Stigma and expressed emotion: a study of people with schizophrenia and their family members in China

Phillips, Michael R.; Pearson, Veronica; Li, Feifei; Xu, Ming; Yang, Lawrence H.

doi:10.1192/bjp.181.6.488

Cited by 227 publications

(186 citation statements)

References 17 publications

Supporting

Mentioning

161

Contrasting

Unclassified

Order By: Relevance

“…The first and fourth factors (intrusiveness and degree of carer's emotional involvement) in the Chinese version highlight the fact that a schizophrenic patient perceives a family with high EE as being highly intrusive to his/her daily activities and private affairs, and, in addition, the family might be seen to indulge in excessive emotional displays and negative preoccupations as well as statements of attitude towards the patient. This perception is consistent with the Chinese belief that open expression of emotions, either positive or negative, should be discouraged and the cultural emphasis on self and emotional control (Phillips et al, 2002;Yeo and Meiser, 2003). It can be argued that Chinese people believe that excessive emotion is harmful to an individual's physical and mental health and that a person should keep his/her emotions under control to maintain family functioning and relationships.…”

Section: Discussionsupporting

confidence: 80%

Further validation of the Chinese version of the Level of Expressed Emotion Scale for research and clinical use

Chien

Chan

2010

International Journal of Nursing Studies

View full text Add to dashboard Cite

Background: Expressed emotion is a construct that has been used for the past three decades to describe family members' criticism, hostility and emotional involvement with a mentally ill relative within the context of family interactions and care-giving. In Western countries this construct is used as an outcome measure of interventions for families of people with schizophrenia or other psychotic disorders, but the use of this construct in Chinese populations is somewhat limited.Objective: To test the reliability and validity of a refined Chinese version of the 52-item Level of Expressed Emotion Scale (LEE).Methods: A convenience sample of 405 outpatients with psychotic disorders in Hong Kong and one of their family caregivers were recruited. Patients were asked to complete a set of questionnaires twice over a six-month period, including the Chinese version of the LEE, the Specific Level of Functioning scale and the Brief Psychiatric Rating Scale; while their caregivers completed the Family Assessment Device twice and a demographic data sheet at recruitment. This study was aimed at establishing the internal consistency, reproducibility, responsiveness, and construct validity of the LEE.  This study also provides evidence that similar to Western studies, the construct of expressed emotion of family members in Chinese population consists of four factor solutions, including intrusiveness, expectations of the patient, attitude towards the illness, and emotional involvement.

show abstract

Section: Discussionsupporting

confidence: 80%

Further validation of the Chinese version of the Level of Expressed Emotion Scale for research and clinical use

Chien

Chan

2010

International Journal of Nursing Studies

View full text Add to dashboard Cite

show abstract

“…When compared to Ng and Sun's [35] [14] studies that over 40% of family members of patients with schizophrenia were rated as having high EE.…”

Section: Levels Of Perceived Ee In Chinese Patients With Smimentioning

confidence: 72%

“…For example, in India, emotional involvement is the norm and if a carer does not show much emotional involvement, it is seen as lack of care for the ill relative [13]. In Chinese population, Li and Arthur [12] and Philips et al [14] found that over 40% of Chinese family members of patients with schizophrenia were rated as showing high EE. They also observed that there was a significant increase in the relative risk of illness relapse for the Chinese patients with high EE, when compared to those in low EE families.…”

Section: Introductionmentioning

confidence: 99%

Testing the psychometric properties of a Chinese version of the Level of Expressed Emotion scale

Chien

Chan

2008

Research in Nursing & Health

View full text Add to dashboard Cite

This study tested the psychometric properties of a Chinese version of the level of expressed emotion scale in Hong Kong Chinese patients with severe mental illness and their family caregivers. First, the semantic equivalence with the original English version and test-retest reliability at 2-week interval of the Chinese version was examined. After that, the reproducibility, construct validity, and internal consistency of the Chinese version were tested. The Chinese version indicated good semantic equivalence with the English version (kappa values = 0.76-0.95 and ICC = 0.81-0.92), test-retest reliability ( = 0.89-0.95, < 0.01), and internal consistency (Cronbach's = 0.86-0.92). Among 262 patients with severe mental illness and their caregivers, the 50-item Chinese version had substantial loadings on one of the four factors identified (intrusiveness/hostility, attitude towards patient, tolerance, and emotional involvement), accounting for 71.8% of the total variance of expressed emotion. In confirmatory factor analysis, the identified fourfactor model showed the best fit based on all fit indices ( 2 /df = 1.93, = 0.75; AGFI = 0.96; TLI = 1.02; RMSEA = 0.031; WRMR = 0.78) to the collected data. The four-factor Chinese version also indicated a good concurrent validity with significant correlations with family functioning ( = −0.54) and family burden ( = 0.49) and a satisfactory reproducibility over six months (intraclass correlation coefficient of 0.90). The mean scores of the overall and subscale of the Chinese version in patients with unipolar disorder were higher than in other illness groups (schizophrenia, psychotic disorders, and bipolar disorder; < 0.01). The Chinese version demonstrates sound psychometric properties to measure families' expressed emotion in Chinese patients with severe mental illness, which are found varied across countries.

show abstract

“…stigma) with respect to seeking professional care than urban residents. In contrast, Phillips et al (2002) found that people with schizophrenia living in more urbanized areas of China report a greater influence of stigma in their lives; they feel socially inferior because of their difficulty meeting the minimal adult standards expected of city dwellers. Because stigma can discourage the use of psychiatric care (e.g.…”

Section: Introductionmentioning

confidence: 89%

Travel Distance and the Use of Inpatient Care among Patients with Schizophrenia

Tseng

Hemenway

Kawachi

et al. 2008

Adm Policy Ment Health

View full text Add to dashboard Cite

This study examines the variations in the use of inpatient care that can be explained by travel distance among patients with schizophrenia living in Taiwan. Data were drawn from the Psychiatric Inpatient Medical Claims Database. We used mediation analysis and multilevel analysis to identify associations. Travel distance did not significantly account for lower readmission rates after an index admission, but significantly explained the longer length of stay of an index admission by 9.3 days (P < 0.001, 85% of variation) between remote and non-remote regions. Policies are discussed aimed at reducing the impact of travel distance on rural mental health care through inter-disciplinary collaboration and telepsychiatry.

show abstract

Stigma and expressed emotion: a study of people with schizophrenia and their family members in China

Abstract: Clinicians should assess the effect of stigma as part of the standard work-up for patients with mental illness, and help patients and family members reduce the effect of stigma on their lives.

Cited by 227 publications

References 17 publications

Further validation of the Chinese version of the Level of Expressed Emotion Scale for research and clinical use

Further validation of the Chinese version of the Level of Expressed Emotion Scale for research and clinical use

Testing the psychometric properties of a Chinese version of the Level of Expressed Emotion scale

Travel Distance and the Use of Inpatient Care among Patients with Schizophrenia

Contact Info

Product

Resources

About