title: The relationship between clinical and recovery dimensions of outcome in mental health.
abstract: Little is known about the empirical relationship between clinical and personal recovery.
  
  
  
  To examine whether there are separate constructs of clinical recovery and personal recovery dimensions of outcome, how they change over time and how they can be assessed.
  
  
  
  Standardised outcome measures were administered at baseline and one-year follow-up to participants in the REFOCUS Trial (ISRCTN02507940). An exploratory factor analysis was conducted and a confirmatory factor analysis assessed change across time.
  
  
  
  We identified three factors: patient-rated personal recovery, patient-rated clinical recovery and staff-rated clinical recovery. Only the personal recovery factor improved after one year. HHI, CANSAS-P and HoNOS were the best measures for research and practice.
  
  
  
  The identification of three rather than two factors was unexpected. Our findings support the value of concurrently assessing staff and patient perceptions of outcome. Only the personal recovery factor changed over time, this desynchrony between clinical and recovery outcomes providing empirical evidence that clinical recovery and personal recovery are not the same. We did not find evidence of a trade-off between clinical recovery and personal recovery outcomes. Optimal assessment based on our data would involve assessment of hope, social disability and patient-rated unmet need.
authors.affiliation: 2gether NHS Foundation Trust, Gloucestershire, England, United Kingdom. Electronic address: rob.macpherson@glos.nhs.uk.
authors.forename: Rob
authors.initials: R
authors.lastname: Macpherson
authors.affiliation: King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, England, United Kingdom.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pesola
authors.affiliation: King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, England, United Kingdom.
authors.forename: Mary
authors.initials: M
authors.lastname: Leamy
authors.affiliation: King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, England, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Bird
authors.affiliation: King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, England, United Kingdom.
authors.forename: Clair
authors.initials: C
authors.lastname: Le Boutillier
authors.affiliation: King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, England, United Kingdom.
authors.forename: Julie
authors.initials: J
authors.lastname: Williams
authors.affiliation: King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, England, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: Slade
mesh_terms: D000328:Adult; D005163:Factor Analysis, Statistical; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D008603:Mental Health; D000071066:Patient Reported Outcome Measures; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D016896:Treatment Outcome
keywords: Clinical recovery; Personal recovery