Expressed emotion in the families of psychiatrically hospitalized adolescents: A relapse study

Nancy Sandra Cahan (1990)

Twenty-four psychiatrically hospitalized adolescents and their parent(s) were involved in a study of Expressed Emotion (EE) and relapse. EE is an empirically derived construct that measures the level of criticism, emotional overinvolvement, and warmth in the key relatives of a hospitalized family member. High levels of criticism or emotional over involvement expressed by the key relatives about the hospitalized family member during an interview soon after admission have been found to predict relapse in the family member post-hospitalization within 9 months to 2 years. Predictive validity has been found with the schizophrenic, bi-polar disorder, and depressed neurotic population. The parent(s) of the adolescents in this quantitatively designed study were interviewed within two weeks of their child's admission, and assigned expressed emotion ratings based on audiotapes of the interviews. Adolescent relapse was determined by level of functioning 6 months after discharge, or rehospitalization. Adolescents returning home to families rated as high EE were found to relapse more than those returning home to families rated as low EE. More notable was the finding that relapse rates increased when high EE was combined with severity of illness or lack of therapy following hospitalization, suggesting that high EE exacerbates relapse for adolescents who are more ill and/or do not have therapeutic support. Separate from the impact of EE, severity of illness was strongly related with outcome; greater pathology, based on diagnosis or level of functioning at discharge, resulted in more relapse. Adolescents who did not continue in therapy relapsed to a statistically significant degree. The impact of gender, neuroleptic medication, and intact versus single-family status were not found to influence outcome. The results of this research are discussed, and the implications for future research and clinical implications are presented.