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

Abstract

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.

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

“…In this study, the four-factor structure of the Chinese version of the LEE is not only consistent with the multidimensional nature of the original English version proposed by Cole and Kazarian (1988) but also satisfactorily corresponds with the findings of its initial testing by Chien and Chan (2009) in a similar patient population. Indeed, there is no direct comparison between the original concept of caregivers' perceived EE (Vaughn and Leff, 1976) and the patients' perceived EE measured by the LEE in this study.…”

“…In view of the satisfactory results on content validity and reliability of a Chinese version of the LEE in a previous psychometric evaluation by Chien and Chan (2009), the present study, reported in this paper, aims to enhance the scale by further testing the internal consistency, reproducibility, responsiveness, and construct validity of the Chinese version with a sample comprising a larger group of Chinese patients with schizophrenia or other psychotic disorders as well as their families in Hong Kong.…”

“…The LEE scale comprised four domainsintrusiveness, attitude toward illness, tolerance/expectancy, and emotional response to illness, and each consisted of 15 items on a four-point Likert scale (1 -Not true; 2 -More or less untrue; 3 -More or less true; and 4 -True). The scale was translated into Chinese and psychometrically tested by Chien and Chan (2009) The Family Assessment Device (FAD) developed by Epstein et al (1983) is used to assess multiple dimensions of family functioning among patients with mental illness. It consists of 60 items used to measure family functioning on a 4-point Likert scale, ranging from 1-'strongly disagree' to 4-'strongly agree'.…”

The Schizophrenia Care Management Program for Family Caregivers of Chinese Patients With Schizophrenia

“…The Chinese versions of these instruments were validated, indicating satisfactory reliability and validity (11,14). The patients' average number and length of rehospitalizations in the previous six months were also calculated.…”

Testing the Psychometric Properties of a Chinese Version of the Level of Expressed Emotion Scale

“…It is a self-reported measure of a patient's perception of interactions with family during the previous one to three months and initially 25 psychologists generated 604 items based on four aspects of EE of family members, which included the level of intrusiveness, emotional responses to the illness, negative attitude towards illness, and level of tolerance and expectations concerning the patient. A panel of psychologists and psychiatrists rated and agreed that 60 of the items reflected the construct of patients' perceived EE in their family, which possessed the highest item-scale correlations, the lowest social desirability loadings, and the highest content relevance and appropriateness of their respective dimensions (subscales) of EE [10, 11]. Feasibility and accuracy of asking about patients' perceptions of EE with careful consideration to the influence of psychotic symptoms were found satisfactory [2, 6, 9].…”