High Expressed Emotion and Warmth among Families of Patients with Schizophrenia in Greece
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample
2.2. Questionnaires
- A socio-demographic characteristics form collecting relatives’ gender, age, education, marital status, religion, employment status, income, current residence, financial status, family structure, relation to the patient and professional support (psychiatrist, psychologist, group therapy, etc.).
- Camberwell Family Interview (CFI): EE is assessed using the CFI [24], as used in previous Greek studies [25]. The CFI is the gold standard for assessing EE and is a semi-structured interview of the patient’s key relatives. The CFI has five subscales:
- Criticism: the number of critical comments that the relative makes about the patient.
- Hostility: a global scale that shows the relative’s generalized critical attitude and dislike towards the patient as a person and/or shows the relative’s rejection of the patient (0 = absence of hostility, 1 = hostility as a generalization, 2 = hostility as rejection and 3 = both generalization and rejection).
- Emotional overinvolvement: a global rating taken from the whole interview and scored from 0 to 5. This shows how intrusive, self-sacrificing and/or emotionally over-reactive the relative is towards the patient.
- Positive remarks: a frequency count of the number of positive comments that the relative makes in the interview.
- Warmth: a global scale for the warmth the relatives express towards the patient. The aspects considered are the tone of voice, spontaneity, sympathy, concern, empathy and interest in the person. Warmth is scored on a scale ranging from 0 to 5 (0 = no warmth, 1 = very little warmth, 2 = some warmth, 3 = moderate warmth, 4 = moderately high warmth and 5 = high warmth). For the scope of this data analysis, answers were unified in two categories: some or higher warmth = 1 (scores 2, 3, 4, and 5) and no/very little warmth = 0 (scores 0, 1).
- 3.
- Brief COPE: COPE and its different versions are the most widely used scales for assessing coping [26]. The Greek version of the Brief COPE, which has been shown to have adequate psychometric properties, was used [27]. The Brief COPE is a 28-item scale, and the answers to each item are given on a four-point Likert-type scale, ranging from 1 (I have not been doing this at all) to 4 (I have been doing this a lot). The 28 items represent 14 2-item subscales [28,29]. The higher the score on a certain subscale, the higher the use of the specific coping type for the specific stress and problem. The coping styles can be expected to be adaptive or maladaptive and the creator of the questionnaire, Carver C.S., invited researchers to adapt the items of the COPE according to the researcher’s hypotheses, samples and situations [28]. In the current study, eight COPE scales were considered adaptive (namely acceptance, humor, active coping, positive reframing, planning, use of instrumental support, use of emotional support and religion) and six maladaptive (namely behavioral disengagement, self-distraction, self-blame, denial, venting and substance use) [30].
- 4.
- The World Health Organization Well-Being Index (WHO-5): this is one of the most popular questionnaires used to assess wellbeing. It has been translated into over 30 languages and has been implemented in five continents. It is a useful tool for assessing subjective wellbeing, taking into account the last fourteen days, and consists of 5 simple questions that are answered on a 6-point Likert-type scale: all of the time = 5, most of the time = 4, more than half of the time = 3, less than half the time = 2, some of the time = 1 and at no time = 0. After scoring the above five questions, there will be a total score of 0–25. This first score is multiplied by the number 4 and a final score of 0–100 is reached. Lower scores represent a worse wellbeing and higher scores represent a better wellbeing [31]. Moreover, the WHO-5 Well-Being Index is used as a screening tool for depression [32].
2.3. Statistical Analysis
3. Results
3.1. Description of the Sample
3.2. Expressed Emotion
3.3. Warmth
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Demographic Characteristics | Low EE | High EE | |||
---|---|---|---|---|---|
N (%) | N (%) | p | Effect Size phi | ||
EE | 17 (35.4) | 31 (64.6) | |||
Gender | Male | 8 (50.0) | 8 (50.0) | 0.135 | 0.22 |
Female | 9 (28.1) | 23 (71.9) | |||
Relation | Parent | 10 (25.6) | 29 (74.4) | 0.006 | 0.43 |
Sibling | 7 (77.8) | 2 (22.2) | |||
Marital status | Married | 9 (33.3) | 18 (66.7) | 0.732 | 0.05 |
Other | 8 (38.1) | 13 (61.9) | |||
Income | <1000 | 12 (35.3) | 22 (64.7) | 1.000 | 0.01 |
>1000 | 5 (35.7) | 9 (64.3) | |||
Profession | With their own income | 13 (34.2) | 25 (65.8) | 0.704 | 0.08 |
Without their own income (students, housekeepers, unemployed) | 4 (44.4) | 5 (55.6) | |||
Professional support | No | 1 (12.5) | 7 (87.5) | 0.230 | 0.21 |
Yes | 16 (40.0) | 24 (60.0) | |||
Mean ± Std. dev. | Mean ± Std. dev. | p | Effect Size Cohen’s D | ||
Age (years) | 49.5 ± 17.4 | 51.7 ± 11.8 | 0.940 | 0.16 | |
Education (years) | 11.7 ± 4.3 | 11.9 ± 3.3 | 0.841 | 0.06 | |
Number of household members | 2.8 ± 0.7 | 2.2 ± 0.9 | 0.035 | 0.65 |
Low EE | High EE | |||
---|---|---|---|---|
Scales | Mean ± Std. dev. | Mean ± Std. dev. | P | Effect Size Cohen’s D |
WHO-5 | 56.0 ± 24.6 | 43.2 ± 19.4 | 0.062 | 0.60 |
Maladaptive coping | 24.4 ± 6.0 | 25.9 ± 5.1 | 0.346 | 0.28 |
Adaptive coping | 40.3 ± 6.9 | 41.5 ± 8.5 | 0.503 | 0.14 |
Demographic Characteristics | No or Very Little Warmth | Some or Higher Warmth | |||
---|---|---|---|---|---|
N (%) | N (%) | p | Effect Size phi | ||
Warmth | 14 (29.2) | 34 (70.8) | |||
Gender | Male | 7 (43.8) | 9 (56.3) | 0.178 | 0.23 |
Female | 7 (21.9) | 25 (78.1) | |||
Relation | Parent | 12 (30.8) | 27 (69.2) | 0.611 | 0.07 |
Sibling | 2 (22.2) | 7 (77.8) | |||
Marital status | Married | 8 (29.6) | 19 (70.4) | 0.936 | 0.01 |
Other | 6 (28.6) | 15 (71.4) | |||
Income | <1000 | 9 (26.5) | 25 (73.5) | 0.728 | 0.09 |
>1000 | 5 (35.7) | 9 (64.3) | |||
Profession | With their own income | 12 (31.6) | 26 (68.4) | 0.704 | 0.08 |
(students, housekeepers, unemployed) | 2 (22.2) | 7 (77.8) | |||
Professional support | No | 4 (50.0) | 4 (50.0) | 0.208 | 0.21 |
Yes | 10 (25.0) | 30 (75.0) | |||
Mean ± Std. dev. | Mean ± Std. dev. | P | Effect Size Cohen’s D | ||
Age (years) | 50.0 ± 13.3 | 51.3 ± 14.3 | 0.768 | 0.09 | |
Education (years) | 14.1 ± 1.9 | 10.9 ± 3.8 | 0.007 | 0.96 | |
Number of household members | 2.5 ± 1.1 | 2.4 ± 89.0 | 0.729 | 0.09 |
No or Very Little Warmth | Some or Higher Warmth | ||||
---|---|---|---|---|---|
N (%) | N (%) | p | Effect Size phi | ||
EE | Low | 3 (17.6) | 14 (82.4) | 0.320 | 0.19 |
High | 11 (35.5) | 20 (64.5) | |||
Hostility (2 categories) | No | 9 (23.7) | 29 (76.3) | 0.130 | 0.24 |
Yes (as generalization, rejection, or both) | 5 (50.0) | 5 (50.0) | |||
Mean ± Std. dev. | Mean ±Std. dev. | p | Effect Size Cohen’s D | ||
CC 1 | 8.4 ± 4.6 | 5.2 ± 4.6 | 0.009 | 0.70 | |
EOI 2 | 1.9 ± 1.1 | 3.2 ± 1.0 | 0.002 | 1.18 | |
Positive Remarks | 0.4 ± 0.7 | 1.2 ± 1.6 | 0.179 | 0.57 |
No or Very Little Warmth | Some or Higher Warmth | |||
---|---|---|---|---|
Scales | Mean ± Std. dev. | Mean ± Std. dev. | p | Effect Size Cohen’s D |
WHO-5 | 39.1 ± 20.4 | 51.3 ± 22.0 | 0.073 | 0.56 |
Maladaptive coping | 28.4 ± 5.0 | 24.1 ± 5.2 | 0.006 | 0.83 |
Adaptive coping | 42.1 ± 9.7 | 40.6 ± 7.2 | 0.544 | 0.19 |
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Avraam, G.; Samakouri, M.; Tzikos, A.; Arvaniti, A. High Expressed Emotion and Warmth among Families of Patients with Schizophrenia in Greece. Healthcare 2022, 10, 1957. https://doi.org/10.3390/healthcare10101957
Avraam G, Samakouri M, Tzikos A, Arvaniti A. High Expressed Emotion and Warmth among Families of Patients with Schizophrenia in Greece. Healthcare. 2022; 10(10):1957. https://doi.org/10.3390/healthcare10101957
Chicago/Turabian StyleAvraam, Georgios, Maria Samakouri, Anthimos Tzikos, and Aikaterini Arvaniti. 2022. "High Expressed Emotion and Warmth among Families of Patients with Schizophrenia in Greece" Healthcare 10, no. 10: 1957. https://doi.org/10.3390/healthcare10101957
APA StyleAvraam, G., Samakouri, M., Tzikos, A., & Arvaniti, A. (2022). High Expressed Emotion and Warmth among Families of Patients with Schizophrenia in Greece. Healthcare, 10(10), 1957. https://doi.org/10.3390/healthcare10101957