Profiles in Canadian Literature 7: Volume 7: 007
Schmitt Hall G Office Phone: Multiculturalism and Race in Contemporary Fr. Defended in June African, Caribean and French Cinema. Some students attended this event. April , , in association with the Institute for the Humanities. About speakers over three days. With many other colleagues from MSU, we helped these students with the registration process choice of courses and registration.
Thought, Ideology and Relevance. Submitted to Brill Academic Publishers. An Alternative Account of African History. Published by Africa World Press. An Alternative Account of African History during the summer of Africa World Press, To be published by the Pan African Institute. Forthcoming in the first quarter of From Humanitarianism to a Strategic View.
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British Travellers in Tunisia A History of Encounters and Representations. Centre de Publication Universitaire, Volume 3 Fall Africa World Press Edited by Daniel M. White Eyes, Dark Reflections". Deconstructing the Past in Order to Reconstruct the Future. Edited By Adel Manai. Edited by Vicki Carstens and Frederick Parkinson. Volume 7, Issue 2 Spring Francophonia in Black and White". Transculture 1, 2 Towards a New Understanding of the African Experience.
Eurocentric Aryanism, Afrocentricity and the African Experience. Using data from that study, the present paper is distinct by virtue of its different analytical strategy person-oriented analysis and its consideration of an array of variables e. Thirteen community organizations in Quebec Canada and France were asked to send an email invitation to members of their mailing list and to advertise the study on their website. An invitation was also published in a Montreal Canada free newspaper.
The invitation included a URL link for participants to complete the study online. After reading and consenting to an online consent form, participants answered self-reported preliminary questions to verify their eligibility. Pregnant women or those who had given birth in the previous year were excluded, given that the recovery process is different in these situations Hendrick et al.
To prevent symptom exacerbation due to filling out the questionnaire, people scoring high on symptom measures see Section Recovery Indicators were excluded and presented with a list of available help resources. The same list was presented to all participants after questionnaire completion. The questionnaire was filled out on a secured online survey platform. The final sample was composed of participants. The majority of participants reported having been diagnosed with a depressive disorder In terms of comorbidity, around one-quarter Based on the scores on the depression severity measure see Section Recovery Indicators; Kroenke and Spitzer, , at the time of the study, Based on the scores on the anxiety severity measure Spitzer et al.
The vast majority reported they had been undergoing pharmacotherapy Participants were mostly female Most reported being from Canada or having immigrated there The sample was very educated: The remaining participants either had a vocational 9. About half the participants were married or had a life partner As explained below Section Background Characteristics , low-income status was calculated only for those from Canada; nearly one-quarter The questionnaire included the validated French version of the following instruments. Self-management was measured using the MHSQ developed as part of the larger study see Table 5 for the complete item list.
Items were created on the basis of qualitative interviews Villaggi et al. As reported in the validation paper Coulombe et al. For each item, participants were asked to indicate to what extent they had used the strategy during the two previous months, on a scale from 0 Never to 4 Very often. Each subscale had adequate internal consistency: Three recovery indicators were included, two measuring recovery from the clinical perspective symptom severity and one from the personal perspective positive mental health. The PHQ-9 requires participants to rate to what extent they had experienced nine symptoms e.
According to a systematic review Kroenke et al. Both scales had adequate internal consistency in the current study: Participants were required to answer on a 6-point frequency scale: The questionnaire also included a sociodemographic form including age, gender, education level, marital status, number of people in the household, and household income. Using the last two variables, each participant's status as living or not in a low-income household was determined based on the national cut-off depending on household size Statistics Canada, For comparability purposes, only participants from Canada, who made up the vast majority of the sample, were included in the analysis pertaining to low income.
Assessment of participants' personal goal appraisal was based on the Personal Project System Rating Scale PSRS; Little, ; Pychyl and Little, ; Chambers, , which was translated into French and adapted for the purposes of the present study. Participants were asked to appraise their goal system presented as their current goals, activities, commitments, and projects considered on the whole on a scale from 1 Not significant for me to 10 Very significant for me along six dimensions: Social participation was measured with the Social Participation Scale Richard et al.
The scale assessed to what extent participants had taken part in 10 social activities e. The 12 items were developed for patients living with physical illness, but are also pertinent in a mental health context. The scale measures knowledge and competence with regard to management of the disorder, such as understanding what needs to be done to address one's symptoms, being able to take one's medication if applicable , etc. Answers were given on a 6-point Likert scale, from 0 Not at all to 5 Completely. Use of coping strategies was measured with the Brief COPE Carver, ; Muller and Spitz, , in which participants indicated to what extent they had used 28 strategies to deal with the stress associated with their mental health problem, on a 4-point scale: Instead of using the instrument's 14 original subscales, four coping subscales were created to reduce the number of variables in the analysis, following the procedure used by Desbiens and Fillion As a preliminary analysis, bivariate correlations were examined between the main study variables.
To ensure the analysis did not converge on a local solution, the estimation process aimed to replicate the solution, using sets of random starts and iterations, and retaining the best sets of starting values for final stage optimization 4 , following Morin's recommendation Models with increasing numbers of profiles were compared using a variety of statistical criteria.
Finally, although entropy which varies from 0 to 1 cannot be used to identify the optimal number of latent profiles in the data, it provides useful information regarding the accuracy of the participants' classification into the various latent profiles, with higher levels being indicative of less classification error Tein et al. Once the number of profiles was selected, each profile's standardized means on the self-management subscales and recovery indicators were graphed and compared with the overall sample mean.
Introduction of variables using such a command does not have an impact on the nature of the profiles Morin et al. It recognizes classification uncertainty, and thus each participant is correctly considered as having a degree of probability of being a member of every profile Bolck et al. For pragmatic purposes, as an additional analysis that could facilitate interpretation for practitioners, we performed an analysis in which participants were classified into only one of the profiles based on their Most Likely Latent Profile Membership.
Each self-management subscale and recovery indicator was dichotomized into high and low scores, using the documented clinical cut-off when available for symptom severity or, when not available, by splitting the variable at the nearest score above the overall mean. The distributions of high vs. Despite the fact that this involves a certain loss of information compared to the auxiliary command, this supplementary analysis is particularly informative for transposing our results to clinical settings, in which practitioners will find useful to have a clear portrait of clients that would be assigned to each profile.
To achieve the second objective part a , scores on individual items of the self-management questionnaire were compared across profiles. This tested equality of means across profiles for each self-management strategy. The DCAT command provides a between-profile comparison of the estimated probability of each characteristic. As shown in this table, only a small proportion of missing values were observed for these variables between 0. The same was found for background characteristics between 0. For deriving the latent profiles, which was the analysis at the core of the study, models were estimated in Mplus using a full information maximum likelihood FIML algorithm.
This estimation method does not require deletion of cases with missing data but instead uses the information available from all the participants Schlomer et al. This algorithm has proved to be the most robust approach for dealing with missing values without deleting cases Newman, For the analysis performed in SPSS, deletion of cases with missing values was used. Total sample size varies between and due to missing data on some variables.
With regard to the recovery indicators, positive mental health had a negative relationship with both depression and anxiety symptom severity. Supporting the discriminant validity of the measures, the confidence interval of the correlation coefficients of positive mental health with depression and anxiety symptom severity did not include 1 Cheng, The same observation applied for depression and anxiety symptom severity, which were positively related, but the confidence interval also did not include 1. As for the association between self-management strategies and recovery indicators, clinical strategies were positively related to depression and anxiety symptom severity, but not to positive mental health.
Empowerment and vitality strategies were both negatively associated with depression and anxiety symptom severity and positively associated with positive mental health. LPA was performed using clinical, empowerment, and vitality self-management strategies, as well as depression severity, anxiety severity, and positive mental health as recovery indicators. The analysis was performed multiple times, each time increasing the requested number of profiles. P -value of the BLRT test suggested that adding profiles was necessary up to seven profiles.
A graphical examination elbow plot, Morin, of the evolution of these indicators showed that the slope flattened after four profiles with only minimal decrease with more profiles subsequently.
Given this pattern of indices, the three-profile and four-profile models were both examined. Three profiles from these two models showed a very similar pattern in terms of self-management and recovery indicators. The only difference was the fourth profile of the four-profile model. This profile did not add substantive meaning i. For the sake of parsimony and because of its greater theoretical conformity, the three-profile model was thus selected as the final one.
The entropy value was high. Based on the overall pattern of these results, a summary label inspired by Keyes and Lopez's classification was assigned to each profile, which admittedly could not fully convey, in just a few words, the recovery dynamics underlying each profile.
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Comparison of the latent profiles on the profile variables continuous and their dichotomized version. Total sample size varies between and due to missing data on some of the variables. The first profile—those who were Floundering , yet trying to manage their symptoms—included 52 participants These had moderately severe depression and anxiety symptoms, as well as the lowest level of positive mental health among the three profiles. More than half scored over the clinical cut-off for moderate depression and anxiety symptoms, and only one participant had a high level of positive mental health.
Their use of self-management strategies was overall low to moderate, and empowerment and vitality strategies were used significantly less often than in the other profiles. The second profile— Struggling , but fully engaged—was comprised of 14 participants 9. Their use of vitality strategies was more than one SD above the overall sample mean. All participants in this profile scored above the clinical cut-off for depression symptom severity.
They also reported a higher level of anxiety symptoms compared to the overall sample more than one SD above the mean. Despite this pattern of symptoms similar to the Floundering profile, participants from the Struggling profile reported experiencing a higher positive mental health level. Profiles were compared regarding use of the 18 specific self-management strategies measured in the questionnaire.
The remaining clinical strategies looking for available help resources, consulting a professional, and being actively involved in one's follow-up with professionals were used more frequently, between often and very often , by people in the Struggling profile as compared to the two other profiles.
Overall, empowerment strategies were used between very rarely or sometimes by people in the Floundering profile. In contrast, as a general pattern, participants in the Struggling and Flourishing profiles used these strategies between sometimes and often. These two profiles used the following empowerment strategies more frequently, compared to Floundering participants: Finally, participants in the Struggling profile used all the vitality strategies more frequently overall between often and very often than those in the other profiles: Comparisons of latent profiles on the frequency of use of self-management strategies.
Items were presented to participants in French. The English version above was produced using a back-translation approach Vallerand, Total sample size varies between and due to missing data on some of the items. Probability of self-reporting a depression diagnosis was higher for the Floundering or Struggling profiles than for the Flourishing profile. Probability of self-reporting an anxiety disorder diagnosis was higher for the Floundering profile than for the Flourishing profile.
Probability of self-reporting a bipolar disorder diagnosis was higher for the Flourishing profile than for the Floundering profile. Being currently involved in psychotherapy was more likely for the Struggling profile than for the two other profiles. Probability of being a man was higher in the Floundering profile than the other two profiles. Probability of living in a low-income household or probability of being single were higher for the Floundering profile than for the Flourishing profile.
Associations between participants' background characteristics and latent profiles. For the low-income variable, only participants from Canada were included, given that this variable was created only for this subgroup. Thus, probabilities were calculated on available data total sample size varies between and depending on the characteristic considered. They also reported having more developed self-care abilities and using more adaptive coping behavioral and cognitive to deal with the stress associated with their mental health problem. This is consistent with these people's higher levels of positive mental health and engagement in self-management strategies.
Also converging with the fact that the highest level of self-management was found in the Struggling profile, this profile had among the highest scores for all coping types. Interestingly, the Struggling and the Floundering profiles scored as high for avoidance coping. Their scores indicated a relatively low frequency of this type of coping, but nevertheless higher than in the Flourishing profile. This shared aspect of the Floundering and Struggling profiles, in terms of the use of this maladaptive coping style, is consistent with the fact that both profiles presented more severe symptoms.
Total sample size varies between and due to missing data on a criterion variable. In line with the shift of mental health services toward a person-centered approach Corrigan, , the present study explored for the first time individual recovery profiles. The results suggest three such profiles underlying the engagement of people with mental disorders in their recovery.
Their pattern of associations with criterion variables personal goal appraisal, social participation, self-care abilities, coping was consistent with previous theoretical and empirical work on factors that form the foundation of successful self-management and mental health recovery. In keeping with the description of these profiles in terms of recovery indicators and self-management strategies, the Floundering profile presented the most unfavorable portrait on the criterion variables, while the Flourishing profile presented the most favorable portrait, and the in-between Struggling profile presented a mostly favorable, yet mixed portrait.
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Although traditional variable-oriented analytical strategies are useful for seeing the big picture of how specific variables relate to each other at the group level, they are insufficient to inform health professionals working from a person-centered perspective Cloninger, In contrast, there is a natural fit between the person-centered philosophy of care and person-oriented statistical analysis, because both recognize the person as more than the sum of parts Laursen, Nevertheless, person-oriented analysis is still rarely used even to study topics closely related to person-centered care, such as people's engagement in self-management and recovery.
Our study illustrates that person-oriented analysis can provide insightful results with the potential to stimulate reflection. By definition, from a traditional variable-oriented perspective, positive associations would have been expected between self-management and recovery. By extension, it would have been expected that those who were more engaged in strategies to reduce their symptoms clinical self-management , trying more actively to gain control by harnessing their positive sense of self empowerment self-management , and adopting a healthier and active lifestyle vitality self-management would have had less severe symptoms as well as higher levels of positive mental health.
Of the three identified profiles, the Floundering and Flourishing profiles were overall in line with this reasoning. Participants in the Floundering profile used empowerment and vitality self-management strategies less frequently than did those who were Flourishing. As a corollary, people in the former profile scored more negatively on recovery indicators than did those in the latter profile.
In that same vein, a surprising result was seen in the Struggling profile, where respondents reported high self-management co-existing with moderately severe symptoms. People in this profile were the most activated and were involved in a diverse combination of frequently used clinical, empowerment, and vitality self-management strategies. They were also more likely to be currently involved in psychotherapy, potentially indicating or resulting from their higher engagement see review from Kreyenbuhl et al.
Their symptoms were among the most severe observed across the different profiles, suggesting that a high level of engagement, even in clinical strategies specifically targeting symptoms, is not necessarily associated with reduced symptomatology. Indeed, these participants had on average the most severe anxiety levels and used avoidance coping strategies i. Even though Struggling participants' score on the use of such maladaptive coping strategies was low, it was nevertheless similar to levels observed in studies with other clinical samples Meyer, ; Nazir and Mohsin, One of those studies Meyer, suggested that the use of maladaptive coping is associated with higher symptom severity.
A review of the literature supports the notion that avoidance coping could be associated with relapse, recurrence, and greater time to recovery in mood disorders Christensen and Kessing, Over the long term, use of avoidance coping has been shown to generate stress, which can increase symptoms Holahan et al. It is also possible that Struggling participants' focus on working through their symptoms elevated their stress level. This would be consistent with literature suggesting that, as part of the health engagement process, people with chronic diseases tend to experience a phase of arousal in which they are hyper-attentive to their symptoms yet are still unable to cope adequately, causing them anxiety Barello et al.
Taking part in a psychotherapeutic process can also be demanding for a person, especially when using stressful procedures such as exposure Wills, The burden associated with self-management can also cause stress Sav et al. Likewise, our cross-sectional results may suggest that actively seeking to get better and wanting to do the best for one's health might put additional stress on people with mood and anxiety disorder, at least temporarily or in the short term.
An alternative interpretation is that participants in the Struggling profile engaged in self-management to deal with their residual symptoms. The literature on depression the diagnosis most reported in this profile is clear on the fact that, even when responding successfully to pharmacotherapy or psychotherapy, a significant proportion of people still have to contend with incapacitating residual symptoms see review from Fava et al. Anxiety is one of the most common residual symptoms in depression disorders Fava et al. From that standpoint, it is possible that Struggling participants' symptoms notably their relatively high anxiety did not result from their active self-management, but rather were the very reason why they actively engaged in self-management.
These participants' attempts to deal with stressful residual symptoms may also explain their involvement in a diversity of coping strategies, as shown by their elevated coping scores, even on apparently contradictory subscales e. As put forward by Folkman and Lazarus , a person may seek and try several, sometimes opposite, ways of dealing with a stressful situation. While persons in this profile may not be reaping the benefits of their coping and self-management efforts in the moment, they might experience less severe symptoms over the longer term.
Longitudinal studies exploring how symptom severity and self-management relate to each other over time are needed to verify this. Provencher and Keyes's Complete Mental Health Recovery model , , was developed on the idea that symptom severity and positive mental health are two distinct dimensions and that their intersections form six states of recovery. This proposition was based on studies in which participants from the general population were artificially classified into different profiles corresponding to these six states Keyes, , Our results based on an inductive method of classification LPA confirm the existence of some of these profiles, thereby providing general supporting evidence for their model.
The Flourishing profile found in the present study resembles the state described by Provencher and Keyes , , in which the person is recovered in terms of symptom severity and shows a moderately high level of positive mental health. Similarly, the Floundering profile mirrors their description of the opposite state non-recovered from the mental illness and low positive mental health. Finally, the Struggling profile echoes Provencher and Keyes' , , state of non-recovery from symptoms concomitant with a moderate level of positive mental health.
Although our participants were not numerous in this profile, its existence is supported by the model's adequate fit and the satisfactory classification probabilities. The existence of this profile is essential because it demonstrates the foundational idea that people with important mental health symptoms can nevertheless experience frequent manifestations of well-being that help make their life worth living, as positive psychologists would say Seligman et al.
Three others states e. However, it is possible that, with a larger sample size, probabilities of observing these would have been augmented. Even in the large general population studies cited above Keyes, , , such states have been shown to be among the least frequent. Beyond providing confirmation, the present study complements the Complete Mental Health Recovery model by explicitly incorporating self-management strategies. Provencher and Keyes recognized people's active role in their recovery and gave examples of strategies that could promote the process.
The present study expands on this by providing unprecedented empirical data on the level of self-management engagement shown by people in different profiles of recovery. It also reveals specific self-management strategies that people in each profile tend to combine. The level of engagement in almost all self-management strategies was lowest for participants in the Floundering profile. Although time since onset of their disorder was not collected, this profile relates to the description of people who are in the beginning of the recovery process Provencher and Keyes, Taking their medication as prescribed was the only self-management strategy that participants from this profile implemented on a regular basis, which seems consistent with the dependence on external support that distinguishes this beginning stage Andresen et al.
People in the Struggling profile had the highest level of self-management. Their combination of self-reported strategies was characterized by regular use of help-seeking strategies e. They also were keeping themselves physically active and healthy by maintaining a good diet and engaging in sports and relaxation exercises. Among other strategies, they were trying to solve their problems one step at a time and to focus on the present moment.
These self-management strategies evoke lifestyles changes, behavioral activation, problem resolution, and mindfulness activities that are suggested or recommended in clinical guidelines e. Participants in this profile may have been encouraged to use such strategies by a psychotherapist or other health professional they consulted. In those stages the individual struggles with the illness but, at some turning point, manages to move into action Davidson and Strauss, ; Spaniol and Wewiorski, As for those in the Flourishing profile, their moderately high self-management scores suggested that, although well on the way to full recovery, they were still very engaged in getting better.
Even though taking their medication as prescribed and recognizing relapse signs were important for them, in all likelihood their main focus was not on managing the disorder for itself, but rather for the benefit of optimizing their overall well-being. Provencher and Keyes , p. Guidelines for person-centered health services emphasize the importance of culturally sensitive assessment and intervention practices Adams et al.
The present study revealed several background characteristics associated with each profile. Most notably, the least favorable profile Floundering was characterized by an array of clinical self-reported depressive or anxiety disorder and sociodemographic variables male gender, low income, and singlehood. In contrast, the most favorable profile Flourishin g was characterized by a different clinical background self-reported bipolar disorder , as well as the opposite sociodemographic variables being a female, having sufficient income, and having a life partner.
These variables may represent risk and protective factors for practitioners to consider in their holistic comprehension of their clients' situation. Consistent with a previous study Vermeulen-Smit et al. Also of particular interest was the association of the Floundering profile with social variables gender, singlehood, low income , in line with several previous studies in the wider mental health field. For example, several studies have shown singlehood to be related to higher prevalence of depression and anxiety see Martins et al.
In a recent study of people with a depressive disorder, single marital status at baseline predicted non-recovery in terms of depressive symptoms 11 years later Markkula et al. This relation could be due to multiple reasons, such as the fact that economic, psychological, and social resources are less accessible to single people see reviews from Robards et al.
Economic disadvantage is also associated with higher prevalence of depression and anxiety disorders see Martins et al. It has been suggested that psychosocial resources helpful for coping effectively with life stressors, such as personal control and social support, may be less available to disadvantaged people Taylor and Seeman, People with low incomes are also more likely to face financial barriers to obtaining mental health services Sareen et al.
Concerning gender, although anxiety and mood disorders prevalence rates are generally higher in women than in men Faravelli et al. Overall results from the present study expand these previous findings by pointing out potential social inequalities in terms of chances of recovery from mood and anxiety disorders. From a person-centered care perspective, people's idiosyncratic recovery profiles in terms of self-management strategies and recovery indicators should be considered by professionals who intervene with them. Traditional self-management support interventions usually focus on symptom reduction e.
Our findings confirmed that people use different combinations of self-management strategies, focusing not only on symptoms, but also on promoting their overall positive mental health. Thus, health professionals should consider the whole diversity of self-management behaviors implemented by their clients.
Through a comprehensive investigation, professionals can seize opportunities to build clients' confidence by offering sincere praise for their self-management actions, even small ones, in line with solution-focused principles Winbolt, The low frequency of self-management strategies observed in the Floundering profile might warrant discussions with clients in such a profile to identify potential emotional e. Health engagement in the context of chronic illness is intertwined with emotional and cognitive processes Graffigna and Barello, ; Graffigna et al.
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If done appropriately and respecting the individual's wishes, working through these barriers together could help set the client on a path of increased engagement in self-management, and ultimately into the Flourishing profile. Discussing this scale's results in the clinical encounter can be useful to stimulate person-centered communication between practitioner and client Graffigna et al.
Such a client—practitioner partnership could facilitate engagement in self-management Trivedi et al. Results from the Struggling profile highlight a possibility that anxiety can arise, at least temporarily, from engaging deeply in self-management. Although the level of self-management was not sufficiently high to be deemed excessive in itself in the present study, the existence of this profile raises a yellow flag.
In self-management, as in other domains of life, it is possible that excessiveness causes stress and leads to negative outcomes Witkin, While being respectful of clients' engagement, professionals could personalize follow-ups to support people in achieving the delicate balance between actively managing their illness and pursuing other life activities and goals without undue stress.
Our findings suggest that additional efforts should be expended to ensure that mental health services effectively reach and support men, single persons, and those with low incomes in their self-management and recovery. Examples of interventions from the chronic illness or physical health field can be instructive for this purpose, such as self-management interventions developed for people on low income with diabetes Eakin et al.
In , the Geneva Declaration on Person- and People-centered Integrated Health Care for All was adopted, which encouraged commitment to reducing health inequalities and to making person-centered care available for all Cloninger et al. The present study is limited by its cross-sectional design. Capturing time elapsed since the onset of the disorder would have enabled a first examination of this question, but unfortunately it was not measured in this study.
Provencher and Keyes suggested that people transition from one state to another on the pathway toward complete mental health recovery. One can intuitively conceive that the Flourishing profile is more likely to be experienced later in the recovery process, while the Floundering profile is more likely to be experienced at the beginning of the process.
The Struggling profile might represent an intermediate state in which the person becomes deeply engaged in self-management, possibly paving the way toward flourishing. It might also be an end-state for some people who need to deal with residual symptoms over the long run. Such speculations illustrate a set of research questions that have yet to be explored with longitudinal designs. Although the current sample size appears to be sufficient to conduct LPA according to some suggested guidelines e.
Our sample size was modest for multivariate statistics like LPA Mueller et al. If the power was sufficient to detect meaningful differences between profiles, larger sample sizes would make it possible to verify the few associations that were only marginally significant. Online research provides valid data Gosling et al. However, future studies would benefit from using a traditional face-to-face method, allowing the use of structured clinical interviews e. Such objective symptom assessment could help rule out alternative interpretations for the findings.
In the present study, it is possible that people in the Struggling profile, being focused on getting better through self-management and psychotherapy, were more conscious of their symptoms and thus biased toward giving higher scores to self-reported severity measures such as the PHQ-9 and GAD Beyond background characteristics, several other variables possibly related to profiles warrant examination. Notably, while self-management refers mainly to the actions involved in taking care of one's health, other cognitive e. Also, the study did not examine health professionals' e.
Mood and anxiety disorders figure among the 20 leading causes of disability worldwide Institute for Health Metrics and Evaluation, At the heart of person-centered approaches in mental health services Davidson et al. Yet systematic research-based evidence on self-management and recovery from these disorders is scarce.
The present study represents a first thorough quantitative examination of recovery, combining self-management strategies used and recovery indicators. Although the results need to be replicated, the person-oriented analyses conducted in this study yielded insights for practitioners interested in developing services that are personalized to clients' unique profiles and backgrounds. The list of profiles identified in the study is in no way definitive. Thus, we advise practitioners not to strive to classify their clients into these exact profiles.
Rather, we hope the individualized person-centered approach developed in this study can encourage them to adapt their services to their clients' own profiles. At the theoretical levels, this study integrated notions from different domains of research and interventions, such as the chronic illness, mental health, positive psychology, and patient-centered care literature.
We hope the findings will stimulate reflection on how an integrative theoretical framework and innovative methods can provide original empirical information on people's health engagement and how it supports their health and well-being.
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SC developed the research design, coordinated data collection, performed the statistical analyses, and wrote the manuscript as part of his Ph. SR contributed to the design of the study and critically reviewed the paper several times. SM conducted the qualitative interviews that served as the basis for the validated self-management questionnaire, enriching the manuscript with her experience.
HP took part in planning the study as a co-investigator of the larger research project.
Her knowledge as a recovery expert was useful in improving the manuscript. CH is a co-investigator of the larger research project and took part in planning the study. Her expertise on self-management helped improve the manuscript. PR took part in planning the study as a co-investigator of the larger research project.
As an expert in mental health services, she critically reviewed the manuscript. MP is a co-investigator in the larger research project and contributed to its planning. His contribution to the study concerned the evaluation of symptom severity. JH is the principal investigator of the larger research project of which the present study is a part.
As SC's thesis advisor, JH closely supervised all research stages and critically reviewed the paper. The authors have approved the article and agree to be accountable for all aspects of the work. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewers, ES and SB, and handling Editor declared their shared affiliation, and the handling Editor states that the process nevertheless met the standards of a fair and objective review.
We wish to thank the participants for the time invested in the study. We are also grateful to the advisory committee and recovery experts who contributed to the design of the study and the questionnaire: However, in the case of mood and anxiety disorders, the focus of the present article, inclusion of such a measure is not mandatory e. Furthermore, a task force Rush et al. For this reason, the level of functional impairment is not taken into account as a recovery indicator in the present article. We also tested models in which variance was freely estimated Morin et al. However, these models were not retained given that their solutions failed to be sufficiently replicated or that they converged on improper solutions negative variance.
These problems suggest that more parsimonious models in which variance is constrained to be equal across profiles were more appropriate Morin et al. National Center for Biotechnology Information , U. Journal List Front Psychol v. Published online Apr Provencher , 4 and Janie Houle 1, 5. Author information Article notes Copyright and License information Disclaimer. This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology.
Received Jan 13; Accepted Apr 8. The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
This article has been cited by other articles in PMC. Introduction Contemporary mental health services are more person-centered 1 than they used to be Mechanic, Recovery from mood and anxiety disorders Mood and anxiety disorders are among the most prevalent mental disorders in the world Kessler et al. Self-management in mental health recovery Exploring recovery from a person-centered perspective necessitates considering what people actually do in their pathway toward recovery.
Objectives The aim of this study was to explore person-centered recovery profiles presented by individuals who reported having received a diagnosis of mood and anxiety disorders. Recruitment Thirteen community organizations in Quebec Canada and France were asked to send an email invitation to members of their mailing list and to advertise the study on their website. Participants The final sample was composed of participants. Measures The questionnaire included the validated French version of the following instruments.
Self-management Self-management was measured using the MHSQ developed as part of the larger study see Table 5 for the complete item list. Recovery indicators Three recovery indicators were included, two measuring recovery from the clinical perspective symptom severity and one from the personal perspective positive mental health. Criterion variables Assessment of participants' personal goal appraisal was based on the Personal Project System Rating Scale PSRS; Little, ; Pychyl and Little, ; Chambers, , which was translated into French and adapted for the purposes of the present study.
Analysis As a preliminary analysis, bivariate correlations were examined between the main study variables. Clinical self-management — 2. Depression symptom severity 0. Anxiety symptom severity 0.
Open in a separate window. Identifying the number of latent profiles and drawing their general portrait LPA was performed using clinical, empowerment, and vitality self-management strategies, as well as depression severity, anxiety severity, and positive mental health as recovery indicators. Table 4 Comparison of the latent profiles on the profile variables continuous and their dichotomized version. Describing the specific self-management strategies used in each profile Profiles were compared regarding use of the 18 specific self-management strategies measured in the questionnaire.
Table 5 Comparisons of latent profiles on the frequency of use of self-management strategies. I take medication for my mental health problem as directed by a healthcare professional. Table 6 Associations between participants' background characteristics and latent profiles. Low income yes vs. Table 7 Comparisons of latent profiles on criterion variables. Criterion variables Floundering M S. Discussion In line with the shift of mental health services toward a person-centered approach Corrigan, , the present study explored for the first time individual recovery profiles.
Understanding self-management differently Although traditional variable-oriented analytical strategies are useful for seeing the big picture of how specific variables relate to each other at the group level, they are insufficient to inform health professionals working from a person-centered perspective Cloninger, Supporting and expanding the complete mental health recovery model Provencher and Keyes's Complete Mental Health Recovery model , , was developed on the idea that symptom severity and positive mental health are two distinct dimensions and that their intersections form six states of recovery.
Bringing background characteristics and recovery inequalities to the foreground Guidelines for person-centered health services emphasize the importance of culturally sensitive assessment and intervention practices Adams et al.
Implications for patient-centered interventions From a person-centered care perspective, people's idiosyncratic recovery profiles in terms of self-management strategies and recovery indicators should be considered by professionals who intervene with them. Limitations and future research The present study is limited by its cross-sectional design. Conclusion Mood and anxiety disorders figure among the 20 leading causes of disability worldwide Institute for Health Metrics and Evaluation, Author contributions SC developed the research design, coordinated data collection, performed the statistical analyses, and wrote the manuscript as part of his Ph.
Conflict of interest statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Acknowledgments We wish to thank the participants for the time invested in the study. Footnotes 1 As described by Davidson et al. A focus on Communities. The altman self-rating mania scale. Psychiatry 42 , — Stages of recovery instrument: Development of a measure of recovery from serious mental illness.
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