Chapter 4 92 Our IMR model was tested as follows. First, we fitted the full unconstrained model, i.e. a model including the full set of illness-management constituents (insight, coping, social support, alcohol and drug use, and medication adherence) as independent variables, and functional and personal recovery as dependent variables. Clinical recovery was included as a mediating variable; see S2 Fig. We estimated the size and significance of all direct and indirect paths. Then, in subsequent steps, we removed all paths that did not significantly contribute to the fit of the model. The fit of the final, simplified, model was then tested against the fit of the full model. A non-significant result indicates that the simplified model fits the data as well as the full model does. To allow for deviation from multivariate normality of the data and missing datapoints the fit of the path-model and of the path coefficients were estimated using the robust maximum likelihood estimation-method (49–50). Chi2-tests with Satorra-Bentler correction were used to compare the fit of the nested models (51). The fit of the final model was evaluated using the following: Chi2 and p-value (p>.05) and Chi2/df ratio (where a ratio smaller than 1.5 indicates a good fit); the Comparative Fit Index (CFI) (52) and Tucker-Lewis Index (TLI) (53) (where values above .95 indicate a good fit); Root Mean Square Error of Approximation (RMSEA) (54) (where a value lower than.06 indicates a good fit); and Standardized Root Mean Square Residuals (SRMR) (55)(where a value lower than .05 indicates a good fit). As well as using statistical significance of path coefficients, three categories were used in our interpretation of the strength of the relationships: weak (0.2, 0.5), moderate (0.5, 0.8) or strong (0.8) (48). We used SPSS 23.0 for data-management and descriptive analyses (56). SEM-analyses were performed using MPlus version 7.4 software (57). Results Participants’ characteristics Modal participants were male, living alone, had a secondary educational level, had been born in the Netherlands, and had a psychotic disorder. The modal length of treatment was more than five years, they had been admitted at least three times, had been hospitalized for less than one year, and had an income from unemployment, invalidity, or sickness benefit (see Table 1).
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