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2004, Journal of Abnormal Psychology
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12 pages
1 file
The authors examined the role of family factors and the course of schizophrenia by carrying out additional assessments and analyses in 2 previously published studies of Mexican American and Anglo American patients and families. The authors found partial support for an attributional model of relapse for families who are low in emotional overinvolvement. Attributions of control, criticism, and warmth together marginally predicted relapse. The data also indicated that for Mexican Americans, family warmth is a significant protective factor, whereas for Anglo Americans, family criticism is a significant risk factor. These findings suggest that the sociocultural context shapes the pathways by which family processes are related to the course of illness. Moreover, the warmth findings suggest that families may contribute to preventing relapse.
Journal of Abnormal Psychology, 1993
In this study we tested an attributional model of expressed emotion (EE) among Mexican-American families. A sample of 46 key family members of schizophrenic patients were measured on three dimensions: affect toward patient, controllability attributions, and level of EE. Consistent with an attributional model, we found that high EE families (denned on the basis of critical comments) viewed the illness and associated symptoms as residing within the patient's personal control, more so than did low EE families. We also found that attributions held by family members are related to their affective reactions. Specifically, family members who perceived the patient as having control over the symptoms of schizophrenia tended to express greater negative emotions such as anger and annoyance toward the patient than did family members who viewed the symptoms as beyond the patient's personal control. An examination of the types of affects found and their relationship to EE status is discussed, along with implications for this research. The course of schizophrenia is highly responsive to the influence of the family atmosphere (Vaughn & Leff, 1976a). Over the past two decades, studies using a construct termed expressed emotion (EE) have offered valuable insights into the relationship between family factors and psychopathology (Hooley, 1987). An EE rating is thought to reflect the attitudes of a close relative toward a mentally ill family member, specifically measuring critical and hostile comments and evidence of emotional overinvolvement (e.g., exaggerated affect, overly self-sacrificing behavior; . Studies consistently indicate that patients returning from the hospital to live with relatives who talk about them in a critical, hostile, or emotionally overinvolved way during a semistructured interview relapse more often than do patients whose relatives do not express these negative attitudes (for a review, see Hooley, 1987). Furthermore, these studies have been replicated across diverse cultural groups (e.g., British, Mexican American, and Indian) and across other mental disorders (e.g., unipolar depression ) and recent onset mania ). Despite the strength of the association between EE and relapse and the robustness across cultures and diagnostic groups, the mechanism by which EE might operate to bring about a return of schizophrenic symptoms is still poorly understood
Family Process, 1996
This study was designed to test whether two sociocultural variables, family cohesion and religiosity, related to affective reactions toward schizophrenia. It was hypothesized that increasing perceptions of one's family as cohesive and religious would be associated with the expression of more favorable and less unfavorable emotions toward patients with the disorder. Eighty-eight Anglo-American undergraduates from Los Angeles and 88 Mexican undergraduates from Guadalajara read vignettes of a hypothetical family member described as meeting DSM-IV criteria for schizophrenia. Results of this study suggest that perceptions of family unity may be one important factor underlying emotional reactions toward schizophrenia. As expected, increasing perceptions of family cohesion were associated with greater reports of favorable emotion and decreased reports of unfavorable emotion toward the patient. However, after controlling for social desirability, family cohesion no longer significantly predicted unfavorable affect. Contrary to expectations, religiosity was not found to predict unfavorable or favorable emotions. However, religiosity was found to covary with nationality. Mexicans, compared to Anglos, reported greater moral-religious values in their families. No national differences were found with respect to family cohesion. Implications of this study are discussed along with suggested directions for future research. Family behaviors and attitudes correlate with the course of severe mental illnesses. International studies in the area of expressed emotion (EE) consistently demonstrate that patients with schizophrenia relapse more frequently when returning to homes in which relatives talk about them in a critical and hostile manner, as compared to patients whose relatives do not express these negative attitudes (Kavanagh, 1992). For years, however, EE researchers have been criticized for what Jenkins and Karno (1992, p. 10) term "the problem of prediction without understanding." Fortunately, recent breakthroughs in schizophrenia research have provided a much needed theoretical framework for the expressed emotion construct. Three sets of investigators recently found that highly critical and hostile relatives (high EE) attribute symptomatic behaviors to factors more controllable by the patient than do relatives (low EE) who do not express as many of these negative attitudes (Barrowclough,
The Journal of Nervous and Mental Disease, 2006
Patients with schizophrenia who are exposed to family environments high in expressed emotion (EE) are at increased risk of relapse. EE is usually measured by an interview with one family member and does not include a direct assessment of family interaction. To understand better the key processes that underlie the relationship between EE and course of illness, we applied a wellvalidated measure of family interaction, the Structural Family Systems Ratings (SFSR), to 28 Mexican-Americans with schizophrenia and their families. The relationships among EE indices, SFSR components, and relapse were examined. Although measures of EE and family interactions were not related, both EE and one component of the SFSR, family resonance, were associated with a psychotic relapse within 1 year of the assessment. The results suggest that Mexican Americans with schizophrenia benefit from living with families that are able to adapt to the ever-changing circumstances and needs of their ill relatives.
2010
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.
Treatment of schizophrenia: Family …, 1986
Social desirability, while a recognized source of respondent bias among Mexican-Americans, has not been evaluated as an explanation for the lower rate of high expressed emotion (EE) found in the family members of Mexican-Americans versus Caucasians with schizophrenia. In this study, we tested the hypothesis that the lower rate of high EE (hostility and criticism) among Mexican-Americans was the result of cultural factors impacting on how information was reported by the Mexican-American relative of a patient with schizophrenia. We compared the ratings of EE between Caucasian (N 17) and Mexican-American (N 44) patients with schizophrenia or schizoaffective disorder and their key relatives using the level of expressed emotion (LEE) scale (paper and pencil instrument rated by the patient and relative separately) and the Five Minute Speech Sample (observational experimenter rated). The ability of the various measures to predict relapse over two years was also examined. Contrary to our hypothesis, there were no differences between patient and family measures within ethnic group. Mexican-American patients and relatives reported lower rates of high EE than Caucasians across all measures. High EE predicted relapse across measures for Caucasian participants, but did not predict relapse for Mexican-Americans on any of the measurement instruments. We discuss the implications of these ®ndings on cross-cultural research and family interventions for individuals with psychotic disorders.
Journal of abnormal …, 2010
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.
Schizophrenia …, 2002
Social desirability, while a recognized source of respondent bias among Mexican-Americans, has not been evaluated as an explanation for the lower rate of high expressed emotion (EE) found in the family members of Mexican-Americans versus Caucasians with schizophrenia. In this study, we tested the hypothesis that the lower rate of high EE (hostility and criticism) among Mexican-Americans was the result of cultural factors impacting on how information was reported by the Mexican-American relative of a patient with schizophrenia. We compared the ratings of EE between Caucasian (N 17) and Mexican-American (N 44) patients with schizophrenia or schizoaffective disorder and their key relatives using the level of expressed emotion (LEE) scale (paper and pencil instrument rated by the patient and relative separately) and the Five Minute Speech Sample (observational experimenter rated). The ability of the various measures to predict relapse over two years was also examined. Contrary to our hypothesis, there were no differences between patient and family measures within ethnic group. Mexican-American patients and relatives reported lower rates of high EE than Caucasians across all measures. High EE predicted relapse across measures for Caucasian participants, but did not predict relapse for Mexican-Americans on any of the measurement instruments. We discuss the implications of these ®ndings on cross-cultural research and family interventions for individuals with psychotic disorders. q
Psychiatry Research, 2007
This study examined associations among ethnicity, expressed emotion (EE) and interdependence in a sample of 41 Latino/ Hispanic and White family members of patients with schizophrenia. EE was assessed using both the Camberwell Family Interview (CFI) and the Five Minute Speech Sample (FMSS). These measures were found to be highly concordant for rating EE. However, the CFI appears to identify high EE more often than does the FMSS. Whites were designated as high EE significantly more often than were Latinos/Hispanics, regardless of assessment method. Using the interdependence subscale of the Self-Construal Scale, we found a strong trend for Latino/Hispanics to report a more interdependent self-construal than did Whites. However, contrary to expectations, interdependence was not found to mediate the relationship between ethnicity and EE. EE and interdependence may both play a role in the better course of illness observed for patients from traditional cultures. However, these two constructs may relate to patient functioning through different mechanisms.
Journal of Nervous & Mental Disease, 2006
Expressed emotion is a widely researched construct. However, less is known about patients' own perceptions of their relatives' expressed emotion. Using a sample of 42 patient/family member dyads with schizophrenia, we examined the concordance between the number of criticisms expressed by relatives during the Camberwell Family Interview and patients' perceptions of how critical they perceived their relative to be. As predicted, white and Latino family members who expressed more criticism during the Camberwell Family Interview were indeed perceived as more critical by patients. Among blacks, however, no significant association was found between relatives' expressed criticism and patients' perceptions of their relatives' criticism. Findings from this study suggest that cultural/ethnic values may influence how criticism from relatives is perceived and experienced by patients.
Journal of Applied Social Psychology, 1997
The present study uses attribution theory to identify factors that may lead to unfavorable emotional reactions toward patients with schizophrenia and to highlight factors that may contribute to the observed inverse relationship between industrial status of a country and schizophrenia outcome. University students from Mexico and the U.S., 2 countries differing in industrial status, served as participants. Eighty-eight Mexicans from Guadalajara and 88 Anglo Americans from Los Angeles, California read vignettes of a patient described to meet DSM-IV criteria for schizophrenia. In one vignette, the patient's disorder was characterized by predominantly positive symptoms (e.g., hallucinations, delusions), whereas in the other vignette negative symptoms (e.g., social withdrawal, apathy) predominated. In support of an attributional approach, negative symptoms were associated with greater perceived control than were positive symptoms. Correspondingly, negative symptoms were found to provoke more intense negative affect and less intense positive affect than were positive symptoms. Some national and gender differences were also found. The antecedents of emotions such as compassion or anger are extremely relevant to understanding the tension and distress that sometimes surface among family members. Research suggests that controllability attributions may aid in this understanding. Specifically, perceptions of one's ability to control the cause of an event or a particular outcome have been found to be closely linked to the emotional reactions that follow (Leff & Vaughn, 1985; Weiner, 1993, 1995). In one study, for example, Weiner (1980) manipulated the perceived control of an event, a man stumbling and falling down, by informing half of the subjects that it was due to an illness and the other half that he fell because he was intoxicated. As hypothesized, Weiner found that for the same event, research participants who believed that it was due to a potentially controllable factor (getting drunk), were more likely to report negative feelings, less 'The authors wish to thank Bernard Weiner for his insightful comments on an earlier draft of this manuscript.
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