Leendertse J C P, Wierdsma A I, van den Berg D, Ruissen A M, Slade M, Castelein S, Mulder C L
Emergis Institute for Mental Healthcare, Kloetinge, Netherlands.
Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, Netherlands.
Front Psychiatry. 2021 Feb 23;12:622628. doi: 10.3389/fpsyt.2021.622628. eCollection 2021.
Personal recovery (PR) is a subjective, multidimensional concept, and quantitative research using PR as an outcome is rapidly increasing. This systematic review is intended to support the design of interventions that contribute to PR in psychotic disorders, by providing an overview of associated factors and their weighted importance to PR: clinical factors, social factors, and socio-demographic characteristics are included, and factors related to the concept of PR (organized into CHIME dimensions). A systematic literature search was conducted from inception to March 2020. Quantitative studies that had used a validated questionnaire assessing the concept of PR were included. Mean effect sizes for the relationship between PR-scale total scores and related factors were calculated using meta-analyses. Sources of heterogeneity were examined using meta-regression tests. Forty-six studies, that used (a total of) eight PR measures, showed that in clinical factors, affective symptoms had a medium negative association with PR-scale total scores ( = -0.44, 95%CI -0.50 to -0.37), while positive, negative and general symptoms had small negative correlations. No association was found with neuro-cognition. Social factors (support, work and housing, and functioning) showed small positive correlations. Gender and age differences had barely been researched. Large associations were found for PR-scale total scores with the CHIME dimensions hope ( = 0.56, 95%CI 0.48-0.63), meaning in life ( = 0.48, 95%CI 0.38-0.58) and empowerment ( = 0.53, 95%CI 0.42-0.63); while medium associations were found with connectedness ( = 0.34, 95%CI 0.43-0.65) and identity ( = 0.43, 95%CI 0.35-0.50). Levels of heterogeneity were high, sources included: the variety of PR measures, variations in sample characteristics, publication bias, variations in outcome measures, and cultural differences. Most interventions in mental healthcare aim to reduce symptoms and improve functioning. With regard to stimulating PR, these interventions may benefit from also focusing on enhancing hope, empowerment, and meaning in life. The strength of these findings is limited by the challenges of comparing separate CHIME dimensions with questionnaires assessing the concept of PR, and by the high levels of heterogeneity observed. Future research should focus on the interaction between elements of PR and clinical and social factors over time.
个人康复（PR）是一个主观的、多维度的概念，将PR作为结果的定量研究正在迅速增加。本系统综述旨在通过概述相关因素及其对PR的加权重要性来支持有助于精神障碍患者实现PR的干预措施的设计：包括临床因素、社会因素和社会人口学特征，以及与PR概念相关的因素（分为CHIME维度）。从开始到2020年3月进行了系统的文献检索。纳入了使用经过验证的问卷评估PR概念的定量研究。使用荟萃分析计算PR量表总分与相关因素之间关系的平均效应量。使用元回归检验检查异质性来源。46项研究（共使用了8种PR测量方法）表明，在临床因素方面，情感症状与PR量表总分呈中度负相关（=-0.44，95%CI -0.50至-0.37），而阳性、阴性和一般症状呈小负相关。未发现与神经认知有关联。社会因素（支持、工作和住房以及功能）呈小正相关。性别和年龄差异几乎未被研究。发现PR量表总分与CHIME维度希望（=0.56，95%CI 0.48-0.63）、生活意义（=0.48，95%CI 0.38-0.58）和赋权（=0.53，95%CI 0.42-0.63）有较大关联；而与联系感（=0.34，95%CI 0.43-0.65）和身份认同（=0.43，95%CI 0.35-0.50）有中度关联。异质性水平较高，来源包括：PR测量方法的多样性、样本特征的差异、发表偏倚、结果测量的差异以及文化差异。大多数精神卫生保健干预措施旨在减轻症状和改善功能。关于促进PR，这些干预措施可能还应侧重于增强希望、赋权和生活意义，从而从中受益。这些研究结果的力度受到将CHIME各个维度与评估PR概念的问卷进行比较的挑战以及所观察到的高度异质性的限制。未来的研究应关注PR要素与临床和社会因素随时间的相互作用。
