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Published in: BMC Psychiatry 1/2012

Open Access 01-12-2012 | Research article

The association between expressed emotion, illness severity and subjective burden of care in relatives of patients with schizophrenia. Findings from an Italian population

Authors: Giuseppe Carrà, Carlo Lorenzo Cazzullo, Massimo Clerici

Published in: BMC Psychiatry | Issue 1/2012

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Abstract

Background

An appropriate understanding of the association between high-Expressed Emotion (EE) in family members of people with schizophrenia, patients’ and relatives’ correlates is needed to improve adaptation of psychoeducational interventions in diverse cultures. The aim of this study was to test the hypothesis that relatives designated as high EE would report higher subjective burden of care, and would be associated with objective variables that indicate greater illness severity i.e. number of previous hospitalizations and duration of illness.

Methods

We performed secondary analyses of baseline data from a randomized controlled trial conducted in Italy.

Results

High-EE relatives reported more subjective burden of care in disturbed behaviours and adverse effects areas, but did not perceive more deficits in social role performances. As regards illness severity characteristics, neither the number of previous hospital admissions nor the duration of illness was associated with high-EE. However, patients’ previous psychosocial functioning, as measured by educational attainments, seems to protect the relative from high-EE status.

Conclusion

There is a need for cross-cultural comparisons of the subjective experience of distress and burden among high EE carers as a target for intervention, aimed at reducing family stress as much as improving patient outcomes.
Literature
1.
go back to reference Baronet AM: Factors associated with caregiver burden in mental illness: a critical review of the research literature. Clin Psychol Rev. 1999, 19: 819-841. 10.1016/S0272-7358(98)00076-2.CrossRefPubMed Baronet AM: Factors associated with caregiver burden in mental illness: a critical review of the research literature. Clin Psychol Rev. 1999, 19: 819-841. 10.1016/S0272-7358(98)00076-2.CrossRefPubMed
2.
go back to reference Awad AG, Voruganti LN: The burden of schizophrenia on caregivers: a review. PharmacoEconomics. 2008, 26: 149-162. 10.2165/00019053-200826020-00005.CrossRefPubMed Awad AG, Voruganti LN: The burden of schizophrenia on caregivers: a review. PharmacoEconomics. 2008, 26: 149-162. 10.2165/00019053-200826020-00005.CrossRefPubMed
3.
go back to reference Hoenig J, Hamilton MW: The schizophrenic patient in the community and his effect on the household. Int J Soc Psychiatry. 1966, 12: 165-176. 10.1177/002076406601200301.CrossRefPubMed Hoenig J, Hamilton MW: The schizophrenic patient in the community and his effect on the household. Int J Soc Psychiatry. 1966, 12: 165-176. 10.1177/002076406601200301.CrossRefPubMed
4.
go back to reference Guarnaccia PJ, Parra P: Ethnicity, social status, and families' experiences of caring for a mentally ill family member. Community Ment Health J. 1996, 32: 243-260. 10.1007/BF02249426.CrossRefPubMed Guarnaccia PJ, Parra P: Ethnicity, social status, and families' experiences of caring for a mentally ill family member. Community Ment Health J. 1996, 32: 243-260. 10.1007/BF02249426.CrossRefPubMed
5.
go back to reference Rosenfarb I, Bellack A, Aziz N: A Sociocultural Stress, Appraisal, and Coping Model of Subjective Burden and Family Attitudes Toward Patients With Schizophrenia. J Abnorm Psychol. 2006, 115: 157-165.CrossRefPubMed Rosenfarb I, Bellack A, Aziz N: A Sociocultural Stress, Appraisal, and Coping Model of Subjective Burden and Family Attitudes Toward Patients With Schizophrenia. J Abnorm Psychol. 2006, 115: 157-165.CrossRefPubMed
6.
go back to reference Johnson ED: Differences among families coping with serious mental illness: a qualitative analysis. Am J Orthopsychiatry. 2000, 70: 126-134.CrossRefPubMed Johnson ED: Differences among families coping with serious mental illness: a qualitative analysis. Am J Orthopsychiatry. 2000, 70: 126-134.CrossRefPubMed
7.
go back to reference Jenkins JH: Ethno-psychiatric interpretations of schizophrenic illness: the problem of nervios within Mexican-American families. Cult Med Psychiatry. 1988, 12: 301-329. 10.1007/BF00051972.CrossRefPubMed Jenkins JH: Ethno-psychiatric interpretations of schizophrenic illness: the problem of nervios within Mexican-American families. Cult Med Psychiatry. 1988, 12: 301-329. 10.1007/BF00051972.CrossRefPubMed
8.
go back to reference Magaña SM, Ramírez García JI, Hernández MG, Cortez R: Psychological distress among latino family caregivers of adults with schizophrenia: the roles of burden and stigma. Psychiatr Serv. 2007, 58: 378-384. 10.1176/appi.ps.58.3.378.CrossRefPubMedPubMedCentral Magaña SM, Ramírez García JI, Hernández MG, Cortez R: Psychological distress among latino family caregivers of adults with schizophrenia: the roles of burden and stigma. Psychiatr Serv. 2007, 58: 378-384. 10.1176/appi.ps.58.3.378.CrossRefPubMedPubMedCentral
9.
go back to reference Magliano L, Fadden G, Madianos M, de Almeida J, Held T, Guarneri M, Marasco C, Tosini P, Maj M: Burden on the families of patients with schizophrenia: results of the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol. 1998, 33: 405-412. 10.1007/s001270050073.CrossRefPubMed Magliano L, Fadden G, Madianos M, de Almeida J, Held T, Guarneri M, Marasco C, Tosini P, Maj M: Burden on the families of patients with schizophrenia: results of the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol. 1998, 33: 405-412. 10.1007/s001270050073.CrossRefPubMed
10.
go back to reference Magliano L, Fiorillo A, Malangone C, De Rosa C, Maj M: Patient functioning and family burden in a controlled, real-world trial of family psychoeducation for schizophrenia. Psychiatr Serv. 2006, 57: 1784-1791. 10.1176/appi.ps.57.12.1784.CrossRefPubMed Magliano L, Fiorillo A, Malangone C, De Rosa C, Maj M: Patient functioning and family burden in a controlled, real-world trial of family psychoeducation for schizophrenia. Psychiatr Serv. 2006, 57: 1784-1791. 10.1176/appi.ps.57.12.1784.CrossRefPubMed
11.
go back to reference Roick C, Heider D, Bebbington P, Angermeyer M, Azorin J, Brugha T, Kilian R, Johnson S, Toumi M, Kornfeld Å, the EuroSC Research Group: Burden on caregivers of people with schizophrenia: comparison between Germany and Britain. Br J Psychiatry. 2007, 190: 333-338. 10.1192/bjp.bp.106.025353.CrossRefPubMed Roick C, Heider D, Bebbington P, Angermeyer M, Azorin J, Brugha T, Kilian R, Johnson S, Toumi M, Kornfeld Å, the EuroSC Research Group: Burden on caregivers of people with schizophrenia: comparison between Germany and Britain. Br J Psychiatry. 2007, 190: 333-338. 10.1192/bjp.bp.106.025353.CrossRefPubMed
12.
go back to reference Carrà G, Montomoli C, Clerici M, Cazzullo CL: Family interventions for schizophrenia in Italy: randomized controlled trial. Eur Arch Psychiatry Clin Neurosci. 2007, 257: 23-30. 10.1007/s00406-006-0677-z.CrossRefPubMed Carrà G, Montomoli C, Clerici M, Cazzullo CL: Family interventions for schizophrenia in Italy: randomized controlled trial. Eur Arch Psychiatry Clin Neurosci. 2007, 257: 23-30. 10.1007/s00406-006-0677-z.CrossRefPubMed
13.
go back to reference Bebbington P, Kuipers L: The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychol Med. 1994, 24: 707-718. 10.1017/S0033291700027860.CrossRefPubMed Bebbington P, Kuipers L: The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychol Med. 1994, 24: 707-718. 10.1017/S0033291700027860.CrossRefPubMed
14.
go back to reference Butzlaff RL, Hooley JM: Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry. 1998, 55: 547-552. 10.1001/archpsyc.55.6.547.CrossRefPubMed Butzlaff RL, Hooley JM: Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry. 1998, 55: 547-552. 10.1001/archpsyc.55.6.547.CrossRefPubMed
15.
go back to reference Wearden AJ, Tarrier N, Barrowclough C, Zastowny TR, Rahill AA: A review of expressed emotion research in health care. Clin Psychol Rev. 2000, 20: 633-666. 10.1016/S0272-7358(99)00008-2.CrossRefPubMed Wearden AJ, Tarrier N, Barrowclough C, Zastowny TR, Rahill AA: A review of expressed emotion research in health care. Clin Psychol Rev. 2000, 20: 633-666. 10.1016/S0272-7358(99)00008-2.CrossRefPubMed
16.
go back to reference Vaughn C, Leff J: The measurement of expressed emotion in the families of psychiatric patients. Br J Soc Clin Psychol. 1976, 15: 157-165. 10.1111/j.2044-8260.1976.tb00021.x.CrossRefPubMed Vaughn C, Leff J: The measurement of expressed emotion in the families of psychiatric patients. Br J Soc Clin Psychol. 1976, 15: 157-165. 10.1111/j.2044-8260.1976.tb00021.x.CrossRefPubMed
17.
go back to reference Vaughn CE, Snyder KS, Jones S, Freeman WB, Falloon IR: Family factors in schizophrenic relapse. Replication in California of British research on expressed emotion. Arch Gen Psychiatry. 1984, 41: 1169-1177. 10.1001/archpsyc.1984.01790230055009.CrossRefPubMed Vaughn CE, Snyder KS, Jones S, Freeman WB, Falloon IR: Family factors in schizophrenic relapse. Replication in California of British research on expressed emotion. Arch Gen Psychiatry. 1984, 41: 1169-1177. 10.1001/archpsyc.1984.01790230055009.CrossRefPubMed
18.
go back to reference Scazufca M, Kuipers E: Links between expressed emotion and burden of care in relatives of patients with schizophrenia. Br J Psychiatry. 1996, 168: 580-587. 10.1192/bjp.168.5.580.CrossRefPubMed Scazufca M, Kuipers E: Links between expressed emotion and burden of care in relatives of patients with schizophrenia. Br J Psychiatry. 1996, 168: 580-587. 10.1192/bjp.168.5.580.CrossRefPubMed
19.
go back to reference Scazufca M, Kuipers E: Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients’ social functioning. Psychol Med. 1998, 28: 453-461. 10.1017/S0033291797005977.CrossRefPubMed Scazufca M, Kuipers E: Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients’ social functioning. Psychol Med. 1998, 28: 453-461. 10.1017/S0033291797005977.CrossRefPubMed
20.
go back to reference Raune D, Kuipers E, Bebbington P: Expressed emotion at first-episode psychosis: Investigating a carer appraisal model. Br J Psychiatry. 2004, 184: 321-326. 10.1192/bjp.184.4.321.CrossRefPubMed Raune D, Kuipers E, Bebbington P: Expressed emotion at first-episode psychosis: Investigating a carer appraisal model. Br J Psychiatry. 2004, 184: 321-326. 10.1192/bjp.184.4.321.CrossRefPubMed
21.
go back to reference Hashemi A, Cochrane R: Expressed emotion and schizophrenia: a review of studies across cultures. Int Rev Psychiatry. 1999, 11: 219-224. 10.1080/09540269974401.CrossRef Hashemi A, Cochrane R: Expressed emotion and schizophrenia: a review of studies across cultures. Int Rev Psychiatry. 1999, 11: 219-224. 10.1080/09540269974401.CrossRef
22.
go back to reference Bhugra D, McKenzie K: Expressed emotion across cultures. Adv Psychiatr Treat. 2003, 9: 342-348. 10.1192/apt.9.5.342.CrossRef Bhugra D, McKenzie K: Expressed emotion across cultures. Adv Psychiatr Treat. 2003, 9: 342-348. 10.1192/apt.9.5.342.CrossRef
23.
go back to reference Rosenfarb I, Bellack A, Aziz N, Kratz K, Sayers S: Race, family interactions, and patient stabilization in schizophrenia. J Abnorm Psychol. 2004, 113: 109-115.CrossRefPubMed Rosenfarb I, Bellack A, Aziz N, Kratz K, Sayers S: Race, family interactions, and patient stabilization in schizophrenia. J Abnorm Psychol. 2004, 113: 109-115.CrossRefPubMed
24.
go back to reference Hooley JM: Expressed Emotion and Relapse of Psychopathology. Annu Rev Clin Psychol. 2007, 3: 329-352. 10.1146/annurev.clinpsy.2.022305.095236.CrossRefPubMed Hooley JM: Expressed Emotion and Relapse of Psychopathology. Annu Rev Clin Psychol. 2007, 3: 329-352. 10.1146/annurev.clinpsy.2.022305.095236.CrossRefPubMed
25.
go back to reference Zahid MA, Ohaeri JU: Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia. BMC Psychiatry. 2010, 10: 71-10.1186/1471-244X-10-71.CrossRefPubMedPubMedCentral Zahid MA, Ohaeri JU: Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia. BMC Psychiatry. 2010, 10: 71-10.1186/1471-244X-10-71.CrossRefPubMedPubMedCentral
26.
go back to reference Wolthaus JE, Dingemans PM, Schene AH, Linszen DH, Wiersma D, Van Den Bosch RJ, Cahn W, Hijman R: Caregiver burden in recent-onset schizophrenia and spectrum disorders: the influence of symptoms and personality traits. J Nerv Ment Dis. 2002, 190: 241-247. 10.1097/00005053-200204000-00005.CrossRefPubMed Wolthaus JE, Dingemans PM, Schene AH, Linszen DH, Wiersma D, Van Den Bosch RJ, Cahn W, Hijman R: Caregiver burden in recent-onset schizophrenia and spectrum disorders: the influence of symptoms and personality traits. J Nerv Ment Dis. 2002, 190: 241-247. 10.1097/00005053-200204000-00005.CrossRefPubMed
27.
go back to reference Magliano L, Fiorillo A, Malangone C, Aletti A, Belotti G, Bevilacqua P, Delle Femine AL, Fontana G, Maucioni F, Travi M, Zanus P, Rossi A, Maj M: Family burden in schizophrenia: effects of socio-environmental and clinical variables and family interventions. Epidemiol Psichiatr Soc. 1998, 7: 178-187. 10.1017/S1121189X00007375.CrossRefPubMed Magliano L, Fiorillo A, Malangone C, Aletti A, Belotti G, Bevilacqua P, Delle Femine AL, Fontana G, Maucioni F, Travi M, Zanus P, Rossi A, Maj M: Family burden in schizophrenia: effects of socio-environmental and clinical variables and family interventions. Epidemiol Psichiatr Soc. 1998, 7: 178-187. 10.1017/S1121189X00007375.CrossRefPubMed
28.
go back to reference Dyck DG, Short R, Vitaliano PP: Predictors of burden and infection illness in schizophrenia caregivers. Psychosomatic Med. 1999, 61: 411-419.CrossRef Dyck DG, Short R, Vitaliano PP: Predictors of burden and infection illness in schizophrenia caregivers. Psychosomatic Med. 1999, 61: 411-419.CrossRef
29.
go back to reference Reher D: Family ties in Western Europe: persistent contrasts. Popul Dev Rev. 1998, 24: 203-234. 10.2307/2807972.CrossRef Reher D: Family ties in Western Europe: persistent contrasts. Popul Dev Rev. 1998, 24: 203-234. 10.2307/2807972.CrossRef
30.
go back to reference Weiler , Sue N: Family Security or Social Security? The Family and the Elderly in New York State during the 1920s. J Fam Hist. 1986, 11: 77-96. 10.1177/036319908601100105.CrossRef Weiler , Sue N: Family Security or Social Security? The Family and the Elderly in New York State during the 1920s. J Fam Hist. 1986, 11: 77-96. 10.1177/036319908601100105.CrossRef
31.
go back to reference Bertrando P, Beltz J, Bressi C, Clerici M, Farma T, Invernizzi G, Cazzullo CL: Expressed emotion and schizophrenia in Italy A study of an urban population. Br J Psychiatry. 1992, 161: 223-229. 10.1192/bjp.161.2.223.CrossRefPubMed Bertrando P, Beltz J, Bressi C, Clerici M, Farma T, Invernizzi G, Cazzullo CL: Expressed emotion and schizophrenia in Italy A study of an urban population. Br J Psychiatry. 1992, 161: 223-229. 10.1192/bjp.161.2.223.CrossRefPubMed
32.
go back to reference American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). 1994, Washington DC: American Psychiatric Association American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). 1994, Washington DC: American Psychiatric Association
33.
go back to reference Endicott J, Spitzer R, Fleiss J, Cohen J: The Global Assessment Scale: a procedure for measuring the overall severity of psychiatric disturbance. Arch Gen Psychiatry. 1976, 33: 766-771. 10.1001/archpsyc.1976.01770060086012.CrossRefPubMed Endicott J, Spitzer R, Fleiss J, Cohen J: The Global Assessment Scale: a procedure for measuring the overall severity of psychiatric disturbance. Arch Gen Psychiatry. 1976, 33: 766-771. 10.1001/archpsyc.1976.01770060086012.CrossRefPubMed
34.
go back to reference Leff J, Vaughn C: Expressed Emotion in Families: Its Significance for Mental Illness. 1985, New York: Guilford Press Leff J, Vaughn C: Expressed Emotion in Families: Its Significance for Mental Illness. 1985, New York: Guilford Press
35.
go back to reference Platt S, Weyman A, Hirsch S, Hewett S: The Social Behaviour Assessment Schedule (SBAS): Rationale, contents, scoring and reliability of a new interview schedule. Soc Psychiatry. 1980, 15: 43-55. 10.1007/BF00577960.CrossRef Platt S, Weyman A, Hirsch S, Hewett S: The Social Behaviour Assessment Schedule (SBAS): Rationale, contents, scoring and reliability of a new interview schedule. Soc Psychiatry. 1980, 15: 43-55. 10.1007/BF00577960.CrossRef
36.
go back to reference Platt S: Measuring the burden of psychiatric illness on the family: an evaluation of some rating scales. Psychol Med. 1985, 15: 383-393. 10.1017/S0033291700023680.CrossRefPubMed Platt S: Measuring the burden of psychiatric illness on the family: an evaluation of some rating scales. Psychol Med. 1985, 15: 383-393. 10.1017/S0033291700023680.CrossRefPubMed
37.
go back to reference Gibbons J, Horn S, Powell J, Gibbons J: Schizophrenic patients and their families: a survey in a psychiatric service based on a DGH unit. Br J Psychiatry. 1984, 144: 70-77. 10.1192/bjp.144.1.70.CrossRefPubMed Gibbons J, Horn S, Powell J, Gibbons J: Schizophrenic patients and their families: a survey in a psychiatric service based on a DGH unit. Br J Psychiatry. 1984, 144: 70-77. 10.1192/bjp.144.1.70.CrossRefPubMed
38.
go back to reference Mors O, Sorensen L, Therkildsen M: Distress in the relatives of psychiatric patients admitted for the first time. Acta Psychiatr Scand. 1992, 85: 337-344. 10.1111/j.1600-0447.1992.tb10315.x.CrossRefPubMed Mors O, Sorensen L, Therkildsen M: Distress in the relatives of psychiatric patients admitted for the first time. Acta Psychiatr Scand. 1992, 85: 337-344. 10.1111/j.1600-0447.1992.tb10315.x.CrossRefPubMed
39.
go back to reference Jeppesen P, Petersen L, Thorup A, Abel MB, Oehlenschlaeger J, Christensen TØ, Krarup G, Hemmingsen R, Jørgensen P, Nordentoft M: Integrated treatment of first-episode psychosis: effect of treatment on family burden: OPUS trial. Br J Psychiatry. 2005, 187 (Suppl 48): 85-90.CrossRef Jeppesen P, Petersen L, Thorup A, Abel MB, Oehlenschlaeger J, Christensen TØ, Krarup G, Hemmingsen R, Jørgensen P, Nordentoft M: Integrated treatment of first-episode psychosis: effect of treatment on family burden: OPUS trial. Br J Psychiatry. 2005, 187 (Suppl 48): 85-90.CrossRef
40.
go back to reference Corporation S: Stata Statistical Software, Release 10. 2007, College Station, TX: Stata Corporation LP Corporation S: Stata Statistical Software, Release 10. 2007, College Station, TX: Stata Corporation LP
41.
go back to reference McCreadie R, Robinson D: The Nithsdale Schizophrenia Survey. VI. Relatives' expressed emotion: prevalence, patterns, and clinical assessment. Br J Psychiatry. 1987, 150: 640-644. 10.1192/bjp.150.5.640.CrossRefPubMed McCreadie R, Robinson D: The Nithsdale Schizophrenia Survey. VI. Relatives' expressed emotion: prevalence, patterns, and clinical assessment. Br J Psychiatry. 1987, 150: 640-644. 10.1192/bjp.150.5.640.CrossRefPubMed
42.
go back to reference Glynn S, Randolph E, Eth S, Paz G, Leong G, Shaner A, Strachan A: Patient psychopathology and expressed emotion in schizophrenia. Br J Psychiatry. 1990, 157: 877-880. 10.1192/bjp.157.6.877.CrossRefPubMed Glynn S, Randolph E, Eth S, Paz G, Leong G, Shaner A, Strachan A: Patient psychopathology and expressed emotion in schizophrenia. Br J Psychiatry. 1990, 157: 877-880. 10.1192/bjp.157.6.877.CrossRefPubMed
43.
go back to reference Smith J, Birchwood M, Cochrane R, George S: The needs of high and low expressed emotion families: a normative approach. Soc Psychiatry Psychiatr Epidemiol. 1993, 28: 11-16. 10.1007/BF00797827.CrossRefPubMed Smith J, Birchwood M, Cochrane R, George S: The needs of high and low expressed emotion families: a normative approach. Soc Psychiatry Psychiatr Epidemiol. 1993, 28: 11-16. 10.1007/BF00797827.CrossRefPubMed
44.
go back to reference Miklowitz D, Goldstein M, Falloon I: Premorbid and symptomatic characteristics of schizophrenics from families with high and low levels of expressed emotion. J Abnorm Psychol. 1983, 92: 359-367.CrossRefPubMed Miklowitz D, Goldstein M, Falloon I: Premorbid and symptomatic characteristics of schizophrenics from families with high and low levels of expressed emotion. J Abnorm Psychol. 1983, 92: 359-367.CrossRefPubMed
45.
go back to reference Vaughn C, Doyle M, McConaghy N, Blaszczynski A, Fox A, Tarrier N: The relationship between relative's expressed emotion and schizophrenic relapse: an Australian replication. Soc Psychiatry Psychiatr Epidemiol. 1992, 27: 10-15. 10.1007/BF00788950.CrossRef Vaughn C, Doyle M, McConaghy N, Blaszczynski A, Fox A, Tarrier N: The relationship between relative's expressed emotion and schizophrenic relapse: an Australian replication. Soc Psychiatry Psychiatr Epidemiol. 1992, 27: 10-15. 10.1007/BF00788950.CrossRef
46.
go back to reference McCreadie R, Williamson D, Athawes R, Connolly M, Tilak Singh D: The Nithsdale Schizophrenia Surveys. XIII. Parental rearing patterns, current symptomatology and relatives' expressed emotion. Br J Psychiatry. 1994, 165: 347-352. 10.1192/bjp.165.3.347.CrossRefPubMed McCreadie R, Williamson D, Athawes R, Connolly M, Tilak Singh D: The Nithsdale Schizophrenia Surveys. XIII. Parental rearing patterns, current symptomatology and relatives' expressed emotion. Br J Psychiatry. 1994, 165: 347-352. 10.1192/bjp.165.3.347.CrossRefPubMed
47.
go back to reference Heikkilä J, Karlsson H, Taiminen T, Lauerma H, Ilonen T, Leinonen K, Wallenius E, Virtanen H, Heinimaa M, Koponen S, Jalo P, Kaljonen A, Salakangas R: Expressed emotion is not associated with disorder severity in first-episode mental disorder. Psychiatry Res. 2002, 111: 155-165. 10.1016/S0165-1781(02)00134-8.CrossRefPubMed Heikkilä J, Karlsson H, Taiminen T, Lauerma H, Ilonen T, Leinonen K, Wallenius E, Virtanen H, Heinimaa M, Koponen S, Jalo P, Kaljonen A, Salakangas R: Expressed emotion is not associated with disorder severity in first-episode mental disorder. Psychiatry Res. 2002, 111: 155-165. 10.1016/S0165-1781(02)00134-8.CrossRefPubMed
48.
go back to reference Brown G, Birley J, Wing J: Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry. 1972, 121: 241-258. 10.1192/bjp.121.3.241.CrossRefPubMed Brown G, Birley J, Wing J: Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry. 1972, 121: 241-258. 10.1192/bjp.121.3.241.CrossRefPubMed
49.
go back to reference Tarrier N, Barrowclough C, Vaughn C, Bamrah J, Porceddu K, Watts S, Freeman H: The community management of schizophrenia A controlled trial of a behavioural intervention with families to reduce relapse. Br J Psychiatry. 1988, 153: 532-542. 10.1192/bjp.153.4.532.CrossRefPubMed Tarrier N, Barrowclough C, Vaughn C, Bamrah J, Porceddu K, Watts S, Freeman H: The community management of schizophrenia A controlled trial of a behavioural intervention with families to reduce relapse. Br J Psychiatry. 1988, 153: 532-542. 10.1192/bjp.153.4.532.CrossRefPubMed
50.
go back to reference Jackson H, Smith N, McGorry P: Relationship between expressed emotion and family burden in psychotic disorders: an exploratory study. Acta Psychiatr Scand. 1990, 82: 243-249. 10.1111/j.1600-0447.1990.tb03060.x.CrossRefPubMed Jackson H, Smith N, McGorry P: Relationship between expressed emotion and family burden in psychotic disorders: an exploratory study. Acta Psychiatr Scand. 1990, 82: 243-249. 10.1111/j.1600-0447.1990.tb03060.x.CrossRefPubMed
51.
go back to reference Barrowclough C, Parle M: Appraisal, psychological adjustment and expressed emotion in relatives of patients suffering from schizophrenia. Br J Psychiatry. 1997, 171: 26-30. 10.1192/bjp.171.1.26.CrossRefPubMed Barrowclough C, Parle M: Appraisal, psychological adjustment and expressed emotion in relatives of patients suffering from schizophrenia. Br J Psychiatry. 1997, 171: 26-30. 10.1192/bjp.171.1.26.CrossRefPubMed
52.
go back to reference Patterson P, Birchwood M, Cochrane R: Expressed emotion as an adaptation to loss: prospective study in first-episode psychosis. Br J Psychiatry. 2005, 187 (Suppl 48): 59-64.CrossRef Patterson P, Birchwood M, Cochrane R: Expressed emotion as an adaptation to loss: prospective study in first-episode psychosis. Br J Psychiatry. 2005, 187 (Suppl 48): 59-64.CrossRef
53.
go back to reference Onwumere J, Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, Watson P, Garety P: Caregiving and illness beliefs in the course of psychotic illness. Can J Psychiatry. 2008, 53: 460-468.PubMed Onwumere J, Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, Watson P, Garety P: Caregiving and illness beliefs in the course of psychotic illness. Can J Psychiatry. 2008, 53: 460-468.PubMed
54.
go back to reference Scazufca M, Kuipers E: Coping strategies in relatives of people with schizophrenia before and after psychiatric admission. Br J Psychiatry. 1999, 174: 154-158. 10.1192/bjp.174.2.154.CrossRefPubMed Scazufca M, Kuipers E: Coping strategies in relatives of people with schizophrenia before and after psychiatric admission. Br J Psychiatry. 1999, 174: 154-158. 10.1192/bjp.174.2.154.CrossRefPubMed
55.
go back to reference Leff J, Wig N, Ghosh A, Bedi H, Menon DK, Kuipers L, Korten A, Ernberg G, Day R, Sartorius N: Expressed emotion and schizophrenia in north India. III. Influence of relatives’ expressed emotion on the course of schizophrenia in Chandigarh. Br J Psychiatry. 1987, 151: 166-173. 10.1192/bjp.151.2.166.CrossRefPubMed Leff J, Wig N, Ghosh A, Bedi H, Menon DK, Kuipers L, Korten A, Ernberg G, Day R, Sartorius N: Expressed emotion and schizophrenia in north India. III. Influence of relatives’ expressed emotion on the course of schizophrenia in Chandigarh. Br J Psychiatry. 1987, 151: 166-173. 10.1192/bjp.151.2.166.CrossRefPubMed
56.
go back to reference Weisman A, Gomes L, Lopez S: Shifting blame away from ill relatives: Latino families’ reactions to schizophrenia. J Nerv Ment Dis. 2003, 191: 1-8. 10.1097/00005053-200301000-00001.CrossRef Weisman A, Gomes L, Lopez S: Shifting blame away from ill relatives: Latino families’ reactions to schizophrenia. J Nerv Ment Dis. 2003, 191: 1-8. 10.1097/00005053-200301000-00001.CrossRef
57.
go back to reference Jenkins J, Karno M: The meaning of expressed emotion: theoretical issues raised by cross-cultural research. Am J Psychiatry. 1992, 149: 9-21.CrossRefPubMed Jenkins J, Karno M: The meaning of expressed emotion: theoretical issues raised by cross-cultural research. Am J Psychiatry. 1992, 149: 9-21.CrossRefPubMed
58.
go back to reference Singh S, Harley K, Suhail K: Cultural specificity of emotional overinvolvement: a systematic review. Schizophr Bull. 10.1093/schbul/sbr170. in press Singh S, Harley K, Suhail K: Cultural specificity of emotional overinvolvement: a systematic review. Schizophr Bull. 10.1093/schbul/sbr170. in press
59.
go back to reference Nomura H, Inoue S, Kamimura N, Shimodera S, Mino Y, Gregg L, Tarrier N: A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England. Soc Psychiatry Psychiatr Epidemiol. 2005, 40: 564-570. 10.1007/s00127-005-0924-z.CrossRefPubMed Nomura H, Inoue S, Kamimura N, Shimodera S, Mino Y, Gregg L, Tarrier N: A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England. Soc Psychiatry Psychiatr Epidemiol. 2005, 40: 564-570. 10.1007/s00127-005-0924-z.CrossRefPubMed
60.
go back to reference Kuipers E, Onwumere J, Bebbington P: Cognitive model of caregiving in psychosis. Br J Psychiatry. 2010, 196: 259-265. 10.1192/bjp.bp.109.070466.CrossRefPubMed Kuipers E, Onwumere J, Bebbington P: Cognitive model of caregiving in psychosis. Br J Psychiatry. 2010, 196: 259-265. 10.1192/bjp.bp.109.070466.CrossRefPubMed
61.
go back to reference Watson P, Garety P, Weinman J, Dunn G, Bebbington P, Fowler D, Freeman D, Kuipers E: Emotional dysfunction in schizophrenia spectrum psychosis: the role of illness perceptions. Psychol Med. 2006, 36: 761-770. 10.1017/S0033291706007458.CrossRefPubMed Watson P, Garety P, Weinman J, Dunn G, Bebbington P, Fowler D, Freeman D, Kuipers E: Emotional dysfunction in schizophrenia spectrum psychosis: the role of illness perceptions. Psychol Med. 2006, 36: 761-770. 10.1017/S0033291706007458.CrossRefPubMed
62.
go back to reference Schene A, Tessler R, Gamache G: Instruments measuring family or caregiver burden in severe mental illness. Soc Psychiatry Psychiatr Epidemiol. 1994, 29: 228-240. 10.1007/BF00796381.CrossRefPubMed Schene A, Tessler R, Gamache G: Instruments measuring family or caregiver burden in severe mental illness. Soc Psychiatry Psychiatr Epidemiol. 1994, 29: 228-240. 10.1007/BF00796381.CrossRefPubMed
63.
go back to reference Grella C, Grusky O: Families of the seriously mentally ill and their satisfaction with services. Hosp Community Psychiatry. 1989, 40: 831-835.PubMed Grella C, Grusky O: Families of the seriously mentally ill and their satisfaction with services. Hosp Community Psychiatry. 1989, 40: 831-835.PubMed
64.
go back to reference Pharoah F, Mari J, Rathbone J, Wong W: Family intervention for schizophrenia. Cochrane Database of Syst Rev. 2010, 12: CD000088- Pharoah F, Mari J, Rathbone J, Wong W: Family intervention for schizophrenia. Cochrane Database of Syst Rev. 2010, 12: CD000088-
65.
go back to reference Magliano L, Fiorillo A, Fadden G, Gair F, Economou M, Kallert T, Schellong J, Xavier M, Gonçalves Pereira M, Torres Gonzales F, Palma-Crespo A, Maj M: Effectiveness of a psychoeducational intervention for families of patients with schizophrenia: preliminary results of a study funded by the European Commission. World Psychiatry. 2005, 4: 45-49.PubMedPubMedCentral Magliano L, Fiorillo A, Fadden G, Gair F, Economou M, Kallert T, Schellong J, Xavier M, Gonçalves Pereira M, Torres Gonzales F, Palma-Crespo A, Maj M: Effectiveness of a psychoeducational intervention for families of patients with schizophrenia: preliminary results of a study funded by the European Commission. World Psychiatry. 2005, 4: 45-49.PubMedPubMedCentral
66.
go back to reference Sharif F, Shaygan M, Mani A: Effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz. Iran. BMC Psychiatry. 2012, 12: 48-10.1186/1471-244X-12-48.CrossRefPubMed Sharif F, Shaygan M, Mani A: Effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz. Iran. BMC Psychiatry. 2012, 12: 48-10.1186/1471-244X-12-48.CrossRefPubMed
67.
go back to reference Carrà G, Sciarini P, Segagni-Lusignani G, Clerici M, Montomoli C, Kessler RC: Do they actually work across borders? Evaluation of two measures of psychological distress as screening instruments in a non Anglo-Saxon country. Eur Psychiatry. 2011, 26: 122-127.CrossRefPubMed Carrà G, Sciarini P, Segagni-Lusignani G, Clerici M, Montomoli C, Kessler RC: Do they actually work across borders? Evaluation of two measures of psychological distress as screening instruments in a non Anglo-Saxon country. Eur Psychiatry. 2011, 26: 122-127.CrossRefPubMed
68.
go back to reference Kymalainen JA, Weisman de Mamani AG: Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: a review of the literature. Cultur Divers Ethnic Minor Psychol. 2008, 14: 85-91.CrossRefPubMed Kymalainen JA, Weisman de Mamani AG: Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: a review of the literature. Cultur Divers Ethnic Minor Psychol. 2008, 14: 85-91.CrossRefPubMed
Metadata
Title
The association between expressed emotion, illness severity and subjective burden of care in relatives of patients with schizophrenia. Findings from an Italian population
Authors
Giuseppe Carrà
Carlo Lorenzo Cazzullo
Massimo Clerici
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2012
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-12-140

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