Expressed Emotion in the Family: A Meta-Analytic Review of Expressed Emotion as a Mechanism of the Transgenerational Transmission of Mental Disorders

Expressed Emotions in Patients with Mild to Moderate Ulcerative Colitis: A Descriptive Study

Background

Ulcerative colitis (UC) is an autoimmune disease with phases of relapse and remission. Empirical data shows that expressed emotion (EE) is one of the important stressors which shows a direct association with the recurrence of illness. Though a huge amount of research has been done on mental illness, in this research, it has been used to see how this construct effects people with UC.

Purpose

To assess the level of EE among patients with mild-to-moderate UC. It also aims to find whether there is a significant difference among UC patients with respective to demographic variables like age, gender, education, marital status and socio-economic status (SES).

Methods

It followed a quantitative approach and descriptive survey research design. The sample size was 100, including both males and females (50 each) in the age group of 30-50 years. The tools used were the family emotional involvement (EI) and criticism scale (FEICS) to quantify the perceived criticism (PC) and EI. Inferential statistics and a chi-square test were used.

Results

UC patients showed a mean PC score of 14.87 out of 28 and a mean EI score of 17.24 out of 28. UC patients had a total mean score of 32.11, which depicted high EE. There was no significant association found between the demographic variables in this study and EE.

Conclusion

The present findings show that patients with UC show moderate PC but high EI. For UC, the family environment can be improved by better interventions in the form of family counselling and psychoeducation. Fostering coping skills, stress management and effective communication in families will help in emotional regulation among patients of UC.

The Effects of Home Quarantine Duration, Parental Emotional Intelligence, and Family Socioeconomic Status on Children's Anxiety During the Pandemic: A Survey of 29,550 Parents

Background

The pandemic has led to unprecedented home quarantine measures affecting children's anxiety levels due to routine disruptions. This study investigated the role of the length of the quarantine period, parents' emotional intelligence, and family socioeconomic status (SES) in influencing children's anxiety.

Objective

This study aims to examine the relationship between quarantine duration and children's anxiety and to explore the mediating role of parents' emotional intelligence and the moderating role of family socioeconomic status in this relationship.

Methods

An online questionnaire surveyed 29,550 parents in Guangdong, Hubei, Henan, and Guangxi provinces of China. The measurement tools used included the Preschool Anxiety Scale, the Family Socioeconomic Status (SES) Scale, and the Emotional Intelligence Questionnaire. The data were analyzed via SPSS 25.0 and Mplus 8.0.

Results

A longer quarantine period (as measured by the number of days) significantly reduced children's anxiety. Parents' emotional intelligence mediates the relationship between quarantine days and children's anxiety, explaining 51.79% of the effect. Family SES moderates the mediating effect of parents' emotional intelligence on children's anxiety, benefiting higher-SES families more than lower-SES families. Children's adaptation during the quarantine period demonstrates psychological resilience.

Conclusion

The mediating effect of parents' emotional intelligence accounted for 51.79% of the total effect of quarantine duration on children's anxiety, with longer quarantine periods associated with decreased anxiety. Family socioeconomic status moderated this effect, benefiting higher-socioeconomic-status families more than lower-socioeconomic-status families. Children's adaptation during the quarantine period demonstrates psychological resilience. To alleviate anxiety, policies should focus on supporting families with lower socioeconomic status and enhancing parental emotional skills.

Expressed emotion of caregivers to children at familial high risk of schizophrenia or bipolar disorder: The Danish High Risk and Resilience Study - VIA 11

A high level of parental expressed emotion is thought to play an important role in the development and course of mental disorders in offspring. This study investigates expressed emotion among primary caregivers to 11-year-old children at familial high risk of schizophrenia or bipolar disorder and population-based controls, and whether potential differences in expressed emotion are related to child psychopathology. Expressed emotion was assessed with the Five-Minute Speech Sample and a total of 440 audio files from primary caregivers were collected. Child psychopathology was assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children. Primary caregivers from families with a parental diagnosis of schizophrenia spectrum disorder or bipolar disorder were classified as high on expressed emotion significantly more often than population-based controls. Between-group differences remained significant after adjusting for any current axis I child diagnosis indicating that high expressed emotion is not solely attributable to the presence of child psychopathology. These findings underline the importance of assessing the emotional climate in families with parental schizophrenia and bipolar disorder.

A case-control study to differentiate parents' personality traits on anorexia nervosa and affective disorders

Eating disorders (ED) and affective disorders (AD) in adolescent population and several investigations have pointed out that specific family dynamics play a major role in the onset, course, and maintenance of both disorders. The aim of this study was to extend the literature of this topic by exploring differences between parents' personality traits, coping strategies, and expressed emotion comparing groups of adolescents with different mental conditions (anorexia nervosa vs. affective disorder vs. control group) with a case-control study design. A total of 50 mothers and 50 fathers of 50 girls with anorexia nervosa (AN), 40 mothers and 40 fathers of 40 girls with affective disorder (AD), and 50 mothers and 50 fathers of 50 girls with no pathology that conformed the control group (CG) were measured with the Temperament and Character Inventory (TCI), the COPE Inventory, the Family Questionnaire (FQ), and psychopathology variables, anxiety, and depression. Both parents of girls with AN showed a significant difference in personality, coping strategies, and expressed emotion compared to both parents in the CG, while they presented more similarities to parents of girls in the AD group. Identifying personality traits, expressed emotion, coping strategies, and psychopathology of parents and their daughters will allow improvements in the interventions with the adolescents, parents, and families.

Differential correlates of criticism versus emotional overinvolvement towards patients with schizophrenia living in halfway houses or with their families

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.

Editorial: "What say you?" The promise and potential pitfalls of using automated and passive monitoring approaches to assess parenting behaviours from verbal and written communication

Rates of mental health problems in adolescence are rising as highlighted in this current issue of the Journal. It is therefore increasingly important to identify children who may be at risk so that preventive interventions can be deployed before they reach adolescence. Adverse parenting has long been considered a risk factor for poor mental health in adolescence, but the methods traditionally used to assess this are laborious, burdensome and costly. Recently, passive monitoring and automated approaches to collecting and analysing spoken and written forms of parental communication have been proposed. This editorial examines the promise of such technological advances for assessing parenting and provides words of caution from parents and young people that should be heeded before rolling these approaches out at scale.

Understanding the Dynamics: A Comprehensive Review of Family Therapy's Impact on Expressed Emotions in Schizophrenia Patients

This comprehensive review examines the impact of family therapy on expressed emotions (EE) within the context of psychiatric disorders. EE, characterized by high levels of criticism, hostility, or emotional over-involvement, have been consistently linked to poorer treatment outcomes and increased severity of psychiatric symptoms. The review explores various family therapy approaches and their effectiveness in reducing high EE levels in families of psychiatric patients. It synthesizes existing literature to highlight the mechanisms underlying the changes in EE, such as modifying communication patterns and enhancing family cohesion. Additionally, the review discusses the implications for clinical practice, emphasizing the importance of integrating family therapy into psychiatric treatment plans and providing psychoeducation to empower families to manage emotions effectively. Future research directions are also outlined, including investigating the long-term sustainability of changes brought about by family therapy and exploring cultural considerations in therapeutic approaches. Overall, the review underscores the pivotal role of family therapy in addressing EE and promoting recovery and resilience in psychiatric patients and their families.

Psychometric properties of the Chinese version of the Family Questionnaire among the caregivers of people with schizophrenia

Introduction

Expressed emotion refers to relatives' attitudes and emotional behaviors toward mentally ill family members. It is a robust predictor of patients' illness outcomes and caregivers' wellbeing in a wide range of mental disorders. However, expressed emotion has not been fully explored in the Chinese context. One reason is the lack of reliable and cost-effective measurements. A reliable, valid, and user-friendly instrument is needed to support the research and clinical practice based on expressed emotion in China. This study aimed to translate, adapt, and examine the psychometric properties (factorial structure, measurement invariance, internal consistency reliability, and concurrent validity) of a Chinese version of the Family Questionnaire.

Methods

A total of 248 caregivers participated in the study. A translation and back-translation procedure was applied to translate the Family Questionnaire into Chinese. We compared two models to examine the factor structure of the questionnaire by performing confirmatory factor analysis. We also conducted measurement invariance analysis to test whether the factor structure of the tool is invariant across male and female groups. Reliability was evaluated with Cronbach's α. The concurrent validity was examined by testing the predictivity of the expressed emotion on relevant outcomes with path analysis. We used the STROBE checklist to report.

Results

The item-total correlation coefficients of the scale ranged from 0.375 to 0.752. The confirmatory factor analysis indicated that the Chinese version of the Family Questionnaire displays the original two-factor structure (emotional overinvolvement and criticism; X² = 335.50, df = 169, X²/df = 1.985, RMSEA = 0.063, SRMR = 0.058, CFI = 0.913, and TLI = 0.902). In addition, the two-factor structure was invariant across the male and female groups. The two subscales showed excellent internal consistency, with Cronbach's alpha of 0.92 for both emotional overinvolvement and criticism. The concurrent validity of the Chinese version was supported by the good predictivity of the two subscales to care burden, family function, and quality of life. All path coefficients were significant, and the absolute values of path coefficients ranged from 0.23 to 0.72.

Conclusion

The Chinese version of the Family Questionnaire is a valid and reliable measurement of expressed emotion in the Chinese context.

A comparison of expressed emotion between mothers and their adolescent daughters with and without a history of nonsuicidal self-injury

BACKGROUND

Expressed Emotion refers to the extent to which close relatives express critical/hostile and/or emotionally overinvolved attitudes and feelings when speaking about a family member. High Expressed Emotion is a valuable predictor of clinical outcomes and is related to the presence of various mental disorders, including nonsuicidal self-injury (NSSI). Interpersonal factors have been shown to be relevant in initiating and in maintaining with NSSI, as interpersonal difficulties are often reported as triggers for emotional dysregulation. The parental role in the etiology and treatment of NSSI needs to be further investigated. This study assesses Expressed Emotion in adolescents who engage in NSSI and their mothers.

METHOD

We examined Expressed Emotion levels of mother-daughter dyads among adolescents who engage in NSSI, clinical controls (CCs), and nonclinical controls (NCs). The sample consisted of 70 female adolescents aged 12-20 years (M = 15.28 years, SD = 1.81; NSSI: n = 21, CC: n = 17, NC: n = 32) and 24 mothers aged 38-56 years (M = 46.47 years, SD = 4.61) using The Five-Minute Speech Sample (FMSS).

RESULTS

Adolescents who engage in NSSI exhibited significantly more covert criticism and critical tone toward their mothers than CCs (d = 0.65, d = 1.10) and NCs (d = 1.30, d = 1.10).

CONCLUSION

The findings highlight the importance of family-based interventions for the treatment of NSSI in order to enhance a positive relationship quality between parents and adolescents.