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Influence of carer expressed emotion and affect on relapse in non-affective psychosis

Department of Psychology, Institute of Psychiatry, King’s College London, London

P. BEBBINGTON, PhD, FRCP, FRCPsych

Department of Mental Health Sciences, Royal Free and University College London Medical School, London

G. DUNN, PhD

Biostatistics Group, Division of Epidemiology and Health Sciences, University of Manchester, Manchester

D. FOWLER, MSc

School of Medicine, Health Policy and Practice, University of East Anglia, Norwich

D. FREEMAN, PhD, P. WATSON, MSc, A. HARDY, BSc and P. GARETY, PhD, FBPsS

Department of Psychology, Institute of Psychiatry, King’s College London, London, UK

Correspondence: Professor E. Kuipers, Department of Psychology, PO Box 77, Institute of Psychiatry, King’s College London, London SE5 8AF, UK. E-mail: e.kuipers{at}iop.kcl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background High expressed emotion in carers predicts relapse in psychosis, but it is not known why this is so. In our cognitive model of psychosis, we postulated that the effect is mediated through affective changes.

Aims To investigate the relationships between carer expressed emotion, patients’ symptoms and carer characteristics during a recent relapse of psychosis.

Method A total of 86 patients and carers were investigated in a cross-sectional design.

Results Patients whose carers showed high expressed emotion had significantly higher levels of anxiety and depression, but not more psychotic symptoms or lower self-esteem. Linear regression showed that carers’critical comments predicted anxiety in patients. Critical comments were related to low carer self-esteem and avoidant coping strategies. Low carer self-esteem was also related to carer depression, stress and carer ‘burden’, and to low patient self-esteem.

Conclusions Our hypothesis was partially supported. Carer criticism was associated with patient anxiety, low carer self-esteem and poor carer coping strategies. Family interventions should focus on improving these after a relapse of symptoms of psychosis.

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