High Expressed Emotion and Warmth among Families of Patients with Schizophrenia in Greece

Expressed emotion (EE) is an established prognostic factor for relapse in schizophrenia. Through critical comments (CC), hostility (H) and emotional overinvolvement (EOI), a relative can be rated as high or low EE, but the role of warmth should also be evaluated in order to consider the influence of a positive affect within the family context. In this study, EE was assessed in a sample of 48 relatives of patients with schizophrenia using the Camberwell Family Interview (CFI). Questionnaires assessing coping (brief-COPE), their wellbeing (World Health Organization Well-Being Index WHO-5) and the socio-demographic variables were also administered. Relatives who expressed a higher level of warmth were found to make fewer CC (5.2 +/- 4.6 vs. 8.4 +/- 4.6, p = 0.009) and have, on average, higher EOI scores (3.2 +/- 1.0 vs. 1.9 +/- 1.1, p = 0.002) than those who expressed no or very little warmth. High EE was found to be associated with having fewer family members (p = 0.035), while relatives with a higher level of education expressed less warmth (p = 0.007). Relatives with a low level of warmth had higher maladaptive coping scores and tended to score worse for their overall wellbeing in comparison to relatives who showed a higher level of warmth (28.4 +/- 5.0 vs. 24.1 +/- 5.2, p = 0.006 and 39.1 +/- 20.4 vs. 51.3 +/- 22.0, p = 0.073, respectively). Since the role of warmth is important, it should be taken into account when designing family interventions, independently from lowering EE. Customized interventions to promote warmth and the routine screening of relatives are recommended.

Automated summary

This study found that relatives who expressed higher warmth had fewer critical comments and higher emotional overinvolvement. Higher expressed emotion was associated with having fewer family members, while higher education level was associated with expressing less warmth. Relatives with lower warmth had higher maladaptive coping scores and worse overall wellbeing.