High expressed emotion

•What is meant by “high expressed emotion”?

•Consider the mental health impact of living in an environment in which the other people demonstrate “high expressed emotion” as opposed to “low expressed emotion”

Early Research

George Brown (1956) Many patients were to be readmitted soon after discharge due to symptom relapse.

A study was initiated by George Brown and his colleagues with 229 men discharged from psychiatric hospitals, 156 of them with a diagnosis of schizophrenia.

The strongest link with relapse and readmission was the type of home to which patients were discharged.

Surprisingly, the patients who discharged from hospital to stay with their parents or wives were more likely to get relapse and needed readmission than those who lived in lodgings or with their siblings.

It was also found that patients staying with their mothers had reduced risk of relapse and readmission if patients and/or their mother went out to work. It suggested the probable adverse influence of prolonged contact of patients with their family members in influencing the degree of disability and level of functioning.

More recent research

Kuipers et al (2006)

High expressed emotion in carers predicts relapse in psychosis.

WHY?

They proposed a cognitive model – the effect is mediated through affective changes.

86 service users – cross sectional design.

Service users whose carers showed high expressed emotion had more anxiety and depression but NOT more psychotic symptoms.

Low carer self esteem was related to carer depression, stress and burden and to service user low self esteem.

Critical comments (from carers) predicted anxiety (for service users) and were linked to carer low self esteem and avoidant coping strategies.

Recommendation for practice – Family interventions should focus on improving carer self esteem and coping.

* Note – these models / research are not “blaming” carers but highlighting complex interactions between variables and highlight that carers may need compassionate support in their own right. (The Care Act 2014 also highlighted the role of carers and for carers to be offered assessments of their needs).

Please watch this video which explains expressed emotion and psychosis in more depth

Do mental health nurses ever demonstrate "high expressed emotions"?

Dennis and Leach (2007) examined the level of expressed emotion (EE) and burnout in staff caring for people with learning disabilities on a medium secure unit. High EE was evident in 31% of responses based on critical comments and negative relationships. Expressed emotion was higher in male staff and in Health Care Support Workers.

Moore et al (2002) measured expressed emotion in staff-patient relationships in three forensic services. 75 Keyworker or team nurse and patient pairs consented to participate in an interview which included an audiotaped task. 12 months after this interview, information on outcome for staff and patients was collected by researchers blind to the Expressed emotion status of participants. Comparatively high levels of criticism were rated during staff speech samples: 55 high-Expressed emotion relationships as determined by conventional criteria. Principal component analysis of the Expressed emotion rating scales comprising the Five-Minute Speech-Sample (FMSS) established a composite of 'low-Expressed Emotion' vs 'high-Expressed Emotion' variables. The staff 'continuum' measure of high criticism, low positive remarks and 'negative' relationship quality was significantly associated with change in the relationship 12 months later. The study replicates recent findings that staff attitudes and behaviour in professional relationships influence clinical outcomes.

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