A Psychometric Study of Empowerment and Confidence among Veterans with Psychiatric Disabilities

The word "recovery" as used in every day language is taken by most people to mean a cure, or the complete absence of illness. In the mental health field, the term has increasingly been given a broader meaning that addresses the multi-faceted process of living a full and meaningful life with a mental illness (Resnick, Fontana, Lehman, & Rosenheck, 2005). With the release of prominent commission reports such as the President's New Freedom Commission report (President's New Freedom Commission on Mental Health, 2003) and SAMHSA's National Consensus Statement on Recovery (e.g., SAMHSA, 2004), as well as the growing recognition of the importance of broader conceptualizations of living with mental illness, identifying tools for reliably and validly measuring recovery has become increasingly necessary. As Mancini (2008) has mused, based on the high level of interest in the recovery concept, one might expect the field to have developed empirically-supported definitions of the term and to have identified well-defined recovery-oriented practices supported by scientific data. Yet there is little consistency or consensus across recovery definitions (Resnick et al., 2005; Silverstein & Bellack, 2008), with the same terms sometimes used to describe different constructs, and different terms used to describe similar constructs, making it difficult to generalize across studies. For example, Figure 1 is an illustration of some potential recovery domains. In this figure self-esteem and optimism are included twice, representing different theoretical perspectives on their placement in a recovery definition. Empowerment is an often cited recovery domain that has been linked empirically with participation in peer support (Burti et al., 2005; Dumont & Jones, 2002; Resnick & Rosenheck, 2008; Rogers et al., 2007), working for pay, and participation in family psycho-education (Resnick, Rosenheck, & Lehman, 2004). Rogers et al. (1997) using a mixed-methods approach, created a tool to measure empowerment, and identified five subordinate factors: self-esteem/self-efficacy, power-powerlessness, community activism and autonomy, optimism and control over the future, and righteous anger. Carpinello et al. (2000) identified a related concept, confidence, with similar components to those identified by Rogers et al.: optimism, coping, and advocacy, suggesting overlap between the operationalization of empowerment by Rogers et al. and that of confidence by Carpinello. The current study is an evaluation of the psychometric properties of these two measures and their interrelationships. We examine the internal consistency and test-retest reliability for each measure and examine convergent and discriminant validity of both the total scale and subscales in a sample of veterans receiving community-based outpatient mental health services.  Participants consisted of 296 veterans with severe mental illness who were admitted to the Community Reintegration Program, a community-based outpatient program at the Errera Community Care Center of the V.A. Connecticut Healthcare System between 2002 and 2006, and who agreed to participate in a quasi-experimental efficacy study of a peer education program for veterans. In the parent study, participants were recruited in two cohorts, but are pooled into a single sample for the present study, and thus represent both control and experimental groups (Resnick & Rosenheck, 2008). As summarized in Table 1, respondents were predominantly male (95%) and white (66%), averaging 48.5 years of age and 12.6 years of education. One-third (36%) indicated regular full- or part-time employment. Although a comparable number (34%) reported unemployment due to disability, only one in five (19%) were receiving service-connected disability payments from the Veterans Administration for either medical or psychiatric reasons. PTSD symptom severity was high (mean [+ or -] SD = 46. …