Social Psychiatry and Psychiatric Epidemiology

, Volume 45, Issue 2, pp 165–174 | Cite as

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

Original Paper

Abstract

Background

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.

Methods

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.

Results

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

Conclusions

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.

Keywords

Case management Case manager Expressed emotion Medication adherence 

Notes

Acknowledgments

This research was funded by NIMH Grant R03MH52734-02 to Leslie B. Alexander.

References

  1. 1.
    Ball RA, Moore E, Kuipers L (1992) Expressed emotion in community care staff. Soc Psychiatry Psychiatr Epidemiol 27:35–39CrossRefPubMedGoogle Scholar
  2. 2.
    Barrowclough C, Haddock G, Lowens I, Connor A, Pidiswyi J, Tracey N (2001) Staff expressed emotion causal attribution for client problems on a low security unit: an exploratory study. Schizophr Bull 27:517–526PubMedGoogle Scholar
  3. 3.
    Brown G, Rutter M (1966) The measurement of family activities and relationships: a methodological study. Hum Relat 19:241–263CrossRefGoogle Scholar
  4. 4.
    Brown G, Carstairs G, Topping (1958) Post hospital adjustment of chronic mental patients. Lancet 2:685–689Google Scholar
  5. 5.
    Brown G, Monck E, Carstairs G, Wing J (1962) Influence of family life on the course of schizophrenia illness. Br J Prev Soc Med 16:55–68Google Scholar
  6. 6.
    Butzlaff A, Hooley J (1998) Expressed emotion and psychiatric relapse. Arch Gen Psychiatry 55:547–552CrossRefPubMedGoogle Scholar
  7. 7.
    Charlesworth B, Sacks J, Templer D, Thackrey M (1993) Negative emotion of relapse in persons with schizophrenia living in board and care homes. Community Ment Health J 29:261–268CrossRefPubMedGoogle Scholar
  8. 8.
    Cole J, Kazarian s (1988) The level of expressed emotion scale: a new measure of expressed emotion. J Clin Psychol 4944:392–397CrossRefGoogle Scholar
  9. 9.
    Day J, Bentall R, Roberts C, Randall F, Rogers A, Cattell D, Healy D, Rae P, Power C (2005) Attitudes toward antipsychotic medication. Arch Gen Psychiatry 62:717–724CrossRefPubMedGoogle Scholar
  10. 10.
    Dennis M, Leach C (2007) Expressed emotion and burnout: the experience of staff caring for men with learning disability and psychosis in a medium secure setting. J Psychiatr Mental Health Nurs 14:267–276CrossRefGoogle Scholar
  11. 11.
    Draine J (1999) Measuring attitudes toward psychiatric medication among persons with serious mental illness. In: The image of madness: the public facing mental illness and psychiatric treatment. Karger, LondonGoogle Scholar
  12. 12.
    Drake R, Osher F (1987) Using family psychoeducation where there is no family. Hosp Community Psychiatry 38:274–277PubMedGoogle Scholar
  13. 13.
    Finnema EJ, Louwerens JW, Sloof CJ, Van den Bosh RJ (1996) Expressed emotion on long-stay wards. J Adv Nurs 24:473–478CrossRefPubMedGoogle Scholar
  14. 14.
    Gamble C, Midence K, Leff J (1994) The effects of family work training on mental health nurses’ attitude to and knowledge of schizophrenia: a replication. J Adv Nurs 19:893–896CrossRefPubMedGoogle Scholar
  15. 15.
    Gerisma C, Hale W (1997) Predictive and construct validity of the Level of Expressed Emotion (LEE) Scale: depressed out-patients and couples from the general community. Br J Psychiatry 170:520–525CrossRefGoogle Scholar
  16. 16.
    Gough H (1987) California psychological inventory administrator’s guide. Consulting Psychologist Press, Palo AltoGoogle Scholar
  17. 17.
    Hansen J, Berman S, Babcock C (1991) The relationship of family and staff expressed emotion to residents’ functioning in community residences. Psychosoc Rehabil J 14:85–89Google Scholar
  18. 18.
    Hooley J, Hiller J (1994). Do high and low EE relatives differ in personality? Poster presented at the annual meeting of the Society for Research in Psychopathology. Coral Gables, FloridaGoogle Scholar
  19. 19.
    Hooley J, Hiller J (2000) Personality and expressed emotion. J Abnorm Psychol 109:40–44CrossRefPubMedGoogle Scholar
  20. 20.
    Hooley J, Parker H (2006) Measuring expressed emotion: an evaluation of the shortcuts. J Fam Psychol 20:386–396CrossRefPubMedGoogle Scholar
  21. 21.
    Horvath, A. (1981). An exploratory study of the working alliance: it’s measurement and relationship to outcome. Unpublished doctoral dissertation, University of British ColumbiaGoogle Scholar
  22. 22.
    Horvath A, Greenberg L (1989) Development and validation of the working alliance inventory. J Couns Psychol 36:223–233CrossRefGoogle Scholar
  23. 23.
    Hoult J, Reynolds I, Charbonneau-Powis M, Weekes P, Briggs J (1983) Psychiatric hospital versus community treatment: the results of a randomized trial. Aust NZ J Psychiatry 17:160–167CrossRefGoogle Scholar
  24. 24.
    Kuipers E, Moore E (1995) Expressed emotion and staff–client relationships: implications for community care of the severely mentally ill. Int J Mental Health 24:13–26Google Scholar
  25. 25.
    Lam D, Kuipers L, Leff J (1993) Family work with patients suffering from schizophrenia: the impact of training on psychiatric nurses’ attitude and knowledge. J Adv Nurs 18:233–237CrossRefPubMedGoogle Scholar
  26. 26.
    Leff J, Sharpley M, Chisholm D, Bell R, Gamble C (2001) Training community psychiatric nurses in schizophrenia family work: a study of clinical and economic outcomes for patients and relatives. J Mental Health 10:189–197CrossRefGoogle Scholar
  27. 27.
    Lehman AF (1988) A quality of life interview for the chronically mentally ill. Eval Prog Plan 11:51–62CrossRefGoogle Scholar
  28. 28.
    Magana A, Goldstein J, Karno M, Miklowitz D, Jenkins J, Falloon I (1986) A brief method for assessing expressed emotion in relatives of psychiatric patients. Psychiatry Res 17:203–212CrossRefPubMedGoogle Scholar
  29. 29.
    McGurrin M, Worley N (1989) Treatment participation scale. (Unpublished)Google Scholar
  30. 30.
    Moore E, Kuipers E (1999) The measurement of expressed emotion in relationships between staff and service users: the use of short speech samples. Br J Clin Psychol 38:345–356Google Scholar
  31. 31.
    Moore E, Ball R, Kuipers L (1992) Expressed emotion in staff working with the long-term adult mentally ill. Br J Psychiatry 161:802–808CrossRefPubMedGoogle Scholar
  32. 32.
    Moore E, Yates M, Mallindine C, Ryan S, Jackson S, Chinnon N, Kuipers E, Hammond S (2002) Expressed emotion in relationships between staff and patients in forensic services: changes in relationship status at 12 month follow-up. Legal Criminol Psychol 7:203–218CrossRefGoogle Scholar
  33. 33.
    Oliver N, Kuipers E (1996) Stress and its relationship to expressed emotion in community mental health workers. Int J Soc Psychiatry 42:150–159CrossRefPubMedGoogle Scholar
  34. 34.
    Overall JE, Gorham DR (1962) The brief psychiatric rating scale. Psychol Rep 10:799–812CrossRefGoogle Scholar
  35. 35.
    Pepper B, Ryglewicz H (1987) Is there expressed emotion away from home? Interactional Intensity”(“II”) in the treatment program. Tie Lines 4:1–3Google Scholar
  36. 36.
    Pharoah F, Mari J, Rathbone J, Wong W (2008) family intervention for schizophrenia (review). The Cochrane Collaboration. http://www,thecochranelibrary.com
  37. 37.
    Siol T, Stark FM (1995) Therapists and parents interacting with schizophrenic patients. Int J Mental Health 24:3–12Google Scholar
  38. 38.
    Snyder K, Wallace C, Moe K, Ventura J, Liberman R (1995) The relationship of residential care-home operators’ expressed emotion and schizophrenia residents’ symptoms and quality of life. Int J Mental Health 24:27–37Google Scholar
  39. 39.
    Solomon P, Draine J (1994) Satisfaction with mental health treatment in a randomized trial of consumer case management. J Nerv Ment Dis 182(17):9–184Google Scholar
  40. 40.
    Solomon P, Draine J, Delaney M (1995) The working alliance and consumer case management. J Mental Health Adm 22:126–134CrossRefGoogle Scholar
  41. 41.
    Stanhope V, Solomon P (2007) Bridging the gap: using microsociological theory to understand how expressed emotion predicts clinical outcomes. Psychiatr Q 78:117–128CrossRefPubMedGoogle Scholar
  42. 42.
    Strachan A, Feingold D, Goldstein M, Miklowitz D, Nuechterlein K (1989) Is expressed emotion an index of a transactional process? II. Patient’s coping style. Fam Process 28:169–181CrossRefPubMedGoogle Scholar
  43. 43.
    Streicker S, Amdur M, Dincin J (1996) Educating patients about psychiatric medication: failure to enhance compliance. Psychosoc Rehabil J 9(1):5–28Google Scholar
  44. 44.
    Tattan T, Tarrier N (2000) The expressed emotion of case managers of the seriously mentally ill: the influence of expressed emotion on clinical outcomes. Psychol Med 30:195–204CrossRefPubMedGoogle Scholar
  45. 45.
    Van Audenhove C, Van Humbeeck G (2003) Expressed emotion in professional relationships. Curr Opin Psychiatry 16:431–436CrossRefGoogle Scholar
  46. 46.
    Van Humbeck G, Van Audenhove C (2003) Expressed emotion of professionals towards mental health patients. Epidemol Psichiatr Soc 12:232–237Google Scholar
  47. 47.
    Van Humbeeck G, Van Audenhove C, Pieters G, De Hert M, Storms G, Vertommen H, Peuskens J, Heyrman J (2001) Expressed emotion in staff-patient relationships: the professionals’ and residents’ perspectives. Soc Psychiatry Psychiatr Epidemiol 36:486–492CrossRefPubMedGoogle Scholar
  48. 48.
    Van Humbeeck G, Van Audenhove C, Pieters G, De Hert M, Storms G, Vertommen H, Peuskens J, Heyrman J (2002) Expressed emotion in the client-professional caregiver dyad: are symptoms, coping strategies and personality related? Soc Psychiatry Psychiatr Epidemiol 37:364–371CrossRefPubMedGoogle Scholar
  49. 49.
    Van Humbeeck G, Van Audenhove C, Declercq A (2004) Mental health, burnout and job satisfaction among professionals in sheltered living in Flanders. Soc Psychiatry Psychiatr Epidemiol 39:569–575CrossRefPubMedGoogle Scholar
  50. 50.
    Van Humbeeck G, Van Audenhove C, Storms g, De Hert M, Pieters G, Vertommen H, Peuskens J, Heyrman J (2004) Expressed emotion in the client–professional dyad: a comparison of three Expressed emotion Instruments. Eur J Psychol Assess 20:237–246CrossRefGoogle Scholar
  51. 51.
    Vaughan C, Leff J (1976) The measurement of expressed emotion in the families of psychiatric patients. Br J Soc Clin Psychol 15:157–165Google Scholar
  52. 52.
    Wearden AJ, Tarrier N, Borrowclough C, Zastowny TR, Rahill AA (2000) A review of expressed emotion research in health care. Clin Psychol Rev 20:633–666CrossRefPubMedGoogle Scholar
  53. 53.
    Weigel L, Langdon P, Collins S, O’Brien Y (2005) Challenging behaviour and learning disabilities: the relationship between expressed emotion and staff attributions. Br J Clin Psychol 45:205–216CrossRefGoogle Scholar
  54. 54.
    Willetts L, Leff J (1997) Expressed emotion and schizophrenia: the efficacy of a staff training programme. J Adv Nurs 26:1125–1133PubMedGoogle Scholar
  55. 55.
    Zeger SL, Liang KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121–130CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.School of Social Policy and PracticeUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Bryn Mawr CollegeBryn MawrUSA
  3. 3.ECRI InstitutePlymouth MeetingUSA

Personalised recommendations