Determinants of recovery: a cross-sectional analysis 97 Discussion Main findings This study was cross-sectional in design, with baseline data for 187 clients from an RCT used to examine pathways between specific IMR components—insight, medication adherence, addiction, coping and social support—and degree of clinical, functional, and personal recovery, utilizing SEM. We also sought to explore whether clinical recovery mediated functional and personal recovery. By using baseline data, we did not seek to examine the impact of the IMR program but empirical support for the associations between the concepts proposed by the conceptual framework of IMR. We found that coping was directly and strongly associated with personal and functional recovery; we also found that these associations were moderated only marginally by clinical recovery. Therefore, coping seems to be more important for the degree of functional and personal recovery than the level of clinical recovery is. We found a weak direct pathway between social support and functional recovery. Insight, medication adherence, alcohol and drug use were not associated with any type of recovery. As Fig 1 shows, we found partial empirical support for the conceptual framework of IMR– see S1 Fig— (1) there was a strong, direct pathway between coping–a component of illness management— and the degree of clinical recovery; and (2) clinical recovery was associated, albeit marginally, with functional and personal recovery. However, in a divergence from the conceptual framework, there were strong, direct associations between coping and the degree of functional and personal recovery. Social support—also a component of illness management— was not associated with clinical recovery but had a weak direct association with functional recovery. In another divergence from the conceptual framework, there were no relationships between the three other constituents of illness management we measured and the degree of clinical recovery (12). And, in a third divergence from the conceptual framework, clinical recovery appeared not to be a prerequisite for personal and functional recovery. Our finding that clinical recovery was not a prerequisite for functional recovery is in line with the results of earlier studies that reported that functional recovery had occurred in certain patients despite continuing symptoms (58–60) and with another study that concluded that no sequential relationship could be suggested between symptomatic remission and functional remission (61). In line with our finding of a significant but weak pathway between clinical recovery and personal recovery, a
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