The DOI matches its Crossref record; 76 of the 80 references it cites were found in a registry or an index; 4 of the 117 sources its claims cite were checked for support.
Cognitive model of caregiving in psychosis
Open accessAbstract
BACKGROUND: There is a long history of research into the attributes of carers of people with psychosis, but few interventions target their distress or their difficulties. AIMS: To describe an empirically based model of the relationships of those caring for people with psychosis to inform clinical and theoretical advances. METHOD: We developed a model of informal carer relationships in psychosis, based on an integration of the literature elaborating the concept of expressed emotion. The model accounts for divergent outcomes of three relationship types: positive, overinvolved and critical/hostile relationships. RESULTS: Good evidence supports a number of hypotheses concerning the origin and maintenance of these relationship outcomes, which relate to specific differences in carer attributions, illness perceptions, coping behaviour, social support, distress, depression and low self-esteem predicted by our model. We propose that interventions aimed at modifying the specific maintenance factors involved in the different styles of relationships will optimise therapeutic change both for service users with psychosis and for their carers. CONCLUSIONS: Family work in psychosis, which improves relationships through problem-solving, reduces service user relapse. It is now time to consider theory-based interventions focused on improving carer outcomes.
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Claims the paper makes
52 Not checked yet · 22 Own interpretation · 6 No basis given · 4 Sources not found · 3 Partly supported · 1 Own method · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ Pioneering research > Coping
What the sources say
- Partly supportedcites [19] 19. Raune D, Kuipers E, Bebbington PE. Expressed emotion at first-episode psychosis: investigating a carer appraisal model. Br J Psychiatry 2004; 184: 321-6. sourceExperimental — accuracy not yet measured
The Discussion (page not supplied) links avoidant coping and higher subjective burden to high expressed emotion in carers at first-episode psychosis. The therapeutic-intervention section recommends lowering burden and reducing avoidant coping, but does not show that active or proactive strategies are better at reducing burden. (LLM, conf=0.84)
- Not checked yetcites [43] 43. Scazufca M, Kuipers E. Coping strategies in relatives of people with schizophrenia before and after psychiatric admission. Br J Psychiatry 1999; 174: 154-8. source
- Not matchedcites [46] 46. Magliano L, Fadden G, Economou M, Held T, Xavier M, Guarneri M, et al. Family burden and coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol 2000; 35: 109-15.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Carer exhausted”
§ Pioneering research > Discussion
What the sources say
- Partly supportedcites [35] 35. Grice SJ, Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, et al. Carers' attributions about positive events in psychosis relate to expressed emotion. Behav Res Ther 2009; 47: 783-9. sourceExperimental — accuracy not yet measured
The Introduction (‘Expressed emotion’; page unavailable) identifies emotional overinvolvement as one form of high expressed emotion and says high expressed emotion is associated with increased carer distress. The Discussion (‘Implications for clinical intervention’; page unavailable) also describes substantial carer burden. Neither passage says that overinvolvement specifically causes carers to become exhausted. (LLM, conf=0.78)
- Not checked yetcites [63] 63. Leff J, Vaughn C. Expressed Emotion in Families. Guilford, 1985.
- Not checked yetcites [64] 64. Bentsen H, Notland TH, Munkvold OG, Boye B, Ulstein I, Bjorge H, et al. Guilt proneness and expressed emotion in relatives of patients with schizophrenia or related psychoses. Br J Med Psychol 1998; 71: 125-38. source
- Not checked yetcites [65] 65. Peterson EC, Docherty NM. Expressed emotion, attribution, and control in parents of schizophrenic patients. Psychiatry 2004; 67: 197-207. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
In the paper
“Our own intervention study showed that service users with carers demonstrated better outcomes from cognitive-behavioural therapy or family intervention.70”
§ Pioneering research > Discussion
What the sources say
- Not checked yetcites [70] 70. Garety PA, Fowler DG, Freeman D, Bebbington P, Dunn G, Kuipers E. Cognitive-behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised controlled trial. Br J Psychiatry 2008; 192: 412-23.
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Carers' appraisals of their situation and of the resources they have to cope with it are more crucial to both carer and service user outcomes than the apparent severity or scope of the problems faced.6”
§ Pioneering research > Abstract
What the sources say
- Not checked yetcites [6] 6. Scazufca M, Kuipers E. Links between expressed emotion and burden of care in relatives of patients with schizophrenia. Br J Psychiatry 1996; 168: 580-7. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“and perceptions of carer criticism have in turn been linked to poorer service user functioning.27”
§ Pioneering research > Attributions
What the sources say
- Not checked yetcites [27] 27. Onwumere J, Kuipers E, Bebbington P, Dunn G, Freeman D, Fowler D, et al. Patient perceptions of caregiver criticism in psychosis links with patient and caregiver functioning. J Nerv Ment Dis 2009; 197: 85-91. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Since then it has become clear that high-criticism carers are more likely to make 'controllable' and 'personal' attributions, both in psychosis and in other disorders such as diabetes.23,24”
§ Pioneering research > Attributions
What the sources say
- Not checked yetcites [23] 23. Barrowclough C, Hooley JM. Attributions and expressed emotion: a review. Clin Psychol Rev 2003; 23: 849-80.
- Not checked yetcites [24] 24. Wearden AJ, Ward J, Barrowclough C, Tarrier N, Davies R. Attributions for negative events in the partners of adults with type I diabetes: associations with partners' expressed emotion and marital adjustment. Br J Health Psychol 2006; 11: 1-21.
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The stigma and shame associated with mental ill health can lead to a significant reduction in social networks, even for carers.49,50”
§ Pioneering research > Social support
What the sources say
- Not checked yetcites [49] 49. Magliano L, Fiorillo A, De Rosa C, Malangone C, Maj M. Family burden in long-term diseases: a comparative study in schizophrenia vs. physical disorders. Soc Sci Med 2005; 61: 313-22. source
- Not matchedcites [50] 50. Gutie ´rrez-Maldonado J, Caqueo-Urı ´zar A, Kavanagh D. Burden of care and general health in families of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2005; 40: 899-904.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although all carers face potential stresses, their appraisal of the situation and how they try to deal with it contribute to the well-being of service users and should be key targets for intervention.”
§ Pioneering research > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“More recent evidence suggests a mechanism for this: service users are able to perceive criticism from their carers accurately, [25][26][27]”
§ Pioneering research > Attributions
What the sources say
- Not checked yetcites [25][26][27]
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Further, carer warmth can serve as a protective factor against relapse, 2,38,39 particularly in some Black and minority ethnic groups.40,41”
§ Pioneering research > Positive caregiving experiences
What the sources say
- Not checked yetcites [2] 2. Brown GW, Birley JLT, Wing JK. Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry 1972; 121: 241-58. source
- Not checked yetcites [38] 38. Bertrando P, Beltz J, Bressi C, Clerici M, Farma T, Invernizzi G, et al. Expressed emotion and schizophrenia in Italy. A study of an urban population. Br J Psychiatry 1992; 161: 223-9. source
- Not checked yetcites [39] 39. Ivanovic M, Vuletic Z, Bebbington P. Expressed emotion in the families of patients with schizophrenia and its influence on the course of illness. Soc Psychiatry Psychiatr Epidemiol 1994; 29: 61-5. source
- Not checked yetcites [40] 40. Lopez SR, Hipke KN, Polo AJ, Jenkins JH, Karno M, Vaughn C, et al. Ethnicity, expressed emotion, attributions, and course of schizophrenia: family warmth matters. J Abnorm Psychol 2004; 113: 428-39. source
- Not matchedcites [41] 41. Breitborde NJK, Lopez SR, Wickens TD, Jenkins JH, Karno M. Toward specifying the nature of the relationship between expressed emotion and schizophrenia relapse: the utility of curvilinear models. Int J Methods Psychiatr Res 2007; 16: 1-10.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 27
- Probably not a substantial claim. 18
- The quote only partly states this claim. 2
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ Pioneering research > Declaration of interest
What the sources say
- Partly supportedcites [19] 19. Raune D, Kuipers E, Bebbington PE. Expressed emotion at first-episode psychosis: investigating a carer appraisal model. Br J Psychiatry 2004; 184: 321-6. sourceExperimental — accuracy not yet measured
The Clinical Implications section reports that, even at first episode, high expressed emotion was linked to greater burden and avoidant coping. The discussion says high-EE carers appraised their caring situation as more stressful. But the paper explicitly finds no association with carer distress, and it does not establish low self-esteem as an outcome. (LLM, conf=0.90)
- Partly supportedcites [20] 20. Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, Watson P et al. Influence of carer expressed emotion and affect on relapse in non-affective psychoses. Br J Psychiatry 2006; 188: 173-9. sourceExperimental — accuracy not yet measured
The Abstract and ‘Carer characteristics and expressed emotion’ sections link carer criticism with low self-esteem, stress, depression and avoidant coping; they also link carer burden with stress. But the Methods specify patients in a second or subsequent episode, so this paper does not support the ‘even at first episode’ qualifier. It also says burden was not directly related to expressed emotion. (LLM, conf=0.90)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
In the paper
“We have shown, in an analysis of prospective studies, that high levels of this expressed emotion (EE) are a reliable predictor of patient outcomes in schizophrenia: overall, the relapse rate for those returning to families with low EE was 21% compared with a 50% relapse rate in families with high EE.18”
§ Pioneering research > Declaration of interest
What the sources say
- Not matchedcites [18] 18. Bebbington P, Kuipers L. The predictive utility of expressed emotion in schizophrenia -an aggregate analysis. Psychol Med 1994; 24: 707-18.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
In the paper
“This is based on the ideas of Lazarus & Folkman that coping itself depends on accurate appraisal of situations, on one's resources and on how these are marshalled.45”
§ Pioneering research > Coping
What the sources say
- Not matchedcites [45] 45. Lazarus RS, Folkman S. Stress Appraisal and Coping. Springer, 1984.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The model accounts for divergent outcomes of three relationship types: positive, overinvolved and critical/hostile relationships.”
§ Pioneering research > Method
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In psychosis, avoidant coping (a style of emotional response characterised by 'hoping problems will go away') may be useful for problems that resolve naturally, but not with more enduring or worsening problems.”
§ Pioneering research > Coping
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This in turn relates to greater carer distress and negative evaluations of the caring role.”
§ Pioneering research > Attributions
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There is a long history of research into the attributes of carers of people with psychosis, but few interventions target their distress or their difficulties.”
§ Pioneering research > Background
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“Carers' appraisals of and reactions to their role not only affect their own well-being, but also may improve or impede recovery in those they care for.18”
§ Pioneering research > Attributions
What the sources say
- Not matchedcites [18] 18. Bebbington P, Kuipers L. The predictive utility of expressed emotion in schizophrenia -an aggregate analysis. Psychol Med 1994; 24: 707-18.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“Family work in psychosis, which improves relationships through problem-solving, reduces service user relapse.”
§ Pioneering research > Conclusions
What the sources say
- Not matchedcites [54] 54. National Institute for Health and Clinical Excellence. Schizophrenia (Update). Clinical Guidelines CG82. NICE, 2009 (http://www.guidance.nice.org.uk/ CG82).
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked yetcites [55] 55. Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev 2006; 4: CD000088. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“Caring for a family member with psychosis is demanding, often prolonged, and associated with increased levels of stress and distress.6,[9][10][11]”
§ Pioneering research > Abstract
What the sources say
- Not checked yetcites [6] 6. Scazufca M, Kuipers E. Links between expressed emotion and burden of care in relatives of patients with schizophrenia. Br J Psychiatry 1996; 168: 580-7. source
- Not matchedcites [9][10][11]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“if carers feel that they are not in control of their relative's illness and that it will last a long time, they experience more stress and depression and have more negative views of the impact of care.”
§ Pioneering research > Illness perceptions
What the sources say
- Not checked yetcites [30] 30. Lobban F, Barrowclough C, Jones S. Assessing cognitive representations of mental health problems. II. The illness perception questionnaire for schizophrenia: relatives' version. Br J Clin Psychol 2005; 44: 163-79. source
- Not checked yetcites [31] 31. Onwumere J, Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, et al. Caregiving and illness beliefs in the course of psychotic illness. Can J Psychiatry 2008; 53: 460-8. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Recent evidence suggests that as many as a third of carers meet criteria for post-traumatic stress disorder.12”
§ Pioneering research > Abstract
What the sources say
- Not checked yetcites [12] 12. Barton K, Jackson C. Reducing symptoms of trauma among carers of people with psychosis: pilot study examining the impact of writing about caregiving experiences. Aust N Z J Psychiatry 2008; 42: 693-701. source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“The importance of social support in reducing distress and encouraging more proactive coping in carers has been confirmed.51,52”
§ Pioneering research > Social support
What the sources say
- Not checked yetcites [51] 51. Joyce J, Leese M, Kuipers E, Szmukler G, Harris T, Staples E. Evaluating a model of caregiving for people with psychosis. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 189-95.
- Not checked yetcites [52] 52. Magliano L, Fiorillo A, Malangone C, Marasco C, Guarneri M, Maj M, et al. The effect of social network on burden and pessimism in relatives of patients with schizophrenia. Am J Orthopsychiatry 2003; 73: 302-9.
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In this relationship type, carers themselves are likely to be angry, upset, anxious and depressed.They may have low self-esteem, and feel that nothing they can do will make any difference.”
§ Pioneering research > Not clinically depressed
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In this relationship style a longer duration of untreated psychosis is likely, associated with poor role performance.”
§ Pioneering research > Not clinically depressed
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is these appraisals that engender carer cognitive and affective reactions, and lead to a range of carer behaviours towards service users and towards services, and to different carer outcomes.”
§ Pioneering research > Cognitive model of caregiving
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“This is associated with more avoidant coping, low self-esteem and an understandable pessimism.20”
§ Pioneering research > Not clinically depressed
What the sources say
- Not checked yetcites [20] 20. Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, Watson P et al. Influence of carer expressed emotion and affect on relapse in non-affective psychoses. Br J Psychiatry 2006; 188: 173-9. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Worried, stressed, anxious, feels depressed and guilty”
§ Pioneering research > Discussion
What the sources say
- Not checked yetcites [35] 35. Grice SJ, Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, et al. Carers' attributions about positive events in psychosis relate to expressed emotion. Behav Res Ther 2009; 47: 783-9. source
- Not checked yetcites [63] 63. Leff J, Vaughn C. Expressed Emotion in Families. Guilford, 1985.
- Not checked yetcites [64] 64. Bentsen H, Notland TH, Munkvold OG, Boye B, Ulstein I, Bjorge H, et al. Guilt proneness and expressed emotion in relatives of patients with schizophrenia or related psychoses. Br J Med Psychol 1998; 71: 125-38. source
- Not checked yetcites [65] 65. Peterson EC, Docherty NM. Expressed emotion, attribution, and control in parents of schizophrenic patients. Psychiatry 2004; 67: 197-207. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Takes over adult roles and responsibilities, service user can become childlike”
§ Pioneering research > Discussion
What the sources say
- Not checked yetcites [35] 35. Grice SJ, Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, et al. Carers' attributions about positive events in psychosis relate to expressed emotion. Behav Res Ther 2009; 47: 783-9. source
- Not matchedcites [63] 63. Leff J, Vaughn C. Expressed Emotion in Families. Guilford, 1985.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [64] 64. Bentsen H, Notland TH, Munkvold OG, Boye B, Ulstein I, Bjorge H, et al. Guilt proneness and expressed emotion in relatives of patients with schizophrenia or related psychoses. Br J Med Psychol 1998; 71: 125-38.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked yetcites [65] 65. Peterson EC, Docherty NM. Expressed emotion, attribution, and control in parents of schizophrenic patients. Psychiatry 2004; 67: 197-207. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Earlier relationships between service users and carers will often have been poor, with the service user perhaps displaying a long history of adolescent turmoil and poor performance at school.”
§ Pioneering research > Not clinically depressed
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“Emotional overinvolvement in those caring for people with psychosis is a strong marker of poor current psychological and physical health.The evidence suggests that it may also be an indicator of poor future health. 62”
§ Pioneering research > Emotionally overinvolved relationships
What the sources say
- Not checked yetcites [62] 62. Breitborde N, Lopez S, Chang C, Kopelowicz A, Zarate R. Emotional over- involvement can be deleterious for caregivers' health. Soc Psychiatry Psychiatr Epidemiol 2010; 44: 716-23. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Although our typology of the characteristics of caregiving can never be exact, it is based in empirical research, and we think it will be of use in shaping interventions to the needs of caregivers.”
§ Pioneering research > Cognitive model of caregiving
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Critical and hostile attitudes are the more common negative reactions to the stresses of the caring role in psychosis”
§ Pioneering research > Critical and hostile relationships
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“be found in all types of carer, whether parents, partners, children or siblings.”
§ Pioneering research > Not clinically depressed
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Given the overall model, we suggest further that three different styles or types are at present supported by the evidence, interpreted in the light of clinical experience of intervention with families dealing with psychosis.”
§ Pioneering research > Cognitive model of caregiving
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Low self-esteem, depression, frustration”
§ Pioneering research > Initial relationship previously poor
What the sources say
- Not checked yetcites [19] 19. Raune D, Kuipers E, Bebbington PE. Expressed emotion at first-episode psychosis: investigating a carer appraisal model. Br J Psychiatry 2004; 184: 321-6. source
- Not checked yetcites [20] 20. Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, Watson P et al. Influence of carer expressed emotion and affect on relapse in non-affective psychoses. Br J Psychiatry 2006; 188: 173-9. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“When asked, long-standing carers may be more optimistic than those caring for people at an early stage of their illness.31”
§ Pioneering research > Discussion
What the sources say
- Not checked yetcites [31] 31. Onwumere J, Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, et al. Caregiving and illness beliefs in the course of psychotic illness. Can J Psychiatry 2008; 53: 460-8. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Angry, stressed, anxious, worried”
§ Pioneering research > Initial relationship previously poor
What the sources say
- Not checked yetcites [19] 19. Raune D, Kuipers E, Bebbington PE. Expressed emotion at first-episode psychosis: investigating a carer appraisal model. Br J Psychiatry 2004; 184: 321-6. source
- Not checked yetcites [20] 20. Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, Watson P et al. Influence of carer expressed emotion and affect on relapse in non-affective psychoses. Br J Psychiatry 2006; 188: 173-9. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Longer DUP likely, as service user may withdraw and not discuss problems”
§ Pioneering research > Initial relationship previously poor
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“More problems then occur, confirming that the only solution is the struggle to get better treatment.”
§ Pioneering research > Discussion
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Service user needs to get better and to control problems”
§ Pioneering research > Initial relationship previously poor
What the sources say
- Not checked yetcites [23] 23. Barrowclough C, Hooley JM. Attributions and expressed emotion: a review. Clin Psychol Rev 2003; 23: 849-80. source
- Not checked yetcites [35] 35. Grice SJ, Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, et al. Carers' attributions about positive events in psychosis relate to expressed emotion. Behav Res Ther 2009; 47: 783-9. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Carer may be parent, spouse, sibling or child”
§ Pioneering research > Initial relationship previously poor
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Families may also become 'stuck' at these initial stages, finding it impossible to adapt to the current reality or to new problems, because this feels like a defeat, giving up.”
§ Pioneering research > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Critical of service user's behaviour, may reject service user”
§ Pioneering research > Initial relationship previously poor
What the sources say
- Not checked yetcites [19] 19. Raune D, Kuipers E, Bebbington PE. Expressed emotion at first-episode psychosis: investigating a carer appraisal model. Br J Psychiatry 2004; 184: 321-6. source
- Not checked yetcites [20] 20. Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, Watson P et al. Influence of carer expressed emotion and affect on relapse in non-affective psychoses. Br J Psychiatry 2006; 188: 173-9. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Service user to blame, personality a problem (e.g.lazy)”
§ Pioneering research > Initial relationship previously poor
What the sources say
- Not matchedcites [23] 23. Barrowclough C, Hooley JM. Attributions and expressed emotion: a review. Clin Psychol Rev 2003; 23: 849-80.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked yetcites [35] 35. Grice SJ, Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, et al. Carers' attributions about positive events in psychosis relate to expressed emotion. Behav Res Ther 2009; 47: 783-9. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Previous problems Likely to have comorbid substance misuse Likely to have long DUP, characterised by poor social functioning”
§ Pioneering research > Initial relationship previously poor
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Families who pass through the initial shock and stigma may find a way of seeing caregiving as enriching.”
§ Pioneering research > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“May be dramatic presentation, as service user more likely to refuse help, symptoms may have to be severe before services can be involved”
§ Pioneering research > Initial relationship previously poor
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The result may be that no one in the family is managing, and all that its members share is pessimism and cynicism.”
§ Pioneering research > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The caregiver role is often difficult and exerts a significant impact on the carer’s own mental health (3, 4).”
From Internet-based psychoeducation and support programme for relatives of young people with early psychosis: results of the first German-language intervention (2024) · cites this paper as [3]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The content is based on scientific evidence and psychological interventions (mainly cognitive-behavioural therapy, CBT), communication and problem-solving skills learning programmes, self-care interventions (including Mindfulness), and peer-support principles in the context of family interventions for psychosis (3, 4, 13–15).”
From Internet-based psychoeducation and support programme for relatives of young people with early psychosis: results of the first German-language intervention (2024) · cites this paper as [3]
Experimental — accuracy not yet measured
Citations
Cites
Eysenck, H. J. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90087-7 · Cited by 32,038
“Stress: appraisal and coping,”
Folkman, S. (2013) · Encyclopedia of Behavioral Medicine · doi:10.1007/978-1-4419-1005-9_215 · Cited by 27,833
An attributional theory of achievement motivation and emotion
Weiner, B. (1985) · Psychological Review · doi:10.1037/0033-295x.92.4.548 · Cited by 7,846
Influence of Family Life on the Course of Schizophrenic Disorders: A Replication
Brown, G. W., Birley, J. L. T., & Wing, J. K. (1972) · British Journal of Psychiatry · doi:10.1192/bjp.121.3.241 · Cited by 1,770
A Meta-Analytic Review of the Common-Sense Model of Illness Representations
Hagger, M. S., & Orbell, S. (2003) · Psychology & Health · doi:10.1080/088704403100081321 · Cited by 1,607
Handbook of Psychology and Health
Gatchel, R. J., Baum, A. E., & Singer, J. E. (2021) · Routledge eBooks · doi:10.4324/9781003161530 · Cited by 1,321
A Controlled Trial of Social Intervention in the Families of Schizophrenic Patients
Leff, J., Kuipers, L., Berkowitz, R., Eberlein-Vries, R., & Sturgeon, D. (1982) · British Journal of Psychiatry · doi:10.1192/bjp.141.2.121 · Cited by 869
Family intervention for schizophrenia
Pharoah, F., Mari, J., Rathbone, J., & Wong, W. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000088.pub2 · Cited by 737
Family Management in the Prevention of Exacerbations of Schizophrenia
Falloon, I. R. H., Boyd, J. L., McGill, C. W., Razani, J., Moss, H. B., & Gilderman, A. M. (1982) · New England Journal of Medicine · doi:10.1056/nejm198206173062401 · Cited by 684
Slade, M., & Thornicroft, G. (2025) · doi:10.1093/med/9780198898818.003.0007 · Cited by 679
Research works printed but not linked: 3
- Kuipers, 2005, Families and Mental Disorder: From Burden to Empowerment
- Breitborde, 2010, Emotional overinvolvement can be deleterious for caregivers' health, Soc Psychiatry Psychiatr Epidemiol, 44
- 2009, Schizophrenia (Update)
Cited by
Sorted by citations
Yesufu-Udechuku, A., Harrison, B., Mayo-Wilson, E., Young, N., Woodhams, P., Shiers, D., Kuipers, E., & Kendall, T. (2015) · British Journal of Psychiatry · doi:10.1192/bjp.bp.114.147561 · Cited by 294
Self-citationSin, J., Gillard, S., Spain, D., Cornelius, V., Chen, T., & Henderson, C. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.05.002 · Cited by 192
“It is possible that these caregiving-related outcomes would mediate into better carers' wellbeing and quality of life (Joyce et al., 2003; Kuipers et al., 2010; Martens & Addington, 2001; Szmukler, 1996).”
Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis
Claxton, M., Onwumere, J., & Fornells‐Ambrojo, M. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00371 · Cited by 165
Self-citationKillaspy, H., Harvey, C., Brasier, C., Brophy, L., Ennals, P., Fletcher, J., & Hamilton, B. (2022) · World Psychiatry · doi:10.1002/wps.20940 · Cited by 173
Expressed Emotion in Schizophrenia: An Overview
Amaresha, A. C., & Venkatasubramanian, G. (2012) · Indian Journal of Psychological Medicine · doi:10.4103/0253-7176.96149 · Cited by 177
“[48] This has led to the inclusion of new targets for these interventions as well as new outcome measures focusing not only on service users, but also on caregivers.”
Metadata
- Authors
- Kuipers, E., Onwumere, J., & Bebbington, P.
- Affiliations
- King's College London (GB)
- University College London (GB)
- Corresponding author
- Kuipers, Elizabeth
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2010-04
- Volume
- 196
- Issue
- 4
- Pages
- 259-265
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2160092944
- Cited by
- 225
- References
- 80
- Citations by year
- 2026: 14 · 2025: 7 · 2024: 13 · 2023: 13 · 2022: 11 · 2021: 12 · 2020: 11 · 2019: 15 · 2018: 13 · 2017: 20 · 2016: 14 · 2015: 21 · 2014: 19 · 2013: 15 · 2012: 10
- FWCI
- 1.91
- 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)
- Funders
- South London and Maudsley NHS Foundation Trust
- National Institute for Health and Care Research
- King's College London
- Topics
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- psychosis, informal caregivers, caregiver distress, expressed emotion, caregiver relationships, illness perception, coping behaviour, social support, family responsibilities, theory-based intervention, relapse prevention
- MeSH terms
- Adaptation, Psychological, Attitude to Health, Family Health, Humans, Interpersonal Relations, Models, Psychological, Psychotic Disorders, Caregivers, Expressed Emotion
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-09-29, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-09-29 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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