Skip to main content
SpringerLink
Log in

Family involvement moderates the relationship between perceived recovery orientation of services and personal narratives among Chinese with schizophrenia in Hong Kong: a 1-year longitudinal investigation

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Family has been found to have an influential role on clinical and recovery outcomes of people with schizophrenia. While recovery-oriented services can facilitate service users to develop a rich and positive identity, it is unclear how different levels of family involvement may interact with recovery-oriented services in affecting personal recovery. The present study aimed to examine how family involvement moderates the relationship between perceived recovery-orientation of services and personal narratives of Chinese people in Hong Kong who had recent onset of schizophrenia spectrum disorder longitudinally.

Method

Multi-method approach (semi-structured interview, researcher ratings, self-report measures) was adopted. 167 participants completed assessments at baseline; 93 and 68 of them were retained at 6-month and 12-month follow-up assessment, respectively.

Results

Baseline perceived recovery orientation of services significantly predicted richer personal narratives at 6-month follow-up when baseline family involvement was optimal (B = 0.26, p = 0.03, 95% CI [0.02–0.48]). As to 12-month assessment, baseline perceived recovery orientation of services significantly predicted poorer personal narratives when family was perceived as under-involved at baseline (B = − 0.45, p = 0.02, 95% CI [− 0.88 to − 0.07]).

Conclusion

Without proper family involvement, recovery-oriented services could be ineffectual in facilitating the development of rich personal narratives for Chinese people in Hong Kong.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

Data and material regarding the present study will be shared upon request.

References

  1. Wunderink L, Sytema S, Nienhuis FJ (2009) Clinical recovery in first-episode psychosis. Schizophr Bull 35(2):362–369

    PubMed  Google Scholar 

  2. Andreasen NC, Carpenter WT, Kane JM, Lasser RA, Marder SR, Weinberger DR (2005) Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 162(3):441–449

    PubMed  Google Scholar 

  3. Anthony WA (1990s) Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosoc Rehabil J 16(4):11–23

    Google Scholar 

  4. Leamy M, Bird V, Boutillier CL, Williams J, Slade M (2011) Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry 199(6):445–452

    PubMed  Google Scholar 

  5. Leonhardt BL, Huling K, Hamm JA, David R, Hasson-Ohayon I, McLeod HJ, Lysaker PH (2017) Recovery and serious mental illness: a review of current clinical and research paradigms and future. Expert Rev Neurother 17(11):1117–1130

    CAS  PubMed  Google Scholar 

  6. Lysaker PH, Ringer J, Maxwell C, Mcguire A, Lecomte T (2010) Personal narratives and recovery from schizophrenia. Schizophr Res 121(1–3):271–276

    PubMed  Google Scholar 

  7. Lysaker PH, Roe D, Yanos PT (2006) Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull 33(1):192–199

    PubMed  PubMed Central  Google Scholar 

  8. Chan RCH, Mak WWS, Chio FHN, Tong ACY (2017) Flourishing with psychosis: a prospective examination on the interactions between clinical, functional, and personal recovery processes on well-being among individuals with schizophrenia spectrum disorders. Schizophr Bull 44(4):778–786

    PubMed Central  Google Scholar 

  9. Lysaker PH, Roe D, Buck KD (2010) Recovery and wellness amidst schizophrenia: definitions, evidence, and the implications for clinical practice. J Am Psychiatr Nurses Assoc 16(1):36–42

    PubMed  Google Scholar 

  10. Farkas M, Gagne C, Anthony W, Chamberlin J (2005) Implementing recovery oriented evidence based programs: identifying the critical dimensions. Community Ment Health J 41(2):141–158

    PubMed  Google Scholar 

  11. Slade M, Amering M, Farkas M et al (2014) Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry 13(1):12–20

    PubMed  PubMed Central  Google Scholar 

  12. Leamy M, Clarke E, Boutillier CL et al (2016) Recovery practice in community mental health teams: national survey. Br J Psychiatry 209(4):340–346

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Ye S, Pan J-Y, Wong DFK, Bola JR (2013) Cross-validation of mental health recovery measures in a Hong Kong Chinese sample. Res Soc Work Pract 23(3):311–325

    Google Scholar 

  14. Davidson L, Tondora J, Oconnell MJ, Kirk T, Rockholz P, Evans AC (2007) Creating a recovery-oriented system of behavioral health care: moving from concept to reality. Psychiatr Rehabil J 31(1):23–31

    PubMed  Google Scholar 

  15. Ochocka J, Nelson G, Janzen R (2005) Moving forward: negotiating self and external circumstances in recovery. Psychiatr Rehabil J 28(4):315–322

    PubMed  Google Scholar 

  16. Pernice-Duca F, Onaga E (2009) Examining the contribution of social network support to the recovery process among clubhouse members. Am J Psychiatr Rehabil 12(1):1–30

    Google Scholar 

  17. Bedford O, Hwang K-K (2003) Guilt and shame in Chinese culture: a cross-cultural framework from the perspective of morality and identity. J Theory Soc Behav 33(2):127–144

    Google Scholar 

  18. Corrigan PW, Phelan SM (2004) Social support and recovery in people with serious mental illnesses. Community Ment Health J 40(6):513–523

    PubMed  Google Scholar 

  19. Kelly M, Gamble C (2005) Exploring the concept of recovery in schizophrenia. Psychiatr Ment Health Nurs 12(2):245–251

    CAS  Google Scholar 

  20. Hsiao C-Y, Lu H-L, Tsai Y-F (2017) Effect of family sense of coherence on internalized stigma and health-related quality of life among individuals with schizophrenia. Int J Ment Health Nurs 27(1):138–146

    PubMed  Google Scholar 

  21. Jewell TC, Downing D, Mcfarlane WR (2009) Partnering with families: multiple family group psychoeducation for schizophrenia. J Clin Psychol 65(8):868–878

    PubMed  Google Scholar 

  22. Mcfarlane W (2016) Family interventions for schizophrenia and the psychoses: a review. Fam Process 55(3):460–482

    PubMed  Google Scholar 

  23. Lloyd C, Deane FP, Tse S, Waghorn G (2009) Supporting recovery orientated services for people with severe mental illness. Aust J Rehabil Couns 15(1):1–11

    Google Scholar 

  24. Chien WT, Wong K-F (2007) A family psychoeducation group program for Chinese people with schizophrenia in Hong Kong. Psychiatr Serv 58(7):1003–1006

    PubMed  Google Scholar 

  25. Aldersey HM, Whitley R (2015) Family influence in recovery from severe mental illness. Community Ment Health J 51(4):467–476

    PubMed  Google Scholar 

  26. Hwang W-C, Chun C-A, Kurasaki K, Mak W, Takeuchi DT (2000) Factor validity of scores on a social support and conflict measure among Chinese Americans. Educ Psychol Meas 60(5):808–816

    Google Scholar 

  27. Tse S, Ng RMK (2014) Applying a mental health recovery approach for people from diverse backgrounds: the case of collectivism and individualism paradigms. J Psychosoc Rehabil Ment Health 1(1):7–13

    Google Scholar 

  28. Venkatasubramanian G, Amaresha A (2012) Expressed emotion in schizophrenia: an overview. Indian J Psychol Med 34(1):12

    PubMed  PubMed Central  Google Scholar 

  29. Chien W-T, Yeung FKK, Chan AHL (2012) Perceived stigma of patients with severe mental illness in Hong Kong: relationships with patients’ psychosocial conditions and attitudes of family caregivers and health professionals. Adm Policy Ment Health Ment Health Serv Res 41(2):237–251

    Google Scholar 

  30. Mak WWS, Chen SX (2010) Illness behaviors among the Chinese. Oxford Handbooks Online, London

    Google Scholar 

  31. Hsiao F-H, Klimidis S, Minas H, Tan E-S (2006) Cultural attribution of mental health suffering in Chinese societies: the views of Chinese patients with mental illness and their caregivers. J Clin Nurs 15(8):998–1006

    PubMed  Google Scholar 

  32. Chen W-W, Wu C-W, Yeh K-H (2015) How parenting and filial piety influence happiness, parent–child relationships and quality of family life in Taiwanese adult children. J Fam Stud 22(1):80–96

    CAS  Google Scholar 

  33. Dai B, Zhang B, Li J (2012) Protective factors for subjective well-being in Chinese older adults: the roles of resources and activity. J Happiness Stud 14(4):1225–1239

    Google Scholar 

  34. Chio FH, Mak WW, Chan RC, Tong AC (2018) Unraveling the insight paradox: 1-year longitudinal study on the relationships between insight, self-stigma, and life satisfaction among people with schizophrenia spectrum disorders. Schizophr Res 197:124–130

    PubMed  Google Scholar 

  35. Lysaker PH, Clements CA, Plascak-Hallberg CD, Knipscheer SJ, Wright DE (2002) Insight and personal narratives of illness in schizophrenia. Psychiatr Interpers Biol Process 65(3):197–206

    Google Scholar 

  36. Andreasen NC (1984) Scale for the Assessment of Positive Symptoms (SAPS). The University of Iowa, Iowa City

    Google Scholar 

  37. Andreasen NC (1984) Scale for the Assessment of Negative Symptoms (SANS). The University of Iowa, Iowa City

    Google Scholar 

  38. O’connell M, Tondora J, Croog G, Evans A, Davidson L (2005) From rhetoric to routine: assessing perceptions of recovery-oriented practices in a state mental health and addiction system. Psychiatr Rehabil J 28(4):315–322

    Google Scholar 

  39. Hayes AF, Hayes AF (2018) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. The Guilford Press, New York

    Google Scholar 

  40. Lee PW, Lieh-Mak F, Wong M, Fung AS, Mak K, Lam J (1998) The 15-year outcome of Chinese patients with schizophrenia in Hong Kong. Can J Psychiatry 43(7):706–713

    CAS  PubMed  Google Scholar 

  41. Goodwin R, Costa P, Adonu J (2004) Social support and its consequences: ‘positive’ and ‘deficiency’ values and their implications for support and self-esteem. Br J Soc Psychol 43(3):465–474

    PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the following individuals for their assistance with participant recruitment: Ms. Sania Yau (New Life Psychiatric Rehabilitation Association), Dr. William Lo, Dr. Catherine Chong (Kwai Chung Hospital), Dr. Wai-Song Yeung (Pamela Youde Nethersole Eastern Hospital), Dr. Roger Ng (Kowloon Hospital), Prof. Eric Chen, Dr. Sherry Chan (Department of Psychiatry, University of Hong Kong), Dr. Edwin Pang (United Chris- tian Hospital), Mr. Dan Yu (Mental Health Association of Hong Kong), Ms. Peony Lai (Caritas Hong Kong), Dr. Keith Wong (Richmond Fellowship of Hong Kong), Ms. Dora Tam (Hong Kong Stewards), and Mr. Jacky Chan (Baptist Oi Kwan Social Service).

Funding

The present study was funded by the General Research Fund of the Research Grants Council of Hong Kong (Ref. No. 449312).

Author information

Authors and Affiliations

  1. Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong

    Ben C. L. Yu & Winnie W. S. Mak

  2. Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong

    Floria H. N. Chio

Authors
  1. Ben C. L. Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Winnie W. S. Mak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Floria H. N. Chio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Winnie W. S. Mak.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical standard statement

The present study has obtained clinical research ethics approval from the authors’ institution and hospitals’ clinical ethics committees and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, B.C.L., Mak, W.W.S. & Chio, F.H.N. Family involvement moderates the relationship between perceived recovery orientation of services and personal narratives among Chinese with schizophrenia in Hong Kong: a 1-year longitudinal investigation. Soc Psychiatry Psychiatr Epidemiol 56, 401–408 (2021). https://doi.org/10.1007/s00127-020-01935-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-020-01935-4

Keywords

Search

Navigation