Expressed emotion and sociocultural moderation in the course of schizophrenia

Department of Psychiatry, University of California, San Francisco CA, USA.
Journal of Abnormal Psychology (Impact Factor: 4.86). 11/2010; 119(4):875-85. DOI: 10.1037/a0020908
Source: PubMed


This study examined whether the sociocultural context moderates the relationship between families' expressed emotion (EE) and clinical outcomes in schizophrenia. In a sample of 60 Mexican American caregivers and their ill relatives, we first assessed whether EE and its indices (criticism, emotional overinvolvement [EOI], and warmth) related to relapse. Second, we extended the analysis of EE and its indices to a longitudinal assessment of symptomatology. Last, we tested whether bidimensional acculturation moderated the relationship between EE (and its indices) and both relapse and symptom trajectory over time. Results indicated that EOI was associated with increased relapse and that criticism was associated with increased symptomatology. Additionally, as patients' Mexican enculturation (Spanish language and media involvement) decreased, EE was increasingly related to relapse. For symptomatology, as patients' U.S. acculturation (English language and media involvement) increased, EE was associated with increased symptoms longitudinally. Our results replicate and extend past research on how culture might shape the way family factors relate to the course of schizophrenia.

Download full-text


Available from: Adrian Aguilera,
  • Source
    • "Although there is mixed evidence with regard to whether the global EE construct (i.e., high EE versus low EE) predicts relapse for Mexican-Americans (Karno et al., 1987; Kopelowicz et al., 2006) or does not predict relapse for Mexican-Americans (Aguilera et al., 2010; Kopelowicz et al., 2002), the EE index of EOI is a reliable predictor of relapse among Mexican-Americans (Aguilera et al., 2010; Breitborde et al., 2007). Of note, the EE index of criticism does not predict relapse among Mexican-Americans (Aguilera et al., 2010; Kopelowicz et al., 2002; López et al., 2004). Previously, Breitborde et al. (2007) found that a curvilinear model best fits the relationship between EOI and relapse among Mexican-Americans, among whom high EOI was associated with a greater than average risk for relapse and moderate EOI was associated with a lower than average risk for relapse. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although it is clear that expressed emotion (EE) is associated with the course of schizophrenia, proposed models for this association have struggled to account for the relationship between the EE index of emotional overinvolvement (EOI) and relapse. To expand our understanding of the EOI-relapse association, we first attempted to replicate the finding that the EOI-relapse association is curvilinear among 55 Mexican-Americans with schizophrenia and their caregiving relatives. Second, we evaluated whether the caregivers' perception of their ill relative's efficacy may account for the EOI-relapse association. Our results comport with past findings with regard to the curvilinear nature of the EOI-relapse association among Mexican-Americans and suggest that EOI may only seem to be a risk factor of relapse because of its strong association with a true risk factor for relapse (i.e., caregivers' perception of their ill relative's efficacy).
    The Journal of nervous and mental disease 10/2013; 201(10):833-840. DOI:10.1097/NMD.0b013e3182a5bf1d · 1.69 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of schizophrenia, as well as the symptoms, course, and outcomes for people so diagnosed seem to vary across some cultural contexts. The mechanisms by which cultural variations may protect one from or increase one's risk of developing schizophrenia remain unclear. Recent findings from transdisciplinary cross-cultural research, indicate ways that we may better understand how socioenvironmental and cultural variables interact with physiologic pathways relating psychosocial stress and psychotic symptoms, epigenetic changes, and people's use of culturally available tools to mitigate stress, in ways that may inform relevant, effective interventions for people diagnosed with psychotic disorders worldwide.
    Current Psychiatry Reports 06/2011; 13(4):305-11. DOI:10.1007/s11920-011-0208-0 · 3.24 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study examined the short term effects of a brief familial intervention on schizophrenic the patient's levels of psychopathology and their primary caregiver's functioning in India. Caregiver functioning was measured by the caregiver's levels of burden and coping along with the patient's perceived level of expressed emotion (EE). The participants were 18 schizophrenic patients and their related primary carer from a medical facility in India. The patients' levels of psychopathology and EE were assessed at baseline and at completion of the study with the Positive and Negative Syndrome Scale (PANSS; Kay et al., 1987) and the Family Emotional Involvement And Criticism Scale (FEICS; Shields et al., 1992), respectively. The primary caregiver's levels of burden and coping were also measured at baseline and upon completion of the study by the Burden Assessment Scale (BAS; Thara et al., 1998) and the Family Crisis Oriented Personal Evaluation Scale (F-COPES; McCubbin et al., 1981), respectively. The brief intervention was comprised of 3 one hour sessions aimed at educating the primary caregiver and patient about schizophrenia; along with improving their communication, problem solving skills and expression of emotions. A significant improvement was found between baseline and the final 3-month follow-up on measures of psychopathology for the patients, as well as family functioning for both the caregivers and patients. The implications of the findings are discussed, along with future research directions.
    09/2011; 4(3):183-7. DOI:10.1016/j.ajp.2011.06.004
Show more