Top

BMC Psychiatry

Published in:

Open Access 01-12-2021 | Schizophrenia | Research

Mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia: a cross-sectional study

Authors: Kuen Tai Lee, Shih Kai Lee, Mei Jou Lu, Wen Ling Hsieh, Wen I. Liu

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

Functional degradation among community-dwelling patients with schizophrenia can negatively influence their recovery. Given the importance of patient empowerment during recovery, this study examined the mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia.

Methods

This cross-sectional study recruited community-dwelling patients with schizophrenia from northern and central Taiwan. Questionnaires with verified reliability and validity were provided and collected on site by trained nurses. Global function, empowerment, and personal recovery were measured using the Global Assessment of Functioning (developed by the American Psychiatric Association), Empowerment Scale, and Questionnaire on the Process of Recovery, respectively. The causal steps approach proposed by Baron and Kenny and the Sobel test were utilized to verify the mediation effect. The causal steps approach tested the four following pathways (regression coefficients): global function on empowerment (Path a), global function and empowerment as predictors of personal recovery (Path b), global function on personal recovery (Path c), and global function and empowerment on personal recovery (Path c’).

Results

A total of 373 participants completed the survey. After controlling for factors associated with recovery, Paths a (β = .24, p < .001), b (β = .68, p < .001), and c (β = .19, p < .001) were found to be significant; however, Path c’ was not significant (β = .03, p = .452). Empowerment was determined to exert “full mediation” over the effects of global function on personal recovery, and the Sobel test indicating significant mediation (Z = 3.61, p < .001).

Conclusions

Empowerment fully mediates the association between global function and personal recovery. This study suggested that offering empowerment-oriented care services may be more effective than global function improvement in recovery among these patients.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington, DC: Author; 2013. https://doi.org/10.1176/appi.books.9780890425596.

Barch DM, Ceaser A. Cognition in schizophrenia: core psychological and neural mechanisms. Trends Cogn Sci. 2012;16(1):27–34. https://doi.org/10.1016/j.tics.2011.11.015.CrossRefPubMed

Elsevier. Schizophrenia. 2019. https://www.clinicalkey.com/#!/content/clinical_overview/67-s2.0-a8814dcd-b1a7-4df4-b829-1097a0af2090?scrollTo=%23prognosis-heading-38. Accessed 6 June 2020.

Ministry of Health and Welfare. Health care utilization of national health insurance. 2017. https://iiqsw.mohw.gov.tw/InteractiveIntro.aspx? L1CGID=BB7A2B19FBD8382F&MTID=8E2EEB289E857B17&STID=4961711909A023A2. Accessed 6 June 2020.

Harrow M, Jobe TH. How frequent is chronic multiyear delusional activity and recovery in schizophrenia: a 20-year multi–follow-up. Schizophr Bull. 2010;36(1):192–204. https://doi.org/10.1093/schbul/sbn074.CrossRefPubMed

Chang WC, Hui CL, Tang JY, Wong GH, Lam MM, Chan SK, et al. Persistent negative symptoms in first-episode schizophrenia: a prospective three-year follow-up study. Schizophr Res. 2011;133(1-3):22–8. https://doi.org/10.1016/j.schres.2011.09.006.CrossRefPubMed

Newman SC, Bland RC, Thompson AH. Long-term course and outcome in schizophrenia: a 34-year follow-up study in Alberta. Canada Psychol Med. 2012;42(10):2137–43. https://doi.org/10.1017/S0033291712000177.CrossRefPubMed

Karson C, Duffy RA, Eramo A, Nylander AG, Offord SJ. Long-term outcomes of antipsychotic treatment in patients with first-episode schizophrenia: a systematic review. Neuropsychiatr Dis Treat. 2016;12:57–67. https://doi.org/10.2147/NDT.S96392.CrossRefPubMedPubMedCentral

Vita A, Barlati S. Recovery from schizophrenia: is it possible? Curr Opin Psychiatry. 2018;31(3):246–55. https://doi.org/10.1097/YCO.0000000000000407.CrossRefPubMed

10.

Ministry of Health and Welfare. Mental Health Act. 2020. https://law.moj.gov.tw/ENG/LawClass/LawAll.aspx?pcode=L0020030. Accessed 2 Feb 2021.

11.

Kasai K, Fukuda M. Science of recovery in schizophrenia research: brain and psychological substrates of personalized value. NPJ Schizophr. 2017;3(1):14. https://doi.org/10.1038/s41537-017-0016-6.CrossRefPubMedPubMedCentral

12.

Brijnath B. Applying the CHIME recovery framework in two culturally diverse Australian communities: qualitative results. Int J Soc Psychiatry. 2015;61(7):660–7. https://doi.org/10.1177/0020764015573084.CrossRefPubMed

13.

Jose D, Ramachandra LK, Gandhi S, Desai G. Nagarajaiah. Consumer perspectives on the concept of recovery in schizophrenia: a systematic review. Asian J Psychiatr. 2015;14:13–8. https://doi.org/10.1016/j.ajp.2015.01.006.CrossRefPubMed

14.

Lim C, Barrio C, Hernandez M, Barragán A, Brekke JS. Recovery from schizophrenia in community-based psychosocial rehabilitation settings: rates and predictors. Res Soc Work Pract. 2017;27(5):538–51. https://doi.org/10.1177/1049731515588597.CrossRef

15.

Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry. 2011;199(6):445–52. https://doi.org/10.1192/bjp.bp.110.083733.CrossRefPubMed

16.

McGuire AB, Kukla M, Green A, Gilbride D, Mueser KT, Salyers MP. Illness management and recovery: a review of the literature. Psychiatr Serv. 2014;65(2):171–9. https://doi.org/10.1176/appi.ps.201200274.CrossRefPubMedPubMedCentral

17.

Pincus HA, Spaeth-Rublee B, Sara G, Goldner EM, Prince PN, Ramanuj P, et al. A review of mental health recovery programs in selected industrialized countries. Int J Ment Health Syst. 2016;10(1):1–9. https://doi.org/10.1186/s13033-016-0104-4.CrossRef

18.

Ministry of Health and Welfare. The 2025 health and welfare policy white paper. 2016. https://www.mohw.gov.tw/dl-47081-ffae335a-3d15-4ebc-bfb8-2c2c2f89b1e6.html. Accessed 6 June 2020.

19.

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

20.

Salyers MP, McGuire AB, Kukla M, Fukui S, Lysaker PH, Mueser KT. A randomized controlled trial of illness management and recovery with an active control group. Psychiatr Serv. 2014;65(8):1005–11. https://doi.org/10.1176/appi.ps.201300354.CrossRefPubMed

21.

Jääskeläinen E, Juola P, Hirvonen N, McGrath JJ, Saha S, Isohanni M, et al. A systematic review and meta-analysis of recovery in schizophrenia. Schizophr Bull. 2013;39(6):1296–306. https://doi.org/10.1093/schbul/sbs130.CrossRefPubMed

22.

Lally J, Ajnakina O, Stubbs B, Cullinane M, Murphy KC, Gaughran F, et al. Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies. Br J Psychiatry. 2017;211(6):350–8. https://doi.org/10.1192/bjp.bp.117.201475.CrossRefPubMed

23.

Martinelli A, Ruggeri M. An overview of mental health recovery-oriented practices: potentiality, challenges, prejudices, and misunderstandings. J Psychopathol. 2020;26:147–54. https://doi.org/10.36148/2284-0249-353.CrossRef

24.

Soundy A, Stubbs B, Roskell C, Williams SE, Fox A, Vancampfort D. Identifying the facilitators and processes which influence recovery in individuals with schizophrenia: a systematic review and thematic synthesis. J Ment Health. 2015;24(2):103–10. https://doi.org/10.3109/09638237.2014.998811.CrossRefPubMed

25.

Van Eck RM, Burger TJ, Vellinga A, Schirmbeck F, de Haan L. The relationship between clinical and personal recovery in patients with schizophrenia spectrum disorders: a systematic review and meta-analysis. Schizophr Bull. 2018;44(3):631–42. https://doi.org/10.1093/schbul/sbx088.CrossRefPubMed

26.

Nevarez-Flores A, Sanderson K, Breslin M, Carr V, Morgan V, Neil A. Systematic review of global functioning and quality of life in people with psychotic disorders. Epidemiol Psychiatr Sci. 2019;28(1):31–44. https://doi.org/10.1017/S2045796018000549.CrossRefPubMed

27.

Morin L, Franck N. Rehabilitation interventions to promote recovery from schizophrenia: a systematic review. Front Psychiatry. 2017;8:100. https://doi.org/10.3389/fpsyt.2017.00100.CrossRefPubMedPubMedCentral

28.

Hasan A, Musleh M. The impact of an empowerment intervention on people with schizophrenia: results of a randomized controlled trial. Int J Soc Psychiatry. 2017;63(3):212–23. https://doi.org/10.1177/0020764017693652.CrossRefPubMed

29.

Jaiswal A, Carmichael K, Gupta S, Siemens T, Crowley P, Carlsson A, et al. Essential elements that contribute to the recovery of persons with severe mental illness: a systematic scoping study. Front Psychiatry. 2020;11. https://doi.org/10.3389/fpsyt.2020.586230.

30.

Chang LC, Li IC. Concept analysis of empowerment. Hu Li Za Zhi. 2004;51(2):84–90. https://doi.org/10.6224/JN.51.2.84.CrossRefPubMed

31.

National Empowerment Center. A working definition of empowerment. 2017. https://power2u.org/a-working-definition-of-empowerment/ Accessed 6 June 2020.

32.

Chan RC, Mak WW, Lam MY. Self-stigma and empowerment as mediating mechanisms between in group perceptions and recovery among people with mental illness. Stigma Health. 2018;3(3):283–93. https://doi.org/10.1037/sah0000100.CrossRef

33.

Chou KR, Shih YW, Chang C, Chou YY, Hu WH, Cheng JS, et al. Psychosocial rehabilitation activities, empowerment, and quality of community-based life for people with schizophrenia. Arch Psychiatr Nurs. 2012;26(4):285–94. https://doi.org/10.1016/j.apnu.2012.04.003.CrossRefPubMed

34.

Kim YY, Park HS. The effects of insight and empowerment on function and quality of life for patients with schizophrenia. J Korean Acad Psychiatr Ment Health Nurs. 2010;19(1):11–21. https://doi.org/10.12934/jkpmhn.2010.19.1.11.CrossRef

35.

Park SA, Sung KM. The effects on helplessness and recovery of an empowerment program for hospitalized persons with schizophrenia. Perspect Psychiatr Care. 2013;49(2):110–7. https://doi.org/10.1111/ppc.12002.CrossRefPubMed

36.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author; 2000.

37.

Rogers ES, Chamberlin J, Ellison ML. Measure empowerment among users of mental health services. Psychiatr Serv. 1997;48(8):1042–7. https://doi.org/10.1176/ps.48.8.1042.CrossRefPubMed

38.

Chen SC, Liu CY, Hsieh CJ, Liu WI. Psychometric testing of a Chinese empower-ment scale for the patients with chronic mental illness. J Psychiatr Ment Health Nurs. 2017;12:5–13. https://doi.org/10.6847/TJPMHN.201709_12(1).0001.CrossRef

39.

Neil ST, Kilbride M, Pitt L, Nothard S, Welford M, Sellwood W, et al. The questionnaire about the process of recovery (QPR): a measurement tool developed in collaboration with service users. Psychosis. 2009;1(2):145–55. https://doi.org/10.1080/17522430902913450.CrossRef

40.

Chien WT, Chan ZC. Chinese translation and validation of the questionnaire on the process of recovery in schizophrenia and other psychotic disorders. Res Nurs Health. 2013;36(4):400–11. https://doi.org/10.1002/nur.21549.CrossRefPubMed

41.

Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep. 1962;10(3):799–812. https://doi.org/10.2466/pr0.1962.10.3.799.CrossRef

42.

Andersen J, Larsen JK, Kørner A, Nielsen BM, Schultz V, Behnke K, et al. The brief psychiatric rating scale: schizophrenia, reliability and validity studies. Nord Psykiatr Tidsskr. 1986;40(2):135–8. https://doi.org/10.3109/08039488609096456.CrossRef

43.

Chang TJ, Hwu HG, Wei FW. The inter-rater reliability of brief psychiatric rating scale (BPRS). Chin Soc Neurol Psychiatry Bull. 1986;12:29–36.

44.

Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res. 2000;42:241–7. https://doi.org/10.1016/S0920-9964(99)00130-9.CrossRefPubMed

45.

Kao YC, Liu YP. Compliance and schizophrenia: the predictive potential of insight into illness, symptoms, and side effects. Compr Psychiatry. 2010;51(6):557–65. https://doi.org/10.1016/j.comppsych.2010.03.007.CrossRefPubMed

46.

Waddell L, Taylor M. A new self-rating scale for detecting atypical or second-generation antipsychotic side effects. J Psychopharmacol. 2008;22(3):238–43. https://doi.org/10.1177/0269881107087976.CrossRefPubMed

47.

Nystazaki M, Tsapakis E, Hadjulis M, Alevizopoulos G. Validation of the Glasgow antipsychotic side-effect scale (GASS) in Greece. J Child Psychol Psychiatry. 2014;1(8):1–6. https://doi.org/10.1371/journal.pone.0201225.CrossRef

48.

Tracey TJ, Kokotovic AM. Factor structure of the working alliance inventory. Psychological Assessment. J Consult Clin Psychol. 1989;1(3):207–10. https://doi.org/10.1037/1040-3590.1.3.207.CrossRef

49.

Munder T, Wilmers F, Leonhart R, Linster HW, Barth J. Working Alliance inventory-short revised (WAI-SR): psychometric properties in outpatients and inpatients. Clin Psychol Psychother. 2010;17:231–9. https://doi.org/10.1002/cpp.658.CrossRefPubMed

50.

Yen CF, Yeh ML, Chong MY, Chung HH, Chen CS. A multidimensional assessment of insights in schizophrenic patients. Kaohsiung J Med Sci. 2001;17(5):253–60.PubMed

51.

Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60. https://doi.org/10.3758/BRM.41.4.1149.CrossRefPubMed

52.

Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82. https://doi.org/10.1037/0022-3514.51.6.1173.CrossRefPubMed

53.

Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol. 1982;13:290–312. https://doi.org/10.2307/270723.CrossRef

54.

Waldemar AK, Esbensen BA, Korsbek L, Petersen L, Arnfred S. Recovery orientation in mental health inpatient settings: inpatient experiences? Int J Ment Health Nurs. 2018;27(3):1177–87. https://doi.org/10.1111/inm.12434.CrossRefPubMed

55.

Lynall ME, Bassett DS, Kerwin R, McKenna PJ, Kitzbichler M, Muller U, et al. Functional connectivity and brain networks in schizophrenia. J Neurosci. 2010;30(28):9477–87. https://doi.org/10.1523/JNEUROSCI.0333-10.2010.CrossRefPubMedPubMedCentral

56.

Bag B. Empowerment: a contemporary approach to community mental health nursing practice. Psikiyatride Guncel Yaklasimlar. 2020;12(3):368–81. https://doi.org/10.18863/pgy.634913.CrossRef

57.

L-y S, C-y S. Implementing a strengths-based model in facilitating the recovery of people with psychiatric disability. Asia Pac J Soc Work Devt. 2014;24:29–44.CrossRef

Title: Mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia: a cross-sectional study
Authors: Kuen Tai Lee
Shih Kai Lee
Mei Jou Lu
Wen Ling Hsieh
Wen I. Liu
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Schizophrenia
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03239-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia: a cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Mapping the PHQ-8 to EQ-5D, HUI3 and SF6D in patients with depression

Perceptions, emotional reactions and needs of adolescent psychiatric inpatients during the COVID-19 pandemic: a qualitative analysis of in-depth interviews

Does the millennial generation of women experience more mental illness than their mothers?

Correction to: Mental health status among family members of health care workers in Ningbo, China, during the coronavirus disease 2019 (COVID-19) outbreak: a cross-sectional study

Prevalence and factors associated with post-traumatic stress disorder in healthcare workers exposed to COVID-19 in Wuhan, China: a cross-sectional survey

Correction to: Prevalence of depression and associated factors among elderly people in Womberma District, north-west, Ethiopia