One theoretical research paper posits a bi-directional relationship between 8 dimensions of overall young adult development similar to that of the MHRC (i.e., physical health, psychological and emotional well-being, life skills, ethical behavior, healthy family and social relationships, educational attainment, constructive educational and occupational engagement, civic engagement) [12]. While many scales exist to measure mental health recovery, as outlined in Sklar et al. [13], it is noted that many of the existing instruments are multi-factor scales, whereas the present study is seeking to evaluate a single factor covered in 6 items [13].

A 2014 psychometric evaluation of the Dutch version of the Mental Health Recovery Measure (MHRM) found the following to be subfactors of mental health recovery (i.e., overcoming stuckness, self-empowerment, learning and self-redefinition, basic functioning, overall well-being, new potentials, advocacy/enrichment, and spirituality) [14]. However, these domains do not take into account community and social factors. Whereas, The Recovery Process Inventory (RPI) identifies six factors related to recovery, such as anguish, connected to others, confidence and purpose, others’ care and help, good living situation, and hopeful/cares for self, which fail to account for important factors like occupation and academic goals [15].

While there is some evidence suggesting an underlying theoretical framework surrounding mental health recovery, despite extensive literature review, there is a lack of brief validated checklists to measure mental health recovery as a unidimensional construct [12]. The present study aims to assess the validity and reliability of a short checklist measuring six all-encompassing factors related to mental health recovery.

Research shows that higher levels of reciprocal family support is associated with a willingness to seek help or assistance, which in turn contributes to greater likelihood of mental health recovery [16]. Further, reciprocity of family support networks correlates positively with self-confidence, self-esteem, and optimism about recovery [16]. While close social relationships have the potential to be both supportive and harmful to mental health, research indicates that, collectively, all social contact is more beneficial than no social contact at all [17]. In family systems with higher levels of warmth, positive regard, and mutuality, relationships with family members provided moral support, practical support, and intrinsic motivation for recovery [18]. Furthermore, the benefits of strong friendships include social connectedness, feelings of support, companionship, and promotion of a healthier sense of self [19].

Employment research clearly outlines the benefit of occupational engagement in the mental health recovery process (i.e., structure and routine, purpose, connectedness, meaningfulness, sense of identity) [20]. Research in clinically acute populations indicates that work provides personal meaning through its impact on pride, self-esteem, and financial benefit, as well as overall mental health recovery [21]. Work is also perceived as an intrinsic motivator because the sense of achievement and personal empowerment that comes with employment contributes to restoration of mental well-being [22]. Research also demonstrates a strong correlation between higher academic achievement and positive mental health [23].

Physical health is important for mental well-being and the recovery process. Research strongly indicates a link between chronic conditions (e.g., cardiovascular disease, diabetes, obesity) and mental illness (e.g., depression, bipolar disorder, and schizophrenia) [24–27]. Additionally, many studies demonstrate that higher levels of physical activity are associated with reduction in symptoms of depression as well as improvements in quality of life among those with mental health disorders [28,29]. Taken together, physical health is an important aspect of the recovery process.

Positive mental health can be defined as not only the absence of symptoms but incorporates the presence of positive emotional states, acceptance, resilience, and overall quality of life [30]. Research clearly demonstrates that mental health and well-being are associated with a decrease in the intensity of mental illness symptoms in various populations [31–34]. Additionally, research shows that as individuals recover from mental health issues, they are better able to set long-term and broader goals in various areas of life (i.e., employment, physical health), as well as experience increased productivity and higher levels of performance in the workplace compared to individuals with active symptoms [35,36].

When defining spirituality in the literature, there is controversy over the complex and multidimensional nature of this concept, and how it is defined (as separate from religion) [37]. Many studies combine the two concepts of religion and spirituality. Spirituality and religion were found to be significantly related to altruism and can potentially act as a source of hope and connection in individuals with mental illness [38]. Additionally, a 2009 review on spirituality, religion, and mental health found that a large portion of the identified studies indicate lower rates of suicide, substance use, and depression in those who identified as religious; however, a flat side to religious beliefs is that religious-related delusions were found to be common in people with psychotic disorders [39]. Other research indicates that utilizing negative religious coping, or manifesting extrinsic religious and spiritual orientation is associated with lower overall well-being [11]. Spirituality is of particular interest in the validation of the MHRC due to the controversial nature of the literature.

Research indicates that social support (i.e., friends, family members, and a larger sense of community) plays a significant role in improving mental health and protecting against onset of mental illness (i.e., anxiety and depression) [40,41]. Important factors of social support include level of engagement within the community and reported satisfaction with members of the social support system, such that higher engagement in community activities and higher self-reported satisfaction with social networks is associated with stronger mental health recovery [42,43]. Research also strongly suggests a bi-directional relationship between social support and recovery, such that those performing altruistic acts of service are more likely to experience greater well-being and mental health, as these types of activities help individuals to feel valued and respected by those they are helping [44,45].

The study was cross-sectional, as data were pulled from clients’ records who were discharged between January 2018 and May 2023. A total of 574 client charts were selected. However, clients were removed from the study if 1) the client’s age was below 18 or more than 35, upon admission, and 2) if any item on the MHRC scale was left blank. In cases where more than one choice was selected for a particular item on the scale, the average score was taken, and the client’s data was included in the study. A total of 351 client charts fit the indicated criteria and were included in analysis.

The Dorm is an intensive outpatient mental health treatment program for young adults that services individuals between the ages of 18 and 35 years old. Over 80% of clients at The Dorm are multi-diagnostic, indicating that they have more than one co-occurring mental health disorder, including anxiety, depression, psychotic disorders, substance use disorders, personality disorders, and eating disorders. Licensed clinical social workers serve as therapists and clinical coaches who meet with clients individually and facilitate group sessions, which make up a majority of the programming at The Dorm, which is community oriented. Empirically supported behavioral psychosocial methodologies are utilized to serve a variance of mental health illnesses and co-occurring disorders. Average length of stay at The Dorm is one year.

The scale being assessed for reliability and validity is The Dorm’s MHRC. This tool measures mental health recovery across six domains: family/relationships, occupation/school, physical health, mental health, spirituality, social support systems. Each item is rated on a 5-point Likert scale (1 = poor, 5 = excellent) (Table 1).

The MHRC is a self-report checklist where clients indicate, at discharge, a rating for each domain. There are a total of 6 items, one item per recovery domain. In responding to the survey, clients are instructed to “rate the following areas of your life as they are today.”

Data were analyzed using SPSS for Mac, version 29.0.1.0. Pearson Correlations and Cronbach’s alpha were used to determine scale reliability. To establish validity, an Exploratory Factor Analysis (EFA) was conducted to assess a single-factor model using Principal Axis Factoring. Prior, KMO and Bartlett’s Test of Sphericity were conducted to ensure the factorial solution was appropriate. Additionally, a two-factor model was assessed via Principal Axis Factoring and Varimax Rotation with Kaiser Normalization. Due to the exploratory nature of this analysis, not knowing how these factors would load, we tested a number of factor structures. Descriptive statistics have been reported below.

Each item on the MHRC scale has been identified as clinically relevant for clients of The Dorm and empirically supported by the literature as important areas for whole-person mental health recovery [5–9]. The spirituality item, in particular, offers unique perspectives that contribute to the holistic understanding of well-being and mental health. Our findings demonstrate that the spirituality item exhibited moderate correlations with the other variables, particularly within the mental health and social support domains. However, while not as strongly correlated as other variables, spirituality does contribute to the unidimensional structure revealed by the factor analysis conducted and is clearly correlated with other dimensions of clinical recovery for young adults. Spirituality does not stand out as a dominant factor in this study, but interacts with mental health and social support dimensions, which have the potential to influence individuals’ overall clinical recovery [11]. Developmental theorists suggest that young adulthood includes a period of psychosocial conflict that can result in existential crisis (i.e., issues concerning morals, values, purpose). The spirituality item’s moderate correlation with the other variables on the scale may suggest that spirituality is context-dependent, such that higher levels of spirituality could be more strongly associated with these domains compared to those with lower levels of spirituality [48]. Future research should explore these subgroups further, which could lead to targeted interventions to acknowledge and leverage spirituality as a potential moderator in the relationship between different life domains.