Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: A review of the literature.

Abstract

The aim of this article is to critically review the literature on expressed emotion (EE), communication deviance (CD), and culture in families of patients with schizophrenia. There is growing evidence that EE and CD are highly linked. Yet the two constructs together predict the development of schizophrenia and the associated symptoms better than either construct alone. In this article, the authors review data indicating that both the expression and the levels of high EE and CD vary by ethnicity. It may be especially difficult for family members to communicate coherently and in a less critical manner when focusing on patients' inability to sustain particular cultural norms and values that are endorsed by their family and ethnic background. The authors propose that more attention to the role of culture in EE and CD and greater focus on the proper assessment of these variables would further enhance our understanding of these constructs.

The association between expressed emotion, illness severity and subjective burden of care in relatives of patients with schizophrenia. Findings from an Italian population

“…Consistently, further research should investigate the subjective experience of distress and burden among high EE carers as a target for intervention, reducing family stress as much as improving patient outcomes. Customs and traditions may define not only the sort of behaviours that warrant criticism [57], but also the burden linked to the relationship between patients and relatives as appraised by the latter, and every attempt should be made to pick up culturally sensitive issues [66,67] of maladjusted interactions between patients and carers [68]. Future cross-cultural comparisons might shed light on crucial adaptations in family psychosocial interventions.…”

Expressed emotion and sociocultural moderation in the course of schizophrenia.

“…We believe that treatments should recognize and incorporate diverse sociocultural stances regarding negativity and emotional overinvolvement in order to focus on aspects of relational functioning that are providing the most stress to patients and caregivers (Kymalainen & Weisman de Mamani, 2007). This would call for the development of a clinical assessment tool that can identify the emotional climate(s) and sources of conflict that should be targeted based on what is most stressful and damaging to the patient.…”

“…What is deemed stressful may depend on the sociocultural context (Kymalainen & Weisman de Mamani, 2007; Weisman de Mamani, Kymalainen, Rosales, & Armesto, 2007). Research on expressed emotion across different national and ethnic groups suggests that the sociocultural context may influence the family's emotional climate and levels of EE (Bhugra & McKenzie, 2003).…”

Differences by Retrospective Illness Course on Burden,Expressed Emotion, Psychological Distress and Quality of Life in Relatives of Mexican Outpatients with Psychosis: A Cross-Sectional Study

“…This might well, at first, call into question the validity of the results; however, other arguments must be considered. The expression and levels of PD may vary by ethnicity; if the individual's behavior and functioning is distant from cultural norms and values endorsed by culture, family member may find more difficult to interact with the patient and being less critical [63]. Previous studies in families of Mexican origin (in the United States) have shown that they are less critical and have a better acceptance of psychosis [64,65].…”