Parental Expressed Emotion and Suicidal Ideation in Adolescents with Bipolar Disorder

Psychiatry Research 05/2014; 216(2). DOI: 10.1016/j.psychres.2014.02.013


Family environmental variables are risk factors for recurrent courses of mood disorder in adolescents. The present study examined the association between parental expressed emotion (EE)—critical, hostile and/or emotionally overinvolved attitudes toward a concurrently ill offspring – and suicidal ideation in adolescents with bipolar disorder. The sample consisted of 95 adolescents with a bipolar I or II diagnosis who had experienced a mood episode in the prior 3 months. Participants (mean age=15.54 yrs., SD=1.4) were interviewed and completed questionnaires regarding current and past suicidal ideation prior to their participation in a treatment trial. Parents completed five-minute speech samples from which levels of EE were assessed. High EE attitudes in parents were associated with current suicidal ideation in adolescents. This relationship was independent of the effects of age, gender, current depressive or manic symptoms, comorbid diagnoses, bipolar I/II subtype, family adaptability, and family cohesion. These results underscore the importance of addressing the emotional reactivity of caregivers in treating adolescents with bipolar disorder who have suicidal ideation.

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    ABSTRACT: Expressed Emotion (EE; criticism/hostility and emotional overinvolvement) displayed in family interactions has been associated with the presence and poorer course of multiple disorders in adults and children. As such, validating appropriate tools for measuring EE could have important implications for research and clinical practice. Child EE measures are limited though there are some established methods of assessing EE in adults. The Expressed Emotion Adjective Checklist (EEAC), a self-report measure of EE, has demonstrated validity with adults but has not been evaluated in child samples. The present study examined reliability, stability, and validity of the EEAC in measuring EE in caregivers of children with mood disorders. EEAC scores were associated with the criticism component of the Five Minute Speech Sample (FMSS), a commonly used EE measure in children. EEAC scores were also stable and predicted manic symptom severity and global impairment one year later. These data suggest the EEAC may be a useful self-report measure of EE in children.
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    ABSTRACT: Childhood mood disorders are associated with substantial impairment and risks for youth and their families. Identifying interventions that improve child and family functioning is essential for child, family, and public health. Several individual therapy modalities have been developed with historically little attention on family participation. However, with the accumulation of research demonstrating the roles family interactions can play in symptom presentation and course, interventions that include family involvement are garnering more attention and have demonstrated promising benefits for children with mood disorders. This article reviews evidence-based family-focused interventions for childhood mood disorders and provides examples of their implementation. Copyright © 2015 Elsevier Inc. All rights reserved.
    Child and Adolescent Psychiatric Clinics of North America 04/2015; 24(3). DOI:10.1016/j.chc.2015.02.008 · 2.60 Impact Factor

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