High levels of expressed emotion are thought to be related to the attributions relatives make about the causes of a patient's illness and problem behaviors. Causal attributions occurring during spontaneous speech in 43 spouses of depressed patients were examined. Consistent with theoretical prediction and with previous research in schizophrenia, high critical spouses were more likely than low critical spouses to attribute patients' symptoms and negative behaviors to factors that were controllable by and personal to the patients. High critical spouses also made more attributions that implied that they held patients responsible for their difficulties. Although predictive of spouses' criticism, these attribution dimensions did not predict patient relapse. The results suggest that causal attributions are important for understanding spouses' criticism but are of limited predictive validity with respect to depressive relapse.

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Previous studies have indicated a robust link between relatives' causal attributions and levels of expressed emotion (EE). However, these studies have primarily been conducted in Western cultures. The current study, conducted in China, examined the spontaneous causal attributions made by 54 relatives of schizophrenia patients during the Camberwell Family Interview. Chinese relatives made few controllable and personal attributions overall. Yet as predicted, highly critical and/or hostile EE relatives attributed patients' negative behaviors to more controllable and personal factors. High EE and controllable attributions positively predicted relapse, whereas personal attributions unexpectedly protected against relapse. EE mediated the effect of controllable, but not personal, attributions on relapse. Relatives' use of a particular Chinese characteristic (narrow-mindedness) was integral to the personal dimension's protective effect.

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