Measuring recovery in high-security patients: psychometric evaluation of the Questionnaire about the Process of Recovery and its utility to assess the forensic recovery journey

Background Forensic mental health services need a reliable and repeatable outcome measure to assess the progression of self-rated recovery during the forensic journey. The Questionnaire about the Process of Recovery (QPR) was developed in individuals with psychosis, and has been used to assess recovery in people with severe mental illness; however, its psychometric properties have not been studied in a forensic psychiatric cohort. Aims This study aimed to assess the psychometric properties of the QPR in a sample of individuals who currently access, or formerly accessed, high-security psychiatric care, including internal consistency, test–retest reliability, factor structure and criterion validity. Method Psychometric analysis was undertaken in a sample of 146 current or former high-security patients. Confirmatory and exploratory factor analysis examined the latent test structure. Non-parametric comparisons of QPR score indices tested for differences according to individuals’ current setting (high-, medium- or low-security or open wards; community) as evidence of criterion validity. Results A unique two-factor structure related to self-actualisation/empowerment and growth/insight fit forensic patients’ QPR responses. Internal consistency and test–retest reliability were adequate for QPR all-item scores for the original and shortened scales, as well as for the new forensic factor scores. QPR score indices differentiated patients by current setting (eta 2 = 0.03–0.04), although only the forensic factor related to growth/insight was significant in corrected post hoc comparisons. Conclusions The original QPR is recommended for use to assess recovery progress in a forensic psychiatric sample. Forensic patients’ scores may be best represented using the unique two-factor structure identified.