Skip to main content

Advertisement

SpringerLink
Log in

Predictors of subjective recovery from recent-onset psychosis in a developing country: a mixed-methods study

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

This study was conducted to: (a) investigate the levels and progress of subjective recovery from recent-onset psychosis; (b) examine its predictive factors and; (c) describe perceived challenges and opportunities affecting recovery. The findings were expected to help inform recovery-oriented psychiatric care in low-income, particularly African, countries.

Methods

This sequential explanatory mixed-methods study involved 263 service users with recent-onset psychosis from Northwestern Ethiopia. For the quantitative part, a 9-month longitudinal study approach was employed with three time point measurements over 9 months. Predictor variables for subjective recovery from recent-onset psychosis were identified by hierarchical multiple linear regression tests. Following the quantitative survey, individual qualitative interviews were conducted with 19 participants. Interview data were transcribed and thematically analysed.

Results

High mean subjective recovery scores were recorded throughout the study (Questionnaire about the Process of Recovery score ranging from 44.17 to 44.65). Quality of life, internalized stigma, disability, hopelessness, satisfaction with social support, and central obesity were significant predictors of subjective recovery across the three time points. Participants’ perceived challenges and opportunities affecting their recovery were categorized into four themes.

Conclusion

In Ethiopia, a low percentage of individuals with SMIs initiate psychiatric treatment and many discontinue this to attend spiritual healing. In this study, the Ethiopian SMI patients engaged consistently in psychiatric treatment indicated high mean subjective recovery scores. Devising mechanisms to integrate the psychiatric treatment and spiritual healing sectors are suggested. Approaches to improve quality of life, functioning, hope, internalized stigma and provide need-based social support are suggested.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Thomas N, Farhall J, Foley F, Leitan ND, Villagonzalo KA, Ladd E, Nunan C, Farnan S, Frankish R, Smark T, Rossell SL, Sterling L, Murray G, Castle DJ, Kyrios M (2016) Promoting personal recovery in people with persisting psychotic disorders: Development and pilot study of a novel digital intervention. Front Psychiatry 7(196):1–12. https://doi.org/10.3389/fpsyt.2016.00196

    Article  CAS  Google Scholar 

  2. Davidson L, Schmutte T, Dinzeo T, Andres-Hyman R (2008) Remission and recovery in schizophrenia: practitioner and patient perspectives. Schizophr Bull 34(1):5–8. https://doi.org/10.1093/schbul/sbm122

    Article  PubMed  Google Scholar 

  3. Jacob KS (2015) Recovery model of mental illness: A complementary approach to psychiatric care. Indian J Psychol Med 37(2):117–119. https://doi.org/10.4103/0253-7176.155605

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Van Eck RM, Burger TJ, Vellinga A, Schirmbeck F, de Haan L (2018) The relationship between clinical and personal recovery in patients with schizophrenia spectrum disorders: A systematic review and meta-analysis. Schizophr Bull 44(3):631–642. https://doi.org/10.1093/schbul/sbx088

    Article  PubMed  Google Scholar 

  5. Bellack A (2006) Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophr Bull 32(3):432–442. https://doi.org/10.1093/schbul/sbj044

    Article  PubMed  PubMed Central  Google Scholar 

  6. Anthony WA (2000) A recovery-oriented service system: Setting some system level standards. Psychosoc Rehabil J 24(2):159–168. https://doi.org/10.1037/h0095104

    Article  Google Scholar 

  7. Valencia M, Caraveo J, Colin R, Verduzco W, Corona F (2014) Symptomatic remission and functional recovery in patients with schizophrenia. Salud Mental 37(3):59–74. https://doi.org/10.17711/SM.0185-3325.2014.008

    Article  Google Scholar 

  8. Slade M (2009) 100 ways to support recovery: a guide for mental health professionals. Rethink recovery series, vol 1. Cambridge University Press, Cambridge

  9. American Psychological Association (2012) Recovery principles. Monit Psychol 43(1):55

    Google Scholar 

  10. Andresen R, Oades L, Caputi P (2003) The experience of recovery from schizophrenia: Towards an empirically validated stage model. Aust N Z J Psychiatry 37(5):586–594. https://doi.org/10.1046/j.1440-1614.2003.01234.x

    Article  PubMed  Google Scholar 

  11. Isaac M, Chand P, Murthy P (2007) Schizophrenia outcome measures in the wider international community. British J Psychiatry 191(S50):s71–s77. https://doi.org/10.1192/bjp.191.50.s71

    Article  Google Scholar 

  12. Jaaskelainen E, Juola P, Hirvonen N, McGrath JJ, Saha S, Isohanni M, Veijola J, Miettunen J (2013) A systematic review and meta-analysis of recovery in schizophrenia. Schizophr Bull 39(6):1296–1306. https://doi.org/10.1093/schbul/sbs130

    Article  PubMed  Google Scholar 

  13. Myers NL (2010) Culture, stress and recovery from schizophrenia: Lessons from the field for global mental health. Cult Med Psychiatry 34(3):500–528. https://doi.org/10.1007/s11013-010-9186-7

    Article  PubMed  PubMed Central  Google Scholar 

  14. Temesgen WA, Chien WT, Bressington D (2019) Conceptualizations of subjective recovery from recent onset psychosis and its associated factors: A systematic review. Early Intervent Psychiatry 13(2):181–193. https://doi.org/10.1111/eip.12698

    Article  Google Scholar 

  15. Patel V (2007) Mental health in low- and middle-income countries. Br Med Bull 81–82:81–96. https://doi.org/10.1093/bmb/ldm010

    Article  PubMed  Google Scholar 

  16. Chilisa B, Kawulich B (2012) Selecting a research approach: paradigm, methodology and methods. In: Wagner C, Kawulich B, Garner M (eds) Doing Social Research, A Global Context. McGraw Hill, London. McGraw Hill, New York

  17. Polit DF (2018) Essentials of nursing research : appraising evidence for nursing practice, 9th edn. Wolters Kluwer, Philadelphia

    Google Scholar 

  18. Ayano G (2016) Primary mental health care services in Ethiopia: Experiences, opportunities and challenges from East African country. J Neuropsychopharmacol Mental Health 1(4):1–3. https://doi.org/10.4172/2472-095x.1000113

    Article  Google Scholar 

  19. Brooks GP, Barcikowski RS (2012) The PEAR method for sample sizes in multiple linear regression. Mult Linear Regres Viewp 38(2):1–16

    Google Scholar 

  20. Stevens J (2009) Applied multivariate statistics for the social sciences. 5th edN. Routledge, New York

  21. Breitborde NJ, Srihari VH, Woods SW (2009) Review of the operational definition for first-episode psychosis. Early Intervent Psychiatry 3(4):259–265. https://doi.org/10.1111/j.1751-7893.2009.00148.x

    Article  Google Scholar 

  22. Neil ST, Kilbride M, Pitt L, Nothard S, Welford M, Sellwood W, Morrison AP (2009) The questionnaire about the process of recovery (QPR): A measurement tool developed in collaboration with service users. Psychosis 1(2):145–155. https://doi.org/10.1080/17522430902913450

    Article  Google Scholar 

  23. World Health Organization (1996) WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. WHO, Geneva

    Google Scholar 

  24. Beck AT, Weissman A, Lester D, Trexler L (1974) The measurement of pessimism: The Hopelessness Scale. J Consult Clin Psychol 42(6):861–865

    Article  CAS  Google Scholar 

  25. Üstün T, Kostanjsek N, Chatterji S, Rehm J (2010) Measuring health and disability: Manual for WHO disability assessment schedule WHODAS 2.0. World Health Organization, Malta

  26. Kay SR, Fiszbein A, Opfer LA (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 13(2):261–276. https://doi.org/10.1093/schbul/13.2.261

    Article  CAS  Google Scholar 

  27. Ritshera JB, Otilingama PG, Grajalesa M (2003) Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res 121(1):31–49. https://doi.org/10.1016/j.psychres.2003.08.008

    Article  Google Scholar 

  28. Sarason IG, Sarason BR, Shearin EN, Pierce GR (1987) A brief measure of social support: Practical and theoretical implications. J Soc Pers Relationsh 4:497–510

    Article  Google Scholar 

  29. Temesgen WA, Chien WT, Bressington D (2019) Factors influencing subjective recovery of people with recent-onset psychosis: A cross-sectional study in a low-income Sub-Saharan country. Psychiatry Res 274:421–429. https://doi.org/10.1016/j.psychres.2019.02.066

    Article  PubMed  Google Scholar 

  30. IBM Corp (2015) IBM SPSS Statistics for Windows, Version 23.0. IBM Corp, Armonk, NY

  31. Petrocelli JV (2003) Hierarchical multiple regression in counseling research: Common problems and possible remedies. Meas Evaluat Couns Dev 36(1):9–22

    Article  Google Scholar 

  32. Tabachnick BG, Fidel LS (2007) Unsing multivariate statistics, vol 1, 5th edn. Pearson Education, Boston

  33. Sandelowski M (2000) Focus on Research Methods: Whatever Happened to Qualitative Description? Res Nurs Health 23:334–340

    Article  CAS  Google Scholar 

  34. Seale C (2011) Researching society and culture, vol 1, 3rd edn. SAGE, Los Angeles

  35. Ostlund U, Kidd L, Wengstrom Y, Rowa-Dewar N (2011) Combining qualitative and quantitative research within mixed method research designs: a methodological review. Int J Nurs Stud 48(3):369–383. https://doi.org/10.1016/j.ijnurstu.2010.10.005

    Article  PubMed  Google Scholar 

  36. Bryman A (2011) Quanttitative and qaulitative reseach: Further reflection in their integration. In: Researching Society and Culture, vol 1. SEGA, London

  37. Bourdeau G, Lecomte T, Lysaker PH (2015) Stages of recovery in early psychosis: Associations with symptoms, function, and narrative development. Psychol Psychother Theory Res Pract 88(2):127–142. https://doi.org/10.1111/papt.12038

    Article  Google Scholar 

  38. Connell M, Schweitzer R, King R (2015) Recovery from first-episode psychosis and recovering self: A qualitative study. Psychosoc Rehabil J 38(4):359–364. https://doi.org/10.1037/prj0000077

    Article  Google Scholar 

  39. Joffe H (2012) Thematic analysis. In: Harper D, Thompson AR (eds) Qualitative research methods in mental health and psychotherapy: a guide for students and practitioners. Wiley-Blackwell, UK

  40. Maguire M, Delahunt B (2017) Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. All Ireland J Teach Learn High Educat 9(3):3351–3365

    Google Scholar 

  41. Holloway I, Wheeler S (2010) Qualitative research in nursing and health care, vol 1, 3th edn. Wiley-Blackwell, London

  42. Law H, Shryane N, Bentall RP, Morrison AP (2016) Longitudinal predictors of subjective recovery in psychosis. British J Psychiatry 209(1):48–53. https://doi.org/10.1192/bjp.bp.114.158428

    Article  Google Scholar 

  43. Morrison AP, Turkington D, Pyle M, Spencer H, Brabban A, Dunn G, Christodoulides T, Dudley R, Chapman N, Callcott P, Grace T, Lumley V, Drage L, Tully S, Irving K, Cummings A, Byrne R, Davies LM, Hutton P (2014) Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. The Lancet 383(9926):1395–1403. https://doi.org/10.1016/s0140-6736(13)62246-1

    Article  Google Scholar 

  44. Eisenstadt P, Monteiro VB, Diniz MJA, Chaves AC (2012) Experience of recovery from a first-episode psychosis. Early Intervent Psychiatry 6(4):476–480. https://doi.org/10.1111/j.1751-7893.2012.00353.x

    Article  Google Scholar 

  45. Slade M, Longden E (2015) The empirical evidence about mental health and recovery: how likely, how long, what helps? MI Fellowship, Victoria

  46. Vass V, Morrison AP, Law H, Dudley J, Taylor P, Bennett KM, Bentall RP (2015) How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences. Psychiatr Res 230(2):487–495. https://doi.org/10.1016/j.psychres.2015.09.042

    Article  Google Scholar 

  47. Hailemariam M, Fekadu A, Prince M, Hanlon C (2017) Engaging and staying engaged: a phenomenological study of barriers to equitable access to mental healthcare for people with severe mental disorders in a rural African setting. Int J Equity Health 16(1):156. https://doi.org/10.1186/s12939-017-0657-0

    Article  PubMed  PubMed Central  Google Scholar 

  48. Sim K, Mahendran R, Siris SG, Heckers S, Chong SA (2004) Subjective quality of life in first episode schizophrenia spectrum disorders with comorbid depression. Psychiatry Res 129(2):141–147. https://doi.org/10.1016/j.psychres.2004.07.007

    Article  PubMed  Google Scholar 

  49. Smith TE, Hull JW, Huppert JD, Silverstein SM, Anthony DT, McClough JF (2004) Insight and recovery from psychosis in chronic schizophrenia and schizoaffective disorder patients. J Psychiatr Res 38(2):169–176. https://doi.org/10.1016/s0022-3956(03)00091-8

    Article  PubMed  Google Scholar 

  50. Andreasen NC, William T, Carpenter J, Kane JM, Lasser OA, Marder SR, Weinberger DR (2005) Remission in schizophrenia: Proposed criteria and rationale for consensus. Am J Psychiatry 162(3):441–449. https://doi.org/10.1176/appi.ajp.162.3.441

    Article  PubMed  Google Scholar 

  51. Carroll A, Fattah S, Clyde Z, Coffey I, David GC, Owens JEC (1999) Correlates of insight and insight change in schizophrenia. Schizophr Res 35(3):247–253. https://doi.org/10.1016/S0920-9964(98)00142-X

    Article  CAS  PubMed  Google Scholar 

  52. Hanlon C, Alem A, Lund C, Hailemariam D, Assefa E, Giorgis TW, Chisholm D (2019) Moving towards universal health coverage for mental disorders in Ethiopia. Int J Mental Health Syst 13(11):1–16. https://doi.org/10.1186/s13033-019-0268-9

    Article  Google Scholar 

  53. Menezes NM, Arenovich T, Zipursky RB (2006) A systematic review of longitudinal outcome studies of first-episode psychosis. Psychol Med 36(10):1349–1362. https://doi.org/10.1017/S0033291706007951

    Article  CAS  PubMed  Google Scholar 

  54. Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube K, Ganev K, Giel R, Der Heiden WA (2001) Recovery from psychotic illness: A 15-and 25-year international follow-up study. British J Psychiatry 178(6):506–517. https://doi.org/10.1192/bjp.178.6.506

    Article  CAS  Google Scholar 

  55. Kukla M, Lysaker PH, Roe D (2014) Strong subjective recovery as a protective factor against the effects of positive symptoms on quality of life outcomes in schizophrenia. Compr Psychiatry 55(6):1363–1368. https://doi.org/10.1016/j.comppsych.2014.04.022

    Article  PubMed  Google Scholar 

  56. Chiu MYL, Lo WTL, Yiu MGC (2010) Recovery components as determinants of the health-related quality of life among patients with schizophrenia: structural equation modelling analysis AU-Ho Winnie. Australian N Z J Psychiatry 44(1):71–84. https://doi.org/10.3109/00048670903393654

    Article  Google Scholar 

  57. Buck KD, Roe D, Yanos P, Buck B, Fogley RL, Grant M, Lubin F, Lysaker PHJP (2013) Challenges to assisting with the recovery of personal identity and wellness for persons with serious mental illness: Considerations for mental health professionals. Psychosis 5(2):134–143. https://doi.org/10.1080/17522439.2012.699544

    Article  Google Scholar 

  58. Hasson-Ohayon I, Kravetz S, Meir T, Rozencwaig S (2009) Insight into severe mental illness, hope, and quality of life of persons with schizophrenia and schizoaffective disorders. Psychiatry Res 167(3):231–238. https://doi.org/10.1016/j.psychres.2008.04.019

    Article  PubMed  Google Scholar 

  59. Assefa D, Shibre T, Asher L, Fekadu A (2012) Internalized stigma among patients with schizophrenia in Ethiopia: A cross-sectional facility-based study. BMC Psychiatry 12(1):239–249. https://doi.org/10.1186/1471-244X-12-239

    Article  PubMed  PubMed Central  Google Scholar 

  60. Girma E, Tesfaye M, Froeschl G, Moller-Leimkuhler AM, Muller N, Dehning S (2013) Public stigma against people with mental illness in the Gilgel Gibe Field Research Center (GGFRC) in Southwest Ethiopia. PLoS ONE 8(12):e82116. https://doi.org/10.1371/journal.pone.0082116

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Chien WT, Leung SF (2013) A controlled trial of a needs-based, nurse-led psychoeducation programme for Chinese patients with first-onset mental disorders: 6 month follow up. Int J Nurs Practice 19(Suppl 1):3–13. https://doi.org/10.1111/ijn.12015

    Article  Google Scholar 

  62. Robson D, Gray R (2007) Serious mental illness and physical health problems: A discussion paper. Int J Nurs Stud 44(3):457–466. https://doi.org/10.1016/j.ijnurstu.2006.07.013

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China

    Worku Animaw Temesgen, Maritta Anneli Valimaki & Daniel Bressington

  2. Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, SAR, China

    Wai Tong Chien

Authors
  1. Worku Animaw Temesgen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wai Tong Chien
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maritta Anneli Valimaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Bressington
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Worku Animaw Temesgen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 31 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Temesgen, W.A., Chien, W.T., Valimaki, M.A. et al. Predictors of subjective recovery from recent-onset psychosis in a developing country: a mixed-methods study. Soc Psychiatry Psychiatr Epidemiol 55, 1187–1199 (2020). https://doi.org/10.1007/s00127-020-01853-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-020-01853-5

Keywords

Search

Navigation