Epidemiology and Psychiatric Sciences

Special Article

International differences in understanding recovery: systematic review

M. Sladea1 c1, M. Leamya1, F. Bacona1, M. Janosika1, C. Le Boutilliera1, J. Williamsa1 and V. Birda1

a1 King's College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK


Mental health policy internationally varies in its support for recovery. The aims of this study were to validate an existing conceptual framework and then characterise by country the distribution, scientific foundations and emphasis in published recovery conceptualisations.

Update and modification of a previously published systematic review and narrative synthesis of recovery conceptualisations published in English.

A total of 7431 studies were identified and 429 full papers reviewed, from which 105 conceptualisations in 115 papers were included and quality assessed using established rating scales. Recovery conceptualisations were identified from 11 individual countries, with 95 (91%) published in English-speaking countries, primarily the USA (47%) and the UK (25%). The scientific foundation was primarily qualitative research (53%), non-systematic literature reviews (24%) and position papers (12%). The conceptual framework was validated with the 18 new papers. Across the different countries, there was a relatively similar distribution of codings for each of five key recovery processes.

Recovery as currently conceptualised in English-language publications is primarily based on qualitative studies and position papers from English-speaking countries. The conceptual framework was valid, but the development of recovery conceptualisations using a broader range of research designs within other cultures and non-majority populations is a research priority.

(Received January 11 2012)

(Accepted February 15 2012)

(Online publication March 15 2012)

Key words

  • Recovery;
  • systematic review;
  • conceptual framework