Factor Analysis of the Level of Expressed Emotion Scale, A Questionnaire Intended to Measure ‘Perceived Expressed Emotion’

Abstract

When the factor structure and psychometric qualities of the Level of Expressed Emotion scale, an instrument intended to assess patient's perceptions of expressed emotion, were evaluated, three moderately intercorrelated factors emerged, with good internal consistency; these were lack of emotional support, intrusiveness/control, and irritability. This did not quite correspond to the a priori scales described in the original version. As in the original LEE, the three factors add to a total score intended to measure 'perceived expressed emotion'.

Testing the psychometric properties of a Chinese version of the Level of Expressed Emotion scale

“…These findings provide evidence that the Chinese depressed patients had the highest level of perceived EE of the family among the major subgroups of SMI. Similar to the findings of Gerlsma et al [31] and Hooley and Teasdale [39], the depressed patients indicated high levels of perceived EE, mainly relating to their high perceived intrusiveness and irritability (emotion overinvolvement) and inadequate social support obtained from their family members. Therefore, the development and course of depression can be seen as a dynamic interactional process in which family support and caring attitude can serve as a buffer of the onset of the illness or a mediator of the recovery process.…”

“…A member in a Chinese family should be expected to keep his/her emotions under control to maintain family functioning and relationships or otherwise, he/she would be considered unfavorable or nonpreferable to other family member's mental well-being, thus attributing to a higher level of perceived family EE. The importance of these two factors, including attitude and tolerance towards patient is also consistent with the findings of a few Western studies [31,38]. Butzlaff and Hooley [4] suggested that family members with high EE are critical and negative towards patient's behaviors, and often expect the patient to take main responsibility for and be able to control his/her emotions and illness-related behaviors.…”

“…The four-factor model shows that "intrusive and hostility, " various negative "attitudes toward patient, " level of "tolerance, " and extent of "emotional involvement" are four moderately correlated factors or concepts that cover patients' perceived EE of their families. The four-factor solution of the Chinese version in this study also accounted for a higher percentage of total variance (i.e., >70%) of the perceived EE than that (about 42% and 60%) in Gerlsma et al [31] and the original authors (Cole and Kazarian) [9] of the LEE scale. Besides explaining more variance, the Chinese version was also shortened (i.e., from the original 60 items to 50 items in this study).…”

“…Model modification indices for the four-factor model also pointed to good fit, especially with additional paths drawn between the four factors themselves. The second two-factor model proposed by the original authors was only an acceptable fit ( 2 /df = 2.02, = 0.58; AGFI = 0.90; TLI = 0.95; RMSEA = 0.050; WRMR = 0.89) but a better fit than the three-factor model proposed by Gerlsma et al [31] for their Dutch version.…”

“…In addition, the four-factor model of this Chinese version of the LEE scale was also found to be the best fit with the data collected, and thus the construct of patients' perceived EE, when compared with the original two-factor model by Cole and Kazarian [9] and the modified Dutch three-factor model by Gerlsma et al [31], Intrusiveness/Hostility and Emotional Involvement are the two key components of EE, being most commonly accepted and agreed by the researchers across cultures [15,35]. The other two factors, including attitudes towards patient and tolerance (of the mental illness and its related behaviors), are more increasingly recognized factors in recent studies, evaluating the emotional climate and interpersonal relationships between family members of people with SMI in Western culture [36].…”