Theoretical model of recovery following a suicidal episode (COURAGE): scoping review and narrative synthesis

Sokol, Yosef; Levin, Chynna; Linzer, Mairav; Rosensweig, Chayim; Hubner, Shifra; Gromatsky, Molly; Walsh, Samantha; Dixon, Lisa B.; Goodman, Marianne

doi:10.1192/bjo.2022.599

Cited by 5 publications

(26 citation statements)

References 22 publications

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“…The square root of the AVE for each construct was higher than the correlations involving the construct (see Table 2), suggesting acceptable internal discriminant validity (Hair et al, 2010). The significant positive correlations of the four constructs (see Table 2) are in line with suicide personal recovery theory and previous research suggesting that these constructs are positively correlated (e.g., Sokol et al, 2022) and indicate internal nomological validity. The lowest factor’s value of maximal reliability (McDonald’s hierarchical omega coefficient; MaxR(H)) was .84.…”

Section: Resultssupporting

confidence: 87%

“…However, research on personal recovery regarding suicidality is limited, with no strong measures developed for assessment. To address this, we used the COURAGE model to develop a scale for assessing corresponding domains of personal recovery (Sokol et al, 2022). To ensure sensitivity and deep respect for personal recovery among individuals who have had previous suicidal episodes, the scale was developed in collaboration with individuals who possess lived experience in this area.…”

Section: Discussionmentioning

confidence: 99%

“…This implies that clinical factors associated with suicidality have opposing positive counterparts within personal recovery. Additionally, parallels have been drawn between the interpersonal theory of suicide (Joiner, 2005) and the COURAGE framework (Sokol et al, 2022), including a comparison between Joiner's concept of TB and the COURAGE framework's inverse process of "Growing connectedness." The negative correlation between TB and the Social Worth subscale of the RESST supports the link between the COURAGE framework and the RESST, as well as the RESST's capability to operate within this theoretical context.…”

Section: Discussionmentioning

confidence: 99%

“…While several studies have identified facets of personal recovery that influence recovery from suicidality (e.g., Sun et al, 2017), these findings were not incorporated into an empirically based, fully specified framework until recently. In 2022, we developed and published the COURAGE model (Sokol et al, 2022), a postsuicidal episode, personal recovery-specific theoretical model, based on a rigorous scoping review and analysis of the current literature along with stakeholder feedback (scientific experts and individuals with lived experience).…”

mentioning

confidence: 99%

“…We subsequently created a preliminary theoretical framework for postsuicidal episode recovery and refined it based on stakeholder feedback. The finalized model (Sokol et al, 2022) includes seven interrelated yet distinct processes integral to personal recovery following a suicidal episode: Choosing life, Optimizing identity, Understanding oneself, Rediscovering meaning, Acceptance, Growing connectedness, and Empowerment (COURAGE). Importantly, these processes are unordered and do not represent stages.…”

mentioning

confidence: 99%

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Recovery after a suicidal episode: Developing and validating the Recovery Evaluation and Suicide Support Tool (RESST).

Sokol,

Glatt,

Levin

et al. 2023

Psychological Assessment

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The personal recovery movement advocates for shifting emphasis from clinical symptom reduction toward reclaiming personal agency and creating meaning-filled lives despite the presence of distressing experiences. Corresponding personal recovery measures have been developed; however, there is no established psychometric assessment of personal recovery following a suicidal episode. This study addressed this gap by developing the Recovery Evaluation and Suicide Support Tool (RESST) and assessing its test score reliability, test score interpretations' validity, and psychometric properties. Throughout RESST's development, input from diverse stakeholders-including clinicians, researchers, and individuals with lived experience-was gathered to ensure a meaningful and useful scale. Exploratory factor analysis techniques were used with adults with a suicidal episode history (N = 502) to select and refine items, culminating in a 21-item scale with four distinct subscales: Self-Worth, Life Worth, Social Worth, and Self-Understanding. Confirmatory factor analysis techniques demonstrated model fit across three samples of adults with a suicidal episode history (combined N = 1,523), and test-retest reliability was obtained (N = 204). The results revealed that RESST scores exhibit an internally consistent and replicable factor structure, consistent with personal recovery theory. Additionally, the interpretation of test scores exhibited both convergent and discriminant validity. Mental health indices related to recovery, negative mood states, suicidality, and meaning in life had significant moderate-to-strong correlations with the RESST, supporting the validity of the test score interpretations and clinical relevance. This measure should aid research into recovery processes and understanding how recovery following a suicidal episode may be enhanced clinically and personally. Public Significance StatementThe study highlights the underexplored area of personal recovery after a suicidal episode. It demonstrates that the Recovery Evaluation and Suicide Support Tool (RESST) offers reliable test scores and valid test score interpretations, effectively aiding in understanding, tracking, and supporting individuals' recovery from suicidal episodes.

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Section: Resultssupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%