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PubMed1993

The needs of high and low expressed emotion families: a normative approach.

Comparison of the needs and characteristics of relatives classified as high and low expressed emotion (EE) across a range of measures including social functioning and indices of stress and family burden revealed that high EE relatives reported higher levels of disturbed behaviour, subjective burden, and perceived themselves as coping less effectively. Individuals from high-EE households were more impaired in terms of social functioning, particularly in terms of independence and interpersonal functioning. No difference in overall knowledge about schizophrenia was observed between high and low EE relatives, although high EE relatives possessed more information about hospital procedures. Analysis of needs assessment data, based on a normative approach to need, revealed that two-thirds of high EE relatives, as against one-third of low EE relatives had high needs in at least one or more of the following five areas: knowledge about schizophrenia, subjective burden, personal stress, behavioural disturbance and perceived coping. No low EE relative had high needs on all five criteria. The implications of the results for the meaning and genesis of EE and for service provision are considered.

Adaptation, Psychological↗
PubMed1998

Expressed emotion of families and negative/depressive symptoms in schizophrenia: a cohort study in Japan.

This study investigated whether the Expressed Emotion (EE) status of families is associated with an increased risk of negative and depressive symptoms in schizophrenia. The subjects were 52 schizophrenic patients from mental hospitals in Kochi, Japan, who satisfied the DSM-III-R or ICD-9 criteria for schizophrenia. The Japanese version of the Camberwell Family Interview was administered to 73 key relatives of the patients within 2 weeks after admission. A certified rater evaluated the EE's status of each family, using an audiotaped interview and its transcript. Using cohort study design, the subjects were followed for 9 months after their discharge and were monitored for negative and depressive symptoms. Trained psychiatrists who were blind to the EE status of the patients' households administered the Brief Psychiatric Rating scale (BPRS) at discharge, and 9 months after discharge. Repeated-measures analyses of variance showed that EE effects were significant in Emotional withdrawal in all subjects, Depressive mood and Total depressive symptoms in non-relapsers. A multiple regression analyses revealed that EE's effect was significant only in Depressive mood in non-relapsers controlling confounding factors. In non-relapsers in positive symptoms, high EE families could make patients depressed. EE's effect on negative symptoms remains to be established.

Adolescent↗
PubMed2004

Causal attributions about schizophrenia in families in China: expressed emotion and patient relapse.

Previous studies have indicated a robust link between relatives' causal attributions and levels of expressed emotion (EE). However, these studies have primarily been conducted in Western cultures. The current study, conducted in China, examined the spontaneous causal attributions made by 54 relatives of schizophrenia patients during the Camberwell Family Interview. Chinese relatives made few controllable and personal attributions overall. Yet as predicted, highly critical and/or hostile EE relatives attributed patients' negative behaviors to more controllable and personal factors. High EE and controllable attributions positively predicted relapse, whereas personal attributions unexpectedly protected against relapse. EE mediated the effect of controllable, but not personal, attributions on relapse. Relatives' use of a particular Chinese characteristic (narrow-mindedness) was integral to the personal dimension's protective effect.

Adult↗
PubMed1990

Relationship between expressed emotion and family burden in psychotic disorders: an exploratory study.

This study explored the relationship between level of expressed emotion (EE) and level of family burden in 20 families of individuals with psychotic disorder. Results indicated that a relationship between EE and family burden did exist, but it appeared to be strongly influenced by demographic and illness-related variables. The usefulness of the 5-min speech sample method of assessing EE was limited by the aversion of some family members to being videotaped and by denial of patient symptoms by some relatives. Other methodological weaknesses are discussed. The relationship between demographic and illness-related variables and level of EE needs further exploration.

Affective Disorders, Psychotic↗
PubMed1995

Training in evaluation of expressed emotion using the Japanese version of the Camberwell Family Interview.

To evaluate the effect of training in rating expressed emotion (EE) using the Japanese version of the Camberwell Family Interview (CFI), interrater reliability between a certified rater and a trainee was examined. The material was 65 CFI interviews with the families of 46 schizophrenic patients. The two raters independently rated EE status, critical comments (CC), hostility (H), emotional overinvolvement (EOI), warmth (W) and positive remarks (PR). The interrater reliability was satisfactory with regard to EE status, CC, H, EOI and PR. In the category of W, however, the results were unsatisfactory, as there was no positive development of agreement over time. In fathers, the interrater reliability of W was lower than in other relationships. Use of interview transcripts could contribute to a more satisfactory interrater agreement in EOI, and this is recommended as a useful training tool in EE evaluation.

Adolescent↗
PubMed1995

[Expressed emotion and six-month treatment of outcome of depressive outpatients with mood disorder].

The relationship of the Expressed Emotion (EE) and the outcome of 45 major depressive outpatients with DSM-II-R Mood Disorder was investigated for 6 month prospectively. In the non-remission group (n = 19, 42.2%), past history of major depressive episode was significantly high (p < .01), and there were more high-EE relatives (p < .05) than in the remission group (n = 26). Including borderline-EE (b-EE) as high-EE, the patients in the non-remission group were also more likely to live with high-EE relatives (p < .01) than those in the remission group. On the EE profile rated by the Five Minute Speech Sample, high-EE was 13.3% (n = 6). In the high-EE relatives, 3 were rated as emotional over-involvement (EOI), 2 were Critical, and 1 was EOI and Critical. All of b-EE, (15.6%; n = 7) were rated as the b-Critical. On the Critical subscale, the rate of non-remission increased gradually in the response of the level of criticism (from pure low-EE, b-Critical, and to Critical). With the Hayashi's second method of quantification, the level of criticism and past history of depression correlated with six month outcome. These results might indicate the problem of vicious circle around the recurence, criticism of families, and relapse or prolongation of the episode in depression. It was also suggested that a careful psychoeducational family approach focusing to reduce the negative escalation for patients and their families would contribute to the treatment for mood disorder.

Adult↗
PubMed2005

Maternal attributions and expressed emotion as predictors of attendance at parent management training.

BACKGROUND: The effectiveness of parent management training (PMT) as a treatment for child behaviour problems is reduced by high attrition rates. One difficulty with engaging mothers is that, by definition, PMT is directed at the parent, yet many parents believe the cause of the problem lies within the child. Hence the model of therapy offered contradicts their understanding about the cause and nature of the problem. Moreover, the emotional consequence of holding child-responsibility causal attributions is associated with high expressed emotion (EE), a known predictor of poor compliance with therapy in other child psychiatric disorders. METHODS: Seventy-five consecutive referrals of mothers to a PMT programme were recruited. EE was assessed using the Camberwell Family Interview methodology. Spontaneous causal attributions about their child's problem behaviour were collected from the same interview material and independently coded using the Leeds Attributional Coding System. Attendance data at the PMT programme was collected following completion of programmes. RESULTS: Contrary to expectations, mothers who made child-responsibility attributions and were highly critical about their child's behaviour were no more likely than non-blaming, low EE parents to drop out prematurely from a course of PMT. However, expressing an understanding of their own role in managing their child's behaviour was predictive of attendance. Two factors were, however, more closely associated with greater attrition: having been offered a clinical diagnosis and being from a lower socio-economic family. CONCLUSIONS: Socio-economic factors should be viewed as barriers to uptake of services and successful strategies for increasing engagement of families are likely to be economical rather than psychological. However, although the causal attributions mothers make about their child's behaviour did not predict whether they were likely to attend PMT, an exploratory analysis found evidence to suggest that successful engagement with PMT begins early in the referral process and that referring clinicians should ensure treatment options are aligned with diagnoses provided.

Affect↗
PubMed2000

Maternal expressed emotion and treatment compliance of children with epilepsy.

This study investigated the association between family relationships and compliance in the treatment of childhood epilepsy. It was a prospective study of 21 families with a child who had epilepsy attending Central Middlesex Hospital, London. There were 13 boys and eight girls, with a mean age of 12.0 years (SD 2.9) at initial assessment. Mothers were interviewed for assessment of expressed emotion as a measure of parent-child relationships. Assessment of the mothers' adjustment using the General Health Questionnaire (Goldberg 1978), and psychological adjustment of the children using the Rutter Scales (Rutter et al. 1970a), were completed by mothers and teachers. Reassessment was 3 to 4 years after initial contact, including a paediatric case-note review to assess clinic attendance and overall treatment compliance. Significantly more of the group who had a good level of compliance had recovered from epilepsy at follow-up. Good treatment compliance was found to be associated with less maternal hostility and criticism. Children and mothers in the good compliance group had fewer psychiatric symptoms. Poor treatment compliance and the associated psychological disturbances suggest that assertive paediatric and psychosocial intervention may be needed for some children with epilepsy.

Adolescent↗
PubMed2003

Family dynamics and preadolescent girls with ADHD: the relationship between expressed emotion, ADHD symptomatology, and comorbid disruptive behavior.

BACKGROUND: Despite the strong biological underpinnings of attention-deficit/hyperactivity disorder (ADHD), family factors remain salient influences on the course of the disorder. However, relatively little is known about how family-level variables relate to ADHD in girls and whether these variables are linked primarily to core ADHD symptomatology or to comorbid aggressive conditions. METHODS: We investigated the relationship between parental expressed emotion (EE), measured via the five-minute speech sample (FMSS), and ADHD as well as comorbid disruptive behavior disorders, in a diverse sample of 131 girls aged 6-12 years. RESULTS: High parental EE was associated with both ADHD and aggression, whether these constructs were measured categorically or continuously. The EE component of criticism, as opposed to emotional overinvolvement (EOI), showed the stronger associations with both constructs. ADHD subtypes (Inattentive vs. Combined) were equivalent with respect to prediction from high EE status. Whereas linkages with EE were stronger for ADHD than for aggression and withstood control of comorbid aggression, the converse was not true--i.e., the link between EE and aggression did not hold with control of ADHD. Multiple regression analyses revealed that the associations were independent of parenting stress and maternal depression; exploratory analyses revealed interactions between EE and (a) maternal depression and (b) Child Verbal IQ with respect to predictions of disruptive behavior. CONCLUSIONS: These findings add to a growing body of literature on ADHD in girls and highlight a pivotal link between family dynamics and the spectrum of ADHD-related behaviors. They also indicate that inattentive symptoms may be equally challenging to parents as hyperactive/impulsive symptoms.

Attention Deficit Disorder with Hyperactivity↗
PubMed2000

Some late nineteenth century perspectives on sex and emotional expression.

A review of nineteenth century popular literature indicates a deep and sustained public interest in sex differences in emotional expression. The conclusions advanced by popular writers included a catalog of perceived sex differences, reinforced by an essentialist philosophy that provided justification for the separation of sexual spheres and restrictions on political, educational, and vocational opportunities for women. Current scientific research on sex differences appears in popular media and is often presented in the context of an essentialist philosophy comparable with that which was dominant in the nineteenth century. Unfortunately, the subtleties and complexities of sex differences are not always communicated to the public and there is thus a potential for misinterpretation or even misuse.

Emotions↗
PubMed2003

The characteristics of expressed emotion among relatives of patients with schizophrenia in Chengdu, China.

We used the Mandarin Chinese version of the Camberwell Family Interview (CFI) to measure the components of expressed emotion among relatives of schizophrenic patients in urban and rural areas of Chengdu, China. The reliability and validity of the Chinese version of the CFI was examined. Seventy-one patients and their key relatives were included in the study. The results showed that high interrater reliabilities were found for the Chinese version of CFI. The proportion of relatives in our sample rated as high-EE was 28.2%, and the Chengdu relatives expressed significantly fewer critical comments (CCs) and less emotional overinvolvement (EOI) than respondents in other similar studies in the West. Within the Chengdu sample, city dwellers were significantly more expressive than villagers expressing warmth, positive remarks, and EOI (p < 0.05). The results of this study could indicate the impact of cultural and ethnic differences and geographical location on EE.

Adult↗
PubMedDate not supplied

Expressed emotion and social functioning in chronic schizophrenia.

The aim of this study was to reveal the relationships between family expressed emotion (EE), family evaluations of social functioning, and the psychopathologic symptoms of patients with schizophrenia. We examined whether EE influenced the social functioning of patients with schizophrenia. Forty-four subjects with schizophrenia and 82 of their relatives participated in this study. The Five-Minute Speech Sample (FMSS) was conducted to evaluate EE, and subjects were divided into high-EE and low-EE groups. The Positive and Negative Symptom Scale (PANSS) was used to assess symptom severity. Social functioning was compared between the two groups using the Social Functioning Scale (SFS). No differences in symptom severity or social adjustment, as evaluated by a global assessment of functioning, were observed between the two groups. However, the high-EE relatives tended to evaluate the social functioning of the schizophrenia patient in their family as being rather low and showed a strong dissatisfaction with the patient's social withdrawal and level of independence (competence). Furthermore, low-EE relatives in high-EE families showed the same tendencies. The family members who were evaluated as low-EE relatives in a high-EE family were dissatisfied with the patient's social withdrawal, level of independence (competence), and also their interpersonal functioning. In the chronic stable phase of schizophrenia, the attention of the family members may be more directed towards changes in social functioning; thus, the EE may reflect a family's attitude towards improvements in the patient's social functioning.

Adolescent↗
PubMedDate not supplied

Expressed emotion and family distress in relatives of patients with schizophrenia in Japan.

We evaluated the association between distress and expressed emotion (EE) in family members of patients with schizophrenia by the General Health Questionnaire (GHQ), the Camberwell Family Interview (CFI), and the Five-Minute Speech Sample (FMSS). The GHQ score was higher in the high-EE group determined by both the CFI and FMSS. The difference in the GHQ score between high-EE and low-EE groups was more marked for the CFI. Family distress is closely associated with the EE classification, but the EE classification by the CFI more markedly reflected family distress versus the FMSS. Even in relatives with low EE, distress was marked, and therefore, coping with mental health in family members is important.

Adaptation, Psychological↗
PubMed1989

Is expressed emotion an index of a transactional process? II. Patient's coping style.

This article examines the extent to which expressed emotion (EE) indexes not only relatives' behavior toward schizophrenic patients but also patients' behavior toward their relatives. The coping styles (CS) of schizophrenic patients were assessed during interactions with their parents and were compared with parental EE attitudes assessed during an acute hospitalization and during the aftercare period. It was found that parental EE attitudes measured during the inpatient period strongly predicted patients' outpatient transactional behavior: patients interacting with low-EE relatives showed significantly fewer critical and more autonomous statements than patients interacting with high-EE relatives. Further, the dominant patient coping style (autonomous, neutral, externalizing, or internalizing) was strongly related to the relatives' interactional affective style (AS) and to their pattern of EE attitudes. Patient coping style was not related to clinical attributes of these patients themselves. This article and its preceding companion (17) together suggest that EE indexes a transactional process so that the quality of both parents' and patients' transactional behaviors may predict subsequent patient functioning.

Adaptation, Psychological↗
PubMed1991

Changes in the electrodermal activity of schizophrenic patients associated with changes in the expressed emotion status of their relatives.

Thirty-nine relatives of schizophrenic patients, who had been rated as high on Expressed Emotion (EE) during the patients' admission for an acute episode, were re-rated on EE 9 months after discharge from the index admission. Electrodermal activity was recorded from the patient during a 15-min period when the relative was absent and a similar period while the relative was present. Recording took place during the index admission and at a 9-month follow-up. A comparison was made between those patients whose relatives remained high EE at follow-up (Stables) and those whose relatives change to low EE (Decreasers). No differences were apparent between these two groups, however, differences were found within groups. At admission both groups showed an increase in electrodermal measures from the relative-absent period to the relative-present period. At 9-month follow-up, the Stables still exhibited this direction of change, whereas the Decreasers showed a decrease in electrodermal activity between these periods.

Adolescent↗
PubMed1994

[A study on the scaling methods of expressed emotion scales from the perspective of relapse predictability of schizophrenia].

We made an analysis on the scaling methods of Expressed Emotion Scales, which was noticeable as one of powerful psycho-social factors to predict the relapse of the schizophrenics, to find out the unitary conceptual substance in the family. The research was conducted at 3 psychiatric hospitals in Chiba. 72 out of 93 cases were followed up after 9 months. The results were as follows. There was not internal consistency in EE sub-scales at all, but there was two-dimensional structure. It was suggested important to enhance the relapse predictability of EE scales that 1) EE should be assessed by means of household level, 2) binary (high or low) variables of Hostility and Emotional Overinvolvement have to be used, 3) Warmth and Positive Remarks make an important contribution, and 4) information of the existence of the rejective family member to CFI interview is also an important factor.

Adult↗
PubMedDate not supplied

Expressed emotion in parents of non-referred children aged 6 to 11 years from two school populations: a pilot study.

This study investigates the role of parental expressed emotion (EE) in families of well-adjusted children. These were randomly selected from two school populations representing two different socio-economic backgrounds. Maternal criticism was strongly correlated with children's behaviour, although both the EE ratings and the scores of children's behaviour were within the established normal range. Mothers were more emotionally over-involved but also more positive towards their children in manual families. Fathers expressed more warmth towards boys. Clinical and methodological issues regarding the concept of EE are discussed.

Child↗
PubMed1992

Expressed Emotion in community care staff. A comparison of patient outcome in a nine month follow-up of two hostels.

Expressed Emotion was measured in the staff of two similar hostels for the long term mentally ill in an Inner London Borough (Hostel A and Hostel B). Patients in the two hostels showed similar levels of disturbance as measured by the PSE and symptom and behaviour profile scores. Staff from Hostel B displayed higher levels of EE, and were more critical, and these attitudes generalised easily into hostility and rejection. Those from Hostel A showed lower EE with warmth and positive attitudes towards clients. At 9 month follow up, Hostel A and B had similar levels of relapse requiring hospital admission. However Hostel B had a 64% discharge rate compared with 12.5% for Hostel A. These results are discussed with reference to the literature.

Adult↗