Expressed emotion and its relationship to anxiety and depression after traumatic brain injury

Abstract

Levels of expressed emotion (EE) within the family, particularly criticism and emotional over-involvement, are associated with a patient's psychological outcome in a range of psychiatric and medical conditions. This study aimed to examine the relationship between levels of family EE and anxiety and depression in patients who have sustained a traumatic brain injury (TBI). A further aim was to examine whether family members' levels of psychological distress and attributions of patient symptom controllability, were related to their levels of patient-directed EE. Participants were 43 patients who had sustained a complicated mild to severe TBI three months to five years previously, and their nominated family members. Results indicated that family members' criticism and emotional over-involvement were associated with patients' levels of anxiety and depression. Moreover, family members' levels of anxiety and depression were associated with their levels of patient-directed criticism and emotional over-involvement, whilst their attributions of patient symptom control were not. These findings suggest that levels of EE within the family are associated with psychological adjustment following TBI. Consequently, interventions targeting EE in family members may help to reduce psychiatric difficulties following TBI.

Factors contributing to outcome following traumatic brain injury

“…Poorer levels of post-injury family functioning are in turn associated with poorer outcomes in the injured family member (Curtiss, Klemz, & Vanderploeg, 2000;Sander et al, 2002;Yeates et al, 2004). The ways in which family members interact with the injured family member may influence their emotional adjustment (Alway, McKay, Ponsford, & Schönberger, 2012). Moreover family caregivers show elevated levels of emotional distress that persist over many years after injury .…”

Attachment and couple satisfaction as predictors of expressed emotion in women facing breast cancer and their partners in the immediate post‐surgery period

“…The predictive value of EE has induced researchers to investigate its effect on the aptitude to cope with the stress of medical and health conditions other than psychiatric conditions, such as traumatic brain injury, type 1 diabetes, rheumatoid arthritis, chronic pain, or chronic fatigue syndrome (for a review, see Wearden, Tarrier, Barrowclough, Zastowny, & Rahill, ). In these cases, EE has been shown to be a significant predictor of increased symptoms and of negative psychological outcomes such as depression, anxiety, and couple dissatisfaction (Alway, McKay, Ponsford, & Schönberger, ; Band, Barrowclough, & Wearden, ; Weddell, ). While some studies have taken into account EE in the patient's family (e.g., parents, children), several studies have specifically pointed out the role of romantic partners (Ballús‐Creus, Rangel, Peñarroya, Pérez, & Leff, ; Burns et al ., ; Wearden, Tarrier, & Davies, ; Wearden, Ward, Barrowclough, Tarrier, & Davies, ).…”

Effect of Mild Traumatic Brain Injury and Demographic Factors on Psychological Outcome

“…Although most of the TBI patients recover well, about 70% - 90% of them complain of psychological and neurological symptoms often weeks or months after the original head trauma ( 3 , 4 ). Neuropsychological literature has shown a direct correlation between TBI and obsessive-compulsive disorder (OCD), anxiety ( 5 ) and other psychological problems including irritability, apathy or depression ( 6 - 8 ). This problem may affect every aspect of an individual’s life, social and family relationships ( 9 ), potential employment opportunities, emotional health and even education ( 10 - 14 ).…”