Longitudinal recovery in serious mental illness: Changes during rehabilitation and their impact on outcome

Research in serious mental illness (SMI) suggests that rehabilitation facilitates recovery of neurocognition, social cognition, and psychosocial functioning. Increasingly, research has sought to identify how these domains of functioning change during rehabilitation and ultimately affect treatment outcomes. Research also indicates there is significant heterogeneity in rehabilitation outcomes with some participants showing greater recovery than others. The present study used longitudinal structural equation modeling (SEM) strategies to address four objectives: (1) to explore longitudinal change in neurocognition, social cognition and psychosocial functioning during rehabilitation; (2) to identify subgroups with different change trajectories in these relevant domains; (3) to determine how these domains were related in the rehabilitation process; and (4) to determine the impact of these domains on distal outcomes such as community functioning. Archival clinical assessment data from a sample of participants with SMI (N = 162) collected during the first 18 months of an inpatient psychosocial rehabilitation program were used. Archival data from a local community health center were also included to determine participants\u27 level of community functioning and rehospitalization rate post-discharge. Results indicate there were significant increases in neurocognitive and psychosocial functioning and positive shifts in social cognitive beliefs and attitudes. With regard to heterogeneity in recovery, two subgroups were identified with different psychosocial recovery profiles. These groups also differed in neurocognitive functioning at admission, length of stay, and previous number of inpatient psychiatric days. With regard to relationships between domains, more external locus of control beliefs were related to poorer neurocognitive functioning and, to a lesser degree, poorer psychosocial functioning at the beginning of rehabilitation. Few relationships between changes in the domains were identified, and only the neurocognitive domain predicted community psychosocial outcomes. Methodological and theoretical implications of these modeling strategies are discussed in the context of understanding the rehabilitation process