High Expressed Emotion Research Articles

6.26 Lost in Translation: Expressed Emotion and Social Functioning in Youth With Autism Spectrum Disorder

Existing studies substantiate a relationship between high familial expressed emotion (EE) and externalizing behaviors in children with autism spectrum disorder (ASD); however, little is known about the relationship between EE and the severity of core symptoms of ASD, specifically social communication and adaptive functioning. This study assesses the hypothesis that EE demonstrates significant relationships with measures of social cognition, perception of the quality of peer relationships, and adaptive functioning. A preliminary analysis includes 16 adolescents with ASD ages 13 to 17 years old, and 12.5% were female. The Social Responsiveness Scale, Second Edition (SRS-2) was administered to measure social interaction and communication deficits. The Child and Adult versions of the Reading the Mind in the Eyes Tests (RMET-C and RMET-A, respectively) were administered as measures of theory of the mind. The Adaptive Behavior Composite score from the Vineland-3 (VABS-3) assessed adaptive functioning. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS) measure was used to evaluate the perception of quality of peer relationships. EE was determined using the Five-Minute Speech Sample. There was a nonsignificant difference in the hypothesized direction between SRS-2 total score (p = 0.34), Social Communication subscale score (p = 0.34), and Social Communication and Interaction DSM-5–compatible subscale score (p = 0.36) between the high and low EE groups. On the RMET-C and -A, subjects with high caregiver EE had similar error rates as those with low EE (p = 0.18 for RMET-C and p = 0.36 for RMET-A). There was no significant difference between the groups on the VABS-3 (p = 0.86). High EE youth rated the quality of their peer relationships lower by 4.9 points on the PROMIS Peer Relationship scale than individuals with low EE (p = 0.16). Although these preliminary results do not support our hypotheses, the nonsignificant differences were in the hypothesized direction. Our sample size was small (N = 16) and likely lacking the power needed to identify significant differences in the social communication of youth with ASD living with low vs high degrees of caregiver EE. Directions for future study include reexamining these hypotheses with a larger sample size and identifying directionality in the association between EE and core deficits.

Machine learning approach to measurement of criticism: The core dimension of expressed emotion.

Expressed emotion (EE), a measure of the family's emotional climate, is a fundamental measure in caregiving research. A core dimension of EE is the level of criticism expressed by the caregiver to the care recipient, with a high level of criticism a marker of significant distress in the household. The Five-Minute Speech Sample (FMSS), the most commonly used brief measure of EE, requires time-consuming manual processing and scoring by a highly trained expert. In this study, we used natural language processing and supervised machine learning techniques to develop a fully automated framework to evaluate caregiver criticism level based on the verbatim transcript of the FMSS. The success of the machine learning algorithm was established by demonstrating that the classification of maternal caregivers as high versus low EE was consistent with the classification of these 298 maternal caregivers of adult children with schizophrenia using standard manual coding procedures, with area under the receiver operating characteristic curve (AUROC) of 0.76. Evidence of construct validity was established by demonstrating that maternal caregivers of adults with schizophrenia, who were classified as having a high level of criticism had higher levels of caregiver burden, reported that their child had more psychiatric symptoms and behaviors and perceived that their child had greater control over these symptoms and behaviors. Additionally, maternal caregivers who had high levels of criticism reported having a poorer quality of relationship with their child with schizophrenia than maternal caregivers low on criticism. Rapid measurement of criticism facilitates the incorporation of this dimension into research across a broad range of caregiving contexts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Role of Criticism in Expressed Emotion Among Psychoactive Substance Users: an Experimental Vignette Study

Expressed emotion (EE) is a rating of criticism, hostility, and emotional over-involvement from a carer towards a person experiencing mental distress. High EE denotes family stress and is associated with greater severity of substance use. Little is known about how EE is perceived by patients with a history of substance use disorder (SUD). The aim of the present study was to investigate perceived EE among substance users and its association with substance use, schizotypy, and depression. Ratings of arousal and relevance of auditory criticism and praise depicting EE, and self-report measures of schizotypy and depression were measured in patients with a recent history of SUD, patients with a recent history of SUD co-occurring with mental disorders (SUD + CMD), and non-clinical healthy control subjects. Group differences in ratings of criticism and praise were tested. The ratings were correlated against schizotypy and depression. Prediction of sensitivity to criticisms by a history of substance use was explored in the SUD groups. Compared to control subjects, individuals with a history of SUD rated criticism as less arousing and those with SUD + CMD rated criticism as more self-relevant. The rating of criticism was positively correlated with schizotypy and depression in the SUD group. Age of onset of substance use was a significant predictor of the arousal of criticism. History of SUD may affect perception of negative audio comments depicting family stress. This effect may be enhanced by high schizotypy traits and negative mental health status, and early age of onset of substance use.

Investigating expressed emotion in individuals at-risk of developing psychosis and their families over 12 months.

This is the first longitudinal study to assess EE from the family/carers' perspective, as well as the service users' perceptions of the family/carers' EE. We explored the effects of EE on transition risk and outcomes of depression, worry, and anxiety. Questionnaires were completed by 70 ARMS individuals and 70 family/carers at three time points: baseline, 6 and 12 months. All participants completed measures of anxiety, depression, and worry, plus a version of the Family Questionnaire to assess EE. EE scores reduced over time for both service users and family/carers. High EE perceived by service users at 6months was associated with higher transition to psychosis at 12 months. High-EE levels at baseline were associated with higher levels of service user depression and family/carer anxiety at 12 months. Higher family/carer total EE scores were associated with less contact with the service user and higher levels of worry. Novel implications suggest that interventions to reduce high EE in families of people with ARMS would benefit service users by protecting them from higher levels of depression and transition to psychosis. Reducing high-EE attitudes would also benefit the family/carers by reducing levels of anxiety and worry. Family interventions focussing on multiple perceptions of the home environment could help to direct services and prevent negative psychological outcomes for all family members.

The predictive power of expressed emotion and its components in relapse of schizophrenia: a meta-analysis and meta-regression

Schizophrenia is a longstanding condition and most patients experience multiple relapse in the course of the condition. High expressed emotion (HEE) has been found to be a predictor of relapse. This meta-analysis and meta-regression examined the association of global EE and relapse specifically focusing on timing of relapse and EE domains. Random-effects model was used to pool the effect estimates. Multiple random-effects meta-regression was used to compute the moderator analysis. Putative effect moderators including culture, EE measurements, age, length of condition and study quality were included. Thirty-three prospective cohort studies comprising 2284 patients were included in the descriptive review and 30 studies were included for meta-analysis and meta-regression. Findings revealed that global HEE significantly predicted more on early relapse (⩽12 months) [OR 4.87 (95% CI 3.22-7.36)] than that on late relapse (>12 months) [OR 2.13 (95% CI 1.36-3.35)]. Higher level of critical comments (CC) significantly predicted relapse [OR 2.22 (95% CI 1.16-4.26)], whereas higher level of warmth significantly protected patients from relapse [OR 0.35 (95% CI 0.15-0.85)]. None of the moderators included significantly change the results. These findings indicate that there is a dynamic interaction between EE-relapse association with time, and CC and warmth are the two important EE domains to influence relapse among patients with schizophrenia. Results also confirmed the foci of family interventions on reducing CC and improving warmth in relationship.

High level of expressed emotions in the family of people with schizophrenia: has a covert abrasive behaviours component been overlooked?

BackgroundHigh expressed emotion (EE) in a patient's family is a known risk factor of relapse in schizophrenia. The three components of high EE – criticism, hostility and emotional over-involvement – were developed through a data-driven approach and a focus on overt abrasive behaviours. The influence of covert abrasive behaviours has not been explored. Aims and methodsThis study aims to explore both overt and covert abrasive behaviours through semi-structured interviews conducted with 22 people with schizophrenia, who were recruited through iterative purposive sampling. ResultsThematic analysis suggests that participants' experiences of overt abrasive behaviours resonate with the three-factor structure of high EE, except “emotional over-involvement” is renamed to “over-involvement” to focus on behaviours and embrace different levels or types of emotional reactions. Regarding covert abrasive behaviours, two domains are proposed: disassociation and apathy, which focus on family members' disengaging actions and indifferent attitudes respectively. While both overt and covert abrasive behaviours cause psychological distresses and behavioural reactions on the participants, their precise impacts are not entirely the same. ConclusionPeople with schizophrenia experience both overt and covert abrasive behaviours with family members. The findings of this study may expand the conceptualization of high EE, enhance its content validity, and provide an extended conceptual framework for developing more comprehensive measures.

Family Focused Therapy for Family Members of Patients with Bipolar Disorder: Case Reports of Its Impact on Expressed Emotions.

Caregivers of patients with bipolar disorder (BD) undergo a considerable amount of burden. In India, family caregivers are the primary source of support and care for their ill relatives. The burden faced by family members of patients with BD often results in physical and mental health consequences. This may lead to negative interaction patterns such as hostility, criticality, and overinvolvement, termed as expressed emotions (EE). Here, we report how we addressed the EE in family members, using a single-subject design that involved the family caregivers (n = 2) of two adults who presented with a diagnosis of BD with a current episode of mania. An assessment of family caregivers, using the family questionnaire, revealed high EE. Family focused therapy (FFT) of 12 sessions was delivered over 3–4 weeks on an inpatient basis, with positive outcomes of reductions in EE and family stress and improved psychosocial functioning in patient that were sustained over 9–10 months. FFT can be an important add on psychosocial therapy to reduce EE and stress and to facilitate functioning and communication.

Affective temperament traits may explain high expressed emotion in caregivers of patients with Alzheimer's disease.

The negative interactions between Alzheimer's disease (AD) patients and their caregivers may provoke criticism, hostility, and emotional overinvolvement that characterise highly expressed emotion (EE) attitudes. In this study, we hypothesised that affective temperament traits of AD caregivers are related to their high EE levels independent from other patient and caregiver characteristics. Eighty AD patients were assessed through Clinical Dementia Rating Scale (CDR), and Mini-Mental State Examination. Expressed Emotion Scale (EES), Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire, and Hamilton Depression Rating Scale were applied to the caregivers. The high (n = 41) and low EE caregivers (n = 39) were compared with respect to some sociodemographic and clinical characteristics of the patients and caregivers, and affective temperament traits of caregivers. The associations of caregiver EES scores with multiple variables related to patients and caregivers were examined by Pearson correlation tests. We performed multiple linear regression analysis to determine the possible predictors of total EES scores. High EE caregivers had significantly higher depressive, cyclothymic, and anxious temperament traits than in low EE subjects. A weak positive correlation was found between the total EES scores and Personal Care scores of CDR. Home and hobbies subscale scores of CDR had a moderately significant positive correlation with total EES scores. There was also moderate significant positive correlations between total EE scores and depressive, cyclothymic, anxious, and irritable temperament traits. Linear regression analysis indicated that depressive temperament significantly predicted the high levels of caregiver EE. These findings suggest that caregivers' depressive temperament is predominantly related to their EE levels even after controlling for the severity of AD, and lower educational level of caregivers. Our results may provide evidence that high EE might be a reflection of caregivers' depressive temperament traits, in accordance with the trait hypothesis.

Reduction of High Expressed Emotion and Treatment Outcomes in Anorexia Nervosa-Caregivers' and Adolescents' Perspective.

High expressed emotion (EE) is common in caregivers of patients with anorexia nervosa (AN) and associated with poorer outcome for patients. In this study, we examined the prevalence of high EE in caregivers of adolescents with AN and analyzed predictors for EE using multivariate linear regression models. We further analyzed whether EE is reduced by the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) intervention using general linear mixed models and whether a reduction of EE predicts patients’ outcomes. Caregivers were randomly allocated to the SUCCEAT workshop (N = 50) or online intervention (N = 50) and compared to a comparison group (N = 49). EE and patients’ outcomes were assessed at the baseline, post-intervention, and at the 12-month follow-up. Up to 47% of caregivers showed high EE. Lower caregiver skills, higher AN symptom impact, higher levels of depression and motivation to change in caregivers were significant predictors for high EE. EE significantly decreased in the SUCCEAT groups and the comparison group according to the caregivers’, but not the patients’ perspective. The level of reduction could partially predict subjective improvement and improvement in clinically assessed AN symptoms and body mass index of patients. Implementing interventions for caregivers addressing EE in the treatment of adolescents with AN is strongly recommended.

T233. CULTURAL CONSENSUS AND HIGH EXPRESSED EMOTION IN RELATIVES OF PEOPLE WITH SCHIZOPHRENIA AT THE MENTAL HEALTH INSTITUTE OF JALISCO, MEXICO

BackgroundSchizophrenia is a chronic mental disorder that affects almost 21 million people (WHO, 2017), in areas like: cognition, perception, language, behavior, and in its general functionality. Also generates complications in primary caregivers, whom in different studies have shown levels of emotional, physical and financial overload (De la higuera, 2005). This variables creates environments with High Expressed Emotionality (EE) in these families. EE is characterized by a series of relationships and communications in the family environment, loaded with negative assessments, criticism, control and over-involvement; such dynamics causes poor self-concept in individuals with psychosis, difficulty in adhering to treatment, negative emotional behaviors, symptomatic exacerbations and continuous relapses according to Rosenfarb, et al. (2000), Barrowclough, et al. (2003), and Sellwood, et al (2003).MethodsThis research had a Mixed method design, with an exploratory sequential strategy. The main objective of this study was to Identify the association between cultural consensus and expressed emotion in relatives of people with schizophrenia from the Mental Health Institute of Jalisco, México (SALME). The universe involved 40 relatives from 18 families of people diagnosed with schizophrenia, users of SALME. The sample was calculated based on Weller and Romney (1998) proporsal to obtain a level of proficiency higher than 50% for cognitive anthropology samples, with a confidence level of 95% and error of 5%. The EE was evaluated with the Seclén & Guanilo (1993) Familiar Expressed Emotionality Scale. The Cultural consensus was analized with Anthropac program for cultural domain analysis.Results66% of the families had high expressed emotion (EE) and 45% of the sample were cataloged with a high EE. A significant difference was found among relatives who had high EE and lower knowledge about schizophrenia vs relatives who had greater scientific knowledge and lower EE (t= -9.15, p=.00 /U. Mann-Witney= 1.00, p=.00). There was no evidence of a significant association between high EE and sociodemographic variables such as: sex, education, type of family member, occupation or religion. There was only a significant association between high EE and relatives living with the patient (x2 = 4.82, p≤.05) versus those relatives who only participated in day care.DiscussionThe sample of relatives contemplated for this study was similar to the number of families that have been included in other studies, for example: Jeff & Kuipers, et al (1982) or Guidorizzi, et al (2012). However, this design and research purposes were innovative in this area since there wasn′t found any reference from another study that addresses the issue of cultural consensus in schizophrenia, nor its relationship with high EE in relatives of people with this disorder. Conclusion: The less scientific knowledge about schizophrenia, the more expressed emotionality is shown.The importance of psychoeducation is highlighted to promote scientific knowledge of mental illnesses in order to reduce high EE.

Health care providers expressed emotions in dealing with bipolar patients

Family's challenges in relation to stress has been functional as whether or not the patient resides with relatives which characterized by high expressed-emotion (EE) attitudes. High EE refers to high levels of criticism, hostility, and/or emotional over involvement from a health care provider who is a relative (typically a parent or spouse) during or immediately following a patients acute episode of illness (David, 2008).

Expressed Emotion Research in India: A Narrative Review.

Background:Expressed emotion (EE) is detrimental to patients with schizophrenia, mood disorders, eating disorders and many other psychiatric and neurological disorders. However, majority of the EE literature is generated from the west, and the results of those studies may have limited application in Indian setting. Hence, we conducted this review with the main aim of understanding EE research in India and its potential role in the course and outcome of psychiatric disorders and other chronic illnesses.Methods:Using keywords, we performed searches of electronic databases (PubMed, IndMed, PsychInfo, Science-Direct and Google Scholar) and internet sources and a manual search in the bibliography of the retrieved articles to identify potential original research articles on EE in India.Results:As per the selection criteria, 19 reports of 16 studies were included and reviewed. The sample size of the EE studies ranged from 20 to 200, and majority of the studies were conducted in psychosis/schizophrenia, followed by obsessive compulsive disorder and epilepsy. Although high EE was found in most of the studies, the impact of EE on illness outcome is not well explored and only two studies examined the relationship between EE and relapse.Discussion and Conclusion:There is a dearth of studies on EE, especially its relationship with relapse or clinical outcomes in the Indian context. We recommend more studies in these areas which may be helpful for clinical decisions and advancement of context knowledge in EE.

Are family warmth and positive remarks related to outcomes in psychosis? A systematic review.

Affective attitudes and behaviours manifested within the family environment have been characterised as expressed emotion (EE). High EE environments have been robustly shown to put psychosis patients at a greater risk of relapse compared with low EE exposure. Positive EE dimensions (warmth; positive remarks) have received far less attention than negative EE dimensions such that EE has become synonymous with a negative family atmosphere; the predictive value of positive EE dimensions is largely ignored. A systematic review examining the relationship between positive family EE and outcomes in psychosis is needed. A systematic search was conducted. Studies reporting bias and study quality were assessed. A total of 2368 studies were identified. Of these, 27 met eligibility criteria reporting outcomes including relapse, symptomatology, social functioning and life satisfaction. Relapse was the most commonly measured outcome. Stronger evidence emerged for the association between EE warmth and outcomes compared with EE positive remarks, with effects mostly evident in the early phase of psychosis. Evidence for protective effects of warmth on relapse was found up to 9 months follow-up. No effects were evident between positive remarks and relapse. Studies assessing symptom outcomes showed inconsistent findings. Evidence for an association with social functioning was evident, primarily in at risk mental states. Warmth and positive remarks predicted life satisfaction. The positive aspects of EE require further investigation with longitudinal research designs. Clinical interventions should focus not only on reducing negative aspects of EE but also foster warmth within families in the context of psychosis.

Characteristics of Parents With High Expressed Emotion and Related Factors: A Study of Parents of Adults With Schizophrenia.

This study aimed to clarify characteristics of parents with high expressed emotion (EE) and related factors among parents of adults with schizophrenia. In total, 73 (25.3%) of the 289 parents had high EE (Family Attitude Scale [FAS] score ≥60), and 216 (74.7%) had low EE (FAS score <60). A multiple logistic regression analysis showed that high EE parents were more distressed (odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.16-1.39) and experienced more physical violence from their adult children with schizophrenia (OR = 2.86; 95% CI = 1.28-6.43); the children with schizophrenia had been hospitalized at time of survey (OR = 6.54; 95% CI = 1.10-38.89) and were less likely to attend rehabilitation services (OR = 2.56; 95% CI = 1.06-6.17). Practitioners need to provide crisis intervention, home-visiting services, and support services for parents during hospitalization of their children with schizophrenia.

Expressed emotion, emotional distress, and individual and familial history of affective disorder among parents of adolescents with bipolar disorder

Parental expressed emotion (EE) attitudes are important prognostic indicators in the course of bipolar disorder (BD) in adolescents and adults. This study examined the hypothesis that parents’ own susceptibility to affective disturbances contributes to their likelihood of high-EE attitudes. We examined past-week levels of emotional distress, lifetime affective diagnoses, and family histories of affective disorder among high- and low-EE parents of 86 adolescents with bipolar I or II disorder who were recovering from an episode of depression or (hypo) mania. High EE parents endorsed higher concurrent levels of depression, anxiety, and anger/hostility than low EE parents, and reported a greater familial history of depression and BD. No differences between high and low EE parents were found in concurrent levels of interpersonal sensitivity, lifetime rates of affective disorders, or familial loading of anxiety disorder. Parents’ distress at the time of the EE assessment was the strongest correlate of EE. The results suggest that susceptibility to affective psychopathology may be an important contributor to the development of EE attitudes among parents of adolescents with BD.

Caregiver correlates of patient-initiated violence in early psychosis

Patient-initiated violence may pose a significant risk to the strength and longevity of informal caregiving relationships in psychosis. We aimed to assess caregiver reports of patient-initiated violence in early psychosis and to examine the relationship between violent incidents and appraisals of caregiving, perceived mental wellbeing in caregivers and Expressed Emotion (EE) in the caregiving relationship. Eighty psychosis caregivers were recruited via Early Intervention (EI) psychosis services in London, United Kingdom. Caregivers were questioned about their experiences of patient-initiated violence during the semi-structured Camberwell Family Interview, and completed the Experience of Caregiving Inventory and the RAND SF-36 health survey in a cross-sectional experimental design. One third of the sample reported at least one incident of patient-initiated violence. Reports of violence were associated with poorer mental wellbeing scores amongst caregivers and more negative appraisals of caregiving. Patient-initiated violence also correlated with greater criticism and hostility expressed towards patients, and a rating of high EE in caregiver reports. The results underscore the need to ask explicitly and routinely about the physical safety of caregivers looking after someone with psychosis. Families should be directed towards appropriate interventions to help manage any risk of violence and the likely negative impact on the caregiving relationship.

Factors contributing to higher caregiving burden in Turkish mothers of children with autism spectrum disorders

ObjectivesThe aim of this study was to explore the caregiver burden and related factors such as expressed emotion (EE), social support, life satisfaction, dyadic adjustment, post-traumatic growth, and socio-demographic characteristics of mothers with autism spectrum disorder (ASD) children.MethodsSixty-two mothers of children with autism spectrum disorder and 60 mothers of typically developing children completed the Zarit Burden Scale, the Multidimensional Scale of Perceived Social Support, the Satisfaction with Life Scale, the Dyadic Adjustment Scale, the Expressed Emotion Scale, and the Post-Traumatic Growth Inventory. The Autism Behavior Checklist was used to examine the severity of autistic behaviors. A socio-demographic data form was applied to the subjects. Participants were recruited in Autistic Children Education Center, homes, and workplaces. Correlation analysis, independent-samples t-tests, post hoc Mann–Whitney U, and SEM tests were conducted for statistical analyses.ResultsHigher maternal caregiving burden was associated with lower life satisfaction and higher level of disability in Turkish children with ASD. Also, higher life satisfaction of mothers with ASD children was related to higher social support and dyadic adjustment, and lower EE. According to the SEM analysis, disability percentages, autism-related behaviors in children, and poor dyadic adjustment were significant predictors of caregiving burden in these mothers which in turn resulted with higher EE and poor life satisfaction.ConclusionsThere are several studies that have investigated the distress in parents of children with developmental disabilities in general, but caregiving burden in ASD was not evaluated elsewhere in detail. These mothers need professional guidance and psychosocial support during the parenting process. Further studies that aim to investigate the whole family, including the father and the siblings, are also necessary.

Stigma, Expressed Emotion, and Quality of Life in Caregivers of Individuals with Dementia.

Expressed emotion (EE) is a measure of a caregiver's critical and emotionally overinvolved (EOI; e.g., intrusive, self-sacrificing) attitudes and behaviors toward a person with a mental illness. Mounting evidence indicates that high levels of these critical and EOI attitudes and behaviors (collectively termed high EE) in family members are associated with a poorer course of illness for people with a range of disorders, including dementia (Nomura et al., 2005). However, less is known about factors that might trigger high EE and how high EE might impact dementia caregivers' own mental health. In this study we propose that caregivers who perceive stigma from their relative's illness may be more likely to be critical or intrusive (high EOI) toward their relative in an attempt to control symptomatic behaviors. We further hypothesized that high EE would partially mediate the link between stigma and quality of life (QoL) as there is some evidence that high EE is associated with poorer mental health in caregivers themselves (Safavi et al., 2015). In line with study hypotheses and using a sample of 106 dementia caregivers, we found that greater caregiver stigma was associated with both high EE (for criticism and EOI) and with poorer QoL. Mediational analyses further confirmed that high EE accounts for much of the association between stigma and poorer QoL. Study results suggest that addressing caregiver stigma in therapy could reduce levels of high EE and indirectly therefore improve caregiver QoL. Intervening directly to reduce high EE could also improve caregiver QoL.

Effect of caregivers' expressed emotion on the care burden and rehospitalization rate of schizophrenia.

BackgroundThis study assessed the effect of expressed emotion (EE) among caregivers of schizophrenia patients on their care burden and the illness rehospitalization rate.Subjects and methodsA total of 64 schizophrenia patients hospitalized for the first time and their key caregivers were recruited. The Chinese version of the Camberwell Family Interview (CFI-CV) was used to evaluate the EE of the key caregivers. A family burden questionnaire was used to evaluate the care burden. The patients’ rehospitalization rate and medication compliance were evaluated by the self-designated criteria. The data collection was carried out at the first meeting in the hospital, at 6 months and 12 months after hospital discharge by using the same instruments.ResultsThe subjective stress burden and subjective demand burden scores were higher in caregivers before and after discharge with statistical difference between the various observation time points (P<0.05). Significant differences were observed in the rehospitalization rate between patients with high medication adherence and low medication adherence at 12 months (P<0.01) and between patients with high expressed emotion (HEE) and low expressed emotion (LEE; P<0.05). The rehospitalization rate in patients with HEE caregivers was higher than that in those with LEE caregivers. The subjective stress burden scores were statistically significant between HEE and LEE caregivers (P<0.05).ConclusionHEE is a predictor of rehospitalization rate in schizophrenic patients. The burdens of care scores are high in caregivers of schizophrenic patients. The caregivers with HEE have a high score in burden of care compared with those with LEE.

Perceived expressed emotions in relatives of patients with severe mental illness: A comparative study

There is paucity of studies on expressed emotion (EE) in families of patients with severe mental illness in sub-Saharan Africa. This study aimed to assess and compare the levels of expressed emotion (LEE) in relatives of patients with schizophrenia and bipolar affective disorder attending an out-patient clinic in Southwestern Nigeria. One hundred and forty consecutive clinic attendees with Mini-Plus diagnosis of schizophrenia and bipolar affective disorder and 140 accompanying relatives were recruited. The patients and relatives were interviewed using a socio-demographic questionnaire. The perceived level of expressed emotion was assessed using the client version of the Level of Expressed Emotion Questionnaire (LEEQ). Although, the prevalence of high expressed emotion was higher among relatives of patients with schizophrenia when compared with relatives of patients with bipolar affective disorder (41% vs 37%), the difference was not statistically significant. The socio-demographic characteristics of the relatives of patients with these disorders were not significantly related to high EE. High expressed emotion is just as prevalent among relatives of patients with bipolar affective disorder as among relatives of patients with schizophrenia and clinicians should give similar attention to early detection of high EE and intervention in this population of patients and their relatives.