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Articles   |    
Illness Management and Recovery: A Review of the Literature
Alan B. McGuire, Ph.D.; Marina Kukla, Ph.D.; Amethyst Green, B.S.; Daniel Gilbride, B.S.; Kim T. Mueser, Ph.D.; Michelle P. Salyers, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200274
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Dr. McGuire, Dr. Kukla, and Ms. Green are with Health Services Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, where Dr. McGuire and Dr. Kukla are with the Center for Healthcare Information and Communication (e-mail: abmcguir@iupui.edu). Dr. McGuire is also with the Department of Psychology, Indiana University–Purdue University Indianapolis, where Dr. Salyers is affiliated. Dr. Salyers is also with the Assertive Community Treatment Center of Indiana, Indianapolis. Mr. Gilbride is with the Department of Psychology, Indiana State University, Terre Haute. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Illness Management and Recovery (IMR) is a standardized psychosocial intervention that is designed to help people with severe mental illness manage their illness and achieve personal recovery goals. This literature review summarizes the research on consumer-level effects of IMR and articles describing its implementation.

Methods  In 2011, the authors conducted a literature search of Embase, MEDLINE, PsycINFO, CINAHL, and the Cochrane Library by using the key words “illness management and recovery,” “wellness management and recovery,” or “IMR” AND (“schizophrenia” OR “bipolar” OR “depression” OR “recovery” OR “mental health”). Publications that cited two seminal IMR articles also guided further exploration of sources. Articles that did not deal explicitly with IMR or a direct adaptation were excluded.

Results  Three randomized-controlled trials (RCTs), three quasi-controlled trials, and three pre-post trials have been conducted. The RCTs found that consumers receiving IMR reported significantly more improved scores on the IMR Scale (IMRS) than consumers who received treatment as usual. IMRS ratings by clinicians and ratings of psychiatric symptoms by independent observers were also more improved for the IMR consumers. Implementation studies (N=16) identified several important barriers to and facilitators of IMR, including supervision and agency support. Implementation outcomes, such as participation rates and fidelity, varied widely.

Conclusions  IMR shows promise for improving some consumer-level outcomes. Important issues regarding implementation require additional study. Future research is needed to compare outcomes of IMR consumers and active control groups and to provide a more detailed understanding of how other services utilized by consumers may affect outcomes of IMR.

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Table 1Studies of Illness Management and Recovery (IMR) outcomes
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a The control group for the RCTs was treatment as usual. Fujita et al. (16) used a wait-list control group. For Salyers et al. (17) four ACT teams were randomly assigned to provide IMR training and peer support (N=2) or to maintain treatment as usual (N=2).

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b Includes 4 participants who received IMR after participating in the control group

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c Two consumers opted to receive individual rather than group IMR.

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d Weighted mean of time to program completion across sites

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e Participants included in analysis had complete baseline and follow-up data.

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Table 2Outcomes of Illness Management and Recovery (IMR), by type of studya
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a Results reflect comparisons from baseline to the longest follow-up period. Studies reported only one scale for each category. Only significant (p<.05) effect sizes (Cohen’s d) are reported. Effect sizes for Färdig et al. (9) are reported as η2. A blank cell indicates the variable was not measured. NS, not significant.

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b Range from the four of eight subscales of the Ways of Coping Scale with significant results

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c Knowledge and goals subscale of the consumer-reported IMR Scale

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d Results were significant for Salyers et al. (18), but the variable was not measured for Salyers et al. (17). Effect sizes were not reported.

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e Results were significant for Salyers et al. (18) but not for Salyers et al. (17). Effect sizes were not reported.

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Table 3Implementation studies of Illness Management and Recovery (IMR), by outcome
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a Possible average scores range from 1.0 to 5.0. Scores represent the average across study sites. When measured at several points, the last time is reported.

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b Reported for IMR and control participants combined. Excluded from mean rate of dropout

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c Excluded from weighted mean for fidelity

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d A specific rate was not reported.

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e Mean rates across site ranged from 24% to 40%.

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f In the United States, 8 of 9 attended ≥50% of sessions, and 6 of 9 attended all sessions. In Australia, 6 of 10 attended all sessions.

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g Mean rate reported across sites (range 10%–50%)

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h Excluded from mean rate of fidelity

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i Dropout and completion rates were reported for the Israeli, but not for the United States, sample

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j NIEBP, National Implementing Evidence-Based Practices

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k Weighted by number of programs

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