Self-stigma, decisional capacity and personal recovery in psychosis
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Introduction: This research portfolio set out to examine service user defined recovery in psychosis. A systematic review was undertaken to examine the evidence-base for the effectiveness of psychosocial interventions on personal recovery, empowerment and other recovery-related outcomes. An empirical study was conducted to examine the relationships between self-stigma, decisional capacity for treatment and personal recovery in service users with psychosis. Methods: A review of published literature identified ten randomised controlled trials investigating the effects of psychosocial interventions on personal recovery. A narrative synthesis was reported for findings relating to primary and secondary outcomes, and standardised effect sizes were calculated to quantify within-group change from pre-to post-intervention and follow-up. Studies were assessed for risk of bias. The empirical study recruited twenty-four participants with diagnoses of non-affective psychosis. Semi-structured interviews and self-report measures were administered to assess self-stigma, decisional capacity for treatment, psychopathology, emotional distress and personal recovery. Results: A small number of studies found that recovery-focused psychosocial interventions improved personal recovery. There were more consistent effects on psychiatric symptoms, functioning and depression. The empirical study found that self-stigma and personal recovery were associated with each other. Large effect sizes were found for the associations between self-stigma and symptoms. These associations persisted when controlling for personal recovery scores. Understanding of treatment was predicted by excitement symptoms, but no other prediction model emerged for decisional capacity. Conclusion: Taken together, the systematic review and empirical project support service user definitions of recovery which highlight the role of psychosocial factors. The systematic review found some evidence for the role of recovery-focused psychosocial interventions in improving personal recovery. Further research is needed so that interventions specifically targeting the processes in personal recovery can be developed. The findings from the empirical project suggested that interventions designed to overcome self-stigmatising beliefs and reduce emotional distress are likely to improve personal recovery outcomes in psychosis. More research is needed to develop a broader conceptualisation of decisional capacity in psychosis, to support the active participation of service users in their recovery journey.