Integrity of Literature on Expressed Emotion and Relapse in Patients with Schizophrenia Verified by a p‐Curve Analysis

Abstract

There is growing concern that much published research may have questionable validity due to phenomena such as publication bias and p-hacking. Within the psychiatric literature, the construct of expressed emotion (EE) is widely assumed to be a reliable predictor of relapse across a range of mental illnesses. EE is an index of the family climate, measuring how critical, hostile, and overinvolved a family member is toward a mentally ill patient. No study to date has examined the evidential value of this body of research as a whole. That is to say, although many studies have shown a link between EE and symptom relapse, the integrity of the literature from which this claim is derived has not been tested. In an effort to confirm the integrity of the literature of EE predicting psychiatric relapse in patients with schizophrenia, we conducted a p-curve analysis on all known studies examining EE (using the Camberwell Family Interview) to predict psychiatric relapse over a 9- to 12-month follow-up period. Results suggest that the body of literature on EE is unbiased and has integrity, as there was a significant right skew of p-values, a nonsignificant left skew of p-values, and a nonsignificant test of flatness. We conclude that EE is a robust and valuable predictor of symptom relapse in schizophrenia.

Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia

“…Another study carried out in Europe demonstrated that in the United Kingdom patients that live in homes with high levels of EOI have higher relapse rates in a 9-month period (1) . However, samples analyzed in other European countries do not show a relationship between EOI and relapses in schizophrenia (8,24) . An analysis carried out with a population of Mexican-Americans demonstrated that EOI may increase the risk of relapse in a 12-month follow-up period, but in longer periods the domain was not considered a predictor of relapse (25) .…”

“…Understanding of these aspects is essential to evaluate how different contexts influence levels of expressed emotion and prognosis of the disease (23) . According to a study carried out in China, developing countries present lower levels of expressed emotion (8) . Another study carried out in Europe demonstrated that in the United Kingdom patients that live in homes with high levels of EOI have higher relapse rates in a 9-month period (1) .…”

“…This instrument was adapted and validated for the Brazilian context in 2013 and contains 20 items, divided into two domains -CC (10 items -2, 4,6,8,10,12,14,16,18,20) and EOI (10 items -1, 3,5,7,9,11,13,15,17,19). The items in the two domains reflect different situations that the family members use to cope with their daily problems.…”

“…These studies confirmed that EE is a good predictor of schizophrenia relapses, especially in patients in the most chronic phase of the disease (6) . Recent prospective studies have shown that patients with schizophrenia living with families with high levels of EE have higher chances of suffering relapses when compared to those that live in family settings with low EE (7)(8) .…”

“…These studies confirmed that EE is a good predictor of schizophrenia relapses, especially in patients in the most chronic phase of the disease (6) . Recent prospective studies have shown that patients with schizophrenia living with families with high levels of EE have higher chances of suffering relapses when compared to those that live in family settings with low EE (7)(8) .Relapses are defined by the exacerbation of symptoms related to the diagnosis of schizophrenia in patients with a stable condition (7) . The main causes of relapses among schizophrenia patients are related to high rates of non-adherence to treatment (9) .…”