Determinants of recovery: a cross-sectional analysis 89 of clinical, functional, and personal recovery. These components of illness management include psychiatric insight, adherence to medication, substance use, coping and social support, all being important ingredients of the theoretical base of the IMR-training. We also explored whether clinical recovery does indeed mediate the association between these constituents of illness management and functional and personal recovery. We hypothesized that while the five illness-management constituents had direct pathways to clinical recovery, they had indirect pathways, via clinical recovery, to functional and personal recovery. SEM is a convenient statistical method for exploring such direct and indirect relationships for inferential purposes in a cross-sectional analysis (29–31). Methods Study participants In this study baseline data were used of 187 people who agreed to participate in the Dutch RCT on IMR (28). There were four inclusion criteria for this RCT: (1) having severe and persistent mental illness (SMI), such as a psychotic disorder or a schizoaffective disorder with or without comorbid disorders such as substance abuse and personality disorders; (2) being aged between 18 and 65; (3) currently at or recently admitted to the outpatient mental health services at one of two participating mental healthcare institutions in the Rotterdam area in the Netherlands; and (4) being willing and able to give written informed consent. There were three exclusion criteria: (1) having already participated in IMR training; (2) being unable to give informed consent due to intellectual disabilities; and (3) insufficient knowledge of the Dutch language. Participants in the study were recruited through clinician referrals for IMR from one of the 14 participating community mental health teams. Data collection In interviews with participating clients and their clinicians, research assistants collected information on social-demographic variables: age, gender, living situation, educational level, native country, and source of income, and on psychiatric history: length of treatment and number and length of hospital admissions. This information was later cross validated in the electronic client files. During the interviews with clinicians, we collected the diagnoses that had previously been made by psychiatrists in the community mental health teams based on clinical interviews: psychotic disorders, mood disorder and/or personality disorder. These were also cross validated in the electronic client files. In these interviews with clients and
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