Cultural Variability in the Manifestation of Expressed Emotion

Department of Psychology, University of Southern California, 3620 S. McClintock, Los Angeles, CA 90089-1061, USA.
Family Process (Impact Factor: 1.73). 07/2009; 48(2):179-94. DOI: 10.1111/j.1545-5300.2009.01276.x
Source: PubMed


We examined the distribution of expressed emotion (EE) and its indices in a sample of 224 family caregivers of individuals with schizophrenia pooled from 5 studies, 3 reflecting a contemporary sample of Mexican Americans (MA 2000, N = 126), 1 of an earlier study of Mexican Americans (MA 1980, N = 44), and the other of an earlier study of Anglo Americans (AA, N = 54). Chi-square and path analyses revealed no significant differences between the 2 MA samples in rates of high EE, critical comments, hostility, and emotional over-involvement (EOI). Only caregiver warmth differed for the 2 MA samples; MA 1980 had higher warmth than MA 2000. Significant differences were consistently found between the combined MA samples and the AA sample; AAs had higher rates of high EE, more critical comments, less warmth, less EOI, and a high EE profile comprised more of criticism/hostility. We also examined the relationship of proxy measures of acculturation among the MA 2000 sample. The findings support and extend Jenkins' earlier observations regarding the cultural variability of EE for Mexican Americans. Implications are discussed regarding the cross-cultural measurement of EE and the focus of family interventions.

Download full-text


Available from: Nicholas J K Breitborde, Sep 29, 2015
33 Reads
  • Source
    • "Kingdon and Turkington [7] for instance, suggested that relapse can be linked to life events and circumstances such as low-key but enduring type of stress or due to specific factors that trigger anxiety to which the person is vulnerable. One of the main contributory factors that have been consistently found to relate to relapse is the emotional climate of household environment demonstrated by family members toward people with schizophrenia known as the expressed emotion (EE) [8] [9] [10] [11] [12] [13]. EE has been considered as " … a thermometer of affective family environment… " [14, p.80] and it has been suggested to reflect family members' general attitudes toward patients with schizophrenia in their daily interactions [15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Schizophrenia which is perhaps the most disabling and puzzling form of a mental disorder is often conceptualized as 'gila' (lunacy or madness) by the Malaysian society. The debilitating nature of the disorder and recurrent relapse of its psychotic episodes have often been misunderstood and lead to confusion among the family members, who play the role as primary caregivers. While expressed emotion (EE) has been widely studied in the Western world, it is not well understood in Malaysia. OBJECTIVES: This study aimed at investigating the predictive role of relatives' EE index and components as well as personality traits in relapse among schizophrenia patients in Kuala Lumpur and Klang Valley, Malaysia. METHODS: A total of 160 subjects consisting of 80 patients diagnosed with chronic schizophrenia and 80 relatives were recruited to participate in Phase 1 of the study. Only patient-participants were followed-up 6 months later for Phase 2 of the study in order to check for possible relapse. The Family Questionnaire (FQ) and the short scale Eysenck Personality Questionnaire-Revised (EPQ-R) were administered to measure relatives' EE and personality traits, respectively. Patients' were considered to relapse if they were readmitted into psychiatric wards 6 months post-hospital discharge. RESULTS: The findings revealed that the odds for patients to relapse were increased by 8 times when relatives demonstrated high-EE level. Relatives' critical comments (CC) turned out to be the strongest predictor with the odds to relapse increased by 12% when they demonstrated an increase in CC level. Relatives' personality traits particularly the extraversion trait also turned out to be the significant direct predictor to patients' relapse. Our results showed that a unit decrease in extraversion trait score predicted the odds for patients to relapse by 23%. DISCUSSIONS: Our findings supported the Western findings on the significant role of relatives' high-EE level particularly the CC scale on the course of schizophrenia. The novelty of the current finding was demonstrated in the significant role of relatives' extraversion trait that directly predicted patients' relapse. Results also indicated the feasibility of EE in predicting relapse among schizophrenia patients in Klang Valley, Malaysia.
    Comprehensive psychiatry 01/2013; 55(1). DOI:10.1016/j.comppsych.2012.12.026 · 2.25 Impact Factor
  • Source
    • "CFI studies have demonstrated that hostility is rarely seen in the absence of high-EE based on criticism. Thus, researchers using the CFI often combine these categories (e.g., Weisman et al., 1998, 2000; Lopez et al., 2009) and newer systems of rating EE, such as the Five Minute Speech Sample (FMSS; Magaña et al., 1986), do not measure hostility as a separate component; instead, it is combined with criticism. EE is important because it is a robust predictor of illness prognosis across a broad range of psychiatric disorders (Wearden et al., 2000) and, with a few exceptions, across a range of cultures and ethnic groups (Weisman de Mamani et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Expressed emotion (EE) is a measure of the family environment reflecting the amount of criticism and emotional over-involvement expressed by a key relative towards a family member with a disorder or impairment. Patients from high EE homes have a poorer illness prognosis than do patients from low EE homes. Despite EE's well-established predictive validity, questions remain regarding why some family members express high levels of EE attitudes while others do not. Based on indirect evidence from previous research, the current study tested whether shame and guilt/self-blame about having a relative with schizophrenia serve as predictors of EE. A sample of 72 family members of patients with schizophrenia completed the Five Minute Speech Sample to measure EE, along with questionnaires assessing self-directed emotions. In line with the hypotheses, higher levels of both shame and guilt/self-blame about having a relative with schizophrenia predicted high EE. Results of the current study elucidate the EE construct and have implications for working with families of patients with schizophrenia.
    Psychiatry Research 02/2012; 196(1):27-31. DOI:10.1016/j.psychres.2011.08.009 · 2.47 Impact Factor
  • Source
    • "This research emphasizes that Mexican American caregivers are less critical, less hostile and show more warmth towards their relatives with schizophrenia than do Anglo-American caregivers. Other studies have suggested that ethno-cultural differences also affect the nature of the association between EE and relapse in patients with schizophrenia and the health status of caregivers [48,49]. Thus, while criticism is considered the main contributor to patient relapse and caregiver burden in Anglo-American samples, EOI seems to be the main predictor of worse health outcomes and burden in Mexican American caregivers [48]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia. Methods We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica. Results Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R2 = .104, F = 4,55; p = .039). Conclusions Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context.
    BMC Family Practice 09/2011; 12(1):101. DOI:10.1186/1471-2296-12-101 · 1.67 Impact Factor
Show more