Background. This study is aimed at verifying a hypothetical model of the structural relationship between the recovery process and difficulties in daily life mediated by occupational dysfunction in severe and persistent mental illness (SPMI). Methods. Community-dwelling participants with SPMI were enrolled in this multicenter cross-sectional study. The Recovery Assessment Scale (RAS), the World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0), and the Classification and Assessment of Occupational Dysfunction (CAOD) were used for assessment. Confirmatory factor analysis, multiple regression analysis, and Bayesian structural equation modelling (BSEM) were determined to analyze the hypothesized model. If the mediation model was significant, the path coefficient from difficulty in daily life to recovery and the multiplication of the path coefficients mediated by occupational dysfunction were considered as each the direct effect and the indirect effect. The goodness of fit in the model was determined by the posterior predictive P value (PPP). Each path coefficient was validated with median and 95% confidence interval (CI). Results. The participants comprised 98 individuals with SPMI. The factor structures of RAS, WHODAS 2.0, and CAOD were confirmed by confirmatory factor analysis to be similar to those of their original studies. Multiple regression analysis showed that the independent variables of RAS were WHODAS 2.0 and CAOD, and that of CAOD was WHODAS 2.0. The goodness of fit of the model in the BSEM was satisfactory with a PPP = 0.27 . The standardized path coefficients were, respectively, significant at -0.372 from “difficulty in daily life” to “recovery” as the direct effect and at -0.322 (95% CI: -0.477, -0.171) mediated by “occupational dysfunction” as the indirect effect. Conclusions. An approach for reducing not only difficulty in daily life but also occupational dysfunction may be an additional strategy of person-centered, recovery-oriented practice in SPMI.

Introduction: Few reports describe interventions combining the Canadian Occupational Performance Measure (COPM) with cognitive behavioral therapy (CBT) although both are important in enabling occupation for a client with depression. We outline the therapy process conducted by an occupational therapist combining the COPM with CBT to enable occupation for a client with depression. Methods: A single-system research design was implemented. The intervention was based on behavioral activation, and the cognitive restructuring was divided into three phases: baseline (Phase I), intervention 1 (Phase II), and intervention 2 (Phase III). Baseline consisted of behavioral activation only. In intervention 1, the COPM was used in addition to the baseline action. In intervention 2, cognitive restructuring was conducted in addition to intervention 1. Results: There was no significant difference in the client's frequency per week of going out in Phase II compared with Phase I (p = 0.062), but the rate increased significantly in Phase III compared with Phase II by binomial test (p = 0.002). As assessed by the COPM, the performance and satisfaction scores for going out were 4 and 3 at the 5th week, but they improved to 7 and 6 at the 17th week. Conclusion: Combining the COPM with CBT significantly increased the frequency of going out that a client with depression hoped to attain. The present intervention might facilitate enabling occupation for clients with depression. Our findings suggested that in clients with depressive symptoms, enabling occupation is possible by combining the COPM with CBT.