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Hope has been a relevant factor in mythology, philosophy and religion for centuries. Its introduction into the field of medicine, however, occurred only in the 1950s when Karl Menninger identified it as integral to the profession of psychiatry, important for initiating therapeutic change, willingness to learn and personal well-being (Menninger, 1959). Today, the psychiatric literature offers a number of reasons why hope is a relevant variable in mental health practice and research: Hope is central to the concept of recovery from mental disorders, both as a trigger of the recovery process and as a maintaining factor (Bonney and Stickley, 2008 and Whitley and Drake, 2010). In line with the increased emphasis on recovery, person-centred integrative care was established as a policy goal in numerous countries all over the world (Mezzich and Salloum, 2007) with hope being a central factor in all of its aspects (Cloninger, 2011). In this context, personal well-being is increasingly viewed as a primary outcome of therapeutic strategies, and hope is considered an important factor associated with well-being (Slade, 2009). Hope is also essential for the concept of resilience (Ong et al., 2006), for human adaptation, and for psychotherapeutic change (Magaletta and Oliver, 1999 and Hayes et al., 2007), being consistently identified as a key factor in psychotherapy by patients, family members and therapists in various settings (Schrank et al., 2008 and Redlich et al., 2010). In people with severe mental disorders, specifically psychosis or schizophrenia, hope was shown to have a consistent negative association with depression, overall psychopathology, as well as with family problems and barriers to employment. Most frequent and consistently positive associations were found with perceived recovery, self-efficacy, self-esteem, empowerment, spirituality, quality of life, and social support (Schrank et al., 2012). This clearly points to the important role of hope for recovery and resilience. For a number of variables, however, correlations have not been replicated or inconclusive study results pose important further questions as to the specific mechanisms by which hope acts in the recovery process. This includes, for example, a negative association between hope and the awareness dimension of insight (Hasson-Ohayon et al., 2009), while qualitative studies clearly suggest insight into illness and treatment as a factor supporting hope because it gives people the tools to manage their symptoms (Kirkpatrick et al., 2001). Another reason for these inconsistent results on hope in mental health, and especially in people with psychosis, may be the large number of overlapping but not equivalent hope concepts and their various corresponding scales that can be found in the literature (Schrank et al., 2008). The most frequently used scales in psychiatric research include the four specific hope scales by Snyder, Herth, Miller and Zimmerman (Snyder State Hope Scale, Snyder et al., 1996; Herth Hope Index, Herth, 1992; Miller Hope Scale, Miller and Powers, 1988; Zimmerman Hope Scale, Zimmerman 1990, as well as the sub-scale on hope on the Recovery Assessment Scale (Schrank et al., 2012). These tools show a considerable overlap but still differ in important areas, making the comparison of research results difficult. For example, the Herth Hope Index is the only one to extensively and explicitly cover spiritual aspects of hope, while the Zimmerman scale draws heavily on negative aspects of hopelessness, and the Snyder scale narrowly focuses on goals and perceived agency and pathways to achieve goals. Miller's scale is the most comprehensive one but unfeasible in research with people with psychosis due to its high number of items. None of the scales was validated for people with severe mental illness. The sub-scale on hope on the Recovery Assessment Scale shows a narrow coverage of hope domains similar to Snyder's scale but, being embedded in a recovery context, at the same time blurs the distinction between the concepts of hope and recovery themselves which are especially important to answer differentiated questions in recovery-oriented research (Schrank et al., 2012). To help bridge the important research gap posed by the lack of a comprehensive, valid, reliable and feasible hope scale, we conducted a comprehensive literature review incorporating all hitherto published definitions of hope and identified a number of key dimensions integral to the concept (Schrank et al., 2008). On the basis of this comprehensive definition, and drawing on the most frequently used hope scales in psychiatric research, we developed an integrative hope scale that spans all relevant dimensions. The 23-item “Integrative Hope Scale” (IHS) is available in the English and German languages. It yields one overall score, and the exploratory factor analysis showed four stable factors: “trust and confidence”, “positive future orientation”, “social relations and personal value” and “lack of perspective”. Apart from covering all relevant dimensions of hope found in the literature, the IHS is more concise when compared with pre-existing assessment instruments. It is easy to use and shows excellent psychometric properties in the general population. None of the other existing measurement tools for hope meets all these criteria (Schrank et al., 2011). The aim of the present study was to validate the IHS for use in people with severe mental illness in order to provide a sound basis for future research on hope in the emergent field of mental health research focused on recovery and well-being.

The present study reports very promising results regarding the validity, reliability and feasibility of the IHS for the assessment of hope in people with severe mental illness. We recommend rewording question 6. For use in people with psychotic conditions we recommend the use of the 22-item version as described in this article. Further studies using the adapted scale are needed to advance our preliminary results and establish the instrument as valid. Moreover, further validation studies in other psychiatric patient groups should investigate the questionnaire in its full original 23-item version to allow more reliable conclusions regarding its factor structure and the items' factor loadings in different diagnostic groups.