Recovery Assessment Scale Research Articles

Self-stigma as a barrier to recovery: a longitudinal study

Stigma limits life opportunities of persons with mental illness. Self-stigma, the internalization of negative stereotypes, undermines empowerment and could hinder recovery. Here we examined self-stigma's effect on recovery among 222 disability pensioners with mental illness over 2years, controlling for age, gender, symptoms and recovery at baseline measured by the Recovery Assessment Scale. More self-stigma at baseline was associated with a significant decrease in recovery after 1year (not significant after 2years). An increase of self-stigma from baseline to follow-up predicted less recovery 1 and 2years later. Interventions that reduce self-stigma could therefore improve recovery.

Twelve months effect of self-referral to inpatient treatment on patient activation, recovery, symptoms and functioning: A randomized controlled study

ObjectiveTo investigate the effect of having a contract for self-referral to inpatient treatment (SRIT) in patients with severe mental disorders. MethodsA randomized controlled trial with 53 adult patients; 26 participants received a SRIT contract, which they could use to refer themselves into a Community Mental Health Centre up to five days for each referral without contacting a doctor in advance. Outcomes were assessed after 12 months with the self-report questionnaires Patient Activation Measure (PAM-13), Recovery Assessment Scale (RAS), and the Behavior and Symptom Identification Scale (BASIS-32) and analyzed using linear mixed and regression models. ResultsThere was no significant effect on PAM-13 (estimated mean difference (emd) −0.41, 95% CI (CI):-7.49–6.67), nor on the RAS (emd 0.02, CI:-0.27–0.31) or BASIS-32 (0.09, CI:-0.28–0.45). An exploratory post hoc analysis showed effect of SRIT in those with low PAM below ≤47 (p=0.049). ConclusionThere were no group differences after 12 months, but both groups maintained their baseline levels. Practice implicationsSRIT contracts can be recommended as it supports the rights to self-determination, promote user participation in decision-making in own treatment without any indication of adverse effects.

Recovery and self-efficacy of a newly trained certified peer specialist following supplemental weekly group supervision: A case-based time-series analysis

ABSTRACTThis single-case time-series study explored the benefits of adding a supervision/support group for peer specialists. Six certified peer specialists, employed by a small community-based peer support program, provided weekly recordings of mental health recovery (as measured by the Recovery Assessment Scale) and peer specialist self-efficacy (measured with an inventory developed by the authors) during an 8-week baseline phase and a 28-week intervention (weekly supervision group) phase. Data from the peer specialist with the most consistent supervision group attendance and greatest number of weekly recordings were chosen for intensive analysis using Simulation Modeling Analysis for Brief Time-Series Data Streams. Results indicated that the peer specialist experienced significant increases in recovery and work-related self-efficacy during the group supervision phase. There was also a statistically significant association between her improvements in mental health recovery and her increases in peer speci...

Recovery Orientation Among Individuals with Serious Mental Illness

In the present study, we examined differences between individuals with schizophrenia and individuals with neuroses in a suburban clinical sample with respect to recovery orientation. A sample of 100 psychiatric patients from one public hospital in Selangor, Malaysia participated in this study. Participants’ recovery orientation was assessed by the Recovery Assessment Scale Questionnaire. The Multivariate Analysis of Variance (MANOVA) was significant. Univariate tests further showed that there was a significant difference across two different diagnoses on reliance on others. In particular, individuals with neuroses had higher reliance on others than individuals with schizophrenia did. In an attempt to promote recovery orientation among individuals with serious mental illness, social connection and social support are domains that mental health care providers could target on.

Recovery assessment scale: Examining the factor structure of the German version (RAS-G) in people with schizophrenia spectrum disorders

BackgroundThe recovery framework has found its way into local and national mental health services and policies around the world, especially in English speaking countries. To promote this process, it is necessary to assess personal recovery validly and reliably. The Recovery Assessment Scale (RAS) is the most established measure in recovery research. The aim of the current study is to examine the factor structure of the German version of the RAS (RAS-G). MethodsOne hundred and fifty-six German-speaking clients with schizophrenia or schizoaffective disorder from a community mental health service completed the RAS-G plus measures of recovery attitudes, self-stigma, psychotic symptoms, depression, and functioning. A confirmatory factor analysis of the original 24-item RAS version was conducted to examine its factor structure, followed by reliability and validity testing of the extracted factors. ResultsThe CFA yielded five factors capturing 14 items which showed a substantial overlap with the original subscales Personal Confidence and Hope, Goal and Success Orientation, Willingness to Ask for Help, Reliance on Others, and No Domination by Symptoms. The factors demonstrated mean to excellent reliability (0.59–0.89) and satisfactory criterial validity by positive correlations with measures of recovery attitudes and functioning, and negative correlations with measures of self-stigma, and psychotic and depressive symptoms. ConclusionsThe study results are discussed in the light of other studies examining the factor structure of the RAS. Overall, they support the use of the RAS-G as a means to promote recovery oriented services, policies, and research in German-speaking countries.

Recovery and its correlates among patients with bipolar disorder: A study from a tertiary care centre in North India.

The goal of treatment in mental illness has evolved from a symptom-based approach to a personal recovery-based approach. The aim of this study was to evaluate the predictors of personal recovery among patients with bipolar disorder. A total of 185 patients with bipolar disorder, currently in remission, were evaluated on Recovery Assessment Scale (RAS), Internalized Stigma of Mental Illness Scale (ISMIS), Brief Religious coping scale (RCOPE), Duke University Religiosity Index (DUREL), Religiousness Measures Scale, Hamilton depression rating scale (HDRS), Young Mania rating scale (YMRS) and Global Assessment of Functioning (GAF) scale. The mean age of the sample was 40.5 (standard deviation (SD), 11.26) years. Majority of the participants were male, married, working, Hindu by religion and belonged to extended/joint families of urban background. In the regression analysis, RAS scores were predicted significantly by discrimination experience, stereotype endorsement and alienation domains of ISMIS, level of functioning as assessed by GAF, residual depressive symptoms as assessed by HDRS and occupational status. The level of variance explained for total RAS score and various RAS domains ranged from 36.2% to 46.9%. This study suggests that personal recovery among patients with bipolar disorder is affected by stigma, level of functioning, residual depressive symptoms and employment status of patients with bipolar disorder.

Short time effect of a self-referral to inpatient treatment for patients with severe mental disorders: a randomized controlled trial.

BackgroundService user participation is a central principle in mental healthcare, and the opportunity to self-refer to inpatient treatment is used to increase service user involvement and activation. The aim of this study was to investigate the short-term effect of a self-referral system in an inpatient rehabilitation unit at a community mental health center on patient activation and recovery in individuals with severe mental disorders.MethodsA randomized controlled study including 53 patients (41 % females, mean age 40 years). Twenty-six patients in the intervention group were given a contract for self-referral to inpatient treatment, limited to maximum 5 days and a quarantine time of 14 days between each stay. The control group (27 participants) received treatment as usual, and was offered the intervention after 1 year. The Patient Activation Measure was the primary outcome and secondary outcome was the Recovery Assessment Scale. Mixed models were used to assess group differences.ResultsDuring the 4 months period, 15 (58 %) of 26 participants in the intervention group used the contract of self-referral to inpatient treatment. The intervention group had more admissions than the control group but both groups had a similar total use of inpatient days and out-patient consultations. The self-referral to inpatient treatment counted for 11 % of all inpatient days for the intervention group. There were no significant differences in the outcome between the groups on patient activation (estimated mean difference 2.7, 95 % confidence interval = −5.5 to 10.8, p = 0.52) or recovery (estimated mean difference 0.01, 95 % confidence interval = −0.3 to 0.3, p = 0.92).ConclusionsGiving persons with severe mental disorders the possibility to self-refer to inpatient treatment did not change their level of patient activation and recovery after 4 months and did not lead to increased use of health services. The cost-effectiveness and long-term effect of self-referral to inpatient treatment should be investigated further.Trial registrationNCT01133587, clinicaltrials.gov.

Length of stay as a predictor of reliable change in psychological recovery and well being following residential substance abuse treatment

Purpose Longer length of stay (LOS) in residential alcohol and other drug treatment has been associated with more favourable outcomes, but the optimal duration has yet to be determined for reliable change indices. Optimal durations are likely to be a function of participant and problem characteristics. The purpose of this paper is to determine whether LOS in a residential therapeutic community for alcohol and other drug treatment community independently predicts reliable change across a range of psychological recovery and well-being measures. Design/methodology/approach In total, 380 clients from Australian Salvation Army residential alcohol and other drug treatment facilities were assessed at intake and three months post-discharge using the Addiction Severity Index 5th ed., The Depression, Anxiety and Stress Scale, The Recovery Assessment Scale, the Mental Health Continuum-Short Form and The Life Engagement Test. Findings The findings confirm LOS as an independent predictor of reliable change on measures of well-being and client perceived assessment of recovery. The mean LOS that differentiated reliable change from no improvement was 37.37 days. Originality/value The finding of LOS as a predictor of reliable change and the identification of an estimated time requirement may be useful for residential drug treatment providers in modifying treatment durations.

Validity of a common quality of life measurement in homeless individuals with bipolar disorder and schizophrenia

ObjectiveTo provide new evidence regarding the validity, reliability, sensitivity to change and acceptability of a schizophrenia (SCZ) quality of life measurement (S-QoL 18) in homeless people with bipolar disorder (BPD). MethodsThis multi-centre prospective study was conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse. In addition to the S-QoL 18, data on sociodemographic information, disease severity using the Modified Colorado Symptom Index (MCSI), recovery using the Recovery Assessment Scale (RAS) and QoL using the Short-Form Health Survey (SF-36) were collected. The S-QoL 18 was tested for construct validity, reliability, external validity, sensitivity to change and acceptability. ResultsIn total, 216 homeless patients with BPD participated in this study. The eight-factor structure of the S-QoL 18 was confirmed by confirmatory factor analysis (RMSEA=0.058, CFI=0.98, TLI=0.966). The scalability was satisfactory, with INFIT statistics within an acceptable range (from 0.77 to 1.20). The internal consistency (from 0.43 to 0.76) and reliability coefficients (Cronbach’s alpha from 0.65 to 0.86) were satisfactory for all dimensions. The external validity testing revealed that the S-QoL 18 dimension scores were significantly correlated with the MCSI, the RAS and the SF-36 scores. The percentage of missing data for the dimensions (<15%) and sensitivity to change were satisfactory. ConclusionsThese results demonstrate adequate acceptability and psychometric properties of the S-QoL 18 among homeless patients with BPD. The S-QoL 18 can be a common instrument for measuring QoL in homeless people with SCZ and BD.

Validity of clinically significant change classifications yielded by Jacobson-Truax and Hageman-Arrindell methods.

BackgroundReporting of the clinical significance of observed changes is recommended when publishing mental health treatment outcome studies and is increasingly used in routine outcomes monitoring systems. Since recovery rates vary with the method chosen, we investigated the validity of classifications of clinically significant change when the Jacobson-Truax method and the Hageman-Arrindell method were used.MethodsOf 718 inpatients who completed the Depression Anxiety Stress Scales (DASS-21) and Quality of Life Enjoyment and Satisfaction Questionnaire at admission and discharge to a psychiatric clinic, 355 were invited (and 119 agreed) to complete the questionnaires and the Recovery Assessment Scale six weeks post discharge.ResultsBoth the JT and HA methods showed comparably good validity when referenced against the other indices. Clinically significant change on the DASS-21 was related to a greater consumer-based sense of recovery, greater perceived quality of life, and fewer readmissions to hospital within 28 days of discharge.ConclusionsSince there was found to be no advantage to using one method over another when recovery is of interest, the simpler JT method is recommended for routine usage.

Validity and Reliability of Recovery Assessment Scale for Cantonese Speaking Chinese Consumers with Mental Illness

The present study aims to determine the reliability and validity of a 24-item Recovery Assessment Scale for Cantonese speakers (RAS-C) in the Chinese cultural context. The original English version of the RAS was translated into the RAS-C by means of forward and backward translation procedures. AThe cross-sectional research design adopted involving 295 participants randomly drawn from a population of Chinese Cantonese speaking consumers with mental illness who have been participating in community-based mental health services. The RAS-C has demonstrated high reliability with Cronbach’s alpha = .92. The RAS-C also shows significant and positive correlations with measures on the stage of recovery, self-esteem and quality of life of the service consumers. An explorative factor analysis of the RAS-C yielded five factors that were consistent with previous research results. The present study confirms the reliability and validity of the RAS-C. The RAS-C can facilitate the development of interventions that are effective in promoting the recovery of consumers in Chinese communities.

The impact of thought disorder on therapeutic alliance and personal recovery in schizophrenia and schizoaffective disorder: An exploratory study

Thought and language disorders are a main feature of schizophrenia. The aim of the study is to explore the impact of thought disorder on therapeutic alliance and personal recovery because of its interference with verbal communication. Thought disorder, positive and negative symptoms (Positive and Negative Syndrome Scale), functioning (Modified Global Assessment of Functioning scale), insight (Scale to Assess Unawareness of Mental Disorder), attachment insecurity (Psychosis Attachment Measure), therapeutic alliance (Scale to Assess the Therapeutic Relationship), and personal recovery (Recovery Assessment Scale, Integration Sealing-Over Scale) were assessed in 133 outpatients with schizophrenia or schizoaffective disorder at baseline and twelve months later. The data were analyzed by hierarchical multiple linear regression. Higher levels of thought disorder were significantly associated with lower clinicians' ratings, but not with patients' ratings of therapeutic alliance. In addition, lower clinicians' ratings of therapeutic alliance were significantly linked to a more sealing over and less integrative recovery style. In fact, the lower therapeutic alliance ratings mediated the association between thought disorder and a sealing over recovery style. The results highlight the importance of considering thought disorder in treatment of schizophrenia and schizoaffective disorder which may interfere with therapeutic alliance and treatment efforts towards recovery.

Recovery in Italy: An Update

:Since the 1990s, a general reflection has gradually evolved in Italy on the effects of the transformation of psychiatry from being mainly institutional to more community-oriented. Increasingly substantial epidemiological studies and processes of outcome evaluations have focused not only on the clinical aspects, but also on the social and functional level (quality of life, care needs, users’ satisfaction for the treatments received). With a certain delay compared to the Anglo-Saxon countries, in recent years, several elements of the concept of recovery have also increasingly emerged in Italy: hope, expectations, self-esteem, self-efficacy, awareness, personal autonomy, and dignity. The present article describes the most relevant experiences conducted in Italy in the latest years developing a recovery-oriented approach in psychiatry, in different areas: methodology, peer support, education, services transformation, and research. In particular, the Italian Study on Recovery (SIR) is described, a research conducted in the “real world” of service-users of Italian mental health services and their family members. Its quantitative part consists of the validation of the Italian translation of the Recovery Assessment Scale (RAS) and its efficacy in identifying persons in recovery (after University of California–Los Angeles [UCLA] criteria). The qualitative research spotlights the experiences and values of services users in recovery and their families. Conclusions focus on the importance of reshaping psychiatric services based on the principles of recovery and on how this transformation should be guided.

Recovery among patients with severe mental illness: Factor analysis of recovery assessment scale in Indian setting

Aim: This study aimed to evaluate recovery among patients with severe mental disorders by using Recovery Assessment Scale (RAS). Additionally this study evaluated the, factor structure of RAS in the Indian setting, and assessed the correlates of recovery in severe mental illness. Methodology: Two hundred and eighty-five patients with severe mental illness (bipolar disorder-185 [BD], schizophrenia-100) currently in remission were recruited for the study. Clinical rating scales - Young Mania Rating Scale, Hamilton Depression Rating Scale, and Positive and Negative Syndrome Scale for Schizophrenia were used for assessing remission and residual symptoms. RAS was administered for recovery assessment. Results: Majority of the patients were married males belonging to urban background with no significant difference in sociodemographic profile of schizophrenia and BD groups. On factor analysis of RAS, all 41 items had loaded on one of the factors (compared to 24 items on the old factor structure). Five-factor were obtained with two factors - personal confidence and hope, goal and success orientation being similar to the old factor structure and three new factors being identified as awareness and control over the illness, seeking and relying on social support and, defeated/overcome the illness. Overall recovery measures were higher in BD group, and higher levels of residual depressive symptoms were associated with significantly lower level of recovery in BD. In the schizophrenia group, level of positive symptoms correlated negatively with goal and success orientation (as per the current analysis) and higher level of negative symptoms correlated positively with the domain of “reliance on others” as per the old factor structure. Conclusion: RAS follows a five-factor structure in Indian context, which is different than that reported in the previous study. There are few sociodemographic and clinical correlates of recovery.

Recovery Assessment Scale: Testing validity with Portuguese community-based mental health organization users.

The aim of the present study was to develop the Portuguese version of the Recovery Assessment Scale (RAS-P), and to assess the validity of the findings using the revised test, with 213 users from 5 nonprofit community-based mental health organizations. Participants in the assessment completed a self-reported survey investigating their sense of personal recovery, personal empowerment, capabilities achievement, psychiatric symptoms' frequency, and demographic data. Evidence from exploratory and confirmatory factor analyses using the 24-item version of the test, validated a 4-factor structure for the RAS-P model based on the dimensions of Personal Goals and Hope, Managing Help Needs, Supportive Interpersonal Relationships, and Life Beyond Symptoms, consistent with components of the recovery process. Convergent and discriminant validity was also achieved using bivariate correlation coefficients among the 4 subscales' scores, between the overall scale and the subscales, and in relation to external variables. Findings allowed for the interpretation that the RAS-P is measuring a particular psychological construct, which is different from symptoms of the mental illness. A hypothesized significant association with personal empowerment and with capabilities achievement was demonstrated. Positive association was also found between participants' use of recovery-oriented services such as independent housing or supported employment programs. The RAS-P scores also revealed excellent internal consistency for the overall scale (α = .90), and good consistency for the subscales (>.75), which attest to its precision in measurement. In conclusion, the study proved the RAS-P a reliable and useful tool in the context of the community mental health practice.

Psychometric properties of the recovery measurement in homeless people with severe mental illness

ObjectiveThe Recovery Assessment Scale (RAS) is one of the most widely used measurements of recovery in mental health research. To date, no data have been available concerning the psychometric characteristics of the RAS in homeless people with severe mental illness. The aim of this study was to provide new data regarding the psychometric properties of the RAS in homeless people with schizophrenia and bipolar disorder. MethodsThis multi-center study was conducted in 4 French cities. In addition to the RAS, data on sociodemographic information, disease severity using the Modified Colorado Symptom Index — MCSI, and the number of mental health comorbidities, care characteristics and quality of life (S-QoL-18) were collected. The RAS was tested for construct validity, reliability, external validity, sensitivity to change and acceptability. ResultsSix hundred fifty-eight homeless patients participated in this study. The five-factor structure was confirmed by confirmatory factor analysis (RMSEA=0.043, CFI=0.95, NFI=0.94 and SRMR=0.063). The internal item consistency (from 0.40 to 0.80) and reliability (Cronbach's alpha from 0.79 to 0.87) were satisfactory for all dimensions. External validity testing revealed that the dimension scores were correlated significantly with the MCSI and S-QoL 18 scores. Significant associations with age, disease severity, psychiatric comorbidities and care characteristics showed good discriminant validity. The percentage of missing data (<14.4%) and sensitivity to change were satisfactory. ConclusionsOur study demonstrated the satisfactory acceptability and psychometric properties of the RAS, supporting its use as a mean of recovery measurement for homeless patients.

한국판 회복평가척도의 라쉬분석

본 연구에서는 라쉬분석을 통하여 한글판 회복평가척도의 문항적합도와 난이도, 평정척도 적합도을 검증함으로써 이 평가도구의 국내 사용을 위한 기초자료를 제시하고자 한다. 이 연구는 18세 이상의 만성 조현병 환자 60명을 대상으로 실시하였다. 자료분석은 라쉬분석을 통하여 항목의 적합도와 항목 난이도, 평정척도 적합도 분석을 실시하였다. 연구 결과 60명의 대상자 중 1명이 부적합 대상자로 판정되었으며, 24개 항목 중 3개 항목이 부적합 판정을 받았다. 부적합 항목은 "나는 지금 가지고 있는 목표를 성취할 수 있을 것이라고 믿는다." "비록 내가 나를 돌보지 못할 때에도, 다른 사람들이 나를 돌봐준다."," 내가 가진 병에 대처하는 것이 더 이상 내 삶의 주요 관심사는 아니다."였다. 항목의 난이도에서 가장 어려운 항목은 "나는 내 삶에서 일어나는 일을 다룰 수 있다" 이고, 가장 쉬운 항목은 "결국에는 잘 될 것이다"로 나타났다. 회복평가척도의 평정척도(1~5)는 적합한 척도 범주로 분석되었으며, 항목에 대한 신뢰도는 .70, 대상자에 대한 신뢰도는 .94로 분석되었다. 본 연구를 통해 한글판 회복평가척도의 타당도와 평정척도 적합도를 확인하였다. 그 결과 5점 평정척도는 적합한 것으로 나타났으나, 일부 부적합 항목이 발견되어 앞으로 국내 타당도 확립과 준거제시를 위한 연구가 추후 이루어져야 할 것이다. The purpose of this study is to investigate validation of the Recovery Assessment Scale(RAS) for Korean Version using Rasch analysis. This study included 60 patients who had chronic schizophrenia and were aged 18 or older. The data were analysed using a Rasch analysis to investigate whether the persons and items fit, the distribution of item difficulty and the appropriateness of the rating scale. 1 out of 60 subjects were found to not fit. 3 out of 24 items were also found to be misfit. The misfitted items was 'I believe that I can meet my current personal goals','Even when I don't care about myself, other people do. ','Coping with my mental illness is no longer the main focus of my life.'. Of the appropriate items, the most difficult was 'I can handle what happens in my life' and the easiest was 'Something good will eventually happen'. The RAS rating scale was shown to be appropriate for patients who had chronic schizophrenia. The item separation reliability was .70, and the person separation reliability was .94. Further studies are needed to investigate validity and criterion cut-off score for many patients with chronic mental illess.

Validation of the Recovery Assessment Scale for Chinese in recovery of mental illness in Hong Kong.

Given the absence of well-validated measures to measure personal recovery in the Chinese communities, this study translated the 24-item Recovery Assessment Scale (RAS-24) into Chinese, investigated its psychometric properties, and confirmed its five-factor structure, as proposed by Corrigan et al. (Schizophr Bull 30(4):1035-1041, 2004), among a sample of people in recovery of mental illness in Hong Kong. A sample of 596 people in recovery was recruited for scale validation. The RAS-24 was translated into traditional Chinese, and its factor structure was tested by confirmatory factor analysis. Cronbach's alpha coefficients were used to assess the internal consistency of the Chinese version of the RAS-24 (RAS-C). Concurrent and construct validity were examined by investigating the correlation of the RAS-C with Recovery Markers Questionnaire (RMQ), Test's Life Satisfaction Scale, Self-Stigma Scale, and Behavior and Symptom Identification Scale. The RAS-C full scale and subscales yielded good internal consistency (Cronbach's α = .73-.93). The finding supported the five-factor solution proposed by Corrigan et al. (2004), χ2(242) = 783.81, p < .001, CFI = .91, RMSEA = .06, SRMR = .05. The RAS-C has established concurrent validity with RMQ and demonstrated construct validity with life satisfaction, self-stigma, as well as symptoms and functional difficulties. The Chinese version of the RAS-24 was found to have promising psychometric properties in assessing the subjective perception of recovery among Hong Kong Chinese. The validation of RAS-C among Chinese enables its usage to gauge personal recovery outcomes among Chinese in recovery. In addition, the validated measure can contribute to the comparison of recovery across English-speaking and Chinese-speaking samples.

Organized Self-Management Support Services for Chronic Depressive Symptoms: A Randomized Controlled Trial.

This study aimed to determine whether a self-management support service was more effective than treatment as usual in reducing depressive symptoms and major depressive episodes and increasing personal recovery among individuals with chronic or recurrent depressive symptoms. The study was a randomized controlled trial of a self-management support service consisting of depression self-management training, recovery coaching, and care coordination. The 18-month intervention included regular telephone or in-person contacts with a care manager and a structured group program co-led by a professional therapist and a trained peer specialist. Intervention (N=150) and control (N=152) participants ages ≥ 18 with chronic or recurrent depressive symptoms were recruited from five clinics in Seattle, Washington. Outcome measures included the Hopkins Symptom Checklist depression scale, the Recovery Assessment Scale, the Patient-Rated Global Improvement scale, and the percentage of participants with a major depressive episode. Interviewers were masked to treatment condition. Repeated-measures estimates of the long-term effect of the intervention versus usual care (average of the six-, 12-, and 18-month outcomes adjusted for age, gender, and site) indicated that intervention participants had less severe symptoms (p=.002) and higher recovery scores (p=.03), were less likely to be depressed (odds ratio [OR]=.52, p=.001), and were more likely to be much improved (OR=1.96, p=.001). These findings support providing regular outreach care management and a self-care group offering a combined behavioral and recovery-oriented approach for people with chronic or recurrent depressive symptoms.

Metacognitive deficits predict future levels of negative symptoms in schizophrenia controlling for neurocognition, affect recognition, and self-expectation of goal attainment

The recalcitrance of negative symptoms in the face of pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. Accordingly, this study investigated whether deficits in metacognition, or the ability to form integrated ideas about oneself, others, and the world, prospectively predicted levels of negative symptoms independent of deficits in neurocognition, affect recognition and defeatist beliefs. Participants were 53 adults with a schizophrenia spectrum disorder. Prior to entry into a rehabilitation program, all participants completed concurrent assessments of metacognition with the Metacognitive Assessment Scale—Abbreviated, negative symptoms with the Positive and Negative Syndrome Scale, neurocognition with the MATRICS battery, affect recognition with the Bell Lysaker Emotion Recognition Task, and one form of defeatist beliefs with the Recovery Assessment Scale. Negative symptoms were then reassessed one week, 9weeks, and 17weeks after entry into the program. A mixed effects regression model revealed that after controlling for baseline negative symptoms, a general index of neurocognition, defeatist beliefs and capacity for affect recognition, lower levels of metacognition predicted higher levels of negative symptoms across all subsequent time points. Poorer metacognition was able to predict later levels of elevated negative symptoms even after controlling for initial levels of negative symptoms. Results may suggest that metacognitive deficits are a risk factor for elevated levels of negative symptoms in the future. Clinical implications are also discussed.