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BMC Psychiatry
Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Research article

Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study

Authors: Sabine Loos, Eleanor Clarke, Harriet Jordan, Bernd Puschner, Andrea Fiorillo, Mario Luciano, Tibor Ivánka, Erzsébet Magyar, Malene Krogsgaard-Bording, Helle Østermark-Sørensen, Wulf Rössler, Wolfram Kawohl, Benjamin Mayer, Mike Slade, CEDAR Study Group

Published in: BMC Psychiatry | Issue 1/2017

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Abstract

Background

Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery.

Methods

Data derived from an observational cohort study “Clinical decision making and outcome in routine care for people with severe mental illness” (CEDAR). Adults (aged 18–60) meeting standardised criteria for severe mental illness were recruited from caseloads of outpatient and community mental health services in six European countries. After consenting, they were assessed using standardised measures of decision-making, clinical outcome and stage of recovery at baseline and 1 year later. Latent class analysis was used to identify course of recovery, and proportional odds models to investigate predictors of recovery stage and change.

Results

Participants (n = 581) clustered into three stages of recovery at baseline: Moratorium (N = 115; 19.8%), Awareness/Preparation (N = 145; 25.0%) and Rebuilding/Growth (N = 321; 55.2%). Higher stage was cross-sectionally associated with being male, married, living alone or with parents, and having better patient-rated therapeutic alliance and fewer symptoms. The model accounted for 40% of the variance in stage of recovery. An increased chance of worse outcome (change over 1 year to lower stage of recovery) was found for patients with active involvement compared with either shared (OR = 1.84, 95% CI 1.15–2.94) or passive (OR = 1.71, 95% CI = 1.00–2.95) involvement. Overall, both process (therapeutic relationship) and outcome (symptomatology) are cross-sectionally associated with stage of recovery.

Conclusions

Patient-rated decision-making involvement and change in stage of recovery are associated. Joint consideration of decision practise within the recovery process between patient and clinician is supposed to be a useful strategy to improve clinical practice (ISRCTN registry: ISRCTN75841675. Retrospectively registered 15 September 2010).
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Metadata
Title
Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study
Authors
Sabine Loos
Eleanor Clarke
Harriet Jordan
Bernd Puschner
Andrea Fiorillo
Mario Luciano
Tibor Ivánka
Erzsébet Magyar
Malene Krogsgaard-Bording
Helle Østermark-Sørensen
Wulf Rössler
Wolfram Kawohl
Benjamin Mayer
Mike Slade
CEDAR Study Group
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1207-4

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