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Consumer-oriented recovery among people with mental illness has been discussed for more than two decades, but few reliable and valid recovery measurements are currently available. This study used Rasch methods to assess the Mental Health Recovery Measure (MHRM). Participants were 156 adults with mental illness who lived in the community. After the...
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Background:
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Citations
... Even so, the instrument used still has items that are declared invalid. In the research of Chang et al. (2013), the invalid items need to be removed as they will damage the measurement results thereby reducing the level of accuracy of the information obtained (Fisher, 2007). However, the results of the above study indicate that the control taxonomy with invalid items still provides fairly accurate measurement information. ...
... Yuen and Austin (2014) review of instrument development papers published within the American Journal of Occupational Therapy (AJOT) between 2009 and 2013 found that 11 studies utilized Rasch analysis. However, Gutman and Raphael-Greenfield (2014) review of mental health specific research published within the AJOT during the same timeframe found that only three of the seven psychometric studies utilized Rasch analysis, with two focusing on self-report measures (Chang et al., 2013;Hancock et al., 2011). Furthermore, the AJOT was the only occupational-therapy specific journal found to have an impact within the Rasch literature as per Aryadoust et al. (2019) recent scientometric review of the Web of Science. ...
... A clear justification for the use of Rasch analysis methodology over other methodologies such as Classical Test Theory and Item Response Theory or explaining the benefits of Rasch analysis methodology for their research (Kielhofner & Forsyth, 2001) OSA (Kielhofner et al., 2009) OVal-pd (Eklund et al., 2009) Reported PRI instead OSA (Kielhofner et al., 2010) MOQ (Scanlan & Bundy, 2011) Reported PRI instead EPM-DC; (Nilsson et al., 2011) RAS (Hancock et al., 2011) Reported PRI instead EMAS (Eakman, 2012) LBI (Matuska, 2012) MHRM (Chang et al., 2013) MS-C OGQ (Eriksson et al., 2013) ASPS (Blanche et al., 2014) TSCL (Chen et al., 2015) RAS-DS (Hancock et al., 2015) CPDM (Chang et al., 2016) ATMS-S (Janesl€ att et al., 2018) sf-ADLs (Pan et al., 2018) OBQ (Håkansson et al., 2020) PROMIS (Cleanthous et al., 2019) Only results from Rasch analyses are included in this review ( was provided in nine (45%) articles. Four (20%) articles were deemed to have partially justified the use of Rasch analysis with reasons outlined in Table 2. Two (10%) articles validated measures which were validated previously using Rasch analysis and hence did not give an explicit justification for using Rasch analysis again, whereas five (25%) articles did not provide any justification for its use. ...
Introduction
Navigating the transition to university can pose occupational performance difficulties for students with mental health disabilities including those on the autism spectrum or with attention deficit hyperactivity disorder. This study aimed to refine the Trinity Student Occupational Performance Profile (TSOPP) – a self-report measure of occupational performance difficulties within the student role for students with mental health disabilities which is based on the Person-Environment-Occupation model.
Method
Data from 667 files were gathered from two Irish universities. Rasch analyses were conducted on the measure’s item-sets (i.e. Person N = 30; Environment N = 20; Occupation N = 24) and on an item-set which combined all 74 items. All item-sets were assessed for fit, rating scale functioning, dimensionality, reliability and separation indices.
Results
The TSOPP demonstrated stronger psychometric properties as a combined item-set which measures the ultimate construct of occupational performance difficulties within the student role. The 6-point scale was collapsed into a 4-point scale and 20 redundant items were removed. The item difficulty hierarchy provided empirical evidence for occupational performance difficulties in the student role.
Conclusion
The TSOPP is a valid and reliable self-report measure of occupational performance difficulties within the student role for students with mental health disabilities in higher education.
... According to SAMHSA (2005), "Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential." Consumer-oriented definitions of recovery have also had a growing influence on research, with some arguing that consumer-oriented models have the potential to better capture the complexity of the recovery process (Chang, Ailey, Heller, & Chen, 2013;Slade, Amering, & Oades, 2008). Consumer-oriented models are useful when trying to identify factors that promote recovery based on the lived experience of mental illness that extends beyond the limited scope of symptoms and disability (Leonhardt et al., 2017). ...
... Psychiatric symptoms and symptom-related impairments are not assessed by the MHRM (Corrigan, Salzer, Ralph, Sangster, & Keck, 2004;Campbell-Orde, Chamberlin, Carpenter, & Leff, 2005). Based on findings from a Rasch analysis, the 26-item version was used in place of the original 30-item MHRM (Chang et al., 2013). Prior studies have shown that that MHRM has good internal consistency Note. ...
Consumer-oriented models have conceptualized recovery in two main ways: as a multicomponent process across various life domains, and as a series of identifiable stages occurring over time. The main goal of the present study was to determine whether psychosocial factors, namely internalized stigma and personal loss, predicted a greater amount of variance in reports of consumer-oriented recovery than demographic, treatment, and illness severity characteristics. Recovery was measured as both a stage and process. Using a sample of 160 adults with serious mental illness from community settings, hierarchical regression analyses were used to examine the relative contribution of demographic characteristics (age, gender), level of enrollment in mental health services, illness severity (psychiatric symptom frequency, insight), and psychosocial factors (personal loss and internalized stigma) on stage- and process-based recovery. Results showed that, beyond demographic, treatment, and illness severity factors, internalized stigma significantly predicted the lowest stage of recovery (moratorium), while personal loss significantly predicted the highest stage of recovery (growth). Neither psychosocial factor alone significantly contributed to the prediction of process-based recovery. Findings suggest that personal loss and internalized stigma are impediments to consumer-oriented recovery, and should be considered alongside clinical measures when evaluating models of mental health recovery. Implications for future research and social policy reform are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Each item on the MHRM is rated on a 7-point Likert scale, ranging from strongly disagree to strongly agree, with higher scores pertaining to greater perceived recovery. The MHRM has been shown to be associated with measures of subjective well-being (Oliveira-Maia et al., 2016) and distress (Bullock et al., 2009), and has good psychometric properties, including internal reliability, test-rest reliability, and convergent validity (Bullock et al., 2009;Chang, Ailey, Heller, & Chen, 2013). The 15 items had high internal reliability in this sample (␣ ϭ .921). ...
Posttraumatic stress disorder (PTSD) in young individuals is associated with an increased risk to develop psychosis or mania, and both trauma and PTSD rates are elevated in people with schizophrenia and other severe mental illnesses. However, less research has examined PTSD in people who have recently developed a first episode of psychosis (FEP). The present study is a secondary analysis of the baseline data collected for the National Institute of Mental Health Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study to examine the rates of trauma and PTSD, and to explore the demographic and clinical correlates of PTSD in a representative sample of 404 persons with an FEP. Approximately 80% of the study sample reported experiencing at least one traumatic event during their lives, with females more likely to report childhood sexual abuse and spousal abuse than males. A total of 20 participants (5.0%) met criteria for a lifetime diagnosis of PTSD, while another 15 participants (3.7%) met subthreshold diagnostic criteria for PTSD. Significant correlations were found between lifetime PTSD and the Calgary Depression Scale, the Mental Health Recovery Measure, the Stigma Scale, and duration of untreated psychosis, with higher scores on each variable associated with a diagnosis of PTSD. The association between PTSD and more severe depression, as well as lower perceptions of personal recovery, suggest that PTSD may be an important target for treatment programs for persons recovering from an FEP. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... This instrument was chosen because it is one of only two self-rated measures of CBR according to the stringent definition presented above (Campbell-Orde et al., 2005;Andresen et al., 2010), i.e., it was developed according to the accounts of service-users. Furthermore, the MHRM has several versions with excellent psychometric properties (Bullock and Young, 2003;Young and Bullock, 2005;Chang et al., 2013;Armstrong et al., 2014) and has been successfully translated and validated into other languages (van Nieuwenhuizen et al., 2014). Once this instrument was validated, we proceeded to compare customer-based and service-based recovery and clarify their differential relationship with other constructs, namely needs and subjective QoL. ...
Within clinical psychiatry, recovery from severe mental illness (SMI) has classically been defined according to symptoms and function (service-based recovery). However, service-users have argued that recovery should be defined as the process of overcoming mental illness, regaining self-control and establishing a meaningful life (customer-based recovery). Here, we aimed to compare customer-based and service-based recovery and clarify their differential relationship with other constructs, namely needs and quality of life. The study was conducted in 101 patients suffering from SMI, recruited from a rural community mental health setting in Portugal. Customer-based recovery and function-related service-based recovery were assessed, respectively, using a shortened version of the Mental Health Recovery Measure (MHRM-20) and the Global Assessment of Functioning score. The Camberwell Assessment of Need scale was used to objectively assess needs, while subjective quality of life was measured with the TL-30s scale. Using multiple linear regression models, we found that the Global Assessment of Functioning score was incrementally predictive of the MHRM-20 score, when added to a model including only clinical and demographic factors, and that this model was further incremented by the score for quality of life. However, in an alternate model using the Global Assessment of Functioning score as the dependent variable, while the MHRM-20 score contributed significantly to the model when added to clinical and demographic factors, the model was not incremented by the score for quality of life. These results suggest that, while a more global concept of recovery from SMI may be assessed using measures for service-based and customer-based recovery, the latter, namely the MHRM-20, also provides information about subjective well-being. Pending confirmation of these findings in other populations, this instrument could thus be useful for comprehensive assessment of recovery and subjective well-being in patients suffering from SMI.
... These domains were not empirically derived and assessments of convergent validity (Bullock, 2005(Bullock, , 2009) focused on the total score of the 30-item measure. Notably, two independent Rasch analyses found that the 30 items tapped a single construct (Chang, Ailey, Heller, & Chen, 2013;Ozbey, 2012). ...
... The MHRM has demonstrated good internal consistency (Cronbach's ␣ ranging between .94 and .95; Armstrong et al., 2014;Chang et al., 2013) and convergent validity with the Recovery Assessment Scale and the Self-Identified State of Recovery-Awareness subscale in individuals with psychotic disorders (Andresen, Caputi, & Oades, 2010). ...
... Of note, a single-factor solution was most appropriate in our sample as was the case for Armstrong and colleagues' (2014) sample of veterans with schizophrenia and for samples of patients with various psychiatric diagnoses (Chang et al., 2013;Ozbey, 2012). The single factor in our sample accounted for a relatively small proportion of variance (9.86%) in the 29 MHRM items we subjected to exploratory factor analysis whereas in Armstrong and colleagues' sample, the single factor accounted for 37.3% of the variance in the 30 MHRM items. ...
Using data from a sample of 398 veterans diagnosed with depression, the present study used principal components analysis to shorten the Mental Health Recovery Measure (MHRM) to a 10-item instrument. Results indicated the 10-item MHRM had excellent internal reliability. Construct validity for the 10-item MHRM was evidenced by correlations with measures of depression coping self-efficacy, social adjustment, hopelessness, and depression. The 10-item MHRM derived in the present study was compared with a 10-item version of the MHRM that was previously empirically derived in a sample of veterans with schizophrenia (Armstrong, Cohen, Hellemann, Reist, & Young, 2014). Results suggest that similar items represent the underlying construct of recovery for veterans with depression and veterans with schizophrenia. Veterans with depression reported lower average levels of recovery than veterans with schizophrenia. Study limitations, directions for future investigations, and the implications of routine assessment of mental health recovery in public mental health systems are discussed. (PsycINFO Database Record
... The Rasch measurement model helps to disclose a lack of variance that is not easily detected with traditional psychometric testing [19]. Over the past 20 years, Rasch analysis has been increasingly used in health sciences for development and evaluation of questionnaires, scales and measures [20,21]. Rasch analysis can be used when a new scale is being developed, when reviewing the psychometric properties of existing scales [22]. ...
The Profiles of Occupational Engagement in people with Severe mental illness (POES) instrument was developed to study time use profiles of occupations and measure the extent they are characterized by engagement. However, the dimensional factors are not known. The aim of the present study was to establish the internal construct validity of the POES using the Rasch measurement model.
A sample of 192 outpatients in Sweden was administered the POES and data were subjected to Rasch analysis.
The POES showed good fit to the Rasch model after accommodation for local dependency. The nine items had high reliability as measured by person separation index, and no threshold disordering was present. Differential item functioning analysis showed no significant differences across groups of age, sex, diagnosis, or country of origin.
The POES is a unidimensional scale that represents a continuum of occupational engagement. The transformed POES sum score can be used on an interval scale to measure status and changes in occupational engagement in mental health practice and research.
... We examined the unidimensionality of each domain in the PEF draft-3 using Rasch rating scale model in the WINSTEPS computer program. This computer program has been used to conduct Rasch analysis in research for patients with schizophrenia [20][21][22]. To examine unidimensionality, we first used infit and outfit statistics to evaluate whether the data fit the model's expectations. ...
A performance-based measure for assessing executive functions (EF) is useful to understand patients' real life performance of EF. This study aimed to develop a performance-based measure of executive functions (PEF) based on the Lezak model and to examine psychometric properties (i.e., unidimensionality and reliability) of the PEF using Rasch analysis in patients with schizophrenia. We developed the PEF in three phases: (1) designing the preliminary version of PEF; (2) consultation with experts, cognitive interviews with patients, and pilot tests on patients to revise the preliminary PEF; (3) establishment of the final version of the PEF and examination of unidimensionality and Rasch reliability. Two hundred patients were assessed using the revised PEF. After deleting items which did not satisfy the Rasch model's expectations, the final version of the PEF contained 1 practice item and 13 test items for assessing the four domains of EF (i.e., volition, planning, purposive action, and effective performance). For unidimensional and multidimensional Rasch analyses, the 4 domains showed good reliability (i.e., 0.77-0.85 and 0.87-0.90, respectively). Our results showed that the PEF had satisfactory unidimensionality and Rasch reliability. Therefore, clinicians and researchers could use the PEF to assess the four domains of EF in patients with schizophrenia.
Objective:
The present study aims to translate into Turkish and investigate the validity and reliability of the Mental Health Recovery Measure (MHRM).
Method:
The sample consisted of 343 outpatients - and in-patients under treatment for a variety of psychiatric diagnoses at a state hospital and a university research hospital. The MHRM along with the Subjective Recovery Assessment Scale (SRAS), Psychological Well Being Scale (PWBS), Emotional Eating Scale (EES), and The Internalized Stigma of Mental Illness Scale (ISMI).
Results:
The mean MHRM total score was estimated at 31.66 (sd=10.02). Exploratory factor analysis revealed one single robust factor explaining 64% of the variance of the total scores. Alpha internal consistency coefficient was calculated as 0.94 and corrected item-total correlation coefficients were entirely above 0.60. The MHRM scores showed positive and strong correlations with the PWBS (r=0.695; p<0.001) and SRAS (r=0.732; p<0.001), negative and strong correlation with the ISMI (r=-0.696; p<0.001) and no correlation with the EES scores (r=-0.021; p=0.703).
Conclusion:
Our data provides initial evidence supporting the validity and reliability of the Turkish MHRM in evaluating the tendency for recovery of mental health consumers for clinical and research purposes. Further studies addressing psychometric properties of the scale are warranted.
Self-report measures can be used to accurately assess client outcomes, providing evidence for the effectiveness of occupational therapy. Rasch analysis, a psychometric research methodology, is increasingly being used to validate self-report measures, however, the extent of its use within mental health occupational therapy is unknown. To address this, a scoping review that included twenty articles published between 2001 and 2019 was conducted. This review quantifies the increase in use of Rasch analysis in this field and finds heterogeneity in the analysis techniques implemented. As the use of Rasch analysis increases, it offers benefits to strengthen self-report measures within mental health occupational therapy.
