Measuring Personal Recovery in Anxiety and Depression: A COSMIN-based Validation of the 14-Item German Recovery Assessment Scale (RAS-G)

Background: Personal recovery - the subjective experience of living a meaningful life, even despite psychiatric symptoms - is increasingly recognized as a central outcome in mental health care. Reliable assessment is essential to capture changes in patients beyond symptom reduction. However, the 14-item short form of the Recovery Assessment Scale (RAS) lacks comprehensive validation in individuals with depression and anxiety, limiting its interpretability in clinical and research settings. Methods: This study evaluated the psychometric properties of the 14-item German version (RAS-G), following COSMIN(COnsensus-based Standards for the selection of health Measurement Instruments)-guidelines. We conducted a secondary analysis of data from a large randomized controlled trial on mental health video consultations (PROVIDE-C), including 281 adult patients with depression and/or anxiety recruited from 29 primary care practices in Germany. Results: Results supported alignment with the theoretical CHIME recovery framework. Confirmatory factor analysis indicated a five-factor structure. Scalar measurement invariance was demonstrated across gender and age groups, and strict longitudinal invariance was confirmed when accounting for trial group, supporting its use for group comparisons and monitoring change over time. Internal consistency was acceptable to good, six-month test-retest reliability moderate and convergent validity satisfactory. Conclusions: Overall, the RAS-G appears suitable for assessing personal recovery in individuals with depression and anxiety. Its use may complement symptom-based outcomes in clinical trials and routine care. Refinement of specific subscales and evaluation of shorter test-retest intervals are recommended to consolidate these findings. Trial registration: ClinicalTrials.gov NCT04316572