Toward specifying the nature of the relationship between expressed emotion and schizophrenic relapse: the utility of curvilinear models. Int J Meth Psych Res

Department of Psychiatry, Yale University, New Haven, CT 06519, USA.
International Journal of Methods in Psychiatric Research (Impact Factor: 3.76). 03/2007; 16(1):1-10. DOI: 10.1002/mpr.194
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Although expressed emotion (EE) has been demonstrated to be associated with the course of schizophrenia, the nature of this relationship is unclear. This study proposes that testing for curvilinear relationships can identify the specific nature of the relationships between EE indices and relapse. The utility of curvilinear models was explored through a reanalysis of data from a prior study of EE among Mexican-Americans (Karno et al., 1987). The results suggest that the relationship between the EE index of emotional overinvolvement (EOI) and relapse is curvilinear and that high levels of EOI may exert a toxic effect on course of illness whereas medium levels of EOI may be protective. The relationship between the EE index of warmth and relapse is also curvilinear and high levels of warmth appear to exert a protective effect on the course of illness. The role of culture is explored in explaining the specific manner in which EE relates to relapse among Mexican-Americans.

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Available from: Nicholas J K Breitborde,
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    • "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. This finding differs from the traditional assumption present within the EE literature that, when assessed as a continuous variable, higher levels of EOI are more problematic (i.e., associated with a greater risk for relapse) than lower levels of EOI and suggests that moderate levels of EOI may be ideal within a family caring for a relative with schizophrenia. "
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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).
    The Journal of nervous and mental disease 10/2013; 201(10):833-840. DOI:10.1097/NMD.0b013e3182a5bf1d · 1.69 Impact Factor
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    • "Latin Americans generally show high levels of engagement with their ill relatives and usually understand and empathize with their problems. However, Breitborde and colleagues [50] suggested that only moderate levels of EOI were associated with better outcomes, both in patients and caregivers. When EOI is too high or too low, patient relapse and caregiver burden rates increase again. "
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    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
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    • "Our findings contribute to past culture and expressed emotion (EE) research in important ways. First, we found that emotional overinvolvement (EOI) predicted schizophrenic relapse for Mexican Americans, which replicates the findings of Breitborde et al. (2007). EOI appears to be the most reliable EE index for predicting relapse in this ethnic group. "
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    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.
    Journal of Abnormal Psychology 11/2010; 119(4):875-85. DOI:10.1037/a0020908 · 4.86 Impact Factor
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