Recovery, Meaning, and Mental Illness:

1. Recovery, Meaning, and Mental Illness: The Impact of Perceived Losses, Religious Coping and Community Based Services Shinakee Gumber, Jeremy P. Cummings, Kenneth I. Pargament, and Catherine H. Stein Bowling Green State University E-mail: sgumbe@bgsu.edu Abstract The present study examined ways that people with serious mental illness (SMI) engage in the recovery process and perceive their lives to be meaningful. Data were collected from 89 consumers receiving various community-based mental health services. Consumers completed a brief survey that consisted of questions about the duration of their engagement in various types of community-based services, types of religious coping, and perceived personal loss due to mental illness. Consumers’ self-reported perceptions of recovery and meaning in life were also assessed. Results show that duration of engagement in specific services such as therapy and case management was differentially but positively associated with greater perceived recovery and meaning in life. Additionally, positive religious coping and duration of medication use moderated the relationship between perceived losses due to mental illness and perceived meaning in life. The implications of these results with regards to community-based services for people with serious mental illness are discussed. Interaction Graphs • Method (Contd.) • Measures • Outcome variables • Meaning in Life Life Regard Index (LRI) - 28-item scale that assesses subjective meaning in life across two dimensions: Framework (cognitive component of meaning) and Fulfillment (affective component of meaning) • Perceived Recovery Recovery Assessment Scale (RAS) – 41-item scale that assesses recovery among people coping with SMI • Predictor Variables • Personal Losses due to Mental Illness (PLMI) – 20-item scale that assesses perceived losses with respect to roles and routines, former relationships, sense of self, and future. • Religious Coping (RCOPE) – Two scales assessing various dimensions of religious coping. The present study used items that assess aspects of positive (4 items) and negative religious coping (5 items) • Length of Services – Single items assessing length of time over which various services have been received, including case management, therapy, and medication • Demographic information • Analyses • Two sets of hierarchical regressions conducted for each outcome variable – one set testing effects of mental health services on outcomes, the other set testing the effects of positive and negative religious coping • Step 1: Controlled for effects of variables with significant correlations with the outcome (e.g., sex, overall length of time receiving mental services) • Step 2: Tested main effect of Perceived Losses due to Mental Illness on outcome • Step 3: Tested main effects of other predictor variables (i.e., mental health services or religious coping) • Step 4: Tested interaction effects of PLMI with each of the other predictor variables • Introduction • Perceived Losses due to Mental Illness • The onset of mental illness causes major life disruptions and loss of valued social roles (Farone & Pickens, 2007). • People with SMI struggle in various life domains related to education, employment, and social networks (Farone & Pickens, 2007). • Such pervasive losses due to SMI can threaten the basic assumption that life is meaningful (Park & Folkman, 1997). • Recovery and Treatment and Services • Initially, treatment and services narrowly focused on symptom reduction or alleviation while ignoring the psychosocial struggles faced by people with SMI (Anthony, 1993). • The current recovery movement highlights the importance of treatment and services that address issues of hope for the future, personal identities, and meaning in life for people coping with SMI (Anthony, 1993). • Meaning in Life and Religious Coping • Meaning in life is related to greater psychological and physical well-being (Melton & Schulenberg, 2008). • Researchers have conceptualized meaning in life as having cognitive aspects (framework of meaning) and affective aspects (life fulfillment; Steger, 2007). • Research also shows a link between adverse life circumstances and positive outcomes such as stress-related growth (Schrimshaw, &Pretter, 2005). From an existential perspective, crisis brought on by serious mental illness may lead to greater strivings for meaning and purpose in life (Melton & Shulenberg, 2008). • Furthermore, there is evidence that religious coping is relevant to people dealing with SMI (Phillips, Lakin, & Pargament, 2002) . Results • Discussion • Summary • Consumers who reported greater perceived losses due to mental illness also perceived less recovery and meaning in life. • Consumers who reported receiving therapy for a longer duration of time also reported greater perceptions of recovery. Longer duration of case management was related to greater self-reported framework and fulfillment (meaning) in life. • For consumers who reported taking psychiatric medications for a longer period of time, perceived losses were positively related to meaning in life. • Consumers who reported using negative religious coping reported less perceived recovery, whereas those who reported using positive religious coping reported greater perceived recovery, as well as greater framework and fulfillment (meaning) in life. • Finally, results suggested that for people who reported using higher levels of positive religious coping, greater perceived losses were related to a greater framework in life. • Implications for Community Based Services • Results highlight the types of challenges and losses that consumers dealing with SMI face. Study findings suggest: • Consumers' reports of mental health service use is related to their perceptions of recovery from mental illness and a sense of meaning in life. • Engaging consumers in services for greater length of time is related to increased perceptions of recovery and greater life fulfillment and framework. • Traditional services such as case management and medications are not only associated with more objective outcomes (e.g., reduced hospital recidivism) but also with subjective perceptions of recovery and meaning in life. • Referrals to less traditional forms of treatment for SMI such as therapy may also enhance consumers’ perception of recovery. • When appropriate, facilitating the use of positive religious coping through partnerships with local religious communities may benefit some consumers as engagement in positive religious coping was associated with greater life framework. • Present Study • Examined the relative contributions of perceived losses due to mental illness, duration of use of specific services, and use of positive and negative religious coping strategies in accounting for variance in self-reported perceptions of recovery and meaning in life. • Hypotheses: • Perceived losses due to SMI are negatively related to perceived recovery and meaning in life. • Length of time receiving mental health services and positive religious coping are positively related to perceived recovery and meaning in life after controlling for perceived losses. • Negative religious coping is negatively related to recovery and meaning in life. • Receipt of mental health services and positive religious coping moderate the relationships of perceived losses due to mental illness with perceptions of recovery and meaning in life. † - p < .10; * - p < .05; ** - p <.01; *** - p < .001 References Anthony, W. 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Measurement and Evaluation in Counseling and Development, 40, 97-109. • Method • Sample • 89 adults having an Axis I diagnosis of Schizophrenia, Bipolar Disorder, or Major Depressive Disorder • Gender - 50.6 % males, 49.4% females • Age - M = 48.02 years (SD = 10.57) • Ethnicity - 78.7% Caucasian; 18% African-American; 3.3% Other • Procedure • Adults coping with SMI recruited through community based mental health agencies • Case managers or staff with direct consumer contact nominated eligible participants • Consumers who consented to participate completed paper-pencil copy of the survey