Abstract
Expressed emotions refer to the affective attitudes and behaviors of relatives toward a family member. It has both positive and negative elements. It can be seen as an indicator of ‘emotional temperature’ in the home. The current study aims to explore persons with mental illness (PwMI) perception of expressed emotions in their relative and understand the family environment and factors related to it. An exploratory qualitative research study was conducted using focus group discussion among 18 PwMI who receive psychiatric rehabilitation services in a tertiary level psychiatric hospital in southern part of India. The collected qualitative data used thematic analysis with Atlas.ti software. Five major themes were identified from the study results. They are: Concept of illness, Negative elements of EE, and Positive elements of EE, Factors influencing the nature of EE and Future apprehensions. The present study explored patient’s perception of expressed emotions. Patients hailing from non-therapeutic family emotional climate may benefit from approaches aimed at reducing their vulnerability to a dysfunctional family environment.
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References
Keung Wong DF, Lok PW. Factors influencing expressed emotion found between Chinese caregivers and their relatives with schizophrenia in Hong Kong: a qualitative analysis. Soc Work Mental Health. 2002;1(2):61–81.
Gandhi S, Pavalur R, Thirthalli J, Phillip M. Perception of family emotional climate by family members of persons with schizophrenia. Int J Soc Psychiatry. 2016;62(5):455–61.
Cutting LP, Aakre JM, Docherty NM. Schizophrenic patients’ perceptions of stress, expressed emotion, and sensitivity to criticism. Schizophr Bull. 2006;32(4):743–50.
Amaresha AC, Venkatasubramanian G. Expressed emotion in schizophrenia: an overview. Indian J Psychol Med. 2012;34(1):12–20.
Kazarian SS, Vanderheyden DA. Family education of relatives of people with psychiatric disability: a review. Psychosoc Rehabil J. 1992;15(3):67.
Vaughn CE. Expressed emotion in family relationships. Child Psychol Psychiatry Allied Discip. 1989;30(1):13–22.
Nirmala BP, Vranda MN, Reddy S. Expressed emotion and caregiver burden in patients with schizophrenia. Indian J Psychol Med. 2011;33(2):119–22.
Hooley JM. Expressed emotion and locus of control. J Nerv Ment Dis. 1998;186(6):374–78.
Barrowclough C, Tarrier N. Social functioning in schizophrenic patients. Soc Psychiatry Psychiatr Epidemiol. 1990;25:125–9.
Leff J, Vaughn C. Expressed emotion in families: Its significance for mental illness. New York: Guilford Press; 1984.
Chaturvedi SK, Ranjan S. Family distress and expressed emotions in caregivers of mentally ill. Indian J Soc Psychiatry. 2006;22(1–2):25–34.
Phillips MR, Pearson V, Li F, Xu M, Yang L. Stigma and expressed emotion: a study of people with schizophrenia and their family members in China. Br J Psychiatry. 2002;181(6):488–93.
Muliyala KP, Thirthalli J. Expressed emotions and relapse of psychosis: new vistas for an old concept. Schizophr Res. 2019;209:48–9.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
Sadath A, Kumar R, Karlsson M. Expressed emotion research in India: a narrative review. Indian J Psychol Med. 2019;41(1):18–26.
Pope C, Ziebland S, Mays N. Qualitative research in health care: analysing qualitative data. BMJ: Br Med J. 2000;320(7227):114–16.
Jagannathan A, Thirthalli J, Hamza A, Hariprasad VR, Nagendra HR, Gangadhar BN. A qualitative study on the needs of caregivers of inpatients with schizophrenia in India. Int J Soc Psychiatry. 2011;57(2):180–94.
Sadath A, Muralidhar D, Varambally S, Jose JP, Gangadhar BN. Caregiving and help seeking in first episode psychosis: a qualitative study. J Psychosoc Rehabil Mental Health. 2014;1:47–53.
Chakrabarti S. Research on family caregiving for mental illness in India and its impact on clinical practice: are we doing enough to help families? Indian J Soc Psychiatry. 2016;32(1):19–24.
Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National mental health survey of India, 2015–16. Bangalore: National Institute of Mental Health and Neuro Sciences; 2016.
Breitborde NJK, López SR, Nuechterlein KH. Expressed emotion, human agency, and schizophrenia: toward a new model for the ee-relapse association. Cult Med Psychiatry. 2009;33:41–60.
Jorm AF. Mental health literacy: public knowledge and beliefs about mental disorders. Br J Psychiatry. 2000;177(5):396–401.
Mehrotra K, Nautiyal S, Raguram A. Mental health literacy in family caregivers: a comparative analysis. Asian J Psychiatry. 2018;31:58–62.
Salve H, Goswami K, Sagar R, Nongkynrih B, Sreenivas V. Perception and attitude towards mental illness in an urban community in South Delhi—a community based study. Indian J Psychol Med. 2013;35(2):154–58.
Ganesh K. Knowledge and attitude of mental illness among general public of Southern India. Natl J Community Med. 2011;2(1):175–8.
Srinivasan TN, Thara R. Beliefs about causation of schizophrenia: do Indian families believe in supernatural causes? Soc Psychiatry Psychiatr Epidemiol. 2001;36:134–40.
Gandhi S, Jose D, Desai G. Perspectives of consumers in India on factors affecting recovery from schizophrenia. Int J Soc Psychiatry. 2019. https://doi.org/10.1177/0020764019877425.
Schoonover J, Lipkin S, Javid M, Rosen A, Solanki M, Shah S, et al. Perceptions of traditional healing for mental illness in rural Gujarat. Ann Glob Health. 2014;80(2):96–102.
Loureiro LM, Jorm AF, Mendes AC, Santos JC, Ferreira RO, Pedreiro AT. Mental health literacy about depression: a survey of portuguese youth. BMC Psychiatry. 2013;13:129.
Nageotte C, Sullivan G, Duan N, Camp PL. Medication compliance among the seriously mentally ill in a public mental health system. Soc Psychiatry Psychiatr Epidemiol. 1997;32:49–56.
Thonse U, Behere RV, Praharaj SK, Sharma PSVN. Facial emotion recognition, socio-occupational functioning and expressed emotions in schizophrenia versus bipolar disorder. Psychiatry Res. 2018;264:354–60.
Ayilara O, Ogunwale A, Babalola E. Perceived expressed emotions in relatives of patients with severe mental illness: a comparative study. Psychiatry Res. 2017;257:137–43.
Weisman AG, Rosales GA, Kymalainen JA, Armesto JC. Ethnicity, expressed emotion, and schizophrenia patients’ perceptions of their family members’ criticism. J Nerv Mental Dis. 2006;194(9):644–9.
Raune D, Kuipers E, Bebbington PE. Expressed emotion at first-episode psychosis: investigating a carer appraisal model. Br J Psychiatry. 2004;184(4):321–6.
Medina-Pradas C, Navarro JB, Pousa E, Montero MI, Obiols JE. Expressed and perceived criticism, family warmth, and symptoms in schizophrenia. Span J Psychol. 2013;16:E45.
Scazufca M, Kuipers E. Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients’ social functioning. Psychol Med. 1998;28(2):453–61.
Subandi MA. family expressed emotion in a Javanese cultural context. Cult Med Psychiatry. 2011;35:331–46.
Ran M-S, Leff J, Hou Z-J, Xiang M-Z, Chan CL-W. The characteristics of expressed emotion among relatives of patients with schizophrenia in Chengdu. China. Cult Med Psychiatry. 2003;27:95–106.
Gandhi S, Thennarasu K. Burden among caregivers of clients with depression—a scientific study. Int J Adv Nurs Sci Pract. 2012;1(1):20–8.
Salazar-Torres LJ, Castro-Alzate ES, Dávila-Vásquez PX. Caregiver burden in families of people with mental illness linked to the day hospital programme of a tertiary institution in the city of Cali (Colombia). Rev Colomb Psiquiatr (English ed). 2019;48(2):88–95.
Yıldız M, İncedere A, Kiras F, Abut FB, Kırcalı A, İpçi K. Development of Self-Stigma Inventory for Families of the patients with schizophrenia (SSI-F): validity and reliability study. Psychiatry Clin Psychopharmacol. 2019;29(4):463–71.
Mak WW, Cheung RY. Affiliate stigma among caregivers of people with intellectual disability or mental illness. J Appl Res Intellect Disabil. 2008;21(16):532–45.
Schulze B, Angermeyer MC. Subjective experiences of stigma A focus group study of schizophrenic patients, their relatives and mental health professionals. Soc Sci Med. 2003;56(7):299–312.
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Gandhi, S., Padmavathi, N., Raveendran, R. et al. Perception of Expressed Emotion Among Persons with Mental Illness. J. Psychosoc. Rehabil. Ment. Health 7, 121–130 (2020). https://doi.org/10.1007/s40737-020-00164-x
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DOI: https://doi.org/10.1007/s40737-020-00164-x