Article

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

ABSTRACT 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.

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Available from: Adrian Aguilera, Jul 29, 2015
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    • "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. "
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    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).
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    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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