Personal Recovery for Transition Age Youth and Young Adults with Mental Health Conditions: A Systematic Review

Background and Purpose: Worldwide, transition age youth and young adults (TAY-YA) have rising rates of mental health conditions (MHCs) including suicidality coupled with low engagement in treatment. While the adult mental health system has expanded its focus from clinical recovery (symptom reduction) to personal recovery (a broader focus toward hope, meaning, and empowerment), the relevance of personal recovery and its distinctions among TAY-YA with MHCs are not well known. While personal recovery is likely influenced by multilevel factors (e.g., structural racism, discrimination, trauma), most research has focused on individual-level determinants. This systematic review seeks to deepen our understanding of personal recovery and the multilevel factors that may influence it among TAY-YA with MHCs.

Methods: This review was registered with PROSPERO and followed the PRISMA guidelines. Key inclusion criteria were: 1) one or more outcomes relate to personal recovery (e.g., including but not limited to dimensions of connectedness, hope and optimism about the future, identity, meaning in life, and empowerment [CHIME] framework); 2) studies are empirical, conceptual, or review articles; and 3) participants aged 16-34 (mean falls within the range) and diagnosed with a MHC (e.g., schizophrenia-spectrum, depressive disorders). Exclusion criteria were: 1) primary focus is other dimensions of recovery (e.g., clinical); 2) primary focus is on substance use; and 3) not published in English. Database searches were conducted in PsycNet, Social Service Abstracts, SocINDEX, and PubMed using a syntax of keywords synonymous to “personal recovery,” “mental health condition” and “TAY and YA.” The strategy was developed in consultation with a research librarian. Studies were assessed for methodological quality and data were extracted and synthesized.

Results: A total of 1,631 records were identified. After title/abstract screening and full text reviews, 22 studies were included. Most studies used qualitative methods (N=14) followed by systematic/scoping reviews (N=5). Studies captured international perspectives with the majority based in Australia (N=7), Canada (N=3), and the United States (N=3). Only two studies explicitly focused on socioeconomically marginalized populations. Common dimensions of personal recovery included desire for personal growth, hope and self-confidence, overcoming symptoms, sense of agency, reconstructing identity, achieving ‘normalcy’ and autonomy, and desire to achieve educational, vocational, and relational life goals. Digital technology, peer relationships, school, family, and non-familial mentors were often described as being important to personal recovery. Stigma, identity disturbance, adverse medication side effects, traumatic experiences, poverty, discrimination, and lack of youth-oriented mental health services were described as barriers to recovery.

Conclusions and Implications: Our synthesis of 22 studies reveal dimensions of personal recovery that align with those in the adult literature (e.g., CHIME) along with developmental and contextual nuances specific to TAY-YA. Our findings indicate that these distinctions include the role of digital technology, family, peer relationships, non-familial mentors, and educational and vocational goals. Consistent with the principles of recovery as a unique, person-centered and individualized process, collaborative research further exploring these developmental distinctions in greater depth among TAY-YA could help expand the relevance, reach, and social impact of recovery-oriented models of care that align with youth culture and preferences.