Hostname: page-component-74656f9884-54qdv Total loading time: 0 Render date: 2026-11-10T11:10:07.688Z Has data issue: false hasContentIssue false
  • English
  • Français

The predictive utility of expressed emotion in schizophrenia: an aggregate analysis

Published online by Cambridge University Press:  09 July 2009

Paul Bebbington  and
Liz Kuipers
Paul Bebbington*
Affiliation:
MRC Social and Community Psychiatry Unit and the Department of Psychology, Institute of Psychiatry, London
Liz Kuipers
Affiliation:
MRC Social and Community Psychiatry Unit and the Department of Psychology, Institute of Psychiatry, London
*
1Address for correspondence: Dr Paul Bebbington, MRC Social and Community Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Get access Rights & Permissions [Opens in a new window]

Synopsis

We analysed aggregate data from 25 studies linking Expressed Emotion (EE) and schizophrenia. We had access to original data sets from 17 studies, and used published data from the remainder. This provided us with 1346 cases from around the world. The association of EE with relapse was overwhelming, and was maintained whatever the geographical location. The predictive capacity of EE was virtually identical in men and women. While high contact with a high EE relative increased the risk of relapse, the opposite was true in low EE households. Medication and EE were independently related to relapse, and thus EE status has no bearing on the decision to prescribe. Our findings were confirmed using log–linear analysis.

Information

Type
Original Articles
Information
Psychological Medicine , Volume 24 , Issue 3 , August 1994 , pp. 707 - 718
Copyright
Copyright © Cambridge University Press 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Arévalo, J. & Vizcaro, C. (1989). ‘Emoción expresada’ y curso de la esquizofrenia en una muestra española. An´lisis y Modification de Conducta 15, 3–23.Google Scholar
Barrelet, L., Ferrero, F., Szigetty, L., Giddey, C. & Pellizzer, G. (1990). Expressed Emotion and first admission schizophrenia: nine month follow-up in a French cultural environment. British Journal of Psychiatry 156, 357–362.CrossRefGoogle Scholar
Bertrando, P., Bressi, C., Cereda, G., Clerici, M., Farma, T. & Cazullo, C. L. (1992). Expressed Emotion and schizophrenia in Italy: a study of an Italian urban population. British Journal of Psychiatry 161, 223–229.CrossRefGoogle Scholar
Birchwood, M. & Smith, J. (1987). Schizophrenia in the family. In Coping with Disorder in the Family (ed. Orford, J.), pp. 7–38. Croom Helm: London.Google Scholar
Brown, G. (1985). The discovery of EE: induction or deduction? In Expressed Emotion in Families (ed. Leff, J. and Vaughn, C.), pp. 7–25. Guilford: New York.Google Scholar
Brown, G. W., Monck, E. M., Carstairs, G. M. & Wing, J. K. (1962). Influence of family life on the course of schizophrenic illness. British Journal of Preventive and Social Medicine 16, 55–68.Google Scholar
Brown, G. W., Birley, J. L. T. & Wing, J. K. (1972). Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry 121, 241–258.CrossRefGoogle ScholarPubMed
Buchkremer, G., Stricker, K., Holle, R. & Kuhs, H. (1991). The predictability of relapses in schizophrenic patients. European Archives of Psychiatry and Clinical Neuroscience 240, 292–300.CrossRefGoogle Scholar
Budzyna-Davidowski, P., Rostworowska, M. & de Barbaro, B. (1989). Stability of Expressed Emotion. A 3 year follow-up study of schizophrenic patients.Paper presented at the 19th Annual Congress of the European Association of Behaviour Therapy,Vienna,Sept 10–24.Google Scholar
Cazzullo, C. L., Bertrando, P., Bressi, C. et al. (1988). Emotività expressa e schizofrenia: studio prospettico di replicazione. Notizie ARS (suppl. 3/88), 16–21.Google Scholar
Dulz, B. & Hand, I. (1986). Short-term relapse in young schizophrenics: can it be predicted and affected by family (CFI), patient and treatment variables? An experimental study. In Treatment of Schizophrenia: Family Assessment and Intervention (ed. Goldstein, M. J., Hand, I. and Hahlweg, K.), pp. 59–77. Springer: Berlin.CrossRefGoogle Scholar
Flanagan, D. A. & Wagner, H. L. (1991). Expressed emotion and panic-fear in the prediction of diet treatment compliance. British Journal of Clinical Psychology, 30, 231–240.CrossRefGoogle ScholarPubMed
Gutiérrez, E., Escudero, V. & Valero, J. A. (1988). Expresión de emociones y curso de la esquizofrenia. II. Expresión de emociones y curso de la esquizofrenia en pacientes en remisión. Análisis y Modificación de Conducta 14, 275–316.Google Scholar
Hatfield, A. B., Spanish, L. & Zipple, A. M. (1987). Expressed Emotion: a family perspective. Schizophrenia Bulletin 13, 221–226.CrossRefGoogle ScholarPubMed
Hogarty, G. E. (1985). Expressed Emotion and schizophrenic relapse: implications from the Pittsburg Study. In Controversies in Schizophrenia (ed. Alpert, M.), pp. 354–365. Guilford Press: New York.Google Scholar
Ivanović, M. & Vuletić, Z. (1989). Expressed Emotion in the families of patients with a frequent type of schizophrenia and its influence on the course of the illness.Paper presented at the 19th Annual Congress of the European Association of Behaviour Therapy,Vienna,Sept 20–24.Google Scholar
Ivanović, M., Vuletić, Z. & Bebbington, P. E. (1994). Expressed Emotion in the families of patients with schizophrenia and its influence on the course of illness. Social Psychiatry and Psychiatric Epidemiology 29, 61–65.CrossRefGoogle ScholarPubMed
Karno, M., Jenkins, J. H., de la Selva, A., Santana, F., Telles, C., Lopez, S. & Mintz, J. (1987). Expressed Emotion and schizophrenic outcome among Mexican-American families. Journal of Nervous and Mental Disease 175, 143–151.CrossRefGoogle ScholarPubMed
Kavanagh, D. J. (1992). Recent developments in expressed emotion and schizophrenia. British Journal of Psychiatry 160, 601–620.CrossRefGoogle ScholarPubMed
Kuipers, L. (1992). Expressed Emotion research in Europe. British Journal of Psychology 31, 429–443.Google ScholarPubMed
Kuipers, L. & Bebbington, P. E. (1988). Expressed Emotion research in schizophrenia: theoretical and clinical implications. Psychological Medicine 18, 893–910.CrossRefGoogle ScholarPubMed
Lam, D. (1991). Psychosocial family intervention in schizophrenia: a review of empirical studies. Psychological Medicine 21, 423–441.CrossRefGoogle ScholarPubMed
Leff, J. P. & Vaughn, C. (1985). Expressed Emotion in Families. The Guilford Press: New York.Google Scholar
Leff, J. P., Kuipers, L., Berkowitz, R., Eberlein-Fries, R. & Sturgeon, D. (1982). A controlled trial of social intervention in schizophrenic families. British Journal of Psychiatry 141, 121–134.CrossRefGoogle Scholar
Leff, J. P., Wig, N., Ghosh, A., Bedi, H., Menon, D. K., Kuipers, L., Korten, A., Ernberg, G., Day, R., Sartorius, N. & Jablensky, A. (1987). Influence of relatives' Expressed Emotion on the course of schizophrenia in Chandigarh. British Journal of Psychiatry 151, 166–173.CrossRefGoogle ScholarPubMed
McCreadie, R. G. & Phillips, K. (1988). The Nithsdale Schizophrenia Survey. VII. Does relatives' high Expressed Emotion predict relapse? British Journal of Psychiatry 152, 477–481.CrossRefGoogle ScholarPubMed
McCreadie, R. G., Phillips, K., Harvey, J. A., Waldron, G., Steward, M. & Baird, D. (1991). The Nithsdale Schizophrenia Survey. VIII. Do relatives want family intervention and does it help? British Journal of Psychiatry 158, 110–113.CrossRefGoogle ScholarPubMed
MacMillan, J. F., Gold, A., Crow, T. J., Johnson, A. L. & Johnstone, E. C. (1986). The Northwick Park Study of First Episodes of Schizophrenia. IV. Expressed Emotion and relapse. British Journal of Psychiatry 148, 133–143.CrossRefGoogle Scholar
MacMillan, J. F., Crow, T. J., Johnson, A. L. & Johnstone, E. C. (1987). Expressed Emotion and relapse in first episodes of schizophrenia. British Journal of Psychiatry 151, 320–323.CrossRefGoogle ScholarPubMed
Moline, R. A., Singh, S., Morris, A. & Meltzer, H. Y. (1985). Family Expressed Emotion and relapse in schizophrenia in 24 urban American patients. American Journal of Psychiatry 142, 1078–1081.Google ScholarPubMed
Montero, I., Gomez-Beneyto, M., Ruiz, I., Puche, E. & Adam, A. (1992). The influence of family Expressed Emotion on the course of schizophrenia in a sample of Spanish patients; a two year follow-up study. British Journal of Psychiatry 161, 217–222.CrossRefGoogle Scholar
Možný, P. & Votpkova, P. (1992). Expressed Emotion, relapse rate and utilisation of psychiatric inpatient care in schizophrenia: a study from Czechoslovakia. Social Psychiatry and Psychiatric Epidemiology 27, 174–179.CrossRefGoogle ScholarPubMed
Norušis, M. J. (1990). SPSS-PC Advanced Statistics Guide. SPSS Inc.: Chicago.Google Scholar
Nuechterlein, K. H., Snyder, K. S., Dawson, M. E., Rappe, S., Gitlin, M. & Fogelson, D. (1986). Expressed Emotion, fixed-dose fluphenazine decanoate maintenance, and relapse in recent onset schizophrenia. Psychopharmacology Bulletin 22, 633–639.Google ScholarPubMed
Parker, G. & Hadzi-Pavlovic, D. (1990). Expressed Emotion as a predictor of schizophrenia relapse: an analysis of aggregated data. Psychological Medicine 20, 961–965.CrossRefGoogle ScholarPubMed
Parker, G., Johnston, P. & Hayward, L. (1988). Parental ‘Expressed Emotion’ as a predictor of schizophrenic relapse. Archives of General Psychiatry 45, 806–813.CrossRefGoogle ScholarPubMed
Parker, G., Hayward, L. & Johnston, P. (1989). Factorial validity of the EE scales. Psychological Medicine 19, 435–446.CrossRefGoogle ScholarPubMed
Preibe, S., Wildgrube, C. & Muller-Oerlinghausen, B. (1992). Expressed Emotion and lithium prophylaxis: a follow-up study. Personal communication.Google Scholar
Rostworowska, M., Barbaro, B. & Cechnicki, A. (1987). The influence of expressed emotion on the course of schizophrenia: a Polish replication.Poster presented at the 17th Congress of the European Association for Behaviour Therapy,Amsterdam,26–29 August.Google Scholar
Stirling, J., Tantam, D., Thomas, P., Newby, D. & Montague, L. (1991). EE and early onset schizophrenia: a one year follow-up. Psychological Medicine 21, 675–685.CrossRefGoogle ScholarPubMed
Tarrier, N., Barrowclough, C., Vaughn, C., Bamrah, J. S., Porceddu, K., Watts, S. & Freeman, H. (1988). The community management of schizophrenia: a controlled trial of a behavioural intervention with families to reduce relapse. British Journal of Psychiatry 153, 532–542.CrossRefGoogle ScholarPubMed
Vaughan, K., Doyle, M., McConaghy, N., Blaszczynski, A., Fox, A. & Tarrier, N. (1992). The relationship between relatives' EE and schizophrenia relapse: an Australian replication. Social Psychiatry and Psychiatric Epidemiology 27, 10–15.CrossRefGoogle ScholarPubMed
Vaughn, C. & Leff, J. P. (1976). The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry 129, 125–137.CrossRefGoogle ScholarPubMed
Vaughn, C. E., Snyder, K. S., Jones, S., Freeman, W. B. & Falloon, I. R. H. (1984). Family factors in schizophrenic relapse: replication in California of British research in Expressed Emotion. Archives of General Psychiatry 41, 1169–1177.CrossRefGoogle ScholarPubMed
Watzl, H., Cohen, R. & Niedermeier, T. (1992). Expressed emotion and relapse in schizophrenic patients.Paper presented at XIIth International Congress of Psychology,Brussels,July, 1992.Google Scholar
Wig, N. N., Menon, D. K., Bedi, H., Leff, J. P., Kuipers, L., Ghosh, A., Day, R., Korten, A., Ernberg, G., Sartorius, N. & Jablensky, A. (1987). The distribution of Expressed Emotion components among relatives of schizophrenic patients in Aarhaus and Chandigarh. British Journal of Psychiatry 151, 160–165.CrossRefGoogle Scholar

An addendum has been issued for this article:

Addendum

P. Bebbington  and L. Kuipers