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Ferentinos P, Douki S, Yotsidi V, Kourkouni E, Dragoumi D, Smyrnis N, Douzenis A. Family in Crisis: Do Halfway Houses Perform Better Than Families with Expressed Emotion toward Patients with Schizophrenia? A Direct Adjusted Comparison. Healthcare (Basel) 2024; 12:375. [PMID: 38338260 PMCID: PMC10855104 DOI: 10.3390/healthcare12030375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Expressed emotion (EE) toward patients with schizophrenia is typically reported to be lower in psychiatric halfway houses than in families. This is the first study directly comparing EE between these settings and investigating the pathways mediating EE differences. We included 40 inpatients in halfway houses and 40 outpatients living with their families and recorded 22 psychiatric nurses' and 56 parents' EE, respectively, through Five Minutes Speech Samples. Each inpatient was rated by 2-5 nurses and each outpatient by 1-2 parents. As EE ratings had a multilevel structure, generalized linear mixed models were fitted, adjusting for patient-related confounders and caregiver demographics. Mediatory effects were investigated in multilevel structural equation models. Outpatients were younger, less chronic, and better educated, with higher negative symptoms and perceived criticism than inpatients. Nurses were younger and better educated than parents. Before adjustment, EE rates were equally high across settings. After adjusting for patient-related confounders, emotional overinvolvement was significantly higher in parents. However, after also adjusting for caregiver demographics, only criticism was significantly higher in nurses. Patients' age, negative symptoms, and perceived criticism and caregivers' age and sex significantly mediated EE group differences. Our findings highlight pathways underlying EE differences between halfway houses and families and underscore the importance of staff and family psychoeducation.
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Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
| | - Stamatina Douki
- Department of Psychiatry, “Evangelismos” General Hospital, 106 76 Athens, Greece; (S.D.); (D.D.)
| | - Vasiliki Yotsidi
- Department of Psychology, Panteion University of Social and Political Sciences, 176 71 Athens, Greece;
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research, 15 451 Athens, Greece;
| | - Dimitra Dragoumi
- Department of Psychiatry, “Evangelismos” General Hospital, 106 76 Athens, Greece; (S.D.); (D.D.)
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
| | - Athanasios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
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Ferentinos P, Douki S, Kourkouni E, Dragoumi D, Smyrnis N, Douzenis A. Differential correlates of criticism versus emotional overinvolvement towards patients with schizophrenia living in halfway houses or with their families. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02609-7. [PMID: 38296844 DOI: 10.1007/s00127-023-02609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE This study systematically searched for differential correlates of criticism vs. emotional overinvolvement (EOI) towards patients with schizophrenia in families and halfway houses, which have only incidentally been reported in previous research. Identified patterns were compared across settings. METHODS We included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the expressed emotion (EE) of 22 psychiatric nurses or 56 parents, respectively, through Five Minutes Speech Samples. Each nurse rated 1-12 inpatients and each inpatient was rated by 2-5 nurses. Each outpatient was rated by one or both parents. As EE ratings had a multilevel structure, weighted Spearman correlations of criticism and EOI with various patient- and caregiver-related characteristics were calculated and compared with Meng's z-test. RESULTS Criticism was weakly negatively correlated with EOI in nurses but negligibly in parents. Distinct patterns of significant differential correlates arose across settings. Outpatients' aggressive behavior and parents' related burden were mainly associated with higher criticism. Inpatients' symptoms (agitation/aggression, negative and other psychotic symptoms) and nurses' burnout (Depersonalization) were mainly associated with lower EOI. Inpatients' perceived criticism and outpatients' previous suicide attempts were equally associated with higher criticism and lower EOI (mirror correlations). Finally, various inpatient attributes (older age, chronicity, unemployment and smoking) triggered higher EOI only. Inpatients' age, psychopathology (esp. agitation/aggression and negative symptoms) and perceived criticism survived adjustment for multiple comparisons. CONCLUSION Our findings suggest setting-specific pathogenetic pathways of criticism and EOI and might help customize psychoeducational interventions to staff and families.
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Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece.
| | - Stamatina Douki
- Department of Psychiatry, "Evangelismos" General Hospital, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research, Athens, Greece
| | - Dimitra Dragoumi
- Department of Psychiatry, "Evangelismos" General Hospital, Athens, Greece
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Athanassios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
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McKenna A, Hazell CM, Souray R, Cai W, Man LC, Brown L, Floyd C, Lyons N, Widuch K, James G, Keay D, Souray J, Afsharzadegan R, Raune D. Do carers of adolescents at first episode psychosis have distinctive psychological needs? A pilot exploration. Int J Soc Psychiatry 2022; 68:600-609. [PMID: 33554710 DOI: 10.1177/0020764021992828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Carers of patients experiencing first episode psychosis (FEP) are at an increased risk of mental and physical health problems themselves. However, little is known about how the psychological needs of carers may differ between those caring for an adolescent versus an adult who has FEP. AIMS This pilot study aimed to explore any differences in the psychological needs of carers caring for adolescents versus adults with FEP. METHODS We surveyed 254 carers of 198 FEP patients (34 carers of adolescents of 24 FEP adolescent patients). Carers completed self-report measures of anxiety, depression, burnout, subjective burden, coping, and key illness beliefs. The sample was divided according to whether the patient was under (adolescent) or over (adult) age 18, and analysed using mixed model logistic regressions. RESULTS Compared to the carers of adult patients, carers of adolescents were more than twice as likely (12% vs. 30%) to experience overall burnout syndrome (all three domains), and to develop it much quicker (19.4 vs. 10.1 months). They were also more likely to adopt behavioural disengagement avoidance as a form of coping. However, there was no difference between carers in terms of anxiety, depression, beliefs and subjective burden. For carers of adolescents, burnout was independently predicted by: a negative belief about the consequences of psychosis for the adolescent patient and an incoherent understanding of the patient's mental health. CONCLUSIONS If our findings can be replicated in a larger sample, then Rapid-Onset-Burnout-Syndrome (ROBS) is a particular problem in carers of adolescents at FEP, suggesting a need for routine screening and possible prophylactic intervention. Carers of adolescent's use of behavioural escape coping maybe also require early intervention. Theoretically, consideration could be given to the development of an adolescent sub-branch to the cognitive model of caregiving.
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Affiliation(s)
- Alice McKenna
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK.,Community Transformation Project, East London NHS Foundation Trust, London, UK
| | - Cassie M Hazell
- Department of Social Sciences, University of Westminster, London, UK
| | - Rowan Souray
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Wenyi Cai
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Lai Chu Man
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Lucy Brown
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Caroline Floyd
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Natasha Lyons
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Kaja Widuch
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Gareth James
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Debra Keay
- CAHMS Ash Tree, Central and North West London NHS Foundation Trust, London, UK
| | - Jonathan Souray
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - Roya Afsharzadegan
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
| | - David Raune
- Harrow and Hillingdon Early Intervention in Psychosis Service, Central and North West London NHS Foundation Trust, London, UK
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Torres Saavedra SJ, Rossani Alatrista GVM. We have to talk about prevention and psychosis. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:82-84. [PMID: 35717387 DOI: 10.1016/j.rcpeng.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 06/15/2023]
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Shetty K, Manikappa S, Murthy S, Anjanappa J, Rawat V. Expressed emotion among families of individuals with alcohol dependence syndrome: A pilot study. ANNALS OF INDIAN PSYCHIATRY 2022. [DOI: 10.4103/aip.aip_14_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Movaghar A, Page D, Saha K, Rynn M, Greenberg J. Machine learning approach to measurement of criticism: The core dimension of expressed emotion. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2021; 35:1007-1015. [PMID: 34410788 PMCID: PMC8478812 DOI: 10.1037/fam0000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
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).
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Affiliation(s)
- Arezoo Movaghar
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
| | - David Page
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Krishanu Saha
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Moira Rynn
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Jan Greenberg
- School of Social Work, University of Wisconsin-Madison, Madison, WI, United States
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Torres Saavedra SJ, Rossani Alatrista GVM. We have to Talk about Prevention and Psychosis. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 51:S0034-7450(20)30115-3. [PMID: 33735045 DOI: 10.1016/j.rcp.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 06/12/2023]
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Relationship between posttraumatic stress symptoms, caregiving response, and parent mental health in youth exposed to single incident trauma. J Affect Disord 2019; 251:15-22. [PMID: 30889475 DOI: 10.1016/j.jad.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/24/2019] [Accepted: 03/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Family factors may alter the risk of developing posttraumatic stress disorder (PTSD) or depression in young people after a traumatic event, but it is not clear which modifiable family variables can be addressed in psychological therapies. This study examined the relationships between family factors (Expressed Emotion [EE] and family accommodation) and psychopathology (posttraumatic stress symptoms; PTSS) in young people following a single incident trauma. Potential mediators of these relationships were also investigated. METHOD Sixty-six parent-child dyads (aged 8-17 years) were assessed within one month of attending an Emergency Department. Self-reported PTSS and perceived EE were assessed in young people. Parents' own PTSS, mood symptoms, EE, and accommodating behaviours were also assessed. RESULTS Cross-sectional analyses revealed that young person-perceived EE, parent-reported emotional over involvement (EOI) and accommodation behaviours significantly predicted higher PTSS in young people. The stress experienced as a consequence of EE mediated the relationship between young person-perceived EOI and PTSS in young people. Parental PTSS and anxiety were positively correlated with EOI and accommodation. Parental PTSS was not significantly associated with symptoms in young people. CONCLUSIONS The results support the hypothesis that EE and accommodation are positively associated with PTSS in young people in the month following a potentially traumatic event. Understanding the child in the context of their family environment and relationships offers an important framework for making sense of and facilitating adaptive adjustment following a traumatic event.
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Zanetti ACG, Vedana KGG, Pereira CCM, de Azevedo Marques JM, da Silva AHS, Martin IDS, Dantas RAS, de Souza J, Galera SAF, Gherardi-Donato ECDS. Expressed emotion and socio-demographic and clinical factors in families of Brazilian patients with schizophrenia. Int J Soc Psychiatry 2019; 65:56-63. [PMID: 30488742 DOI: 10.1177/0020764018815207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Families are the main caregivers of people with schizophrenia. Family dynamic and expressed emotion (EE) of relatives are fundamental determinants on the course of schizophrenia. METHOD This study analyzed socio-demographic and clinical factors related to EE components. A total of 94 dyads (patients with schizophrenia and their relatives) were recruited from three mental health clinics. A form containing socio-demographic and clinical variables and the Brazilian version of Family Questionnaire were used and the data were analyzed through regression model. RESULTS Results showed that factors such as patients' occupation status and patients' age, as well as relatives' gender and the degree of relatedness, were related to emotional overinvolvement and critical comments levels. CONCLUSION This is the first study in the Brazilian cultural context that evaluates EE components and related factors on families of patients with schizophrenia. Other studies concerning EE on different cultural contexts and possible interventions must be carried out to help health professionals to improve patient and family care.
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Affiliation(s)
- Ana Carolina Guidorizzi Zanetti
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Kelly Graziani Giacchero Vedana
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Camila Corrêa Matias Pereira
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | | | - Amanda Heloisa Santana da Silva
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Isabela Dos Santos Martin
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Rosana Aparecida Spadoti Dantas
- 3 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Jacqueline de Souza
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Sueli Aparecida Frari Galera
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Edilaine Cristina da Silva Gherardi-Donato
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
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10
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Abstract
BackgroundThe factors influencing the development of expressed emotion (EE) are still unclear. Understanding the carer and patient appraisals operating during the initial adaptation to psychosis may help to clarify the early ontogenesis of EE.MethodFifty patients and key carers were followed-up over 9 months and their appraisals of loss and burden were measured in relation to the evolution of high emotional overinvolvement (EOI) and critical (CC) relationships.ResultsThe appraisal of loss was linked to high EOI but not high CC relationships at baseline. Loss reduced by 9-month follow-up in those changing from high EOI to high CC or low EE. Subjective burden of carers was linked to loss but not to EE status. Patients' and relatives' appraisals of loss were strongly correlated, particularly in high EOI relationships. Longer duration of untreated psychosis was associated with high CC.ConclusionsThe results are consistent with Bowlby's attachment theory, where EOI and coercive criticism maybe understood as adaptive reactions to perceived loss. Implications for family intervention in first-episode psychosis and the prevention of high EE are discussed.
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Affiliation(s)
- Paul Patterson
- ED:IT, Early Intervention Service, 97 Church Lane, Aston, Birmingham B6 5UG, UK.
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11
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Darmi E, Bellali T, Papazoglou I, Karamitri I, Papadatou D. Caring for an intimate stranger: parenting a child with psychosis. J Psychiatr Ment Health Nurs 2017; 24:194-202. [PMID: 27981693 DOI: 10.1111/jpm.12367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT The care of an adult son or daughter with psychosis is filled with overwhelming demands caused by the symptomatology and illness exacerbations. Parents display disenfranchised grief over multiple losses and report increased levels of emotional burden. Most studies use quantitative methods and rely on pre-existing theoretical frameworks to investigate, through psychometric measures, the effects of being a carer. Meaning attributions to the disorder, and changes in parent-child relations over time, are poorly understood. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE This hermeneutic phenomenological study illuminates the subjective experience of parenting a son or daughter with psychosis, as it is lived and described by parents of young adults with psychosis. Findings suggest that the parents' perceptions of their child changes over the course of the disorder, leading to a redefinition of the parent-child relationship, causing alternations in attachment. Findings illuminate the parents' profound guilt over having contributed or not prevented the disorder, over not being 'good' parents and feeling ambivalent towards an 'intimate stranger.' Guilt is compensated by absolute dedication to the son or daughter's care, at the expense of their own well-being. WHAT ARE THE IMPLICATIONS FOR PRACTICE Interventions for parents must be available as soon as possible, both during hospitalization and after discharge. Professionals should provide a therapeutic space, where parents could express intimate thoughts and feelings, address guilt, fear and resentment issues, be assisted in their parenting role as well as in the reconstruction of a sense of self and self-esteem. Professionals are invited to facilitate illness acceptance, provide accurate information, assist parents to redefine their relationship to the child and facilitate the integration of the traumatic experience into their personal and family narrative. Professionals must develop in depth awareness of their biases and attitudes, have an ongoing training on how to respond to the parents' needs, facilitate therapeutic change and accompany families through the course of their adult child's illness trajectory. ABSTRACT Introduction Children who are diagnosed with psychosis often rely on their parents for prolonged care. The impact of such care is partially understood as most studies use quantitative methods and pre-existing theoretical frameworks that limit their investigation to emotional burden, and emotional responses. Aim Explore the parents' lived experience of caring for a child with psychosis. Method A hermeneutic phenomenological design was used with a sample of 16 parents of children with psychotic disorders who were hospitalized or attended the outpatient clinic of a large psychiatric Greek hospital. Results Identified themes were as follows: (i) the psychosis experience, (ii) redefinition of the parent-child relationship over the course of the disorder and (iii) challenges of parenting a child with psychosis. Discussion 'Caring for an intimate stranger' reflects the parents' overall experience, involving changes in the parent-child relationship, ambivalence towards caretaking and profound guilt, compensated by self-sacrifice parenting practices. IMPLICATIONS FOR PRACTICE Findings highlight the necessity to train mental health professionals to provide individualized information; facilitate family communication; address the parents' guilt, ambivalence, meaning attributions that compromise adjustment; and support them through the challenges of parenting a son or daughter with psychosis.
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Affiliation(s)
- E Darmi
- Department of Psychotherapy, Dromokaiteio Psychiatric Hospital of Attica, Athens, Greece
| | - T Bellali
- Nursing Department, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece
| | - I Papazoglou
- Psychiatric Department, Sismanoglio Public General Hospital of Attica, Athens, Greece
| | - I Karamitri
- General Hospital of Kalamata, Kalamata, Greece
| | - D Papadatou
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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12
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Vasconcelos E Sa D, Wearden A, Hartley S, Emsley R, Barrowclough C. Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis. Psychiatry Res 2016; 245:406-413. [PMID: 27611070 DOI: 10.1016/j.psychres.2016.08.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 07/23/2016] [Accepted: 08/26/2016] [Indexed: 01/11/2023]
Abstract
While research using Experience Sampling Methodology (ESM) suggests that, in general, contact with relatives or friends may be protective for psychotic experiences, contact with high-Expressed Emotion (high-EE) relatives can have adverse consequences for patients. This study investigated whether contact with high-EE relatives, and relatives' behaviourally controlling interactions (BCI) are related to patients' symptoms and to both patients' and relatives' affect when measured using structured diary assessments in the course of everyday life. Twenty-one patients experiencing psychosis and their closest relatives provided synchronized self-reports of symptoms (patients only), affect, dyadic contact and BCI over a 6-days period. Relatives' EE was obtained from Camberwell Family Interviews. Multi-level modeling showed that patients' reports of relatives taking control of them and helping them were associated with increased patient negative affect and symptoms. Relatives' self-reports of nagging, taking control and keeping an eye on the patient were related to fluctuations in relatives' affect. No evidence was found for the moderating effect of EE status on the association between dyadic contact and affect or, in the case of patients, symptoms. When measured using an ecologically valid methodology, momentary behaviourally controlling interactions within dyads experiencing psychosis can impact on patients' affect and symptoms.
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Affiliation(s)
| | - Alison Wearden
- School of Psychological Sciences & Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
| | - Samantha Hartley
- School of Psychological Sciences, The University of Manchester, Manchester, UK
| | - Richard Emsley
- Centre for Biostatistics, The University of Manchester & Manchester Academic Health Science Centre, Manchester, UK
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Koutra K, Triliva S, Roumeliotaki T, Lionis C, Vgontzas AN. Identifying the socio-demographic and clinical determinants of family functioning in Greek patients with psychosis. Int J Soc Psychiatry 2015; 61:251-64. [PMID: 24972747 DOI: 10.1177/0020764014540151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies on determinants affecting family functioning of patients with psychosis are still limited in Greece. AIM The aim of this study was to describe the socio-demographic and clinical characteristics associated with family functioning in patients with schizophrenia and bipolar disorder in Crete, Greece. METHODS A total of 100 patients and their caregivers agreed to participate in the study. Family functioning was assessed in terms of cohesion, adaptability, communication and satisfaction dimensions (Family Adaptability and Cohesion Evaluation Scale IV Package), expressed emotion (Family Questionnaire), family burden (Family Burden Scale) and caregivers' psychological distress (General Health Questionnaire-28). Multivariate linear regression models were implemented to examine the associations between each one of the family measures and different social and clinical characteristics. RESULTS With regard to the caregivers' characteristics, gender, employment status, origin, residence, financial status, relation to the patient, contact with the patient and family structure were among the most significant determinants of family functioning. Also, patients' socio-demographic characteristics, including age, education, origin, residence and employment status, as well as illness-related factors, such as onset of mental illness, number of hospitalisations, last hospitalisation, longer hospitalisation and clinical diagnosis impacted intrafamilial relationships. CONCLUSION The results of this study suggest that a number of social and clinical factors contributed to the family environment of patients with psychosis. Identifying the determinants of family functioning in psychosis is instrumental in developing understandings regarding the factors which may contribute to the rehabilitation or relapse of the patient and the support required to strengthen positive family interactions.
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Affiliation(s)
- Katerina Koutra
- Department of Psychiatry & Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Sofia Triliva
- Department of Psychology, University of Crete, Rethymnon, Greece
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Christos Lionis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Alexandros N Vgontzas
- Department of Psychiatry & Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
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Caregiver distress in first-episode psychosis: the role of subjective appraisal, over-involvement and symptomatology. Soc Psychiatry Psychiatr Epidemiol 2015; 50:371-8. [PMID: 25053150 DOI: 10.1007/s00127-014-0935-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Caregivers of persons with first-episode psychosis (FEP) often report high levels of distress. Preventing long-term or chronic distress within the whole family is an important focus of early intervention for psychosis. However, a more comprehensive understanding of the psychological factors involved is needed. AIMS To examine the impact of subjective appraisals and expressed emotion on caregiver distress in FEP. METHOD Within a cross-sectional design, 154 caregivers of 99 persons with FEP in a clinical epidemiological sample completed a series of questionnaires to examine potential predictors of caregiver distress. RESULTS Thirty-seven percent of caregivers were suffering from clinically significant distress. A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service-user symptoms and global functioning, emotional over-involvement and subjective appraisal of caregiving were significant predictors of caregiver distress. CONCLUSION Caregiver distress is significant in the early phase of illness, and this seems to be more related to their subjective appraisal and over-involvement, than to variations in symptoms and global functioning of the person diagnosed with FEP. This lends further support to the stress-appraisal coping model and the cognitive model of caregiving in FEP, and highlights supportive interventions aimed at handling unhelpful cognitions and behaviors.
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Jansen JE, Gleeson J, Cotton S. Towards a better understanding of caregiver distress in early psychosis: a systematic review of the psychological factors involved. Clin Psychol Rev 2014; 35:56-66. [PMID: 25531423 DOI: 10.1016/j.cpr.2014.12.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 12/04/2014] [Accepted: 12/07/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVES We sought to review empirical studies of psychological factors accounting for distress in caregivers of young people with early psychosis. METHOD Following the PRISMA guidelines, we included studies that empirically tested psychological models of caregiver distress in early psychosis by searching the following databases up until March 2014: PsycINFO, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL). This was followed by additional manual searches of reference lists and relevant journals. RESULTS The search identified 15 papers describing 13 studies together comprising 1056 caregivers of persons with early psychosis. The mean age of caregivers was 47.2years (SD=9.8), of whom 71.5% were female and 74.4% were parents. Nine different psychological variables were examined in the included studies, which were categorised in the following non-mutually exclusive groups: coping, appraisal/attribution and interpersonal response. There was considerable data to support the link between distress and psychological factors such as avoidant coping, appraisal and emotional over-involvement. However, the possibilities of drawing conclusions were limited by a number of methodological issues, including cross-sectional data, small sample sizes, confounding variables not being accounted for, and a wide variation in outcome measures. DISCUSSION The strengths of the review were the systematic approach, the exclusion of non-empirical papers and the rating of methodological quality by two independent raters. Limitations were that we excluded studies published in languages other than English, that data extraction forms were developed for this study and hence not tested for validity, and that there was a potential publication bias in favour of significant findings. CONCLUSION AND IMPLICATIONS A better grasp of the psychological factors accounting for caregiver distress early in the course of illness may help us understand the trajectory of distress. This is an important step in preventing long-term distress in caregivers and supporting recovery in the whole family.
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Affiliation(s)
- Jens Einar Jansen
- Early Psychosis Intervention Center/Psychiatric Research Unit, Region Zealand, Smedegade 10, 4000 Roskilde, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark.
| | - John Gleeson
- School of Psychology, Australian Catholic University, Locked Bag 4115, Fitzroy MDC, Victoria 3065, Australia
| | - Sue Cotton
- Orygen Youth Health Research Centre, Locked Bag 10, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, 3052, Australia
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Jansen JE, Lysaker PH, Harder S, Haahr UH, Lyse HG, Pedersen MB, Trauelsen AM, Simonsen E. Positive and negative caregiver experiences in first-episode psychosis: emotional overinvolvement, wellbeing and metacognition. Psychol Psychother 2014; 87:298-310. [PMID: 24038708 DOI: 10.1111/papt.12014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/23/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES While caregivers of persons with first-episode psychosis often report a range of negative experiences, little is known about what psychological factors are involved. The aim of this study was to examine how caregivers' general wellbeing, emotional overinvolvement and metacognition influenced their reports of both positive and negative caregiving experiences. DESIGN A prospective consecutive cross-sectional study. METHODS Forty caregivers of patients with first-episode psychosis were interviewed using semi-structured interview and questionnaires. RESULTS Greater levels of distress and overinvolvement were associated with more negative experiences of caregiving while greater metacognitive capacity was associated with more positive experiences of caregiving. CONCLUSIONS The experience of positive and negative aspects of caregiving seems to be associated with different variables. Greater metacognitive capacity does not necessarily alleviate the suffering and distress, which is a healthy and normal reaction to having a close one suffering from psychosis. But it might help broaden the perspective, allowing for both negative and positive experiences. Clinical implications in terms of expanding the range of therapeutic interventions are discussed. PRACTITIONER POINTS Assessing the capacity for metacognition in a non-clinical population. Understanding what factors are involved in positive and negative caregiver experiences in first-episode psychosis. A broadening of family interventions by encompassing the concept of metacognition.
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Affiliation(s)
- Jens E Jansen
- Early Psychosis Intervention Center, Zealand Region Psychiatry Roskilde, Denmark; Department of Psychology, University of Copenhagen, Denmark
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Abstract
Understanding cross-cultural aspects of emotional overinvolvement (EOI) on psychosis outcomes is important for ensuring cultural appropriateness of family interventions. This systematic review explores whether EOI has similar impact in different cultural groups and whether the same norms can be used to measure EOI across cultures. Thirty-four studies were found that have investigated the impact of EOI on outcomes across cultures or culturally adapted EOI measures. The relationship between high EOI and poor outcome is inconsistent across cultures. Attempts to improve predictive ability by post hoc adjustment of EOI norms have had varied success. Few studies have attempted a priori adaptations or development of culture-specific norms. Methodological differences such as use of different expressed emotions (EE) measures and varying definitions of relapse across studies may explain a lack of EOI outcome relationship across cultures. However, our findings suggest that the construct and measurement of EOI itself are culture-specific. EOI may not necessarily be detrimental in all cultures. The effect of high EOI may be moderated by the unexplored dimension of warmth and high levels of mutual interdependence in kin relationships. Researchers should reevaluate the prevailing concepts of the impact of family relations on the course and outcome of psychotic disorders, specifically focusing on the protective aspects of family involvement. Clinically, family interventions based on EE reduction should take cultural differences into account when treating families from different ethnocultural groups.
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Affiliation(s)
- Swaran P Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, CV4 7AL, UK.
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Chiu MYL, Wei GFW, Lee S, Choovanichvong S, Wong FHT. Empowering caregivers: impact analysis of FamilyLink Education Programme (FLEP) in Hong Kong, Taipei and Bangkok. Int J Soc Psychiatry 2013; 59:28-39. [PMID: 21971981 PMCID: PMC3764774 DOI: 10.1177/0020764011423171] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Education and support for caregivers is lacking in Asia and the peer-led FamilyLink Education Programme (FLEP) is one of the few provisions to address this service gap. This study aims to evaluate quantitatively its efficacy in reducing subjective burdens and empowering the participants. METHOD One hundred and nine caregiver participants in three Asian cities were successfully surveyed at pre-intervention, post-intervention and six-month intervals with a number of standard inventories. Mixed analysis of variance (ANOVA) procedures showed significant programme impact over time intervals for all sites, and subsequently an empowerment measurement model was tested. RESULTS FLEP was found effective in reducing worry and displeasure, significantly improving intra-psychic strain, depression and all empowerment measures. The measurement model had an acceptable good fit. Baseline difference showed no interference with the programme efficacy. CONCLUSIONS Apart from the initial support for FLEP, the current study also provides some hindsight on the empowerment practice in mental health for Asia, whose sociocultural political contexts are vastly different from that of the developed countries. It remains to be seen whether qualitative data or more stringent research design will yield consistent results and whether FLEP can also work in rural areas.
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Affiliation(s)
- Marcus Y L Chiu
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong.
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Alway Y, McKay A, Ponsford J, Schönberger M. Expressed emotion and its relationship to anxiety and depression after traumatic brain injury. Neuropsychol Rehabil 2012; 22:374-90. [DOI: 10.1080/09602011.2011.648757] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Otero S, Moreno-Iniguez M, Payá B, Castro-Fornieles J, Gonzalez-Pinto A, Baeza I, Mayoral M, Graell M, Arango-López C. Twelve-month follow-up of family communication and psychopathology in children and adolescents with a first psychotic episode (CAFEPS study). Psychiatry Res 2011; 185:72-7. [PMID: 20580840 DOI: 10.1016/j.psychres.2009.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 10/13/2009] [Accepted: 12/15/2009] [Indexed: 12/01/2022]
Abstract
We analyzed the potential influence of family relationships and history of psychiatric disorders on the presentation and course of early psychotic disorders. We recruited 110 subjects aged 9-17 years with a first psychotic episode and 98 matched healthy controls, and followed them for 1 year. Data were collected through clinical interviews and the Parent-Adolescent Communication Inventory. A family history of psychosis-related disorders was more common in patients' families, with a five-fold higher risk for psychoses related disorders than families of healthy controls. If we consider psychoses related disorder in first-degree relatives, the risk is even higher, rising to 15-fold. The families of patients with a first psychotic episode score themselves worse in communication than the families of healthy controls. More problems in communication at baseline correlated with a higher degree of psychopathology and a lower clinical improvement after 12 months of follow-up.
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Affiliation(s)
- Soraya Otero
- Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
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Weddell RA. Relatives' Criticism Influences Adjustment and Outcome After Traumatic Brain Injury. Arch Phys Med Rehabil 2010; 91:897-904. [DOI: 10.1016/j.apmr.2010.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 01/24/2010] [Accepted: 01/30/2010] [Indexed: 11/16/2022]
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Alvarez-Jiménez M, Gleeson JF, Cotton SM, Wade D, Crisp K, Yap MBH, McGorry PD. Differential predictors of critical comments and emotional over-involvement in first-episode psychosis. Psychol Med 2010; 40:63-72. [PMID: 19079825 DOI: 10.1017/s0033291708004765] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Little research has focused on delineating the specific predictors of emotional over-involvement (EOI) and critical comments (CC) in the early course of psychosis. The purpose of this study was to investigate the differential relationships of EOI and CC with relevant predictors in relatives of first-episode psychosis (FEP) patients. METHOD Baseline patient-related factors including psychotic symptoms, depression and duration of untreated psychosis (DUP) and carer attributes comprising CC, EOI, burden of care and carers' stress and depression were assessed in a cohort of 63 remitted FEP patients and their relatives. Carers were reassessed at 7 months follow-up. RESULTS Baseline analysis showed that EOI was more strongly correlated with family stress compared with CC, whereas CC yielded a stronger association with DUP than EOI. Carers' CC at follow-up was not significantly predicted by either baseline family stress, burden of care or patient-related variables. Conversely, baseline EOI predicted both family stress and burden of care at 7 months follow-up. Finally, family burden of care at follow-up was a function of baseline EOI and patients' depressive symptoms. CONCLUSIONS This study provides preliminary support to the postulate that EOI and CC may be influenced by separate factors early in the course of psychosis and warrant future research and therapeutic interventions as separate constructs. Implications for family interventions in the early phase of psychosis and the prevention of CC and EOI are discussed.
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Affiliation(s)
- M Alvarez-Jiménez
- ORYGEN Youth Health Research Centre, Melbourne, Victoria, Australia.
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Emotional over-involvement can be deleterious for caregivers' health: Mexican Americans caring for a relative with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2009; 44:716-23. [PMID: 19190836 DOI: 10.1007/s00127-008-0492-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 12/23/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED The study of emotional over-involvement (EOI) has focused primarily on its relationship with patients' course of illness. We know little about the predictors and possible consequences of EOI for caregivers. Based on past research, we tested the hypotheses that EOI is associated with worse physical and psychological health among caregivers and examined whether caregiver burden and social support may mediate this relationship. METHOD In a sample of 37 Mexican American caregivers and their ill relatives recruited from two outpatient clinics, we examined the relationships between EOI, caregiver burden, caregivers' level of social support, and caregivers' health. Additionally, we examined whether caregiver burden and social support may mediate the relationship between EOI and caregivers' health. Cross-sectional analysis indicates that at baseline EOI was not associated with caregiver burden or social support, but was related to worse current health. Longitudinal analysis, however, indicates that EOI at baseline was associated with greater burden, less instrumental support, and worse health among caregivers at follow-up. Moreover, objective burden and instrumental support mediated the relationship between EOI and several health outcomes. Consequently, EOI may be a marker of poor current health status and predicts worse future health among Mexican-American caregiving relatives of individuals with schizophrenia. Moreover, changes in burden and social support associated with EOI appear to mediate the relationship between EOI and several health outcomes among caregivers. These findings suggest that it might be important for family interventions to not only address the functioning of individuals with schizophrenia but also their caregiving relatives.
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Van Noppen B, Steketee G. Testing a conceptual model of patient and family predictors of obsessive compulsive disorder (OCD) symptoms. Behav Res Ther 2009; 47:18-25. [DOI: 10.1016/j.brat.2008.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Revised: 09/28/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
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Kuipers E, Watson P, Onwumere J, Bebbington P, Dunn G, Weinman J, Fowler D, Freeman D, Hardy A, Garety P. Discrepant illness perceptions, affect and expressed emotion in people with psychosis and their carers. Soc Psychiatry Psychiatr Epidemiol 2007; 42:277-83. [PMID: 17370044 DOI: 10.1007/s00127-007-0165-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Illness perception, a measure of illness representations developed from physical medicine, has recently been applied to psychosis. We investigated how illness perceptions relate to affect and expressed emotion (EE) in carer-patient dyads, particularly if their perceptions differed. METHOD We interviewed 82 carer-patient dyads, after a relapse of psychosis. Carers were assessed for illness perceptions, distress, self-esteem and EE; patients for illness perceptions, depression, anxiety and self-esteem, in a cross sectional study. RESULTS Carers were more pessimistic than patients about illness persistence and consequences, and carers with low mood were particularly pessimistic about persistence and controllability. Discrepant views about illness consequences were related to greater anxiety, depression, and lower self-esteem in patients, while discrepant views on controllability were associated with greater distress, depression, and lower self-esteem in carers. Illness perceptions did not relate directly to EE. CONCLUSIONS In this sample, meta-cognitive carer representations of illness in psychosis are related to negative affective reactions in carers, but not to EE. Resolving discrepant illness perceptions between carers and patients might provide a way of improving family reactions to the health threat of psychosis.
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Affiliation(s)
- Elizabeth Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Box PO77, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
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Bachmann S, Bottmer C, Jacob S, Schröder J. Perceived criticism in schizophrenia: a comparison of instruments for the assessment of the patient's perspective and its relation to relatives' expressed emotion. Psychiatry Res 2006; 142:167-75. [PMID: 16630663 DOI: 10.1016/j.psychres.2005.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Revised: 11/29/2004] [Accepted: 10/10/2005] [Indexed: 11/29/2022]
Abstract
The expression and perception of expressed emotion (EE) in schizophrenic patients and their relatives are likely to differ. The presented exploratory study compares the two views. EE in relatives of 25 chronic schizophrenic patients was assessed using an extended version of the Five-Minute Speech Sample (FMSS). Patients rated their relatives with the Perceived Criticism Scale (PCS), the Family Emotional Involvement and Criticism Scale (FEICS), and a German questionnaire on family atmosphere (FEF). Forty-eight percent of relatives were rated high in EE, due to criticism in all cases but one. Patients' assessments of the whole family on the FEICS and FEF criticism subscales were related to their relatives' EE status. Correlations between the self-rating instruments were moderate to good. As the patients' and the relatives' views corresponded with regard to the criticism domain, the application of a self-rating instrument may be a simple and useful tool for clinical and research purposes.
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Affiliation(s)
- Silke Bachmann
- Department of Psychiatry, University of Heidelberg, Germany
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Heikkilä J, Ilonen T, Karlsson H, Taiminen T, Lauerma H, Leinonen KM, Wallenius E, Heinimaa M, Koponen S, Jalo P, Kaljonen A, Salokangas RKR. Cognitive functioning and expressed emotion among patients with first-episode severe psychiatric disorders. Compr Psychiatry 2006; 47:152-8. [PMID: 16490574 DOI: 10.1016/j.comppsych.2005.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Accepted: 04/26/2005] [Indexed: 11/23/2022] Open
Abstract
Expressed emotion (EE) in families is able to predict the clinical outcome of patients with schizophrenia and mood disorders. However, the origins of EE and its interactions with the patient's clinical characteristics are not clear. In this respect, cognitive functioning of schizophrenic and mood-disorder patients has yielded contradictory results. In this cross-sectional study, we examined a sample of 42 consecutive first-episode patients with schizophrenia-related psychoses and severe mood disorders. Forty-two relatives were interviewed with the Five-Minute Speech Sample method. The relationships between EE and 3 clusters of patient-related variables (sociodemography, performance in cognitive tests, and psychopathology) were analyzed with stepwise regression analysis. With the exception of premorbid adjustment in childhood, only the cognitive variables were significantly associated with EE after controlling for the effect of the other variables. High EE was significantly associated with good performance in cognitive tests. Our results favor the attribution hypothesis of EE instead of the hypothesis that patient psychopathology would explain EE. Good cognitive functioning may lead to higher EE scores because of the higher expectations by the relatives.
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Affiliation(s)
- Jyrki Heikkilä
- City of Turku Municipal Health Care Department, Psychiatry, Kunnallissairaalantie 20, rak. 4, FIN-20700, Turku, Finland.
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Fredman SJ, Chambless DL, Steketee G. Development and validation of an observational coding system for emotional overinvolvement. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2004; 18:339-347. [PMID: 15222841 DOI: 10.1037/0893-3200.18.2.339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The present study investigated the reliability and construct validity of a behavioral observation coding system of emotional overinvolvement (EOI), an index of intrusive, excessively self-sacrificing, or exaggeratedly emotional behavior displayed by the relative of a psychiatric patient. Separate behavioral ratings of relatives' intrusiveness, excessive self-sacrifice, and exaggerated emotional response were generated from 10-min problem-solving interactions between adult outpatients with obsessive-compulsive disorder or panic disorder with agoraphobia and their relatives. The interrater reliability for the 3 scales was adequate to excellent, and the scales appeared to tap related, but distinct, aspects of the EOI construct. Results from a multitrait-multimethod matrix and a confirmatory factor analysis supported the measure's convergent validity but were equivocal with respect to its discriminant validity.
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Affiliation(s)
- Steffany J Fredman
- Department of Psychology, University of North Carolina at Chapel Hill, USA
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30
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Raune D, Kuipers E, Bebbington PE. Expressed emotion at first-episode psychosis: investigating a carer appraisal model. Br J Psychiatry 2004; 184:321-6. [PMID: 15056576 DOI: 10.1192/bjp.184.4.321] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Even at the first episode of psychosis, high expressed emotion (EE) characterises over half of patient-carer relationships. This study compared a carer appraisal model of EE with the ability of illness factors to predict EE at the first episode. AIMS To investigate the utility of a carer appraisal model of EE in first-episode psychosis. METHOD We compared high- and low-EE carers of people who had first-episode psychosis (n=46). RESULTS High EE in carers was associated with higher avoidant coping, higher subjective burden and lower perceived patient interpersonal functioning. Patient illness factors and carers' distress levels were not associated with EE. CONCLUSIONS Even at the first episode, carers' psychological appraisal, not patient illness factors, is influential in determining high EE. Carers' appraisal of their situation should be a primary target to lower or prevent high EE in early intervention for psychosis.
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Affiliation(s)
- D Raune
- Department of Adult Clinical Psychology, Ealing Locality, John Connelly Wing, West London Mental Health Trust, London, UK
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Abstract
Expressed emotion is a measure of an individual's critical and/or emotionally overinvolved attitudes toward another person. The characteristics of parents who are high in expressed emotion are not fully understood. This study examined some variables potentially associated with expressed emotion, as measured by the Camberwell Family Interview, in 54 parents of schizophrenic young adults. Statements of (1) self-blame for the patient's illness, (2) controlling behaviors toward the patient, and (3) controlling behaviors toward others were assessed. As predicted, parents who blamed themselves for the patient's illness had higher emotional overinvolvement ratings than non-self-blaming parents. Measures of controlling behavior revealed that highly critical parents were not more controlling than less critical parents; however, parents high in emotional overinvolvement reported higher levels of patient- and other-controlling behaviors than parents low in emotional overinvolvement. These results suggest that the emotional overinvolvement component of high expressed emotion is associated with self-blaming attributions and controlling behaviors in parents, but that the criticism component is not.
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Boye B, Bentsen H, Malt UF. Does guilt proneness predict acute and long-term distress in relatives of patients with schizophrenia? Acta Psychiatr Scand 2002; 106:351-7. [PMID: 12366469 DOI: 10.1034/j.1600-0447.2002.02276.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the study was to improve our understanding of guilt proneness as predictor of acute and long-term stress responses in relatives of acutely admitted patients. METHOD Forty-nine relatives in close contact with 36 patients suffering from schizophrenia DSM-III-R, completed Hostility Guilt (HG) and Guilt Conscience (GC) scales (Revised Mosher Guilt Inventory), and Levenson's Locus of Control Scale (LOC) at the patient's admission to hospital, and the General Health Questionnaire (GHQ) at the patient's admission and at 9 months after discharge. RESULTS Acute distress (GHQ) was positively related to HG, but not when controlling for LOC. GC was positively associated with acute and long-term distress, GHQ-depression and coping-failure, and long-term GHQ-anxiety. When controlling for LOC, GC was still positively related to long-term distress. HG, GC and LOC explained 32% variance of GHQ at 9 months. CONCLUSION GC seems to be an important predictor of long-term distress in relatives.
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Affiliation(s)
- B Boye
- Blakstad Hospital, Asker, Norway, Aker Hospital, Psychiatric Clinic, Oslo, Norway.
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Heikkilä J, Karlsson H, Taiminen T, Lauerma H, Ilonen T, Leinonen KM, Wallenius E, Virtanen H, Heinimaa M, Koponen S, Jalo P, Kaljonen A, Salakangas RKR. Expressed emotion is not associated with disorder severity in first-episode mental disorder. Psychiatry Res 2002; 111:155-65. [PMID: 12374633 DOI: 10.1016/s0165-1781(02)00134-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A family atmosphere characterized by expressed emotion (EE) is a robust predictor of clinical outcome of patients with schizophrenia and mood disorders. However, there is ongoing discussion as to whether EE is more a cause of clinical outcome or a parental reaction to disorder severity. This cross-sectional study examines a sample of 42 consecutive first-episode patients from a defined geographical area with severe mental disorders (schizophrenia-related disorders, psychotic mood disorders, and non-psychotic mood disorders). Their 42 relatives were interviewed, and the relationships between EE variables derived with the five-minute speech sample method (FMSS) and the patients' demographic, premorbid and clinical measures were analyzed. A high EE score was found in 40% of the relatives. High EE was associated with the interviewed relative's not being a spouse and the patient's being young and unmarried. It was not associated with premorbid characteristics, symptom dimensions or the diagnostic group of the patient. These results do not support the hypothesis that EE is a reaction to the clinical features of the patient. Instead, demographic factors may partly mediate the effect of EE on prognosis.
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Affiliation(s)
- Jyrki Heikkilä
- Department of Psychiatry, University of Turku and Turku City Mental Health Center, Kunnallissairaalantie 20, rakennus 9, FIN 20700 Turku, Finland.
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Riello R, Geroldi C, Parrinello G, Frisoni GB. The relationship between biological and environmental determinants of delusions in mild Alzheimer's disease patients. Int J Geriatr Psychiatry 2002; 17:687-8. [PMID: 12112171 DOI: 10.1002/gps.659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Boye B, Bentsen H, Ulstein I, Notland TH, Lersbryggen A, Lingjaerde O, Malt UF. Relatives' distress and patients' symptoms and behaviours: a prospective study of patients with schizophrenia and their relatives. Acta Psychiatr Scand 2001; 104:42-50. [PMID: 11437749 DOI: 10.1034/j.1600-0447.2001.00190.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study is to explore the relationship between relatives' distress and patients' symptoms and behaviours. METHOD Fifty relatives in close contact with 36 patients with schizophrenia DSM-III-R filled in the General Health Questionnaire (GHQ) and the Perceived Family Burden Scale (PFBS) at the patient's hospital admission, 4.5 and 9 months post-discharge. The patients were assessed by means of the Positive and Negative Syndrome Scale (PANSS). RESULTS The PFBS anxiety-depression cluster was at all three assessments positively correlated with relative's distress (GHQ), not with PANSS anxiety and depression measurements. In multiple regression analysis PFBS, but not PANSS, was related to relatives' distress. CONCLUSION Relatives' distress was related to their reports of problematic patient behaviours, especially anxiety-depressive behaviour, not to symptoms as measured by clinical interviews. High distress is related to high expressed emotion, suggesting that relatives' report of patient's behaviour should be addressed to improve patient's outcome.
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Affiliation(s)
- B Boye
- Blakstad Hospital, p-box 143, N-1371 Asker, Norway
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Steketee G, Chambless DL. Does expressed emotion predict behaviour therapy outcome at follow-up for obsessive-compulsive disorder and agoraphobia? Clin Psychol Psychother 2001. [DOI: 10.1002/cpp.307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Patterson P, Birchwood M, Cochrane R. Preventing the entrenchment of high expressed emotion in first episode psychosis: early developmental attachment pathways. Aust N Z J Psychiatry 2000; 34 Suppl:S191-7. [PMID: 11129307 DOI: 10.1080/000486700243] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE As part of a strategy to consider the options for preventing the developmental entrenchment of expressed emotion (EE), we examine the early ontogeny of EE in a first-episode sample of individuals with psychosis and its links with the process of adaptation to change. METHODS The key relatives of 50 first-episode psychosis patients from two locations were interviewed soon after patient referral and again 9 months later using measures of expressed emotion and loss. RESULTS The developmental pathways of components of expressed emotion, particularly criticism and emotional over-involvement, were independent despite having a similar effect on outcome for patients. Initially, high levels of emotional over-involvement were reduced by follow up, with 37% resolving into high criticism. Overall expressed emotion status changed in 28.2% of key relatives (all parental), predominantly from high to low. High emotional over-involvement and low criticism are associated with significantly high levels of perceived loss in relatives. The metamorphosis of emotional over-involvement to criticism was linked to a reduction in perceived loss. CONCLUSIONS Expressed emotion is not a stable index in relatives of first-episode psychosis samples. Appraisals of loss by relatives may be driving high emotional over-involvement with implications for family intervention programs. Attachment theory may help to explain some of the processes underlying resistance to change in some of the high-EE behaviours measured by expressed emotion.
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Affiliation(s)
- P Patterson
- Early Intervention Service, Northern Birmingham Mental Health Trust, Aston, UK.
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Bentsen H, Notland TH, Boye B, Munkvold OG, Bjørge H, Lersbryggen AB, Uren G, Oskarsson KH, Berg-Larsen R, Lingjaerde O, Malt UF. Criticism and hostility in relatives of patients with schizophrenia or related psychoses: demographic and clinical predictors. Acta Psychiatr Scand 1998; 97:76-85. [PMID: 9504708 DOI: 10.1111/j.1600-0447.1998.tb09967.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Relatives' criticism and hostility are important risk factors for relapse in schizophrenia. In order to explain these attitudes, we examined a Norwegian sample of 47 recently hospitalized patients (with schizophrenia or related psychoses) and 72 relatives. Relatives' expressed emotion was assessed by means of the Camberwell Family Interview. Demographic and clinical data were used as predictor variables in confirmatory regression analyses. The most robust predictors of high levels of criticism were, on the part of the patient, lack of paid employment, more than 3 previous hospital admissions, more troublesome behaviours reported by relatives, especially anxiety/depression, and better cognitive functioning at admission. Robust predictors of hostility were lack of employment and more than 3 previous hospitalizations. Interventions to reduce criticism should include employing patients and working with relatives' unrealistic expectations.
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Affiliation(s)
- H Bentsen
- Gaustad Psychiatric Hospital, Department of Psychiatry, University of Oslo, Norway
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