Predictors of criticism and emotional over-involvement in relatives of early psychosis patients

Abstract

Mechanisms underlying the manifestation of relatives' expressed emotion (EE) in the early stages of psychosis are still not properly understood. The present study aimed to examine whether relatives' psychological distress and subjective appraisals of the illness predicted EE dimensions over-and-above patients' poor clinical and functional status. Baseline patient-related variables and relatives attributes comprising criticism, emotional overinvolvement (EOI), psychological distress, and illness attributions were assessed in 91 early psychosis patients and their respective relatives. Relatives were reassessed regarding EE dimensions at a 6-month follow-up. Relatives' psychological distress and illness attributions predicted criticism and EOI over-and-above patients' illness characteristics at both time points. Relatives' increased levels of anxiety, attributions of blame toward the patients, an emotional negative representation about the disorder, and decreased levels of self-blame attributions predicted EE-criticism at baseline. Relatives' anxiety and negative emotional representation of the disorder were the only significant predictors of EE-criticism at followup, whereas anxiety, attributions of control by the relative and an emotional negative representation about the disorder predicted EE-EOI both at baseline and follow-up assessments. Understanding the components that comprise and maintain EE attitudes should guide early psychosis caregivers in family interventions, enhancing proper management of psychological distress and reduction of negative appraisals about the illness. The prevention of high-EE attitudes over time in a sensitive period such as early psychosis might be critical in shaping the health of caregivers and the outcome of the affected relatives.

Investigating expressed emotion in individuals at‐risk of developing psychosis and their families over 12 months

“…The high‐EE group at baseline had higher family/carer anxiety levels compared with the low‐EE group at 12 months. This study complimented Hinojosa‐Marqués et al's (2020) finding that relatives' psychological distress and negative emotional representation of the condition (fear, worry, or anger) predicted criticism and EOI at 6 months. Family/carers may not understand the experiences of ARMS individuals when they first enter services and express higher levels of concern (Izon et al, 2019; Izon, Au‐Yeung, & Jones, 2020) and experience perceived loss (Hinojosa‐Marqués, Domínguez‐Martínez, Sheinbaum, et al, 2019).…”

“…Parents remain confused, uncertain, worried, and waiting for service involvement (Izon et al, 2019). Hinojosa‐Marqués et al (2020) reported that relatives' anxiety and negative emotional representation of the condition and attributions of blame to the individual predicted EE criticism at baseline, which may be enhanced when they have less SU contact.…”

“…This is important when considering manifestations of EE attitudes are associated with relatives' perception of loss, which can be mediated by anxiety (Hinojosa‐Marqués, Domínguez‐Martínez, Sheinbaum, et al, 2019). A recent study found relatives' psychological distress and negative emotional representation of the condition (fear, worry, or anger of early psychosis) predicted criticism and EOI at 6 months better than individuals' symptoms (Hinojosa‐Marqués et al, 2020). In addition to relatives' anxiety and negative emotional representation of the disorder, attributions of blame to the individual predicted EE criticism at baseline.…”

Family environment and depressive episode are associated with relapse after first‐episode psychosis

“…Violence can trigger feelings of fear, anxiety and stress in family members and, consequently, increase attitudes of excessive concern for the FEP patient and contribute to high-EOI. A recent study found that the experience of psychological distress, such as anxiety, by the relatives was associated with high-EOI (Hinojosa-Marqués et al, 2020). From this perspective, a review study pointed out that the EOI attitudes may have the effect of discouraging the patient's abilities, autonomy and self-confidence and, thus, overprotection may, in the long run, result in difficulty for recovery and greater dependence of the patient on its caregiver (Amaresha & Venkatasubramanian, 2012).…”

Family environmental factors in at‐risk mental states for psychosis

“…Authors suggested that the interaction between caregivers' emotional distress and criticism may emerge after the onset of psychosis but not at the Indeed, relatives' levels of anxiety and depression proved to be predictors of critical attitudes in both ARMS and FEP groups. The difference in results between these studies can be explained by cultural differences between the Japanese (Hamaie et al, 2016) and Spanish samples (Domínguez-Martínez et al, 2017;Hinojosa-Marqués et al, 2020). However, more studies are required on the association between EE and relatives' levels of anxiety and depression at the early stages of psychosis to be able to theorize about it.…”