Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study
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 “C...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
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BioMed Central
2017
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| Online Access: | https://eprints.nottingham.ac.uk/40141/ |
| _version_ | 1848795993539084288 |
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| author | Loos, Sabine Clarke, Eleanor Jordan, Harriet Puschner, Bernd Fiorillo, Andrea Luciano, Mario Ivánka, Tibor Magyar, Erzsébet Krogsgaard-Bording, Malene Østermark-Sørensen, Helle Rössler, Wulf Kawohl, Wolfram Mayer, Benjamin Slade, Mike |
| author_facet | Loos, Sabine Clarke, Eleanor Jordan, Harriet Puschner, Bernd Fiorillo, Andrea Luciano, Mario Ivánka, Tibor Magyar, Erzsébet Krogsgaard-Bording, Malene Østermark-Sørensen, Helle Rössler, Wulf Kawohl, Wolfram Mayer, Benjamin Slade, Mike |
| author_sort | Loos, Sabine |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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). |
| first_indexed | 2025-11-14T19:40:55Z |
| format | Article |
| id | nottingham-40141 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:40:55Z |
| publishDate | 2017 |
| publisher | BioMed Central |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-401412020-05-04T18:29:50Z https://eprints.nottingham.ac.uk/40141/ Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study Loos, Sabine Clarke, Eleanor Jordan, Harriet Puschner, Bernd Fiorillo, Andrea Luciano, Mario Ivánka, Tibor Magyar, Erzsébet Krogsgaard-Bording, Malene Østermark-Sørensen, Helle Rössler, Wulf Kawohl, Wolfram Mayer, Benjamin Slade, Mike 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). BioMed Central 2017-01-23 Article PeerReviewed Loos, Sabine, Clarke, Eleanor, Jordan, Harriet, Puschner, Bernd, Fiorillo, Andrea, Luciano, Mario, Ivánka, Tibor, Magyar, Erzsébet, Krogsgaard-Bording, Malene, Østermark-Sørensen, Helle, Rössler, Wulf, Kawohl, Wolfram, Mayer, Benjamin and Slade, Mike (2017) Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study. BMC Psychiatry, 17 (1). p. 38. ISSN 1471-244X Clinical decision making Patient involvement Recovery Severe mental illness (SMI) Routine mental health services Multinational health service research http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1207-4 doi:10.1186/s12888-017-1207-4 doi:10.1186/s12888-017-1207-4 |
| spellingShingle | Clinical decision making Patient involvement Recovery Severe mental illness (SMI) Routine mental health services Multinational health service research Loos, Sabine Clarke, Eleanor Jordan, Harriet Puschner, Bernd Fiorillo, Andrea Luciano, Mario Ivánka, Tibor Magyar, Erzsébet Krogsgaard-Bording, Malene Østermark-Sørensen, Helle Rössler, Wulf Kawohl, Wolfram Mayer, Benjamin Slade, Mike Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study |
| title | Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study |
| title_full | Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study |
| title_fullStr | Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study |
| title_full_unstemmed | Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study |
| title_short | Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study |
| title_sort | recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study |
| topic | Clinical decision making Patient involvement Recovery Severe mental illness (SMI) Routine mental health services Multinational health service research |
| url | https://eprints.nottingham.ac.uk/40141/ https://eprints.nottingham.ac.uk/40141/ https://eprints.nottingham.ac.uk/40141/ |