Perceptions of family criticism and warmth and their link to symptom expression in racially/ethnically diverse adolescents and young adults at clinical high risk for psychosis

Abstract

Aim Little is known about the role of expressed emotion (EE) in early symptom expression in individuals at clinical high risk (CHR) for psychosis. In patients with established schizophrenia, the effects of EE on clinical outcomes have purportedly varied across racial/ethnic groups, but this has not yet been investigated among CHR patients. Furthermore, studies have traditionally focused upon caregiver levels of EE via interview-based ratings, whereas the literature on patient perceptions of caregiver EE on psychosis symptoms is relatively limited. Methods Linear regression models were conducted to examine the impact of criticism and perceived warmth in the family environment, from the CHR patient’s perspective, on positive and negative symptom expression in non-Latino white (NLW; n = 38) and Latino (n = 11) adolescents and young adults at CHR for developing psychosis. Results Analyses examining the sample as a whole demonstrated that perceived levels of maternal criticism were negatively associated with negative CHR symptomatology. Additional analyses indicated that race/ethnicity moderated the relationship between criticism/warmth and clinical symptomatology. We found evidence of a contrasting role of patient perceived criticism and warmth depending upon the patient’s race/ethnicity. Conclusion Family processes shown to impact the course of schizophrenia among NLWs may function differently among Latino than NLW patients. These findings have important implications for the development of culturally appropriate interventions and may aid efforts to improve the effectiveness of mental health services for diverse adolescents and young adults at CHR for psychosis. Given the small sample size of this study, analyses should be replicated in a larger study before more definitive conclusions can be made.

Expressed emotion (EE) in families of individuals at-risk of developing psychosis: A systematic review

“…High-EE for FEP caregivers was between 30-40% (Meneghelli et al, 2011;Domínguez-Martínez et al, 2014), similar to caregivers of the ARMS population (Meneghelli et al, 2011;Schlosser et al, 2010;O"Brien et al, 2006), but lower than chronic psychosis (McFarlane and Cook, 2007). Although Tsai et al (2015) found higher-EE in Latino ARMS groups compared to psychosis literature, possibly due to cultural differences and small sample size. Only one study (Tsai et al, 2015) A cross-sectional study found longer duration of untreated illness (DUI) in the ARMS population positively correlated with higher levels of EE (McFarlane and Cook, 2007).…”

“…Highlevels of warmth by caregivers were associated with reductions in symptoms at 3 and 6month follow up (O"Brien et al, 2006;Schlosser et al, 2010), with a lack of warmth associated with increased negative statements (Carol and Mittal, 2015) and rejection (McFarlane and Cook, 2007). Tsai et al (2015) found ethnicity moderated the relationship of warmth and symptoms. Higher warmth from non-Latino white mothers and fathers of an ARMS individual was associated with lower positive and negative symptomology, higher warmth was associated with higher levels of symptomology for the Latino population.…”

“…were used to assess EE that included interview measures rated by the researchers and completed with the caregiver (n=6), self-report questionnaire measures completed by either the caregiver (n=7) or the individual (n=6). Four studies included more than one measure of EE (Golembo-Smith et al, 2014;O'Brien et al, 2015;Schlosser et al, 2010;Tsai et al, 2015), of which three studies included subjective EE measures completed by both caregivers and individuals (Golembo-Smith et al, 2014;O'Brien et al, 2015;Schlosser et al, 2010).…”

“…Eight found negative forms of criticism worsened symptoms and functioning (O"Brien et al, 2006;Schlosser et al, 2010;Welsh and Tiffin, 2015;Domínguez-Martínez et al, 2014;McFarlane and Cook, 2007;Tsai et al, 2015). Tsai et al (2015) found an effect of ethnicity and gender for criticism: Individuals with critical Latino fathers had more negative symptoms than non-Latino white fathers, albeit with a small sample size. Three studies found no association between symptoms, functioning and criticism (Meneghelli et al, 2011;Hamaie et al, 2016;Golembo-Smith et al, 2014).…”

“…Two studies found EOI and high levels of warmth predicted enhanced functioning and reduction in symptoms (O"Brien et al, 2006;Schlosser et al, 2010), with lower warmth less likely to change functioning regardless of the levels of EOI. Three studies found positive communication (warmth, positive remarks and EOI) and perceptions predicted improvements in negative symptoms and/or social functioning (O"Brien et al, 2006;Tsai et al, 2015) suggesting the importance of warmth, positive remarks and optimal EOI in improving functioning and symptoms.…”