عوامل، استراتژی های خود مدیریتی و مداخلات برای امید در افراد مبتلا به اختلالات روانی: جستجوی سیستماتیک و بررسی روایی

Developing a recovery focus in mental health services is a policy goal internationally, and hope is a central component of recovery. Yet determinants of hope of people with mental disorders are not well known, nor are strategies and interventions that increase hope. This study aims to systematically summarise the available evidence to fill four relevant knowledge gaps: (1) hope scales used in psychiatric research, (2) determinants of hope, (2) hope-fostering self-management strategies, and (3) interventions to increase hope for people with mental disorders. We conducted a systematic literature search in April 2011 and a narrative synthesis of publications including qualitative and quantitative studies. Results for the first time provide a comprehensive overview of existing evidence and identify important scientific knowledge gaps: (1) Hope scales used do slightly vary in focus but are overall comparable. (2) Most published research used cross-sectional designs resulting in a high number of potential determinants of hope. No studies prospectively investigated the influence of these determinants. (3) Hope fostering self-management strategies of people with mental disorders were described in qualitative studies only with experimental studies completely missing. (4) While some recovery oriented interventions were shown to increase hope as a secondary outcome, there are no successful interventions specifically aimed at increasing hope. This review provides the basis for both practical and research recommendations: The five most promising candidate interventions to improve hope in people with mental disorders are (i) collaborative strategies for illness management, (ii) fostering relationships, (iii) peer support, (iv) helping clients to assume control and to formulate and pursue realistic goals, and (v) specific interventions to support multiple positive factors such as self-esteem, self-efficacy, spirituality and well-being. These may serve to directly improve care and to develop theory-based models and testable interventions to improve hope in mental health as well as in allied fields.

Hope has been a relevant topic in mythology, philosophy and religion for centuries. However, it was only in the 1950s when Menninger (1959) identified it as integral to the profession of psychiatry, important for initiating therapeutic change, willingness to learn and personal well-being. Since then, a wealth of research has been conducted investigating hope in various medical fields and different settings (Castañeda et al., 2010, Lalor et al., 2009 and Rhodes et al., 2009), but particularly in oncology and internal medicine (Olson, 2011 and Rhodes et al., 2009). Recently, hope has also become a focus for mental health practice and research (Schrank, Stanghellini, & Slade, 2008). Hope is considered central to the concept of personal recovery from mental disorders, both as a trigger and as a maintaining factor, since it helps people to find the courage to start their recovery journey and the motivation to keep working on recovery despite potential obstacles (Bonney & Stickley, 2008). Hope is also essential for resilience (Ong, Edwards, & Bergeman, 2006), and consistently identified by both patients and therapists in various settings as a key factor in psychotherapy (Schrank et al., 2008).

The results of this review suggest at least five promising elements that may be included in future interventions specifically designed to enhance hope of people with mental disorders: (i) collaborative strategies for illness management, including medication, (ii) a focus on fostering relationships both with staff and people outside the mental health system, (iii) facilitating connections with peers, particularly peer support, (iv) helping clients to assume control and to formulate and pursue realistic goals, and (v) specific interventions to support multiple positive factors such as self-esteem, self-efficacy, spirituality and well-being. Particularly the last element is one that appears to be neglected in clinical practice (Slade, 2010).