Determinants, self-management strategies and interventions for hope in people with mental disorders: systematic search and narrative review

Authors:
SCHRANK Beate, et al
Journal article citation:
Social Science and Medicine, 74(4), February 2012, pp.554-564.
Publisher:
Elsevier

Fifty-seven, mainly quantitative, studies investigating the determinants of hope were selected for review. As well as identifying a number of potential determinants the review reported a range of practical self-management strategies on a number of themes, identified by service users in five qualitative studies. Most of the eight controlled intervention studies reported positive effects on hope compared to treatment as usual but there was no evidence to support a specific intervention for increasing hope in participants with mental health problems. Further research on the causal influences on hope, and the need for theory based models to improve hope are called for.

Extended abstract:
Author

SCHRANK Beate; et al.;

Title

Determinants, self-management strategies and interventions for hope in people with mental disorders: systematic search and narrative review.

Journal citation/publication details

Social Science and Medicine, 74(4), February 2012, pp.554-564.

Summary

Fifty-seven, mainly quantitative, studies investigating the determinants of hope were selected for review. As well as identifying a number of potential determinants the review reported a range of practical self-management strategies on a number of themes, identified by service users in five qualitative studies. Most of the eight controlled intervention studies reported positive effects on hope compared to treatment as usual but there was no evidence to support a specific intervention for increasing hope in participants with mental health problems. Further research on the causal influences on hope, and the need for theory based models to improve hope are called for.       

Context

Hope, which is central to the idea of personal recovery from mental health conditions, has been identified as a key factor in psychotherapy. The growing interest in positive psychology and the focus on positive characteristics offers the opportunity to bring together the varying approaches to hope research. The aim of this systematic review was to examine: the main measures of hope used in mental health research; the predictors of hope; self-management of hope, and; mental health service interventions for enhancing hope.

Methods

What sources were searched?
The following bibliographic databases were searched from the date of inception to April 2011: AMED, British Nursing Index, EMBASE, Medline, PsycINFO, Social Science Policy, CINAHL, International Bibliography of Social Science, British Humanities Index, Sociological Abstracts, and Social Services Abstracts. The reference lists of relevant studies, reviews and opinion papers were hand searched for additional material, and experts in the field were consulted on determinants of hope. Also, a Web of Science Cited Reference Search was conducted on the included studies.

What search terms/strategies were used?
A search strategy using a combination of terms for hope, mental disorders and interventions was devised and adapted to the individual databases searched; the basic search string is reported in the text.

What criteria were used to decide on which studies to include?
Intervention studies examining hope as a primary or secondary outcome, repeated measures studies looking at predictors of hope, cross-sectional studies on the correlation of hope with other variables, and qualitative studies using established research methodology were all eligible for inclusion. Quantitative studies had to use a service user rated measurement tool for hope, or an instrument in which hope was described and quantified as a sub-scale. Study participants were limited to working age adults with a mental disorder based on ICD or DSM. Only papers published in English or German were selected.

Who decided on their relevance and quality?
Titles were initially selected based on examination of the titles and then the abstracts. Full text papers were obtained for potentially relevant studies. The first 100 studies were examined by two authors working independently. A concordance rate of 0.96 was achieved and the remaining studies were examined by one or other of the two authors. There is no indication that the included studies were assessed on study quality.

How many studies were included and where were they from?
The total number of articles screened was 20,150; of these 733 were considered to be potentially relevant and 721 were examined in full (12 could not be obtained). Fifty-seven papers were selected for inclusion in the systematic review. The country settings are not reported.

How were the study findings combined?
Data extraction and synthesis was carried out with reference to the guidance published by Popay, 2006. Hope scales were compared on their coverage of the essential components of hope and reported in a table.Quantitative studies of determinants of hope were split into those reporting associations, isolation, or direction. The characteristics of the 57 studies are summarised in an online data supplement which is not freely available to view.

Findings of the review

Of the 57 studies included, eight were qualitative and 49 were quantitative; the quantitative reports included 35 cross-sectional studies, and 16 prospective studies. The most frequently used hope scales were the Snyder Hope Scale, reported in 19 studies, and the Herth Hope Scale used in 12 studies; the other scales used were the Miller, Zimmerman, Nunn, Gottschalk, Obayuwana, and the factor “Hope” on the Recovery Assessment Scale. The Snyder, the most commonly used scale, represented the narrowest view of hope - covering only four of the seven essential components.

Thirty-eight studies reported cross-sectional associations between hope and other variables. The most frequent and consistently positive associations were found for perceived recovery, self-efficacy, self-esteem, empowerment, spirituality, quality of life, and social support. Negative correlations for symptoms including anxiety, depression, general psychopathology, family problems, and barriers to employment were also been reported. Determinants of hope identified in qualitative studies were similar except for the factor insight to illness which was negatively associated with hope in quantitative studies and positively associated in qualitative studies. Symptoms remained negative predictors of hope after controlling for other variables.

Suggested self-management strategies were reported in five qualitative studies and included illness management, meaning, relationships, peer support, the notion of normality, and the importance of success. Finally, eight controlled intervention studies used hope as a primary or secondary outcome; most succeeded in significantly increasing hope compared to treatment-as-usual. The single intervention study with the primary aim of increasing hope was not effective, possibly due to its narrow frame of intervention in concentrating on goal setting and achievement only. 

Authors' conclusions

“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.”

Implications for policy or practice

None are discussed.


Subject terms:
intervention, mental health problems, self care;
Content type:
systematic review
Link:
Journal home page
ISSN print:
0277-9536

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