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Psychiatric Rehabilitation Journal © 2013 American Psychological Association

2013, Vol. 36, No. 2, 80 – 85 1095-158X/13/$12.00 DOI: 10.1037/h0094975

Recovery of People With Psychiatric Disabilities Living in the Community


and Associated Factors

Yen-Ching Chang Tamar Heller and Susan Pickett


I-Shou University University of Illinois at Chicago

Ming-De Chen
Kaohsiung Medical University

Objective: Consumer-oriented recovery has been discussed for more than two decades in the mental
health field. Although there some qualitative recovery studies have shown important findings, few
quantitative studies of this concept currently exist. This study examined the relationship between
recovery and associated social⫺environmental and individual factors. Method: A total of 159 people
with psychiatric disabilities receiving services from a large community mental health agency participated
in the study. Participants completed a self-report survey that assessed individual recovery status, social
support, perceived recovery-oriented service quality, psychiatric symptoms, and demographics. One
hundred twenty-four surveys were analyzed. Hierarchical multiple regression analysis was conducted to
examine the relationship between recovery and associated factors. Results: Social support and perceived
recovery-oriented service quality had significant positive relationships with recovery; psychiatric symp-
toms had a significant negative relationship with recovery. The final regression model accounted for 58%
of the variance in recovery, F(9, 114) ⫽ 17.72, p ⬍ .001. Conclusion and Implications for Practice:
Social⫺environmental factors play an important role in people’s recovery, even after taking into account
psychiatric symptoms. Namely, people with psychiatric disabilities can pursue recovery with symptoms
as long as they receive appropriate support and services. Mental health professionals should provide
services adhering to recovery principles in order to help their clients achieve personal recovery.

Keywords: recovery, psychiatric disability, recovery-oriented care, social support

Consumer-oriented recovery principles were used as the con- ery components include hope, empowerment, taking personal re-
ceptual framework for this study. Unlike the traditional scientific sponsibility, self-redefinition, and participating in meaningful ac-
view on recovery, which focuses on cure and symptom reduction, tivities (Davidson, O’Connell, Tondora, Lawless, & Evans, 2005;
this consumer-oriented recovery model was developed by people Ridgway, 2001; Young & Ensing, 1999). This consumer-oriented
with psychiatric disabilities and emphasizes personal goals and recovery concept has been regarded as a guiding vision of the
potential (Bellack, 2006; Young & Ensing, 1999). It endeavors to future of mental health services (Anthony, 1993). More and more
improve the lives of people with psychiatric disabilities and to agencies provide recovery-oriented services.
redesign service delivery methods. Under this concept, people with Social support and mental health services, which belong to
psychiatric disabilities are treated as independent individuals social⫺environmental factors, have been discussed in much of the
rather than as dependent patients; mental health professionals are recovery literature, and are regarded as important facilitators of the
helpers rather than controllers. Common consumer-oriented recov- recovery process (Jacobson & Greenley, 2001; Spaniol, Wewior-
ski, Gagne, & Anthony, 2002). Recovery advocates believe that,
with appropriate support and services, people with psychiatric
disabilities can experience a better recovery process and improve
This article was published Online First May 6, 2013.
their quality of life (Davidson, O’Connell, Tondora, Styron, &
Yen-Ching Chang, PhD, OT, Department of Healthcare Administration
and Department of Occupational Therapy, I-Shou University, Kaohsiung Kangas, 2006; Spaniol et al., 2002).
City, Taiwan; Tamar Heller, PhD, Department of Disability and Human Furthermore, advocates have also stated that people with psy-
Development, University of Illinois at Chicago; Susan Pickett, PhD, De- chiatric disabilities can pursue recovery even though symptoms
partment of Psychiatry, University of Illinois at Chicago; Ming-De Chen, exist (Anthony, 1993; Davidson et al., 2005). Psychiatric symp-
PhD, OT, Department of Occupational Therapy, Kaohsiung Medical Uni- toms, which have commonly been regarded as individual prob-
versity, Kaohsiung City, Taiwan. lems, are simply viewed as one attribute of psychiatric disabilities
Supported by the Provost’s Award of University of Illinois at Chicago.
in the consumer-oriented recovery perspective. Although some
Correspondence concerning this article should be addressed to Yen-
Ching Chang, PhD, OT, Department of Healthcare Administration and
studies have found an inverse relationship between psychiatric
Department of Occupational Therapy, I-Shou University, 8 Yida Road, symptoms and recovery (Brown, Rempfer, & Hamera, 2008;
Yanchao District, Kaohsiung City 82445, Taiwan. E-mail: ychang@ Resnick, Rosenheck, & Lehman, 2004), these advocates believe
isu.edu.tw that symptoms do not necessarily prevent recovery. While people
80
RECOVERY OF PEOPLE WITH PSYCHIATRIC DISABILITIES 81

with physical disabilities are not expected to regain their mobility obtained, participants completed the self-report survey. They re-
in order to live successfully in the community, similarly, people ceived a $5 gift card as a reimbursement for their time and
with psychiatric disabilities are not expected to eliminate their participation. This study was approved by the institutional review
symptoms in order to pursue their recovery (Davidson et al., 2006; boards of the University of Illinois at Chicago and the study site.
Davidson et al., 2005). Data collection occurred from June 2010 through August 2010.
Many studies have examined factors related to traditional sci- A total of 159 participants filled out the survey. After removing
entific definition of recovery, but few studies have investigated 35 surveys with significant missing data (i.e., the individual an-
factors associated with consumer-oriented recovery (Resnick et al., swered ⬍ 70% of scale items; n ⫽ 32) and inattentive response
2004). Some qualitative recovery studies have found common sets (i.e., the individual responded to the whole survey with a
recovery components and statements (Ridgway, 2001; Smith, specific answer or a pattern; n ⫽ 3), 124 surveys were included in
2000; Spaniol et al., 2002). However, these results have been the regression analysis. A summary of characteristics of both
limited by small sample sizes (i.e., n ⬍ 20). The above statements analyzed and excluded participants is shown in Table 1. Except for
supported by advocates have not been examined by quantitative race and ethnicity, there were no significant differences between
studies with a large sample size. the analyzed sample and the excluded sample. Sixty-seven percent
Therefore, this study aimed to investigate the relationship be- of participants in the analyzed sample were men. Most participants
tween recovery and social⫺environmental and individual factors were single (73%). Nearly equal percentages of Blacks (40%) and
(i.e., social support, perceived recovery-oriented service quality, Whites (42%) completed surveys. Regarding education level, 53%
and psychiatric symptoms) through a self-report survey. We used of participants had a high school degree or lower while 47% of
hierarchical multiple regression to examine whether social⫺envi- participants reported some college or higher. Most participants
ronmental factors have a significant relationship with recovery were unemployed or not in the workforce (83%). The majority of
after taking into account psychiatric symptoms, and controlling for participants (71%) lived in a private residence or household. Four
demographic characteristics (i.e., age, illness length, sex, race, and diagnoses were reported most often: bipolar disorder (37%),
education). Although few consumer-oriented recovery studies schizophrenia (24%), major depression (19%), and schizoaffective
have discussed the influence of demographic characteristics, it is disorder (15%). The average age of the analyzed sample was 47.10
possible that these factors impact consumer-oriented recovery. For years (range: 20⫺68, Mdn ⫽ 47.96) and the average illness length
example, people of different ages tend to have various personal was 23.82 years (range: 0⫺56, Mdn ⫽ 24.41).
goals, and may exhibit different recovery perspectives. Sex differ-
ence may also influence recovery expectations. Because demo-
graphic factors were not the focus of this study, they were con- Instruments
trolled to examine accurately the relationship between recovery
and associated factors. The self-report survey included two parts. The first part col-
lected personal information, such as age, sex, and education. The
second part included a battery of self-report scales. First, the
Method
revised Mental Health Recovery Measure (MHRM-R) was used to
measure the individual recovery status. The original MHRM (Bull-
Participants and Data Collection ock, 2005; Young & Bullock, 2003) was developed according to
Study participants were recruited from a large community men- the recovery process model of Young and Ensing (1999). Chang,
tal health agency located in metropolitan Chicago, Illinois. The Ailey, Heller, and Chen (in press) evaluated the MHRM using
agency provides a wide range of services, including case manage- Rasch analysis. Four items inappropriate for the measured recov-
ment, housing, vocational rehabilitation, and social skills training, ery concept were removed from the scale to improve its validity.
to people with psychiatric disabilities, regardless of their diagnosis The revised scale (MHRM-R) has 26 items and uses a 4-point
on the Diagnostic and Statistical Manual of Mental Disorders. Likert scale, ranging from 0 (strongly disagree) to 3 (strongly
Because the inpatient population is relatively unstable and the agree). It assesses comprehensive recovery content, including
consumer-oriented recovery model may be inapplicable (Frese, overcoming stuckness, self-empowerment, learning and self-
Stanley, Kress, & Vogel-Scibilia, 2001), only the community redefinition, basic functioning, overall well-being, new potentials,
sample was considered for inclusion in this study. and advocacy/enrichment. It showed high internal consistency in
Study participants had to meet the following inclusion criteria: the present study (Cronbach’s alpha ⫽ .95). Higher total scores
having a diagnosis of mental illness, being age 18 years or older, represent a better recovery status.
living in the community, receiving services from the study site The 19-item Social Support Survey (SSS; Sherbourne & Stew-
(i.e., the collaborating agency), and being able to fill out the study art, 1991) measures five types of social support: emotional sup-
survey independently. People who were actively symptomatic or port, informational support, tangible support, positive social inter-
could not understand the survey content were not enrolled. action, and affectionate support. Respondents were asked how
With assistance of program staff, the first author convened often the support is available if they need it. Response choices
meetings in several community programs of the agency and ex- include: none of the time, a little of the time, some of the time, most
plained the study’s purpose and procedures to potential partici- of the time, and all of the time. The SSS showed high internal
pants. During these recruitment meetings, program staff helped to consistency (Cronbach’s alpha ⫽ .97). Higher total scores repre-
identify individuals who were actively symptomatic or had limited sent greater receipt of social support.
literacy. These individuals were not allowed to complete surveys The revised version of the Recovery Self-Assessment
and were excluded from the study. After informed consent was (O’Connell, Tondora, Croog, Evans, & Davidson, 2005) was used
82 CHANG, HELLER, PICKETT, AND CHEN

Table 1
Characteristics of Participants

Analyzed samplea Excluded samplea


Characteristics Total samplea (n ⫽ 124) (n ⫽ 35) Test statistic df

Sex ␹ ⫽ 0.68
2
1
Female 50 (31%) 41 (33%) 9 (26%)
Male 109 (69%) 83 (67%) 26 (74%)
Marital status ␹2 ⫽ 4.84 2
Single 114 (72%) 91 (73%) 23 (66%)
Married/partner 13 (8%) 7 (6%) 6 (17%)
Other 32 (20%) 26 (21%) 6 (17%)
Race and ethnicityb ␹2 ⫽ 10.17 2
Black 70 (45%) 49 (40%) 21 (68%)
White 56 (36%) 52 (42%) 4 (13%)
Other 29 (19%) 23 (19%) 6 (19%)
Education ␹2 ⫽ 0.57 1
High school or lower 86 (55%) 66 (53%) 20 (61%)
College or higher 71 (45%) 58 (47%) 13 (39%)
Employment ␹2 ⫽ 0.32 1
Work 25 (16%) 21 (17%) 4 (13%)
Not work 129 (84%) 102 (83%) 27 (87%)
Living environment ␹2 ⫽ 0.02 2
Private Residence/household 110 (71%) 87 (71%) 23 (72%)
Supportive/transitional housing 40 (26%) 32 (26%) 8 (25%)
Other 5 (3%) 4 (3%) 1 (3%)
Diagnosis ␹2 ⫽ 1.61 3
Schizophrenia/schizoaffective disorder 61 (40%) 47 (38%) 14 (50%)
Major depression 27 (20%) 23 (19%) 4 (14%)
Bipolar disorder 54 (36%) 46 (37%) 8 (29%)
Other 9 (6%) 7 (6%) 2 (7%)
Age (years) 47.04 (11.12) 47.10 (10.81) 46.77 (12.73) t ⫽ 0.14 148
Illness length (years) 24.07 (12.18) 23.82 (12.17) 27.93 (12.41) t ⫽ ⫺0.92 130
a
Total sample values are n (%) or M (SD). b
p ⫽ .006.

to assess perceived recovery-oriented service quality, defined in Data Analysis


this study as participants’ perceptions of the degree to which the
In addition to descriptive statistics, which explored data distri-
services they received follow recovery principles. This 32-item
butions and characteristics of participants, a hierarchical multiple
scale assesses life goals, involvement, diversity of treatment op-
regression analysis was conducted to further examine the relation-
tions, choice, individually tailored services, and inviting space. It
ship between recovery and associated factors. Demographics (i.e.,
uses a 5-point Likert scale, ranging from 1 (strongly disagree) to
age, illness length, sex, race, and education) were entered first
5 (strongly agree), and includes an N/A (not applicable) option; it
because they were regarded as control variables. Then, the psy-
showed high internal consistency in this study (Cronbach’s
chiatric symptom variable (i.e., GSI score) was entered in the
alpha ⫽ .97). A higher item average indicates better perceived
second block, and social⫺environmental factors (i.e., social sup-
recovery-oriented service quality.
port and perceived recovery-oriented service quality), which were
Finally, psychiatric symptoms were measured by the Brief the focus of this study, were entered in the third block. This
Symptom Inventory (BSI; Derogatis & Melisaratos, 1983). The regression model explored whether the social⫺environmental fac-
BSI is a 53-item self-report symptom scale, and has nine tors had a significant relationship with the individual recovery
dimensions: somatization, obsessive– compulsive, interpersonal status, after taking into account other variables.
sensitivity, depression, anxiety, hostility, phobic anxiety, para- Missing data are common in self-report surveys, and they oc-
noid ideation, and psychoticism. Respondents were asked to curred in this study. Hawthorne and Elliott (2005) found that if at
rate the presence and severity of their symptoms in the past 7 least half the items of the scale are present, person mean substi-
days. Each item is rated on a 5-point scale, ranging from not at tution is a better choice because it has simpler computation and its
all, a little bit, moderately, quite a bit, to extremely. The BSI efficiency is as good as hot deck imputation. Hence, this study
uses three global indices of distress to describe the individual’s used person mean imputation to handle missing data in each scale.
condition, including the General Severity Index (GSI), the To maintain each survey scale, person mean imputation was used
Positive Symptom Distress Index, and the Positive Symptom if the individual answered 70⫺99% of the scale items. As noted
Total. This study used the GSI to represent the severity of above, the 32 surveys that had significant missing data (i.e.,
psychiatric symptoms. The BSI showed high internal consis- individuals failed to answer at least 70% of scale items) were
tency (Cronbach’s alpha ⫽ .98). Higher GSI scores indicate removed from the analysis. SPSS, Version 17.0, for Windows was
greater symptom severity. used for data analysis.
RECOVERY OF PEOPLE WITH PSYCHIATRIC DISABILITIES 83

Results an important support for people with psychiatric disabilities (Mead


& Copeland, 2000; Substance Abuse and Mental Health Services
The hierarchical multiple regression results are presented in Administration, 2005), adding peer support groups to existing
Table 2. The first regression model was not significant, programs may facilitate people’s recovery process.
F(6, 117) ⫽ 0.63, p ⫽ .71. After entering psychiatric symptoms, Perceived recovery-oriented service quality also showed a sig-
the second model, F(7, 116) ⫽ 4.85, p ⬍ .001, accounted for 23%
nificant positive relationship with recovery. In this study, per-
of variance in recovery, and R2 change was significant, F(1,
ceived recovery-oriented service quality was assessed by partici-
116) ⫽ 29.29, p ⬍ .001. When social⫺environmental factors
pants’ perceptions of whether the services they received were
were entered, the third model, F(9, 114) ⫽ 17.72, p ⬍ .001,
recovery-oriented. Although recovery-oriented services have not
accounted for 58% of variance in recovery, and R2 change was
been clearly identified, they have several characteristics in com-
significant as well, F(2, 114) ⫽ 48.79, p ⬍ .001.
mon, including offering services that are consumer-centered and
Social support, perceived recovery-oriented service quality, psy-
that assist individuals in achieving personal goals (Anthony, 2000;
chiatric symptoms, and illness length were significantly associated
Noordsy et al., 2002). In addition, attitudinal changes in mental
with recovery status in the third model. Participants with greater
health professionals are the key of recovery-oriented services.
social support, better perceived recovery-oriented service quality,
Mental health professionals need to believe that recovery is pos-
lower symptom severity, and longer illness lengths tended to have
sible, to respect clients’ decisions, and to provide different sug-
higher recovery scores.
gestions and options for people in different recovery levels (An-
thony, 1993; Mead & Copeland, 2000; Smith, 2000). Although all
Discussion study participants were from the same mental health agency, they
This study provided preliminary findings on the factors signif- may have had different experiences in receiving services due to
icantly associated with consumer-oriented recovery. Results of the various attitudes or behaviors of designated service providers and
hierarchical multiple regression analysis found that social support, variability in the quality of the specific programs provided. The
perceived recovery-oriented service quality, psychiatric symp- research finding indirectly confirms the effectiveness of services
toms, and illness length had significant relationships with individ- that are perceived as recovery oriented. Namely, people who
ual recovery status and accounted for a significant amount of receive services that are viewed as adhering more to recovery
variance in recovery. These findings have several implications for principles tend to have better recovery statuses. Therefore, it is
mental health providers who seek to enhance clients’ recovery. recommended that mental health professionals, administrators, and
Social support had the positive and highest standardized coef- policy-makers implement recovery principles in their work.
ficient in the final regression model (see Table 2), which indicates Greater adaptation of recovery-oriented services is likely to lead to
that it had the most impact in the model. People with more social greater recovery among people with psychiatric disabilities.
support tend to have a better recovery status. This result is similar Moreover, psychiatric symptoms had a significant negative re-
to that of previous research findings (Corrigan & Phelan, 2004; lationship with recovery. Using the MHRM-R, this study had
Hendryx, Green, & Perrin, 2009; Pernice-Duca & Onaga, 2009), findings similar to other previous studies, which assessed recovery
and indicates the importance of social support for people in recov- with recovery-related measures, such as hope and empowerment
ery. It also suggests that programs that facilitate connections scales (Brown et al., 2008; Resnick et al., 2004). The result is not
among people with psychiatric disabilities may enhance their surprising. Symptom reduction has been the main focus of the
recovery. For example, because peer support has been regarded as traditional scientific recovery paradigm and has been discussed by

Table 2
The Hierarchical Regression Model for Recovery (n ⫽ 124)

First model Second model Third model


Block ␤ t ␤ t ␤ t

Block 1
Age ⫺0.01 ⫺0.05 ⫺0.09 ⫺0.88 ⫺0.11 ⫺1.61
Illness length 0.06 0.58 0.11 1.12 0.16 2.24ⴱ
Female 0.13 1.39 0.13 1.57 0.02 0.37
Black ⫺0.07 ⫺0.57 0.01 0.10 ⫺0.07 ⫺0.80
White ⫺0.03 ⫺0.20 ⫺0.05 ⫺0.48 ⫺0.12 ⫺1.36
High school or lower 0.12 1.28 0.13 1.55 0.10 1.48
Block 2
Psychiatric symptoms ⫺0.46 ⫺5.41ⴱⴱⴱ ⫺0.27 ⫺4.15ⴱⴱⴱ
Block 3
Social support 0.49 6.23ⴱⴱⴱ
Perceived recovery-oriented service quality 0.22 2.85ⴱⴱ
R2a 0.03 0.23 0.58
F for change in R2 0.63 29.29ⴱⴱⴱ 48.79ⴱⴱⴱ
a
Unadjusted R2.

p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ
p ⬍ .001.
84 CHANG, HELLER, PICKETT, AND CHEN

numerous researchers and professionals (Harrow, Grossman, Jobe, or receiving no recovery-oriented services. From their demograph-
& Herbener, 2005; Whitehorn, Brown, Richard, Rui, & Kopala, ics and responses to the survey, this sample tended to represent a
2002). However, besides investigating the effectiveness of certain population that had relatively stable conditions, both in regard to
medication and interventions, researchers often overlook that it is symptoms and to the environmental support system. Moreover,
hard for people with psychiatric disabilities to cope with symptoms because participants were required to fill out the survey indepen-
without a good relationship with their service providers. In fact, dently, the experiences of people with limited literacy were ex-
many of them have unpleasant experiences with mental health cluded from this study.
professionals (Mead & Copeland, 2000). To better assist this Finally, the use of a self-report survey also resulted in several
population, mental health professionals should learn how to work study limitations. Social desirability (Huang, Liao, & Chang,
with their clients and to help them find better medication or coping 1998) and missing data are common in self-report surveys. Par-
strategies (Sowers & Quality Management Committee of the ticipants might answer items in a way that matches social desir-
American Association of Community Psychiatrists, 2005). Treat- ability and could skip items that they did not want to answer. These
ing clients with respect and support is one of the critical principles may cause an overestimation or underestimation of the results.
of recovery-oriented services (Jacobson & Greenley, 2001). When
However, the self-report survey is valuable for appropriately re-
people with psychiatric disabilities are treated appropriately, it is
flecting the respondents’ perceptions. This study used anonymous
more likely that they can handle their symptoms and make good
participation to decrease the influence of social desirability, and
progress in their recovery.
used person mean substitution to better estimate participants’
In terms of demographics, only illness length showed a signif-
responses, hence increasing the reliability of the findings.
icant positive relationship with recovery in the final model. People
Although the study participants may not represent all people
with longer illness lengths tend to have a better recovery status.
This result corresponds with previous qualitative findings (Dee- with psychiatric disabilities living in the community, our study
gan, 1988; Smith, 2000; Spaniol et al., 2002). Recovery does not results contribute important quantitative evidence for the
happen suddenly, and it is not an easy process. It takes time for consumer-oriented recovery concept. Future research should col-
people with psychiatric disabilities to accept their illness, have a lect data from various mental health agencies and attempt to reach
desire to change their lives, and to seek help. People with psychi- people with limited services. People with low literacy may be
atric disabilities are likely to enter their recovery journey when included by face-to-face interviews. A larger and diverse sample
they get to know themselves and the illness better. can expand the generalization of study findings. Moreover, al-
Overall, the research findings are encouraging. Social⫺environ- though these associated factors may truly have significant contri-
mental factors had a significant contribution to the final regression butions, it will be beneficial to have more empirical studies to
model, which supports the assertion of recovery advocates: people reconfirm these results.
with psychiatric disabilities can experience a better recovery pro-
cess and pursue better quality of life if they receive appropriate
support and services (Davidson et al., 2006; Spaniol et al., 2002). Conclusion and Implications for Practice
Although psychiatric symptoms seem to have a negative impact The study explored the relationship between recovery and so-
on people’s recovery, the positive relationships between recov- cial⫺environmental and individual factors. We found that social
ery and social support as well as perceived recovery-oriented support and perceived recovery-oriented service quality had sig-
service quality after taking into account psychiatric symptoms nificant positive relationships with recovery; psychiatric symp-
were evident. This finding advances another advocates’ asser- toms had a significant negative relationship with recovery. The
tion: people with psychiatric disabilities can pursue recovery final regression model accounted for 58% of variance in recovery.
even though symptoms persist (Anthony, 1993; Davidson et al.,
These findings support the statements of recovery advocates. So-
2005). Namely, even though they have symptoms, as long as the
cial⫺environmental factors do play an important role in people’s
social⫺environmental support is available, people with psychi-
recovery, even after taking into account psychiatric symptoms. It
atric disabilities can gradually improve their lives and pursue
indicates that people with psychiatric disabilities can pursue re-
their recovery.
covery with symptoms as long as they receive appropriate support
and services. In addition to symptom control, people with psychi-
Study Limitations atric disabilities who live in the community also need adequate
Several limitations exist in this study. First, cross-sectional data support and services to improve their lives and achieve their
cannot determine the causal direction of these relationships be- personal goals.
tween recovery and associated factors. It is unclear whether the The results of this study are useful for mental health service
improvement in social support, perceived recovery-oriented ser- designs and mental health policy-making. Mental health profes-
vice quality, and psychiatric symptoms influences recovery and/or sionals can have more confidence to follow the consumer-
whether the enhancement of recovery helps people with psychiat- oriented recovery paradigm, and they are encouraged to adopt
ric disabilities to receive social support, better services, and control and provide recovery-oriented services to help their clients
their symptoms. achieve personal recovery. These research results expand the
Second, several factors limit the generalization of this study. knowledge base of the consumer-oriented recovery concept, and
The present study sample is limited to people with psychiatric they are beneficial for further follow-up or randomized controlled
disabilities served in one recovery-oriented mental health agency. studies, which can provide stronger evidence to verify the rela-
The results may not reflect experiences of people without services tionship between recovery and associated factors.
RECOVERY OF PEOPLE WITH PSYCHIATRIC DISABILITIES 85

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