Past studies have demonstrated a clear relationship between expressed emotion (EE) and relapse for individuals with schizophrenia. However, little attention has been directed toward exploring whether EE may have negative health consequences for caregivers as well. We recruited 60 Mexican-American family caregivers of individuals with schizophrenia and examined whether EE predicted the health of caregivers and ill relatives approximately 13 months later. For caregiving relatives, the EE indices of emotional over-involvement and warmth were predictive of worse mental health among caregivers at follow-up. There was no association between EE and health outcome among individuals with schizophrenia. Our findings suggest that, among Mexican-Americans, family factors may be associated with health outcomes among individuals with schizophrenia and their caregiving relatives.
"Growing evidence suggests that critical comments (CC) are more predictive for the course of the illness than EOI (Marom et al., 2005). Furthermore, relatives with marked emotional overinvolvement (EOI) attribute positive events more often to the patients (Grice et al., 2009), show more self blame (Peterson and Docherty, 2004) and have poorer health (Breitborde et al., 2010). "
[Show abstract][Hide abstract] ABSTRACT: The study tests assumptions from the “cognitive model of caregiving” (Kuipers et al., 2010), which aims to inform interventions for carers of people with psychoses. The sample comprised 61 relatives of patients with schizophrenia. Standardized psychological assessments were conducted twice within 6 months including: Involvement Evaluation Questionnaire (IEQ-EU), a short form of the Symptom Checklist 90-R (SCL K9), the Family Questionnaire (FQ), scales measuring control attributions of the Illness Perception Questionnaire for Schizophrenia (IPQS-R) and emotions toward the ill relative. Structural equation modelling was used to analyse data. We identified two pathways: a) from “attributing control to relatives” to distress, intermediated by anxiety for the patient and emotional overinvolvement (EOI), and b) from “attribution control to patient” to distress, intermediated by anger about the patient and criticism. The model provided a good fit to the data and was successfully replicated at a second point in time. We were able to find supporting evidence for a cognitive model of caregiving. Control attributions and emotions of informal caregivers are important when interventions are planned reducing expressed emotion and burden of caregivers.
[Show abstract][Hide abstract] ABSTRACT: Understanding cross-cultural aspects of emotional overinvolvement (EOI) on psychosis outcomes is important for ensuring cultural appropriateness of family interventions. This systematic review explores whether EOI has similar impact in different cultural groups and whether the same norms can be used to measure EOI across cultures. Thirty-four studies were found that have investigated the impact of EOI on outcomes across cultures or culturally adapted EOI measures. The relationship between high EOI and poor outcome is inconsistent across cultures. Attempts to improve predictive ability by post hoc adjustment of EOI norms have had varied success. Few studies have attempted a priori adaptations or development of culture-specific norms. Methodological differences such as use of different expressed emotions (EE) measures and varying definitions of relapse across studies may explain a lack of EOI outcome relationship across cultures. However, our findings suggest that the construct and measurement of EOI itself are culture-specific. EOI may not necessarily be detrimental in all cultures. The effect of high EOI may be moderated by the unexplored dimension of warmth and high levels of mutual interdependence in kin relationships. Researchers should reevaluate the prevailing concepts of the impact of family relations on the course and outcome of psychotic disorders, specifically focusing on the protective aspects of family involvement. Clinically, family interventions based on EE reduction should take cultural differences into account when treating families from different ethnocultural groups.
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