0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Recovery From Serious Mental Illness: Trajectories, Characteristics, and the Role of Mental Health Care
Carla A. Green, Ph.D., M.P.H.; Nancy A. Perrin, Ph.D.; Michael C. Leo, Ph.D.; Shannon L. Janoff, M.P.H.; Bobbi Jo H. Yarborough, Psy.D.; Robert I. Paulson, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200545
View Author and Article Information

Dr. Green, Dr. Perrin, Dr. Leo, Ms. Janoff, and Dr. Yarborough are with the Center for Health Research, Science Programs Division, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR 97227-1110 (e-mail: carla.a.green@kpchr.org). Dr. Paulson is professor emeritus at the Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  The objective was to identify trajectories of recovery from serious mental illnesses.

Methods  A total of 177 members (92 women; 85 men) of a not-for-profit integrated health plan participated in a two-year mixed-methods study of recovery (STARS, the Study of Transitions and Recovery Strategies). Diagnoses included schizophrenia, schizoaffective disorder, bipolar disorder, and affective psychosis. Data sources included self-reported standardized measures, interviewer ratings, qualitative interviews, and health plan data. Recovery was conceptualized as a latent construct, and factor analyses and factor scores were used to calculate recovery trajectories. Individuals with similar trajectories were identified through cluster analyses.

Results  Four trajectories were identified—two stable (high and low levels of recovery) and two fluctuating (higher and lower). Few demographic or diagnostic factors differentiated clusters at baseline. Discriminant analyses for trajectories found differences in psychiatric symptoms, physical health, satisfaction with mental health clinicians, resources and strains, satisfaction with medications, and mental health service use. Those with higher scores on recovery factors had fewer psychiatric symptoms, better physical health, greater satisfaction with mental health clinicians, fewer strains and greater resources, less service use, better quality of care, and greater satisfaction with medication. Consistent predictors of trajectories included psychiatric symptoms, physical health, resources and strains, and use of psychiatric medications.

Conclusions  Having access to good-quality mental health care—defined as including satisfying relationships with clinicians, responsiveness to needs, satisfaction with psychiatric medications, receipt of services at needed levels, support in managing deficits in resources and strains, and care for general medical conditions—may facilitate recovery. Providing such care may improve recovery trajectories.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Figure 1 Mean recovery factor scores of 177 adult respondents with serious mental illness at baseline, follow-up 1, and follow-up 2a

aPossible scores ranged from –1.5 to 1.5, with higher scores indicating better recovery.

Anchor for Jump
Table 1Demographic characteristics of 177 adult respondents recovering from serious mental illness in an integrated health plan
Table Footer Note

a Totals exceed 100%; participants were asked to indicate all categories that applied.

Table Footer Note

b Does not include Hispanic heritage

Table Footer Note

c Respondents indicated all that applied, thus total could exceed 100%.

Table Footer Note

d Temporary Assistance for Needy Families

Anchor for Jump
Table 2Analysis of variance results for recovery measures of 164 adults with serious mental illness, by recovery cluster at baseline
Table Footer Note

a df=3 and 160. p<.001 for between-groups comparisons for all measures

Table Footer Note

b The Medical Outcomes Study 12-Item Short-Form subscale scores can range from 0 to 100, with 100 indicating the best functioning.

Table Footer Note

c Wisconsin Quality of Life Inventory. Possible subscale scores range from –3.00 to 3.00, with 3.00 indicating greater satisfaction.

Table Footer Note

d Global Assessment of Functioning. Possible scores range from 0 to 100, with 100 indicating the best functioning.

Table Footer Note

e From the National Opinion Research Center’s General Social Survey. Possible scores range from 1 to 4, with 4 indicating greater happiness.

Table Footer Note

f Possible scores range from 24 to 120, with higher scores indicating greater recovery.

Anchor for Jump
Table 3Cluster characteristics at baseline for 164 adults recovering from serious mental illness, by trajectory of recovery
Table Footer Note

a Highest education level. Possible scores range from 1 to 6 (1, grade school; 2, some high school; 3, high school graduate; 4, some college or technical school; 5, college graduate; 6, postgraduate education).

Table Footer Note

b Percentages may add to >100% because participants could code all races that apply.

Table Footer Note

c Global Assessment of Functioning. Possible scores range from 0 to 100, with 100 indicating the best possible functional level.

Table Footer Note

d Possible scores range from 0 to 100, with 100 indicating greater activation.

Table Footer Note

*p<.05 for between-clusters comparisons

Anchor for Jump
Table 4Means for discriminant functions, baseline canonical correlations, and changes in means over time, by recovery clustera
Table Footer Note

a All canonical correlations were significant at p<.05.

+

References

Angst  J;  Sellaro  R:  Historical perspectives and natural history of bipolar disorder.  Biological Psychiatry 48:445–457, 2000
[CrossRef] | [PubMed]
 
Harding  CM;  Zahniser  JH:  Empirical correction of seven myths about schizophrenia with implications for treatment.  Acta Psychiatrica Scandinavica Supplementum 384:140–146, 1994
[CrossRef] | [PubMed]
 
Davidson  L;  McGlashan  TH:  The varied outcomes of schizophrenia.  Canadian Journal of Psychiatry 42:34–43, 1997
 
DeSisto  MJ;  Harding  CM;  McCormick  RV  et al:  The Maine and Vermont three-decade studies of serious mental illness: I. matched comparison of cross-sectional outcome.  British Journal of Psychiatry 167:331–338, 1995
[CrossRef] | [PubMed]
 
DeSisto  MJ;  Harding  CM;  McCormick  RV  et al:  The Maine and Vermont three-decade studies of serious mental illness: II. longitudinal course comparisons.  British Journal of Psychiatry 167:338–342, 1995
[CrossRef] | [PubMed]
 
Harding  CM;  Brooks  GW;  Ashikaga  T  et al:  The Vermont Longitudinal Study of persons with severe mental illness, I: methodology, study sample, and overall status 32 years later.  American Journal of Psychiatry 144:718–726, 1987
[PubMed]
 
Harding  CM;  Brooks  GW;  Ashikaga  T  et al:  The Vermont Longitudinal Study of persons with severe mental illness, II: long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia.  American Journal of Psychiatry 144:727–735, 1987
[PubMed]
 
Harding  CM;  Zubin  J;  Strauss  JS:  Chronicity in schizophrenia: revisited.  British Journal of Psychiatry Supplement 18:27–37, 1992
[PubMed]
 
Harrison  G;  Hopper  K;  Craig  T  et al:  Recovery from psychotic illness: a 15- and 25-year international follow-up study.  British Journal of Psychiatry 178:506–517, 2001
[CrossRef] | [PubMed]
 
Hopper  K;  Harrison  G;  Wanderling  JA:  An overview of course and outcome in ISoS; in  Recovery From Schizophrenia: An International Perspective . Edited by Hopper  K;  Harrison  G;  Janca  A  et al.  Oxford,  Oxford University Press, 2007
 
Warner  R:  Recovery From Schizophrenia .  London,  Routledge, 1994
 
Gitlin  MJ;  Swendsen  J;  Heller  TL  et al:  Relapse and impairment in bipolar disorder.  American Journal of Psychiatry 152:1635–1640, 1995
[PubMed]
 
Cortese  L;  Malla  AK;  McLean  T  et al:  Exploring the longitudinal course of psychotic illness: a case-study approach.  Canadian Journal of Psychiatry 44:881–886, 1999
 
Strauss  JS;  Hafez  H;  Lieberman  PB  et al:  The course of psychiatric disorder, III: longitudinal principles.  American Journal of Psychiatry 142:289–296, 1985
[PubMed]
 
Young  AT;  Green  CA;  Estroff  SE:  New endeavors, risk taking, and personal growth in the recovery process: findings from the STARS study.  Psychiatric Services 59:1430–1436, 2008
[CrossRef] | [PubMed]
 
Wisdom  JP;  Saedi  GA;  Green  CA:  Another breed of “service” animals: STARS study findings about pet ownership and recovery from serious mental illness.  American Journal of Orthopsychiatry 79:430–436, 2009
[CrossRef] | [PubMed]
 
Corrigan  PW;  Giffort  D;  Rashid  F  et al:  Recovery as a psychological construct.  Community Mental Health Journal 35:231–239, 1999
[CrossRef] | [PubMed]
 
Becker  M:  A US experience: consumer responsive quality of life measurement.  Canadian Journal of Community Mental Health 3(suppl):41–52, 45–58, 1998
[PubMed]
 
Becker  M;  Diamond  R;  Sainfort  F:  A new patient focused index for measuring quality of life in persons with severe and persistent mental illness.  Quality of Life Research 2:239–251, 1993
[CrossRef] | [PubMed]
 
Diamond  R;  Becker  M:  The Wisconsin Quality of Life Index: a multidimensional model for measuring quality of life.  Journal of Clinical Psychiatry 60(suppl 3):29–31, 1999
[CrossRef] | [PubMed]
 
General Social Survey. Report 10-10-2012. Chicago, National Opinion Research Center, 2012
 
Link  BG;  Struening  EL;  Rahav  M  et al:  On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse.  Journal of Health and Social Behavior 38:177–190, 1997
[CrossRef] | [PubMed]
 
Ware  JE;  Kosinski  M;  Keller  SD:  SF-12: How to Score the SF-12 Physical and Mental Health Summary Scales .  Boston,  New England Medical Center, Health Institute, 1995
 
Boothroyd  RA;  Chen  HJ:  The psychometric properties of the Colorado Symptom Index.  Administration and Policy in Mental Health and Mental Health Services Research 35:370–378, 2008
[CrossRef] | [PubMed]
 
Shern  DL;  Wilson  NZ;  Coen  AS  et al:  Client outcomes II: longitudinal client data from the Colorado Treatment Outcome Study.  Milbank Quarterly 72:123–148, 1994
[CrossRef] | [PubMed]
 
Green  CA;  Perrin  NA;  Polen  MR  et al:  Development of the Patient Activation Measure for mental health.  Administration and Policy in Mental Health and Mental Health Services Research 37:327–333, 2010
[CrossRef] | [PubMed]
 
Drake  RE;  Osher  FC;  Noordsy  DL  et al:  Diagnosis of alcohol use disorders in schizophrenia.  Schizophrenia Bulletin 16:57–67, 1990
[CrossRef] | [PubMed]
 
Bartlett  J;  Chalk  M;  Manderscheid  RW  et al:  Finding common performance measures through consensus and empirical analysis: the forum on performance measures in behavioral healthcare; in  Mental Health, United States, 2004 . DDHS pub no SMA06-4195[8]. Edited by Manderscheid  RW;  Berry  JT.  Rockville, Md,  Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 2006
 
 Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision (DSM-IV-TR) .  Washington, DC,  American Psychiatric Association, 2000
 
Overall  JE;  Gorham  DR:  The Brief Psychiatric Rating Scale.  Psychological Reports 10:799–812, 1962
[CrossRef]
 
Lukoff  D;  Liberman  RP;  Nuechterlein  KH:  Symptom monitoring in the rehabilitation of schizophrenic patients.  Schizophrenia Bulletin 12:578–602, 1986
[CrossRef] | [PubMed]
 
Chien  CF;  Steinwachs  DM;  Lehman  A  et al:  Provider continuity and outcomes of care for persons with schizophrenia.  Mental Health Services Research 2:201–211, 2000
[CrossRef]
 
Johnson  RE;  McFarland  BH:  Lithium use and discontinuation in a health maintenance organization.  American Journal of Psychiatry 153:993–1000, 1996
[PubMed]
 
Green  CA;  Polen  MR;  Janoff  SL  et al:  Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results.  Psychiatric Rehabilitation Journal 32:9–22, 2008
[CrossRef] | [PubMed]
 
Green  CA:  Fostering recovery from life-transforming mental health disorders: a synthesis and model.  Social Theory and Health 2:293–314, 2004
[CrossRef] | [PubMed]
 
Charmaz  K:  Good Days, Bad Days: The Self in Chronic Illness and Time .  New Brunswick, NJ,  Rutgers University Press, 1991
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 1

Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 8.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 8.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 8.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 2.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 38.  >
Topic Collections
Psychiatric News