Expressed emotion at first-episode psychosis: investigating a carer appraisal model
Open accessAbstract
Background: Even at the first episode of psychosis, high expressed emotion (EE) characterises over half of patient–carer relationships. This study compared a carer appraisal model of EE with the ability of illness factors to predict EE at the first episode. Aims: To investigate the utility of a carer appraisal model of EE in first-episode psychosis. Method: We compared high- and low-EE carers of people who had first-episode psychosis (n=46). Results: High EE in carers was associated with higher avoidant coping, higher subjective burden and lower perceived patient interpersonal functioning. Patient illness factors and carers ‘distress levels were not associated with EE. Conclusions: Even at the first episode, carers' psychological appraisal, not patient illness factors, is influential in determining high EE. Carers ‘appraisal of their situation should be a primary target to lower or prevent high EE in early intervention for psychosis.
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High expressed emotion and burden are related to poorer carer outcomes such as stress, distress and low self-esteem, and to less effective avoidant coping, even at first episode.
“It was also related to poor carer outcomes such as stress, distress and low self-esteem, and to less effective, avoidant coping, even at first episode.19,20”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [19]
Active and proactive strategies are better at reducing carer burden, even in the early stages of illness.
“Active and proactive strategies seem better at reducing the impact on levels of carer burden, even in the early stages of illness.19,43,46”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [19]
In critical or hostile relationships, carers are angry with services for not getting the service user better.
“Angry with services who do not 'get service user better'”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [19]
In critical or hostile relationships, carers lose their own social network.
“Loss of own social network”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [19]
In critical or hostile relationships, carers have low self-esteem, depression and frustration.
“Low self-esteem, depression, frustration”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [19]
In critical or hostile relationships, carers use avoidant coping, hoping problems will go away.
“Avoidant coping -hope problems will go away”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [19]
In critical or hostile relationships, carers experience anger, stress, anxiety and worry.
“Angry, stressed, anxious, worried”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [19]
In critical or hostile relationships, carers are pessimistic that anything can change.
“Pessimistic that anything can change”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [19]
In critical or hostile relationships, carers are critical of the service user's behaviour and may reject the service user.
“Critical of service user's behaviour, may reject service user”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [19]
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Self-citation
- Authors
- Raune, D., Kuipers, E., & Bebbington, P. E.
- Affiliations
- West London Mental Health NHS Trust (GB)
- King's College London (GB)
- The Royal Free Hospital (GB)
- Corresponding author
- Kuipers, E.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2004-04
- Volume
- 184
- Issue
- 4
- Pages
- 321-326
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2067497363
- Cited by
- 160
- References
- 32
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2021: 3 · 2020: 10 · 2019: 7 · 2018: 7 · 2017: 8 · 2016: 9 · 2015: 6 · 2014: 16 · 2013: 7 · 2012: 7
- FWCI
- 9.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- OSF Preprints (OSF Preprints) (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Keywords
- expressed emotion, first-episode psychosis, family caregivers, avoidance coping, subjective burden, caregiver distress, early intervention in psychosis
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Child, Child, Preschool, Cross-Sectional Studies, Family Health, Female, Humans, Infant, Interpersonal Relations, Male, Middle Aged, Models, Psychological, Psychometrics, Psychotic Disorders, Multivariate Analysis, Caregivers, Cost of Illness, Expressed Emotion
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