Defining recovery in schizophrenia: A review of outcome studies

Background:

Schizophrenia management has transitioned towards recovery-oriented strategies, challenging its long-standing perception as a chronic condition. This meta-analysis delves into the intricate dynamics between symptomatic remission, functional recovery, and personal recovery within schizophrenia spectrum disorders.



Method:

A meta-analysis until December 2020 reviewed studies meeting DSM-5 criteria for schizophrenia spectrum disorder in at least 90% of samples. Symptomatic remission, functional recovery, and personal recovery were assessed using PANSS, BPRS, GAF, and the Recovery Assessment Scale. Among 1716 initially identified articles, 29 were included after eligibility screening. Effect sizes quantified relationships between recovery domains. Analysis focused on correlating symptom severity with personal recovery and functionality with personal recovery. Pearson's correlation coefficient (r) calculated effect sizes transformed into a common metric (dIG+).



Results:

The meta-analysis involved 6727 outpatient participants, primarily men (64.7%), averaging 40.61 years. Limited longitudinal studies and predominant PANSS use for symptom assessment were noted. Symptom severity displayed a small, significant inverse correlation with personal recovery (dIG+ = -0.18), while functionality exhibited a moderate positive association (dIG+ = 0.26). Moderator analysis highlighted methodological factors influencing effect size heterogeneity.



Discussion

Findings reveal a weak and inverse connection between symptom remission and personal recovery, suggesting limited correlation from the patient's perspective. Conversely, the moderate relationship between functionality and recovery emphasizes the importance of long-term relationships. The diversity in results prompted exploration of moderators, identifying the symptom remission measurement tool (PANSS), educational level, and functionality measurement tool as significant factors. This raises questions about the need to review instrument characteristics. Results underscore the non-equivalence of recovery measures, emphasizing its scope beyond clinical or social improvements, encompassing symptomatology, community functioning, and personal recovery. While the meta-analysis is valuable, it faces limitations such as the absence of longitudinal studies and exclusion of critical perspectives, with publication bias resistance being notable. In conclusion, the study highlights the need to broaden the recovery perspective beyond clinical improvement, prioritizing the patient's voice, and suggests more integrated methodological approaches for future research.



Conclusion:

This study underscores the importance of adopting a holistic recovery approach in schizophrenia management, which prioritizes patient perspectives and calls for methodological rigor in research endeavors.