Efectos del fútbol como ocupación deportiva en el proceso de recuperación de personas con trastorno mental grave: impacto sobre el insight cognitivo, la autoevaluación ocupacional y la percepción subjetiva de recuperación

Background: People with severe mental disorders present a need for help that entails multiple rehabilitative actions. These are currently carried out from the recovery model, in which the focus of recovery is the assessment of the affected persons themselves and the need for human occupation is proposed as a type of rehabilitative intervention based on providing occupational spaces for exploration, competence and achievement. The literature shows that the practice of physical exercise and, specifically, of a sporting activity, as an occupational space, constitutes a means that on numerous occasions is proposed as one of the most suitable for improving the recovery of people with severe mental disorders. However, studies on the repercussions of football as a sporting activity in the recovery of people with severe mental disorders are scarce, tend to have a qualitative methodological approach and lack a comparison group for the evaluation of the effectiveness of the programs and comparison of their results.Aims: The aim of the thesis is to analyze the effects of a sporting occupation, specifically, the participation in the Pro-Mental Health Indoor Football League of the SASM Foundation, on occupational competence, cognitive functioning, and recovery processes in people with mental illness.Methods: A retrospective analytical observational retrospective case-control study design was used. The experimental group consisted of 104 people diagnosed with severe mental disorder, all of them users of different care facilities for people with mental illness in the province of Valencia who participate in an indoor football league, the SASM Foundation Pro-Mental Health Indoor Football League. The control group included 93 subjects with similar characteristics in each center, who did not participate in the football league. The sample consisted of 197 people, of legal age and with a diagnosis of serious mental disorder. Information was collected from the participants on socio-demographic characteristics, variables related to the clinical profile, variables for the description of the occupation, leisure and free time profile, variables related to the activities carried out in the League (these only in the experimental group or the League group), and recovery variables, the main variables of the study. Data analyses included descriptive statistics, confirmatory factor analyses, reliability estimates, tests of comparison of means, tests of comparison of distributions, and analyses of covariance. The research was approved by the Human Research Ethics Committee of the Experimental Research Ethics Committee of the Universitat de València. Results: In terms of descriptive data, in both groups, the majority were men with an average age of around 40 years, with primary education, around nine years of work experience in elementary occupations, mostly single and living with their family or in an institution. The participants had worked on average between eight (the League group) and ten years (control group), mostly in elementary occupations, trades or the service sector. The majority of participants in both the League and control groups had a psychotic disorder as their main diagnosis, followed by similar presence of mood/emotional dysregulation disorders, personality disorders and other disorders. In terms of leisure and free time activities, involving independent living, it was common for participants to go for walks, but very few travelled, went to the cinema or out to dinner. In terms of information specific to the League group, League participants had been participating in the League for about three years, trained for an hour and a half per week and most went to a municipal resource (sports center) to do so. Most were informed of match schedules and standings by a monitor and used the center’s notice board to keep up to date with league news. Regarding the measurement scales used, both the Beck Cognitive Insight Scale, the Occupational Self Assessment Scale and the Maryland Assessment of Recovery Scale showed optimal psychometric properties, although three items were removed from the Beck Cognitive Insight Scale because they did not perform adequately. Medium values of cognitive insight, medium-high levels of occupational self-assessment and also moderate-high levels of subjective perception of recovery were found. As far as group equivalence is concerned, the groups only differed in the means of age and leisure and free time activities, so these variables were controlled for (entered as covariates) in the comparison analyses. Finally, the comparison analyses showed no statistically significant differences in the levels of insight (neither in self-reflectiveness nor in self-certainty), nor in the dimensions of the occupational self-assessment values subscale, but did show differences in the dimensions of the competences subscale, with higher scores for the League group in performance, habituation and volition, and in the subjective perception of recovery variable, in favor of the League group. Conclusions: According to the literature, the practice of sport is beneficial for people with severe mental disorders, as it produces improvements in the symptomatology of the disorders, physically, psychologically and socially. The results of this research are along these lines and show that participation in a football league as a sporting occupation improved the users' levels in all competencies, including performance, habituation and volition, as well as the levels of recovery. However, this was not the case for cognitive insight, in any of its dimensions. Participation in a football league can therefore be a useful tool to improve not only the physical health, mental health and social skills of people with severe mental disorders, but also have an impact on their recovery process, specifically through the improvement of their occupational competences.