Improving recovery for marginalized young adults living with serious mental illnesses using music-based self-management strategies: A mixed methods study - PROJECT SUMMARY. Nearly 4 million U.S. young adults aged 18-25 living with serious mental illnesses (YA- SMI) are at heightened risk for negative outcomes, particularly those who are minoritized, low-income, and experience complex trauma. Enhancing recovery for YA-SMI is, therefore, of great public health significance. In this study, recovery is defined as clinical recovery (i.e., symptoms), and personal recovery, which is a multidimensional process toward hope, meaning, and empowerment while managing symptoms. A key aspect of recovery is the development of self-management (SM) to reduce symptoms and enhance quality of life. Since young people spend nearly 40 hours a week listening to music, its potential as a SM strategy cannot be overlooked. Music is a widely used strategy for maintaining wellness because it is accessible, appealing, and culturally relevant. Yet, little is known about the mechanisms that may explain how music use influences recovery for YA-SMI. In response, NIMH partnered with the Sound Health initiative and the Trans-NIH Music and Health Working Group calling for mechanistic studies that address how music use can promote health and wellness. Informed by the Neurosequential Model of Therapeutics and Social Determinants of Mental Health (SDMH), this study uses an explanatory sequential mixed methods design to advance knowledge on how music use may influence recovery among YA-SMI. It will enhance our capacity to conceptualize and measure unique dimensions of personal recovery and apply experimental therapeutics (ET) to uncover how music use affects recovery. This study has three aims: 1) Identify key dimensions of personal recovery among YA-SMI by (a) evaluating the factor structure of the Recovery Assessment Scale (RAS) and (b) exploring in-depth the meaning of the identified factors to deepen our understanding of YA personal recovery; 2) Describe variation in healthy and unhealthy music use by key sociodemographic factors, SDMH, and recovery outcomes; 3) Apply ET to uncover (a) how music use influences hypothesized mediators and (b) the consequences of such ‘target engagement’ on recovery outcomes. Aim 1a uses secondary data from the sponsor’s NIMH study on YA-SMI (N=121) to factor analyze the RAS. A confirmatory factor analysis (CFA) will be conducted using structural equation modeling (SEM) to evaluate the five-factor structure among YA-SMI. Results will inform the collection and analysis of primary data with a Youth Advisory Board (N=6); we will recruit a purposive sample of YA-SMI (N=60 quantitative scales and subsample of N=25 qualitative interviews) in New York City. Aim 1b analyzes qualitative data on personal recovery using thematic analysis. Aim 2 analyzes mixed methods data on music use with thematic analysis, descriptive, and bivariate analyses. Aim 3 analyzes mixed methods data to uncover how music may affect recovery using grounded theory, descriptive, and bivariate analyses. Data will be integrated using the joint display method. This F31 involves substantive and methodological training and will identify promising targets that will initiate a program of research to co-create novel interventions for YA-SMI.
