is a complex and multidimensional concept, and has been defined in various ways (2–4). In a typology that is used throughout this paper, three types of recovery can be differentiated, which should not be considered as mutually exclusive, but as complementary aspects of recovery (5). In this typology recovery is regarded as an outcome and as a cross-sectional reflection of functional status (3). The first type is clinical or symptomatic recovery, which as defined in the present study, concerns the degree of psychiatric symptomatology (6–8). This does not equate with symptomatic remission, i.e., the absence or a sustained reduction in symptoms over a certain period and scored below distinct thresholds (2, 7, 9– 11). The second type is functional recovery, also named objective recovery (12). While some authors equate this with functional remission (7, 9), others consider it to be part of clinical recovery (13–14). Or they regard cognitive functioning as part of the definition (9, 15–16). However, in the present study, functional recovery is defined as the degree of vocational and social functioning, such as acting according to ageappropriate role expectations, the performance of daily living tasks without supervision, engagement in social interactions (15), and the degree of independence with regard to housing (4, 9). Functional recovery thus concerns functional outcomes rather than functional capacity (17–19). The third type of recovery is personal recovery, a term that originated among people with lived experience of mental illness and also highlights the personal nature of the recovery process (20–21). Sometimes named subjective recovery (12), it includes components such as spirituality, empowerment, actively accepting the illness, and also finding hope, re-establishing a positive identity, developing meaning in life, overcoming stigma, taking control of one’s own life, and having supporting relationships (7). In a shorter definition, it concerns the extents of perceived recovery, sense of purpose, and personal agency (12). To summarize the key elements of personal recovery, various authors use the acronym CHIME: connectedness; hope and optimism about the future; identity; meaning in life; and empowerment (22).
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