Influence of carer expressed emotion and affect on relapse in
                        non-affective psychosis

Kuipers, Elizabeth; Bebbington, P; Dunn, Graham; Fowler, DG; Freeman, Daniel; Watson, P W B; Hardy, Amy; Garety, Philippa

doi:10.1192/bjp.bp.104.007294

Cited by 94 publications

(107 citation statements)

References 23 publications

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“…Furthermore, our findings are similar to those of the pioneer studies of EE by Brown [33] on the key family caregivers' EE using the Camberwell Family Interview that the nature of EE is multidimensional and complex, consisting of four to six domains. The three components of family EE perceived by the patients that are embedded in the LEE scale similar to those identified by Brown [33] and Kuipers et al [34] included emotional overinvolvement, critical comments/hostility, and positive attitude (or remarks) towards patient.…”

Section: Confirmatory Factormentioning

confidence: 98%

“…The Scientific World Journal (6) 0.47 (3) Does not insist on doing things with me (14) 0.48 (4) Does not pry into my life (41) 0.47 (5) Supports me when I need it (36) 0.56 (6) Is not always interfering (10) 0.46 (7) Leaves me feeling overwhelmed (20) 0.49 (8) Often checks up me to see what I am doing (24) 0.46 (9) Isn't always nosing into my business (28) 0.51 (10) Always has to know everything about me (32) 0.49 (11) Butts into my private matters (37) 0.45 (12) Gets upset when I do not check in with him/her (49) 0.52 (1) Is sympathetic toward me when I'm ill or upset (8) 0.51 (2) Encourages me to seek outside help when I'm not feeling well (12) 0.48 (3) Makes me feel valuable as a person (19) 0.50 (4) Tries to make me feel better when I'm upset or ill (26) 0.50 (5) Is willing to gain more information to understand my condition when I'm not feeling well (39) 0.42 (6) Doesn't blame me when I'm feeling unwell (43) 0.47 (7) Tries to reassure me when I'm not feeling well (51) 0.41 (8) Says I just want attention when I say I'm not well (4) 0.45 (9) Doesn't help me when I'm upset or feeling unwell (15) 0.47 (10) Says I cause my troubles to occur in order to get back at him/her (22) 0.50 (11) Says it is OK to seek professional help (30) 0.45 (12) Accuses me of exaggerating when I say I'm unwell (34) 0.50 (13) Often accuses me of making things up when I'm not feeling well (47) 0.48 (1) Is tolerant with me even when I'm not meeting his/her expectations (2) 0.45 (2) Can see my point of view (9) 0.41 (3) Doesn't feel that I'm causing him/her a lot of trouble (13) 0.43 (4) Understands my limitations (23) 0.46 (5) Blames me for things not going well (18) 0.51 (6) Is realistic about what I can and cannot do (27) 0.49 (7) Is understanding if I make mistakes (40) 0.42 (8) Makes me feel guilty for not meeting his/her expectations (5)...…”

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confidence: 99%

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

Chien

Chan

2008

Research in Nursing & Health

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This study tested the psychometric properties of a Chinese version of the level of expressed emotion scale in Hong Kong Chinese patients with severe mental illness and their family caregivers. First, the semantic equivalence with the original English version and test-retest reliability at 2-week interval of the Chinese version was examined. After that, the reproducibility, construct validity, and internal consistency of the Chinese version were tested. The Chinese version indicated good semantic equivalence with the English version (kappa values = 0.76-0.95 and ICC = 0.81-0.92), test-retest reliability ( = 0.89-0.95, < 0.01), and internal consistency (Cronbach's = 0.86-0.92). Among 262 patients with severe mental illness and their caregivers, the 50-item Chinese version had substantial loadings on one of the four factors identified (intrusiveness/hostility, attitude towards patient, tolerance, and emotional involvement), accounting for 71.8% of the total variance of expressed emotion. In confirmatory factor analysis, the identified fourfactor model showed the best fit based on all fit indices ( 2 /df = 1.93, = 0.75; AGFI = 0.96; TLI = 1.02; RMSEA = 0.031; WRMR = 0.78) to the collected data. The four-factor Chinese version also indicated a good concurrent validity with significant correlations with family functioning ( = −0.54) and family burden ( = 0.49) and a satisfactory reproducibility over six months (intraclass correlation coefficient of 0.90). The mean scores of the overall and subscale of the Chinese version in patients with unipolar disorder were higher than in other illness groups (schizophrenia, psychotic disorders, and bipolar disorder; < 0.01). The Chinese version demonstrates sound psychometric properties to measure families' expressed emotion in Chinese patients with severe mental illness, which are found varied across countries.

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Section: Confirmatory Factormentioning

confidence: 98%

mentioning

confidence: 99%

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

Chien

Chan

2008

Research in Nursing & Health

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show abstract

“…The status of "carer'" (consistent with the definition reported in Kuipers et al 29 ) covered parents, spouses, or partners of an identified patient and living with the patient; individuals living with a patient and willingly classified by themselves and the patient as a caregiver; individuals acknowledged as caregivers not living with the patient but maintaining 3 or more face-to-face weekly contacts with the patient, totalling at least 10 hours. Maudsley and Bethlem Royal Hospitals, and the Multi-Centre Research Ethics Committee, provided ethical approval of the study.…”

Section: Methodsmentioning

confidence: 99%

“…The original IPQ was widely used in various physical illness populations and has good psychometric properties. 23,29 To measure the illness beliefs relating to psychosis from a caregiver's perspective, Barrowclough et al 24 modified 3 subscales of the original IPQ (that is, consequences, cure-control, and timeline) to provide parallel patient and caregiver forms.…”

Section: Caregiver Measuresmentioning

confidence: 99%

Caregiving and Illness Beliefs in the Course of Psychotic Illness

et al. 2008

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Objective: Informal caregivers play a central role in patient care, and caregiving can provide positive and negative experiences. Negative caregiving experiences are associated with distress. This study investigates associations between caregiving appraisals in psychosis, distress, and 3 key illness beliefs (consequences, cure-control, and timeline), and whether illness beliefs makes a contribution to the relation between negative caregiving appraisal and distress. Method:We employed a cross-sectional study design. Caregivers (n = 146), including Early Psychosis Services caregivers (n = 60), completed self-report measures of the impact of care and illness beliefs. Results:Negative caregiving appraisals and distress were strongly associated. Caregivers appraised caregiving negatively and reported greater distress when they perceived the illness as having severe consequences for themselves and the patient, and when they perceived it as a long-term illness. In contrast, they appraised caregiving positively when they perceived that both they and the patient could exert some control over the illness. Illness beliefs did not account for the strong relation between negative caregiving appraisals and distress. Caregivers of patients with longer illness histories reported higher levels of positive caregiving appraisals. Conclusion:Caregivers' cognitive representation of psychosis may play an important role in positive and negative appraisals about caregiving, even at an early stage of the illness. Implications for interventions with early psychosis caregivers are discussed. Can J Psychiatry 2008;53(7):460-468Clinical Implications · Caregivers' beliefs about psychosis may play an important role in their appraisals of positive and negative caregiving experiences. · Routine interventions with caregivers should aim to identify their key illness beliefs. · A clinical focus on modifying less adaptive illness beliefs may be helpful in reducing levels of negative appraisals of caregiving and distress, particularly in early psychosis. Limitations· A demographically broader sample of caregivers was not recruited. · Only cross-sectional relations between appraisals of caregiving experiences, illness beliefs, and distress were examined; the data do not denote causality.

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“…Possibly the way relatives appraise interactions determines their emotional responses. Prior evidence suggests that negative evaluations of caregiving directly relate to carer stress (Kuipers et al, 2006) and that understanding relatives' beliefs and appraisals may help us identify those at risk of enduring problems (Barrowclough et al, 2014). Thus, clinical support offered to relatives should identify early on which beliefs and interactional styles are more adaptive.…”

Section: Discussionmentioning

confidence: 99%

Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis

Wearden

Hartley

et al. 2016

Psychiatry Research

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2 Highlights• Patients' self-reports of their relatives being behaviourally controlling in the course of everyday life, namely taking control of them or helping them, were associated with higher levels of negative mood and symptoms.• Relatives' self-reports of behaviourally controlling interactions such as nagging, keeping an eye on the patient or taking control of the patient were significantly linked with fluctuations in relatives' mood, but not with patients' symptoms.• Contact with high-EE relatives (critical and overinvolved), had no association with patients' affect or symptoms in the course of daily life.3 Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis 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-day 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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Influence of carer expressed emotion and affect on relapse in non-affective psychosis

Abstract: Our hypothesis was partially supported. Carer criticism was associated with patient anxiety, low carer self-esteem and poor carer coping strategies. Family interventions should focus on improving these after a relapse of symptoms of psychosis.

Cited by 94 publications

References 23 publications

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

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

Caregiving and Illness Beliefs in the Course of Psychotic Illness

Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis

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