This thesis of Natalia Tiles-Sar addressed these gaps through longitudinal cohort analyses and a systematic review. Using the Dutch GROUP study, it demonstrated strong heterogeneity in recovery: patients follow diverse clinical and psychosocial trajectories, with premorbid social functioning strongly predicting long-term outcomes. Environmental and psychological factors such as trauma, stigma, and self-esteem significantly shaped recovery, with self-esteem partly explaining the impact of perceived stigma on social functioning. Moving from supported to independent living was challenging for most patients, especially for older men with cognitive problems and severe positive symptoms. The scope was extended to comorbidity: a Cochrane review of psychological interventions in inflammatory bowel disease with co-occurring anxiety or depression showed improvements in quality of life and mental symptoms, but not physical disease activity.
To integrate these findings, the HUMANS model (Holistic Unified Model of Anthropological and Natural Systems) was developed based on biopsychosocial model, systems and complexity theories and ecological perspective. Further, a working definition of holistic recovery was proposed. Together, these contributions provide an empirical and theoretical basis for advancing psychiatric epidemiology toward more comprehensive, socially grounded, and patient-centered approaches.
