Influence of carer expressed emotion and affect on relapse in non-affective psychosis
Open accessAbstract
Background: High expressed emotion in carers predicts relapse in psychosis, but it is not known why this is so. In our cognitive model of psychosis, we postulated that the effect is mediated through affective changes. Aims: To investigate the relationships between carer expressed emotion, patients' symptoms and carer characteristics during a recent relapse of psychosis. Method: A total of 86 patients and carers were investigated in a cross-sectional design. Results: Patients whose carers showed high expressed emotion had significantly higher levels of anxiety and depression, but not more psychotic symptoms or lower self-esteem. Linear regression showed that carers' critical comments predicted anxiety in patients. Critical comments were related to low carer self-esteem and avoidant coping strategies. Low carer self-esteem was also related to carer depression, stress and carer ‘burden’, and to low patient self-esteem. Conclusions: Our hypothesis was partially supported. Carer criticism was associated with patient anxiety, low carer self-esteem and poor carer coping strategies. Family interventions should focus on improving these after a relapse of symptoms of 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 [20]
Negative communication patterns are associated with negative affect in patients.
“Negative communication patterns may be particularly unhelpful as they are associated with negative affect in patients.20,67”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [20]
This depression is associated with more avoidant coping, low self-esteem and pessimism.
“This is associated with more avoidant coping, low self-esteem and an understandable pessimism.20”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [20]
Around one third of carers in critical relationships have clinical levels of depression.
“Finally, an appreciable proportion (around a third) of carers in these critical relationships have clinical levels of depression.”
From Cognitive model of caregiving in psychosis (2010) · cites this paper as [20]
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 [20]
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 [20]
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 [20]
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 [20]
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 [20]
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 [20]
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 [20]
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Self-citation
- Authors
- Kuipers, E., Bebbington, P., Dunn, G., Fowler, D., Freeman, D., Watson, P., Hardy, A., & Garety, P.
- Affiliations
- King's College London (GB)
- The Royal Free Hospital (GB)
- University of Manchester (GB)
- University of East Anglia (GB)
- Corresponding author
- Kuipers, E.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2006-02
- Volume
- 188
- Issue
- 2
- Pages
- 173-179
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2105959107
- Cited by
- 102
- References
- 34
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 4 · 2019: 4 · 2018: 5 · 2017: 3 · 2016: 7 · 2015: 5 · 2014: 9 · 2013: 6 · 2012: 2
- FWCI
- 7.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- Wellcome Trust (06452)
- 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, psychosis relapse, non-affective psychosis, affective mediation, patient anxiety, carer stress, caregiver burden, avoidance coping, family intervention
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Anxiety, Cross-Sectional Studies, Depression, Employment, Female, Humans, Interpersonal Relations, Male, Middle Aged, Psychotic Disorders, Recurrence, Self Concept, Stress, Psychological, Caregivers, Sex Distribution, Expressed Emotion
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