Original Paper

Social Psychiatry and Psychiatric Epidemiology

, Volume 45, Issue 2, pp 165-174

First online:

The relationship of case managers’ expressed emotion to clients’ outcomes

  • Phyllis SolomonAffiliated withSchool of Social Policy and Practice, University of Pennsylvania Email author 
  • , Leslie AlexanderAffiliated withBryn Mawr College
  • , Stacey UhlAffiliated withECRI Institute

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Expressed emotion (EE) has been studied in families of a relative with schizophrenia as well as other psychiatric disorders; and high EE (hostile, critical, and overinvolved) families have been found to be strongly related to relapse among their relatives. EE has been assessed on a limited basis among non-familial care providers and determined that providers can also have high EE which results in poor quality of life and negative consequences for their clients.


The present study assessed 42 case managers serving clients with schizophrenia spectrum disorder regarding their EE for specific clients enrolled in a larger study examining the reliability and validity of two alliance measures. Case managers and clients were personally interviewed at baseline, 3, 6, 6 plus 2 weeks, and 9 months post-client entry into case management. The EE measure was inserted into the 6 months plus 2 week case manager interview. Generalized Estimating Equation analysis was employed to examine predicted outcomes of EE.


High EE was found to be related to client attitudes toward medication compliance and social contact.


Family psychoeducation interventions, an evidence-based practice, have been demonstrated to be effective in reducing relapse of relatives with serious mental illness. Given the clinical evidence that EE is modifiable, it is expected that such educational training for non-familial caregivers will have the same potential as for family caregivers. Providers dealing with challenging clients may also need support and skills to better handle difficult situations, especially direct support providers like case managers who are not clinically trained.


Case management Case manager Expressed emotion Medication adherence