Predicting Recovery in Individuals With Serious Mental Illness: Expanding the International Classification of Functioning, Disability, and Health (ICF) Framework

Abstract

People with psychiatric disabilities experience significant impairment in fulfilling major life roles due to the severity of their mental illness. Recovery for people with serious mental illness (SMI) can be a long, arduous process, impacted by various biological, functional, sociological, and psychological factors which can present as barriers and/or facilitators. The purposes of this study were to: (a) investigate the International Classification of Functioning, Disability, and Health (ICF) framework’s ability to predict recovery in adults with SMI and (b) determine to what extent the ICF constructs in the empirical model explain the variance in recovery. Participants ( N = 192) completed a sociodemographic questionnaire and various measures representing all predictor and outcome variables. Results from hierarchical regression analysis with six sets of predictors entered sequentially (1 = personal factors-demographics, 2 = body functions-mental, 3 = activity-capacity, 4 = environmental factors, 5 = personal factors-characteristics, and 6 = participation-performance) accounted for 75% (large effect) of the variance in recovery. Controlling for all factors, by order of salience, higher levels of significant other support, education, executive function impairment, and social self-efficacy; primary, non-bipolar SMI diagnosis; greater resilience; lower levels of explicit memory-health impairment, affective self-stigma, and cognitive self-stigma; being younger; fewer self-care limitations; less severe psychiatric symptoms; and being unemployed and unmarried were found to significantly predict recovery. Findings support the validation of the ICF framework as a biopsychosocial recovery model and the use of this model in the development of effective recovery-oriented interventions for adults with SMI. Clinical and research implications are discussed.

Testing Kumpfer’s Resilience Model Among Adults With Serious Mental Illness

“…1), our findings provide several relevant implications for guiding rehabilitation counseling practices. Consistent with prior research (e.g., Brown et al, 2008; Chang et al, 2013; Sánchez, 2020), our findings support a relationship between psychiatric symptom severity and lower levels of adaptation to the disability reported by adults with SMI. Initial treatment should focus on reducing psychiatric symptoms (e.g., depression) to assist with facilitating adaptation to disability.…”

Factor structure, internal reliability, and construct validity of the Brief Resilience Scale (BRS): A study on persons with serious mental illness living in the community

“…Serious mental illness (SMI) is a medical condition that significantly limits functioning (e.g., ability to self‐manage medication; Sánchez, 2020) and consequently restricts independent and effective engagement in major life roles (e.g., work; Sánchez, 2018). Individuals with SMI experience disproportionately high rates of life stressors, such as interpersonal trauma (Mauritz, Goossens, Draijer, & van Achterberg, 2013), physical and sexual violence (Khalifeh, Oram, Osborn, Howard, & Johnson, 2016), social exclusion (Gardner et al, 2019), unemployment (Krupa, Chen, & Carter, 2015), and poverty (Read, Johnstone, & Taitimu, 2013).…”