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PubMed1986

Levels of expressed emotion and relapse in depressed patients.

The relationship between spouses' levels of expressed emotion (EE) and relapse was examined in a sample of 39 depressed psychiatric hospital patients. Over a nine-month follow-up, 59% of patients with high-EE spouses relapsed, although no patients living with low-EE spouses did so. The results replicate the association found by Vaughn & Leff between EE and depression, and suggest that the EE construct has predictive validity in both schizophrenic and depressed populations.

Adult↗
PubMed1995

Expressed emotion and the course of schizophrenia in Japan.

BACKGROUND: We examined whether expressed emotion (EE) influenced the course of schizophrenia in Japan. METHOD: We conducted a cohort study. Of 73 subjects with schizophrenia meeting the diagnostic criteria of ICD-9 or DSM-III-R, 52 participated in the study. The Camberwell Family Interview was conducted to evaluate EE. The subjects had been followed up for nine months and psychiatrists who were blind to the EE status evaluated their symptoms with the Brief Psychiatric Rating Scale. RESULTS: The relapse rate in the high-EE group was 58% and that in the low-EE group 21% (P < 0.01). Nine-month relapse risk ratio was 2.72 (95% CI 1.24 to 5.97). CONCLUSION. In Japan, as elsewhere, EE is a good predictor of schizophrenic relapse.

Adult↗
PubMed1997

Relatives' expressed emotion and non-verbal signs of subclinical psychopathology in schizophrenic patients.

BACKGROUND: Previous research has generally found that variations in relatives' affective attitudes (expressed emotion; EE) towards a schizophrenic family member could not be accounted for by differences in the severity or form of the patient's symptomatology. These findings have been based on clinicians' ratings of psychopathology in patients. METHOD: To approach the question from a different perspective, videotaped interactions between a patient and family members, obtained four to five weeks after hospital discharge, were coded for subclinical signs of psychopathology expressed by the patient. The Behavioral Subclinical Rating Scale (BSRS) was developed to compare subclinical levels of non-verbal and paralinguistic symptoms expressed by patients from both high- and low-EE families. RESULTS: Highly significant differences were found in the BSRS data. Patients from high-EE families showed more hostile and unusual behaviour with relatives than those from low-EE homes, who, in contrast, showed more anxious behaviour. CONCLUSION: These data suggest that a complex transactional model is necessary to understand how family attitudes evolve during the course of a relatives' schizophrenic disorder.

Adult↗
PubMed2003

Expressed emotion, attributions and depression in mothers of children with problem behaviour.

BACKGROUND: This was an initial study seeking to examine the relationship between Expressed Emotion (EE), spontaneous causal attributions and depression in mothers of children referred for problem behaviour. METHOD: Sixty-one mothers were interviewed using the Camberwell Family Interview (CFI). The CFI was coded for maternal EE and spontaneous causal attributions regarding the child's behaviour. Self-report measures of child problem behaviour and maternal depressive symptoms were also completed. RESULTS: Consistent with previous research, high EE mothers, compared to low EE mothers, were more likely to make attributions thatjudged the cause of problem behaviour to be personal to and controllable by the child and also made more 'child-blaming' attributions than low EE mothers. Mothers' scores on the Beck Depression Inventory were found to be associated with 'child-blaming' attributions and higher levels of EE. Regression analyses did not support the hypothesised role of attributions as a mediator between depression and EE but did identify EE as a potential mediator in the relationship between maternal depressed mood and ratings of child problem behaviour. CONCLUSIONS: These results indicate the relevance of both EE and attributions in mothers of children with problem behaviour and suggest that maternal depressed mood is an important factor which is related to both of these.

Adult↗
PubMed1985

Channels of emotional expression in patients with unilateral brain damage.

The contribution of facial, intonational, and speech channels to spontaneous emotional expression was examined in right brain-damaged (RBD), left brain-damaged (LBD), and normal control (NC) subjects. Subjects were videotaped while viewing and responding to a series of emotionally laden slides; the videotapes were then rated for the three channels of communication. Overall, RBDs used facial expression and intonation less frequently than the other two groups. When the speech output channel was analyzed, oral expression of feelings in the RBDs, relative to the LBDs and NCs, was less appropriate, more propositional than prosodic, and more descriptive than affective. When the ratings for the three channels of communication were examined, facial expression and intonation were significantly correlated for all subjects.

Affect↗
PubMed2000

Expressed emotion and attributions in the relatives of bipolar patients: an analysis of problem-solving interactions.

Among the relatives of schizophrenic and depressed patients, high expressed emotion (EE) attitudes are associated with "controllability attributions" about the causes of patients' symptoms and problem behaviors. However, previous studies have judged EE attitudes and causal attributions from the same assessment measure, the Camberwell Family Interview (CFI; C. E. Vaughn & J. P. Leff, 1976). The authors examined causal attributions among relatives of 47 bipolar patients, as spontaneously expressed to patients in family problem-solving interactions during a postillness period. Relatives rated high EE during the patients' acute episode (based on the CFI) were more likely than relatives rated low EE to spontaneously attribute patients' symptoms and negative behaviors to personal and controllable factors during the postillness interactional assessment. Thus, the EE-attribution linkage extends to the relatives of bipolar patients evaluated during a family interaction task.

Adolescent↗
PubMed1997

Expressed emotion among families and course of schizophrenia in Japan: a 2-year cohort study.

A 2-year cohort study was conducted to determine whether expressed emotion (EE) in families is associated with relapse of schizophrenia in Japan. Key relatives of 52 schizophrenic patients were interviewed using the Camberwell Family Interview (CFI) and the patients were classified into high and low EE groups. The 2-year relapse risks were 71% (17/24) in the high EE group and 37% (10/27) in the low EE group. The risk ratio was 1.9 and the 95% confidence interval (CI) ranged from 1.1 to 3.3. In the multiple logistic regression analysis, the odds ratio between families' EE and schizophrenic relapse was 4.6, controlling for other potential confounding factors. It was concluded that, in Japan, the families' EE is a good predictor for schizophrenic relapse within 2 years. This association between EE and relapse could be due to the strong difference in the first 9 months. The period during which EE's predictive validity for schizophrenic relapse is applicable may vary according to the society to which the patients and their families belong.

Adolescent↗
PubMed1998

A retrospective analysis of expressed emotion (EE) and affective distress in a sample of relatives caring for traumatically brain-injured (TBI) family members.

OBJECTIVES: To examine levels of expressed emotion (EE) and affective distress in relatives caring for severely brain-injured family members. DESIGN: The study took the form of a retrospective, observational cross-sectional analysis. METHOD: Data on 28 relatives were reviewed. Each participant completed one affective health-related questionnaire (Leeds Scales for the Self-Assessment of Anxiety and Depression; Snaith, Bridge & Hamilton, 1976) and their EE was rated using the Camberwell Family Interview (CFI; Brown, Birley & Wing, 1972; Vaughn & Leff, 1976, modified for head-injury relatives. Participants were rated as either high or low EE. Comparative statistical analysis examined differences in affective distress between the two groups. RESULTS: Of the 28 participants, 12 were rated high EE and 16 were rated low EE. Levels of anxiety were significantly higher among the high EE group, but levels of depression were not significantly different between the high and low EE groups. A significant correlation was found between EE and carer status, i.e. sole carers or family carers, with sole carers displaying significantly higher levels of EE than family carers. Multiple regression also revealed that carer status was most predictive of EE. CONCLUSIONS: Discussion considers EE as a coping strategy. Further research into the predictive capability of EE as an indicator of affective distress in head-injury families is suggested.

Adaptation, Psychological↗
PubMed2002

Expressed emotion in relatives of first-episode and chronic patients with schizophrenia and major depressive disorder-a comparison.

Relatives of first-episode and chronic schizophrenic and depressed patients were examined with respect to their expressed emotion (EE) status. The two aims of the study were to (1) investigate whether relatives of first-episode patients differed from family members of chronic patients, and (2) whether EE indices of relatives of schizophrenic patients were comparable to those of depressed subjects. Twenty patients of each diagnostic group (DSM-III-R and DSM-IV) were included, i.e. a total of 80 patients. The EE status of key relatives was assessed with the Five-Minute Speech Sample on the basis of critical comments and emotional overinvolvement. Additionally, the new criterion 'covert criticism' was applied to detect indirect expressions of critique. Relatives of first-episode and chronic patients of both diagnostic groups did not differ significantly regarding their EE status; in first-episode patients, 52.5% of relatives were classified high EE; in chronic patients, 45%. Moreover, EE indices of relatives of schizophrenic and depressed patients were comparable. Analysis revealed 52.5 and 45% high-EE relatives in the depression and the schizophrenia subsamples, respectively. Thus, the overall incidence of high-EE relatives was comparable to numbers reported in the literature. In our study EE status of relatives was not disease-specific, and it was independent of chronicity of illness.

Adult↗
PubMedDate not supplied

Validity of a Five-Minute Speech Sample in measuring expressed emotion in the families of patients with schizophrenia in Japan.

The Five-Minute Speech Sample (FMSS) is a brief measure for the assessment of expressed emotion (EE). No prior studies have investigated the validity of the FMSS in comparison to the Camberwell Family Interview (CFI) in Japan. Therefore, we administered the CFI and the FMSS to schizophrenic families in an attempt to evaluate the usefulness of the FMSS. The ratings obtained from the CFI were then used to estimate the validity of the FMSS. The overall agreement of the two methods was 53.8%. We conclude that the FMSS may be a useful screening method for the evaluation of EE. Borderline low-EE subjects may have to be included in the high-EE group to improve the sensitivity.

Adult↗
PubMed1997

Patient attributes and expressed emotion as risk factors for psychotic relapse.

In the context of a prospective, controlled treatment study, contrasting family interventions with individual treatment, the role of expressed emotion (EE) as a predictor of relapse was examined in patients with recent-onset schizophrenia and related disorders (n = 97). EE was compared with 13 predictor variables. The variables, taken from EE and family intervention studies, related to demography, premorbid functioning, present and past illness history, and comorbid substance abuse. Psychotic relapse was operationalized with a conservatively measured relapse criterion, composed of monthly ratings based on the Brief Psychiatric Rating Scale and on clinical judgment during the 12 months of outpatient treatment. Of the 14 predictor variables entered in stepwise survival analyses, 6 variables had probable predictive power on the conservative relapse criterion. These variables were entered in a Cox regression model. EE turned out to be the major predictor of relapse in the overall sample (hazard ratio [HR] 4.90; confidence interval [CI] 1.05-22.92). This finding remained when only patients with a first psychotic episode (p = 0.02) and patients in the individual treatment condition (p = 0.001) were examined. Cannabis abuse was the major predictor of relapse in patients with high-EE families (HR 4.27; CI 1.12-16.29).

Adolescent↗
PubMed1993

Right hemisphere representation of autonomic conditioning to facial emotional expressions.

In this experiment, a lateralized right hemisphere effect was found for electrodermal associative learning to facial emotional expressions. Sixty-two subjects were presented simultaneously with a slide of a happy face in the right or left visual half field (VHF) and a slide of an angry face in the opposite VHF. Four groups were formed by the combination of the two VHF positions of angry/happy faces and the administration/omission of shock unconditioned stimuli. The results showed that simultaneous presentation of the angry face to the right hemisphere and the happy face to the left hemisphere, together with shock, resulted in a strong conditioned association with the angry face and a relatively weak association with the happy face. Furthermore, simultaneous presentation of the angry face to the left hemisphere and the happy face to the right hemisphere, together with shock, resulted in a relatively weak association with both stimuli. No significant differences were found for the no-shock control groups. The present results confirm previous findings of a right hemisphere advantage for representation of associative learning.

Adolescent↗
PubMed1998

Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients' social functioning.

BACKGROUND: There is evidence that high expressed emotion (EE) in relatives of patients with schizophrenia is associated with higher levels of burden of care, and with worse perception of patient's social functioning. However, it is not clear whether changes in EE levels over time are associated with changes in relatives' burden of care and their perception of patients' social functioning. METHODS: Fifty patients with a diagnosis of schizophrenia and 50 relatives were included in the study soon after patients' admission to hospital. Thirty-six relatives and 31 patients were re-assessed 9 months after patients' discharge. Both assessments included patients' symptomatology and relatives' EE levels, burden of care, and perception of patients' social functioning. RESULTS: Twenty-three relatives (64%) had the same EE level in both assessments, nine (25%) had changed from high to low EE, and four (11%) from low to high EE. Improvement in burden and perception of patients' social role performance were significantly more accentuated among relatives who changed from high to low EE than among relatives who had a stable EE level. Variables that best predicted changes in EE levels were changes in burden scores and number of hours of contact between patients and relatives at follow-up. CONCLUSIONS: Change in EE is associated with change in circumstances and burden. Findings support the idea that EE is better understood in an integrative model.

Adolescent↗
PubMed2000

Partners' expressed emotion and the control and management of type 1 diabetes in adults.

OBJECTIVE: "Expressed emotion" (EE) refers to a set of valid and reliable measures of family emotional attitudes, which are robust predictors of illness course in several psychiatric conditions and which have recently been studied in some medical conditions. We hypothesised that high EE in partners of diabetes patients would be associated with poorer glucose control, management of and adaptation to diabetes. METHODS: Sixty adult Type 1 diabetes patients, who were attending routine clinics at a specialist diabetes centre, and their partners were interviewed separately and completed various questionnaire measures. Partners' EE was rated from a modified Camberwell Family Interview; patients were interviewed to assess self-management practices. Glycated hemoglobin (HbA(1c)) was the measure of glucose control. RESULTS: Only 10/60 (17%) partners were classified as high EE. Patients with high-EE partners had significantly worse self-management scores, more negative appraisal of diabetes, and higher depression scores than those with low-EE partners, but there was no association between EE measures and HbA(1c). CONCLUSIONS: In contrast to findings from previous research on the families of patients with psychiatric illnesses, only a minority of partners of adult patients with Type 1 diabetes are classified as high-EE. We found no evidence that partners' EE was related to patients' blood glucose control.

Adolescent↗
PubMed1991

Expressed emotion and panic-fear in the prediction of diet treatment compliance.

The 'expressed emotion' (EE) of the key relatives of 30 severely obese patients was assessed on intake to a calorie-restricted diet programme. At the same time the patients and 30 matched controls were administered the MMPI 'panic-fear' scale. After five months on the diet the weight of the patients was measured, and weight loss or gain in the five-month period was used as an indicator of compliance or non-compliance with the treatment. The results indicated that the obese patients showed more anxiety (measured by the panic-fear scale) than did the control subjects. Compliant patients had lower panic-fear scores than did non-compliant patients, and patients living with a high EE relative were much less likely to comply with treatment than were those living with a low EE relative. Patients with a high EE relative were more likely to have a high panic-fear score. The results suggest that dietary treatments for obesity need to be accompanied by both individual and family behavioural interventions.

Adult↗
PubMed1993

The Nithsdale schizophrenia surveys. XI: Relatives' expressed emotion. Stability over five years and its relation to relapse.

The level of expressed emotion (EE) in 32 relationships between relatives and schizophrenic patients was assessed on three separate occasions over five years. EE was high on all three occasions in 25% of relatives, low on all three in 38%, and fluctuating in 38%; that is, in the majority of relatives (63%) the level of EE was stable over time. Three relatives who had previously shown high EE had evidence of dementia at the time of the third assessment, and showed low EE. Fourteen patients relapsed at least once over five years; patients who relapsed were evenly spread throughout those living in a home in which EE was consistently high, consistently low, or fluctuating. However, patients living in low-EE homes who did relapse did so significantly less often than those who relapsed and were living in homes in which EE was high or fluctuating. At the time of relapse, EE was not consistently high, and some patients in consistently high-EE homes did not relapse at all over five years.

Adult↗
PubMed1995

Expressed emotion. Trait or state?

BACKGROUND: This exploratory study addresses the question of whether expressed emotion (EE) is a response characteristic of the parent (trait) or a parental response to specific circumstances or persons (state). METHOD: Seventeen parents participated in two audiotaped interviews, using modified versions of the Camberwell Family Interview. One interview concerned the child with chronic schizophrenia and the other a well sibling. Subsequent ratings of the EE variables of critical comments (CC), emotional overinvolvement (EOI) and warmth were completed and compared. RESULTS: EE response patterns directed towards patients, as compared with towards siblings, were significantly different on two measures: EOI (P = 0.01) and warmth (P = 0.02). The parents showed significantly more emotional overinvolvement with the child with schizophrenia and significantly more warmth towards the well child. CONCLUSIONS: These data suggest that the EE variables of EOI and warmth are related to the state of child, and the lack of a significant difference in CC suggests that this is a parental trait.

Adolescent↗
PubMed2000

A review of expressed emotion research in health care.

Much research has been carried out on the impact of family relationships on the development and course of different illness. Research on Expressed Emotion (EE) developed out of studies of the impact of family members on patients with schizophrenia, and has provided us with a robust measure of relatives' emotional attitudes towards patients, which has now been applied in the study of numerous psychiatric and medical illnesses. This review outlines the history of EE research in schizophrenia, and discusses the evidence for the association between family EE and the course of schizophrenic illness. Some of the factors which might moderate the association between EE and illness course are outlined and the issues of the meaning and development of EE are discussed in the light of recent theoretical advances. The application of the EE methodology in other psychiatric and medical conditions is then reviewed and conclusions are drawn about the extent to which EE predicts illness course in conditions other than schizophrenia. Consideration is given to the ways in which the application of the paradigm to a variety of illnesses or conditions with different features can enhance our understanding of the EE construct.

Expressed Emotion↗