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Bitter N, Roeg D, van Nieuwenhuizen C, van Weeghel J. Recovery in Supported Accommodations: A Scoping Review and Synthesis of Interventions for People with Severe Mental Illness. Community Ment Health J 2020; 56:1053-1076. [PMID: 32016620 PMCID: PMC7289772 DOI: 10.1007/s10597-020-00561-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Abstract
Research on the recovery domains beside clinical recovery of people with severe mental illness in need of supported accommodations is limited. The aim of this study was (1) to investigate which recovery interventions exist for this group of people and (2) to explore the scientific evidence. We conducted a scoping review, including studies with different designs, evaluating the effectiveness the recovery interventions available. The search resulted in 53 eligible articles of which 22 focused on societal recovery, six on personal recovery, five on functional recovery, 13 on lifestyle-interventions, and seven on creative and spiritual interventions. About a quarter of these interventions showed added value and half of them initial promising results. The research in this area is still limited, but a number of recovery promoting interventions on other areas than clinical recovery have been developed and evaluated. Further innovation and research to strengthen and repeat the evidence are needed.
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Affiliation(s)
- Neis Bitter
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Diana Roeg
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Chijs van Nieuwenhuizen
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,GGzE Institute for Mental Health Care, PO Box 909, 5600, AX, Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands.,Parnassia Group, Dijk en Duin Mental Health Centre, PO Box 305, 1900, AH, Castricum, The Netherlands
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Fleury MJ, Sabetti J, Bamvita JM, Grenier G. Modeling variables associated with personal recovery among service users with mental disorders using community-based services. Int J Soc Psychiatry 2019; 65:123-135. [PMID: 30791820 DOI: 10.1177/0020764019831310] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mental health research is evolving toward the identification of conceptual models and associated variables, which may provide a better understanding of personal recovery, given its importance for individuals affected by mental disorders (MDs). AIMS This article evaluated personal recovery in a sample of adults with MDs using an adapted conceptual framework based on the Andersen behavioral model, which evaluates predisposing, enabling and needs factors in service use. METHODS The study design was cross-sectional and included 327 mental health service users recruited across four local health service networks in Quebec (Canada). Data were collected using seven standardized instruments and participant medical records. Structural equation modeling was performed. RESULTS Quality of life (QOL), an enabling factor, was most strongly associated with personal recovery. Health behavior variables associated with recovery included the following: use of alcohol services, having a family physician, consulting a psychologist, use of food banks, consulting fewer professionals and not using drug services. Regarding needs factors, higher numbers of needs, lower severity of unmet health, social and basic needs and absence of mood disorders were also associated with personal recovery. No predisposing factors emerged as significant in the model. CONCLUSION Findings suggest that QOL, needs variables and comprehensive service delivery are important in personal recovery. Services should be individualized to the health, social and basic needs of service users, particularly those with mood disorders or co-occurring mental health/substance use disorders.
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Affiliation(s)
- Marie-Josée Fleury
- 1 Department of Psychiatry, McGill University, Montreal, QC, Canada.,2 Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Judith Sabetti
- 2 Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada.,3 School of Social Work, McGill University, Montreal, QC, Canada
| | - Jean-Marie Bamvita
- 2 Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Guy Grenier
- 2 Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada
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Bitter N, Roeg D, Van Nieuwenhuizen C, Van Weeghel J. Training professionals in a recovery-oriented methodology: a mixed method evaluation. Scand J Caring Sci 2019; 33:457-466. [PMID: 30653692 DOI: 10.1111/scs.12644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/27/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several studies have reported difficulties concerning the implementation of recovery-oriented interventions. In this study, the effect of training in the Comprehensive Approach to Rehabilitation (CARe) on daily practice was evaluated. Additionally, we aimed to acquire insight into the experiences with the implementation process involving professionals, management and trainers. METHODS Fourteen teams for sheltered and supported housing in the Netherlands participated in this study. As part of a cluster-randomised controlled trial (RCT) design, eight teams received training in the CARe methodology. Model fidelity (using the CARe fidelity audit) and professionals' knowledge of recovery (using the Recovery Knowledge Inventory) were measured for all teams until 20 months after the start. Afterwards, an evaluation meeting with participating stakeholders was organised in which barriers and facilitators of the implementation of the CARe methodology were inventoried. RESULTS Ten months after the training, the intervention teams scored higher than the control teams on the fidelity subscales: 'recovery', 'strengths orientation' and 'amount of training and coaching'. Twenty months after the training, only the effect of 'amount of coaching and training' remained. Additionally, 'methodological working' clearly differed between the groups after 20 months in favour of the intervention teams. In all teams, model fidelity was moderate at both measurements. The knowledge of recovery of the trained teams was slightly and significantly higher at 10 and 20 months after training. Although professionals were positive about recovery and strength-oriented working, they experienced several organisational and societal barriers. CONCLUSION Training in the CARe methodology improved the fidelity and knowledge of recovery among professionals. However, the differences were small, and fidelity decreased over time. More in-depth knowledge is needed on which barriers professionals experience in practice so that tailored training and implementation strategies can be developed. Furthermore, more attention is needed for professional development and the translation of theory into practice.
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Affiliation(s)
- Neis Bitter
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | - Diana Roeg
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands.,GGzE Institute for Mental Health Care, Eindhoven, The Netherlands
| | - Chijs Van Nieuwenhuizen
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands.,GGzE Institute for Mental Health Care, Eindhoven, The Netherlands
| | - Jaap Van Weeghel
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands.,Phrenos Centre of Expertise, Utrecht, The Netherlands.,Dijk en Duin Mental Health Centre, Parnassia Group, Castricum, The Netherlands
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Bitter N, Roeg D, van Assen M, van Nieuwenhuizen C, van Weeghel J. How effective is the comprehensive approach to rehabilitation (CARe) methodology? A cluster randomized controlled trial. BMC Psychiatry 2017; 17:396. [PMID: 29228919 PMCID: PMC5725818 DOI: 10.1186/s12888-017-1565-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 11/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The CARe methodology aims to improve the quality of life of people with severe mental illness by supporting them in realizing their goals, handling their vulnerability and improving the quality of their social environment. This study aims to investigate the effectiveness of the CARe methodology for people with severe mental illness on their quality of life, personal recovery, participation, hope, empowerment, self-efficacy beliefs and unmet needs. METHODS A cluster Randomized Controlled Trial (RCT) was conducted in 14 teams of three organizations for sheltered and supported housing in the Netherlands. Teams in the intervention group received training in the CARe methodology. Teams in the control group continued working according to care as usual. Questionnaires were filled out at baseline, after 10 months and after 20 months. A total of 263 clients participated in the study. RESULTS Quality of life increased in both groups, however, no differences between the intervention and control group were found. Recovery and social functioning did not change over time. Regarding the secondary outcomes, the number of unmet needs decreased in both groups. All intervention teams received the complete training program. The model fidelity at T1 was 53.4% for the intervention group and 33.4% for the control group. At T2 this was 50.6% for the intervention group and 37.2% for the control group. CONCLUSION All clients improved in quality of life. However we did not find significant differences between the clients of the both conditions on any outcome measure. Possible explanations of these results are: the difficulty to implement rehabilitation-supporting practice, the content of the methodology and the difficulty to improve the lives of a group of people with longstanding and severe impairments in a relatively short period. More research is needed on how to improve effects of rehabilitation trainings in practice and on outcome level. TRIAL REGISTRATION ISRCTN77355880 , retrospectively registered (05/07/2013).
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Affiliation(s)
- Neis Bitter
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Diana Roeg
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- GGzE Institute for Mental Health Care, PO BOX 909, 5600 AX Eindhoven, The Netherlands
| | - Marcel van Assen
- Department of Social and Behavioural Sciences, Methodology and statistics, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- Department of Sociology, Utrecht University, PO BOX 80140, 3508 TC Utrecht, The Netherlands
| | - Chijs van Nieuwenhuizen
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- GGzE Institute for Mental Health Care, PO BOX 909, 5600 AX Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- Phrenos Centre of Expertise, PO Box 1203, 3500 BE Utrecht, The Netherlands
- Parnassia Group, Dijk en Duin Mental Health Centre, PO Box 305, 1900 AH Castricum, The Netherlands
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Bitter NA, Roeg DPK, van Nieuwenhuizen C, van Weeghel J. Identifying profiles of service users in housing services and exploring their quality of life and care needs. BMC Psychiatry 2016; 16:419. [PMID: 27881159 PMCID: PMC5120432 DOI: 10.1186/s12888-016-1122-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not always match their recovery. In order to improve the quality of care, this study aims to explore whether subgroups of service users exist based on three dimensions of recovery and to examine and compare the quality of life and care needs of the persons in these subgroups. METHODS Latent class analysis was performed with data from 263 service users of housing services in the Netherlands. Classes were based on three variables: personal recovery (Mental Health Recovery Measure), social recovery (Social Functioning Scale), and clinical recovery (Brief Symptom Inventory). Subsequently, the quality of life (MANSA) and care needs (CANSAS) of the different classes were analysed by the use of descriptive and inferential statistics. RESULTS Three classes could be distinguished. Class 1 (45%) comprised of people who score the highest of the three classes in terms of personal and social recovery and who experience the least number of symptoms. People in class 2 (44%) and class 3 (11%) score significantly lower on personal and social recovery, and they experience significantly more symptoms compared to class 1. The distinction between class 2 and 3 can be made on the significantly higher number of symptoms in class 3. All three classes differ significantly on quality of life and unmet needs. CONCLUSIONS The quality of life of service users of housing services needs improvement, as even persons in the best-recovered subgroup have a lower quality of life than the average population. Workers of housing services need to be aware of the recovery of a client and what his or her individual needs and goals are. Furthermore, better care (allocation) concerning mental and physical health and rehabilitation is needed. Care should be provided on all dimensions of recovery at the same time, therefore mental health care organisations should work together and integrate their services. TRIAL REGISTRATION ISRCTN registry ISRCTN77355880 retrospectively registered 05/07/2013.
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Affiliation(s)
- Neis A. Bitter
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Diana P. K. Roeg
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands ,GGzE Centre for Mental Health Care, PO BOX 909, 5600 AX Eindhoven, The Netherlands
| | - Chijs van Nieuwenhuizen
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands ,GGzE Centre for Mental Health Care, PO BOX 909, 5600 AX Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands ,Phrenos Centre of Expertise, PO Box 1203, 3500 BE Utrecht, The Netherlands ,Parnassia Group, Dijk en Duin Mental Health Centre, PO Box 305, 1900 AH Castricum, The Netherlands
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McCauley CO, McKenna HP, Keeney S, McLaughlin DF. Concept analysis of recovery in mental illness in young adulthood. J Psychiatr Ment Health Nurs 2015; 22:579-89. [PMID: 26148795 DOI: 10.1111/jpm.12245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/29/2022]
Abstract
Recovery, as a concept, emerged as a core philosophy of the service user movement that began in the late 1960s and 1970s. Previous reviews on recovery in mental health have presented definitions or a conceptual framework; however, over time it has been open to disparate interpretations. The aim of this paper was to conduct the first concept analysis of mental health recovery in young adulthood within various multidisciplinary contexts. Rodgers's (2000) six-stepped evolutionary method enabled the analysis of recovery's conceptual characteristics, the identification of an exemplar and the proposition of a hypothesis with implications for practice. This analysis has revealed the derivation of the term recovery does not convey its identified conceptual characteristics. Identified attributes include the reawakening of hope, reclaiming a positive self and meaning through personal growth. Antecedents include the disruption of illness, stigmatization, internal inventory and contemplative recovery. Identified consequences include the return to normality, reconstruction of self and active social connection. The new conceptual definition is the reawakening of hope and rediscovery of a positive sense of self through finding meaning and purpose within personal growth and connection using creative self-care coping strategies. This paper reveals an apparent disparity between professional and personal interpretations of recovery. Therefore, the implication for mental health nursing is the congruence of recovery-orientated practice with the process of recovery experienced by young adult service users.
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Affiliation(s)
- C O McCauley
- Institute of Nursing and Health Research, Ulster University, Derry City, UK
| | - H P McKenna
- Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - S Keeney
- Institute of Nursing and Health Research, Ulster University, Jordanstown, UK
| | - D F McLaughlin
- Institute of Nursing and Health Research, Ulster University, Jordanstown, UK
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Bitter NA, Roeg DPK, van Nieuwenhuizen C, van Weeghel J. Effectiveness of the Comprehensive Approach to Rehabilitation (CARe) methodology: design of a cluster randomized controlled trial. BMC Psychiatry 2015; 15:165. [PMID: 26198855 PMCID: PMC4510908 DOI: 10.1186/s12888-015-0564-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing amount of evidence for the effectiveness of rehabilitation interventions for people with severe mental illness (SMI). In the Netherlands, a rehabilitation methodology that is well known and often applied is the Comprehensive Approach to Rehabilitation (CARe) methodology. The overall goal of the CARe methodology is to improve the client's quality of life by supporting the client in realizing his/her goals and wishes, handling his/her vulnerability and improving the quality of his/her social environment. The methodology is strongly influenced by the concept of 'personal recovery' and the 'strengths case management model'. No controlled effect studies have been conducted hitherto regarding the CARe methodology. METHODS/DESIGN This study is a two-armed cluster randomized controlled trial (RCT) that will be executed in teams from three organizations for sheltered and supported housing, which provide services to people with long-term severe mental illness. Teams in the intervention group will receive the multiple-day CARe methodology training from a specialized institute and start working according the CARe Methodology guideline. Teams in the control group will continue working in their usual way. Standardized questionnaires will be completed at baseline (T0), and 10 (T1) and 20 months (T2) post baseline. Primary outcomes are recovery, social functioning and quality of life. The model fidelity of the CARe methodology will be assessed at T1 and T2. DISCUSSION This study is the first controlled effect study on the CARe methodology and one of the few RCTs on a broad rehabilitation method or strength-based approach. This study is relevant because mental health care organizations have become increasingly interested in recovery and rehabilitation-oriented care. TRIAL REGISTRATION The trial registration number is ISRCTN77355880 .
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Affiliation(s)
- Neis A. Bitter
- Tilburg University, Department of Social and Behavioural Sciences, Tranzo Scientific Centre for Care and Welfare, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Diana P. K. Roeg
- Tilburg University, Department of Social and Behavioural Sciences, Tranzo Scientific Centre for Care and Welfare, PO Box 90153, 5000 LE Tilburg, The Netherlands ,GGzE Centre for Mental Health Care, PO BOX 909, 5600 AX Eindhoven, The Netherlands
| | - Chijs van Nieuwenhuizen
- Tilburg University, Department of Social and Behavioural Sciences, Tranzo Scientific Centre for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands. .,GGzE Centre for Mental Health Care, PO BOX 909, 5600 AX, Eindhoven, The Netherlands.
| | - Jaap van Weeghel
- Tilburg University, Department of Social and Behavioural Sciences, Tranzo Scientific Centre for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands. .,Phrenos Centre of Expertise, PO Box 1203, 3500 BE, Utrecht, The Netherlands. .,Parnassia Group, Dijk en Duin Mental Health Centre, PO Box 305, 1900 AH, Castricum, The Netherlands.
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van Nieuwenhuizen C, Wilrycx G, Moradi M, Brouwers E. Psychometric evaluation of the Dutch version of the mental health recovery measure (MHRM). Int J Soc Psychiatry 2014; 60:162-8. [PMID: 23396286 DOI: 10.1177/0020764012472302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the past decade, the mental health consumer movement has drawn the attention of mental health providers, researchers and policy makers to the concept of recovery. Traditionally, recovery primarily refers to the remission of symptoms. Nowadays, recovery is also regarded in a sense that all individuals, even those with severe psychiatric disabilities, can improve. Accordingly, recovery for people with severe mental illness refers to hope and optimism, empowerment, regained control and increased self-esteem, illness self-management and engagement in meaningful daily activities (Corrigan, Giffort, Rashid, Leary & Okeke, 1999; Jacobson & Greenley, 2001; Leamy, Bird, le Boutillier, Williams & Slade, 2011; van Gestel-Timmermans, Brouwers, van Assen, Bongers & van Nieuwenhuizen, 2012). Little empirical research, however, has been done and instruments to measure recovery are scarce. AIMS In the current study, the psychometric properties of the Dutch version of the Mental Health Recovery Measure (MHRM) are explored. Convergent and divergent validity of the MHRM was assessed using standardized measures of hope (Hope Herth Index (HHI)), recovery-promoting professional competence (Recovery Promoting Relationships Scale (RPRS)) and general physical health and well-being (RAND Measure of Health-Related Quality of Life (RAND-36)). METHODS A factor analysis was conducted and Cronbach's α of the MHRM scales was assessed. The construct validity was assessed by computing the intercorrelations of the MHRM, HHI, RPRS and RAND-36. RESULTS Data were available for 212 patients: 70 patients completed the MHRM, HHI and RAND 36 and 142 filled out the MHRM and RPRS. Exploratory factor analysis resulted in an interpretable three-factor solution. Cronbach's α ranged from 0.86 to 0.94. The convergent validity of the instrument was satisfactory; the divergent validity was less clear. CONCLUSIONS This study offers evidence to suggest that the Dutch version of the MHRM is a reliable measure (in terms of internal consistency) with a generally acceptable convergent and divergent validity. Further research is needed to clarify the extent to which the MHRM is sensitive enough to capture the individual recovery process of patients.
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