Recovery Processes Reported by People with Severe Mental Illness in Brazil: Systematic Review and Thematic Synthesis

Abstract

In recent decades, personal recovery has emerged as a mental health paradigm, primarily within Global North and WEIRD (Western, Educated, Industrialized, Rich, and Democratic) contexts. However, its conceptualization in Global South countries like Brazil remains incipient. We aimed to synthesize qualitative studies on the recovery process among people with severe mental illness in Brazil and compare these findings with North American and European frameworks, particularly CHIME (Connectedness, Hope, Identity, Meaning, and Empowerment). Following ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) and PICo (Population, Phenomenon of Interest, and Context), guidelines, we screened 1,224 studies; seven were included, representing a total of 83 participants. Quality was assessed using the RATS (Relevance, Appropriateness, Transparency, and Soundness) checklist; all studies achieved acceptable to high quality standards (scores 16–24), with a 91.4% inter-rater agreement rate. Four analytical themes emerged from 13 descriptive themes: Protagonism (Autonomy, Overcoming, Empowerment); Bond (Peer Support, Belonging, Connection with others, Welcoming); Awareness (Insight, Acceptance, Psychotic Episode, Stigma, Pathologization); and Hope. While findings align with universal aspects of recovery, cultural specificities arise from the central role of “Protagonism” and “Bond.” These themes reflect the Brazilian cultural and historical background, emphasizing citizenship and a collectivist orientation over individualistic models. Unlike Global North frameworks focusing on internal psychological states, our findings highlight recovery as deeply rooted in social ties and political agency. We recommend future research and implementation efforts utilize locally salient terms to respect these cultural markers.