Skip to main content
SpringerLink
Log in

Subjective Recovery in Patients with Schizophrenia and Related Factors

  • Original Paper
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Subjective recovery is a personally perceived recovery involving other factors beyond clinical recovery. This study aims at investigating the factors related to subjective recovery in patients with schizophrenia living in Turkey. This study assessed 120 clinically stable outpatients with schizophrenia or schizoaffective disorder using the clinical and psychosocial scales. Gender, type of the diagnosis of disease, and age of the illness onset were found to be correlated with the subjective recovery. Subjective recovery was significantly correlated with CGI-S (r = − 0.25), total PANSS score (r = − 0.29), global assessment of functioning (r = 0.27), social functioning (r = 0.43), internalized stigma (r = − 0.38), self-esteem (r = 0.56), depression (r = − 0.59), and hopelessness (r = − 0.55). Hopelessness and self-esteem were found to be predictive of the subjective recovery explaining 52% of the variance. It can be argued that efforts to promote hope and self-esteem contribute to the subjective recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • Andreasen, N. C., Carpenter, W. T., Kane, J., Lasser, R. A., Marder, S. R., & Weinberger, D. R. (2005). Remission in schizophrenia: Proposed criteria and rationale for consensus. American Journal of Psychiatry,162(3), 441–449.

    Article  PubMed  Google Scholar 

  • Andresen, R., Oades, L., & Caputi, P. (2003). The experience of recovery from schizophrenia: Towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry,37(5), 586–594.

    Article  PubMed  Google Scholar 

  • Anthony, W. A. (1990s). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal,16(4), 11–23.

    Article  Google Scholar 

  • Argentzell, E., Hultqvist, J., Neil, S., & Eklund, M. (2017). Measuring personal recovery—psychometric properties of the Swedish Questionnaire about the Process of Recovery (QPR-Swe). Nordic Journal of Psychiatry,71(7), 529–535.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology,42(6), 861.

    Article  CAS  PubMed  Google Scholar 

  • Beck, A. T. (1961). An inventory for measuring depression. Archives of General Psychiatry,4, 561–571.

    Article  CAS  PubMed  Google Scholar 

  • Bellack, A. S. (2006). Scientific and consumer models of recovery in schizophrenia: Concordance, contrasts, and implications. Schizophrenia Bulletin,32, 432–442.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cavelti, M., Kvrgic, S., Beck, E. M., Kossowsky, J., & Vauth, R. (2012). Assessing recovery from schizophrenia as an individual process. A review of self-report instruments. European Psychiatry,27(1), 19–32.

    Article  CAS  PubMed  Google Scholar 

  • Chan, R. C., Mak, W. W., Chio, F. H., & Tong, A. C. (2017). Flourishing with psychosis: A prospective examination on the interactions between clinical, functional, and personal recovery processes on well-being among individuals with schizophrenia spectrum disorders. Schizophrenia Bulletin,44(4), 778–786.

    Article  PubMed Central  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for behavioral sciences (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Corrigan, P. W., Salzer, M., Ralph, R. O., Sangster, Y., & Keck, L. (2004). Examining the factor structure of the recovery assessment scale. Schizophrenia Bulletin,30, 1035–1041.

    Article  PubMed  Google Scholar 

  • Çuhadaroğlu, F. (1986). Self-esteem in adolescents. Dissertation Thesis. Hacettepe University. Ankara, Turkey.

  • Davidson, L., Borg, M., Marin, I., Topor, A., Mezzina, R., & Sells, D. (2005a). Processes of recovery in serious mental illness: Findings from a multinational study. American Journal of Psychiatric Rehabilitation,8(3), 177–201.

    Article  Google Scholar 

  • Davidson, L., Lawless, M. S., & Leary, F. (2005b). Concepts of recovery: Competing or complementary? Current Opinion in Psychiatry,18, 664–667.

    Article  PubMed  Google Scholar 

  • Deegan, P. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal,11(4), 11–19.

    Article  Google Scholar 

  • Drake, R. E., & Whitley, R. (2014). Recovery and severe mental illness: Description and analysis. The Canadian Journal of Psychiatry,59(5), 236–242.

    Article  PubMed  Google Scholar 

  • Drapalski, A. L., Medoff, D., Dixon, L., & Bellack, A. (2016). The reliability and validity of the Maryland assessment of recovery in Serious Meltal Illness Scale. Psychiatry Research,239, 259–264.

    Article  PubMed  Google Scholar 

  • Ersoy, M. A., & Varan, A. (2007). Reliability and validity of the Turkish version of the Internalized Stigma of Mental Illness Scale. Türk Psikiyatri Dergisi,18(2), 163–171.

    PubMed  Google Scholar 

  • Essock, S., & Sederer, L. (2009). Understanding and measuring recovery. Schizophrenia Bulletin,35, 279–281.

    Article  PubMed  PubMed Central  Google Scholar 

  • Giusti, L., Ussorio, D., Tosone, A., Di Venanzio, C., Bianchini, V., Necozione, S., et al. (2015). Is personal recovery in schizophrenia predicted by low cognitive insight? Community Mental Health Journal,51(1), 30–37.

    Article  PubMed  Google Scholar 

  • Gaag Van der, M., Hoffman, T., Remijsen, M., Hijman, R., de Haan, L., Wiersma, D., et al. (2006). The five-factor model of the Positive and Negative Syndrome Scale II: A ten-fold cross-validation of a revised model. Schizophrenia Research,85(1–3), 280–287.

    PubMed  Google Scholar 

  • Guy, W. (1976). ECDEU assessment manual for psychopharmacology (pp. 534–537). Rockville: US Department of Health and Welfare.

    Google Scholar 

  • Henderson, A. R. (2011). A substantive theory of recovery from the effects of severe persistent mental illness. International Journal of Social Psychiatry,57(6), 564–573.

    Article  PubMed  Google Scholar 

  • Hisli, N. A. (1989). Reliability and validity study of Beck depression inventory in a University student sample. The Journal of Psychology,87, 3–13.

    Google Scholar 

  • Jaeger, M., & Hoff, P. (2012). Recovery: Conceptual and ethical aspects. Current Opinion in Psychiatry,25, 497–502.

    Article  PubMed  Google Scholar 

  • Jørgensen, R., Zoffmann, V., Munk-Jørgensen, P., Buck, K. D., Jensen, S. O. W., Hansson, L., et al. (2015). Relationships over time of subjective and objective elements of recovery in persons with schizophrenia. Psychiatry Research,228(1), 14–19.

    Article  PubMed  Google Scholar 

  • Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin,13(2), 261–276.

    Article  CAS  PubMed  Google Scholar 

  • Kostakoğlu, A. E., Batur, S., Tiryaki, A., & Göğüş, A. (1999). Reliability and validity of the Turkish version of the Positive and Negative Syndrome Scale. Türk Psikoloji Dergisi,14(44), 23–32.

    Google Scholar 

  • Kukla, M., Lysaker, P. H., & Salyers, M. P. (2013). Do persons with schizophrenia who have better metacognitive capacity also have a stronger subjective experience of recovery? Psychiatry Research,209, 381–385.

    Article  PubMed  Google Scholar 

  • Kukla, M., Lysaker, P. H., & Roe, D. (2014). Strong subjective recovery as a protective factor against the effects of positive symptoms on quality of life outcomes in schizophrenia. Comprehensive Psychiatry,6, 1363–1368.

    Article  Google Scholar 

  • Kvrgic, S., Cavelti, M., Beck, E. M., Rüsch, N., & Vauth, R. (2013). Therapeutic alliance in schizophrenia: The role of recovery orientation, self-stigma, and insight. Psychiatry Research,209, 15–20.

    Article  PubMed  Google Scholar 

  • Law, H., Neil, S. T., Dunn, G., & Morrison, A. P. (2014). Psychometric properties of the questionnaire about the process of recovery (QPR). Schizophrenia Research,156(2–3), 184–189.

    Article  PubMed  Google Scholar 

  • Law, H., & Morrison, A. P. (2014). Recovery in psychosis: A Delphi study with experts by experience. Schizophrenia Bulletin,40(6), 1347–1355.

    Article  PubMed  PubMed Central  Google Scholar 

  • Law, H., Morrison, A., Byrne, R., & Hodson, E. (2012). Recovery from psychosis: A user informed review of self-report instruments for measuring recovery. Journal of Mental Health,21(2), 192–207.

    Article  PubMed  Google Scholar 

  • Law, H., Shryane, N., Bentall, R. P., & Morrison, A. P. (2016). Longitudinal predictors of subjective recovery in psychosis. The British Journal of Psychiatry,209(1), 48–53.

    Article  PubMed  Google Scholar 

  • Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. The British Journal of Psychiatry,199(6), 445–452.

    Article  PubMed  Google Scholar 

  • Liberman, R. P., Kopelowicz, A., Ventura, J., & Gutkind, D. (2002). Operational criteria and factors related to recovery from schizophrenia. International Review of Psychiatry,14, 256–272.

    Article  Google Scholar 

  • Liberman, R. P., & Kopelowicz, A. (2005). Recovery from schizophrenia: A concept in search of research. Psychiatric Services,56(6), 735–742.

    Article  PubMed  Google Scholar 

  • Liberman, R. P. (2008). Recovery from disability: Manual of psychiatric rehabilitation. Washington, DC: American Psychiatric Publishing.

    Google Scholar 

  • Lim, M., Li, Z., Xie, H., Tan, B. L., & Lee, J. (2019). An Asian study on clinical and psychological factors associated with personal recovery in people with psychosis. BMC Psychiatry,19, 256. https://doi.org/10.1186/s12888-019-2238-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lysaker, P. H., Roe, D., & Yanos, P. T. (2007). Toward understanding the insight paradox: Internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin,33(1), 192–199.

    Article  PubMed  Google Scholar 

  • Lysaker, P. H., Hamm, J. A., Hasson-Ohayon, I., Pattison, M. L., & Leonhardt, B. L. (2018). Promoting recovery from severe mental illness: Implications from research on metacognition and metacognitive reflection and insight therapy. World Journal of Psychiatry,8(1), 1–11.

    Article  PubMed  PubMed Central  Google Scholar 

  • Macpherson, R., Pesola, F., Leamy, M., Bird, V., Le Boutillier, C., Williams, J., et al. (2016). The relationship between clinical and recovery dimensions of outcome in mental health. Schizophrenia Research,175(1–3), 142–147.

    Article  PubMed  Google Scholar 

  • Mead, S., & Copeland, M. E. (2000). What recovery means to us: Consumers’ perspectives. Community Mental Health Journal,36, 315–328.

    Article  CAS  PubMed  Google Scholar 

  • Morrison, A. P., Shryane, N., Beck, R., Heffernan, S., Law, H., McCusker, M., et al. (2013). Psychosocial and neuropsychiatric predictors of subjective recovery from psychosis. Psychiatry Research,208(3), 203–209.

    Article  PubMed  Google Scholar 

  • Novick, D., Haro, J. M., Suarez, D., Vieta, E., & Naber, D. (2009). Recovery in the outpatient setting: 36-month results from the Schizophrenia Outpatients Health Outcomes (SOHO) study. Schizophrenia Research,108(1–3), 223–230.

    Article  PubMed  Google Scholar 

  • Pitt, L., Kilbride, M., Nothard, S., Welford, M., & Morrison, A. P. (2007). Researching recovery from psychosis: A user-led project. Psychiatric Bulletin,31, 55–60.

    Article  Google Scholar 

  • Resnick, S. G., Rosenheck, R. A., & Lehman, A. F. (2004). An exploratory analysis of correlates of recovery. Psychiatric Services,55(5), 540–547.

    Article  PubMed  Google Scholar 

  • Resnick, S. G., Fontana, A., Lehman, A. F., & Rosenheck, R. A. (2005). An empirical conceptualization of the recovery orientation. Schizophrenia Research,75, 119–128.

    Article  PubMed  Google Scholar 

  • Ritsher, J. B., Otilingam, P. G., & Grajales, M. (2003). Internalized stigma of mental illness: Psychometric properties of a new measure. Psychiatry Research,121(1), 31–49.

    Article  PubMed  Google Scholar 

  • Roe, D., Mashiach-Eizenberg, M., & Lysaker, P. H. (2011). The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders. Schizophrenia Research,131(1–3), 133–138.

    Article  PubMed  Google Scholar 

  • Rosenberg, M. (1965). Rosenberg self-esteem scale (RSE). Acceptance and commitment therapy. Measures package,61, 52.

    Google Scholar 

  • Rossi, A., Amore, M., Galderisi, S., Rocca, P., Bertolino, A., Aguglia, E., et al. (2018). The complex relationship between self-reported ‘personal recovery’ and clinical recovery in schizophrenia. Schizophrenia Research,192, 108–112.

    Article  PubMed  Google Scholar 

  • Schrank, B., & Slade, M. (2007). Recovery in psychiatry. Psychiatry Bulletin,31, 321–325.

    Article  Google Scholar 

  • Schrank, B., Amering, M., Hay, A. G., Weber, M., & Sibitz, I. (2014). Insight, positive and negative symptoms, hope, depression and self-stigma: A comprehensive model of mutual influences in schizophrenia spectrum disorders. Epidemiology and Psychiatric Sciences,23(3), 271–279.

    Article  CAS  PubMed  Google Scholar 

  • Seber, G., Dilbaz, N., Kaptanoğlu, C., & Tekin, D. (1993). Hopelessness Scale: Turkish reliability and validity. Kriz Dergisi,1(3), 139–142.

    Google Scholar 

  • Shanks, V., Williams, J., Leamy, M., Bird, V. J., Le Boutillier, C., & Slade, M. (2013). Measures of personal recovery: A systematic review. Psychiatry Services,64, 974–980.

    Article  Google Scholar 

  • Schulze, B., & Angermeyer, M. C. (2003). Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals. Social Science & Medicine,56(2), 299–312.

    Article  Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). New York: Pearson Education.

    Google Scholar 

  • van Eck, R. M., Burger, T. J., Schenkelaars, M., Vellinga, A., de Koning, M. B., Schirmbeck, F., et al. (2018a). The impact of affective symptoms on personal recovery of patients with severe mental illness. International Journal of Social Psychiatry,64(6), 521–527.

    Article  PubMed  Google Scholar 

  • van Eck, R. M., Burger, T. J., Vellinga, A., Schirmbeck, F., & de Haan, L. (2018b). The relationship between clinical and personal recovery in patients with schizophrenia spectrum disorders: A systematic review and meta-analysis. Schizophria Bulletin,44(3), 631–642.

    Article  Google Scholar 

  • van Os, J., Burns, T., Cavallaro, R., Leucht, S., Peuskens, J., Helldin, L., et al. (2006). Standardized remission criteria in schizophrenia. Acta Psychiatrica Scandinavica,113(2), 91–95.

    Article  PubMed  Google Scholar 

  • Vass, V., Morrison, A. P., Law, H., Dudley, J., Taylor, P., Bennett, K. M., et al. (2015). How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences. Psychiatry Research,230(2), 487–495.

    Article  PubMed  Google Scholar 

  • Vita, A., & Barlati, S. (2018). Recovery from schizophrenia: Is it possible? (2018). Current Opinion Psychiatry,31(3), 246–255.

    Article  Google Scholar 

  • Warner, R. (2009). Recovery from schizophrenia and the recovery model. Current Opinion Psychiatry,2009(22), 374–380.

    Article  Google Scholar 

  • Wciorka, J., Switaj, P., & Anczewska, M. (2015). The stage of recovery in relation to the other subjective and objective aspects of psychosis. Psychiatry Research,225, 613–618.

    Article  PubMed  Google Scholar 

  • Whitley, R., & Drake, R. E. (2010). Recovery: A dimensional approach. Psychiatric Services,61, 1248–1250.

    Article  PubMed  Google Scholar 

  • Whitley, R. (2014). Introducing recovery. The Canadian Journal of Psychiatry,59, 233–235.

    Article  PubMed  Google Scholar 

  • Wood, L., Byrne, R., Burke, E., Enache, G., & Morrison, A. P. (2017). The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem. Psychiatry Research,255, 94–100.

    Article  PubMed  Google Scholar 

  • Yıldız, M., Erim, R., Soygür, H., Tural, U., Kiras, F., & Gules, E. (2018a). Development and validation of the Subjective Recovery Assessment Scale for patients with schizophrenia. Psychiatry and Clinical Psychopharmacology,28(2), 163–169.

    Article  Google Scholar 

  • Yıldız, M., Kiras, F., İncedere, A., Esen, D., Gürcan, M. B., Abut, B., et al. (2018b). Development of Social Functioning Assessment Scale for people with schizophrenia: Validity and reliability study. Anadolu Psikiyatri Dergisi,19, 29–38.

    Article  Google Scholar 

Download references

Funding

The author/s received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Psychosocial Rehabilitation, Kocaeli University Institute of Health Science, Izmit, Kocaeli, Turkey

    Kübra İpçi, Mustafa Yildiz & Aysel İncedere

  2. Department of Psychiatry, Kocaeli University School of Medicine, Umuttepe, 41001, Izmit, Kocaeli, Turkey

    Mustafa Yildiz, Fatma Kiras, Duygu Esen & Mehmet B. Gürcan

Authors
  1. Kübra İpçi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mustafa Yildiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aysel İncedere
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fatma Kiras
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Duygu Esen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mehmet B. Gürcan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mustafa Yildiz.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

İpçi, K., Yildiz, M., İncedere, A. et al. Subjective Recovery in Patients with Schizophrenia and Related Factors. Community Ment Health J 56, 1180–1187 (2020). https://doi.org/10.1007/s10597-020-00616-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-020-00616-5

Keywords

Search

Navigation