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Family warmth in schizophrenia

Ethnicity, Expressed Emotion, Attributions, and Course of Schizophrenia: Family Warmth Matters.

By Lopez, SR; Nelson Hipke, K; Polo, AJ; Jenkins, JH; Karno, M; Vaughn, C; Snyder, KS.
Journal of Abnormal Psychology. 2004 Aug Vol 113(3) 428-439

There is a line of research called family 'expressed emotion' that suggests that family factors can influence the course of schizophrenia. Particularly, it is thought that low levels of criticism, hostility, or emotional overinvolvement are less likely to cause relapse in the person with schizophrenia, and vice versa for high levels of these qualities. Some researchers have proposed an 'attribution theory' which claims that those relatives who judge the patient as being responsible for their symptoms will tend to show more negatively affect (anger, bother, annoyance), whereas those who judge the patient as not being responsible for their illness will tend to feel positive or supportive affect (sympathy, compassion, concern). These 'expressed emotions' then are thought to influence the course of schizophrenia. These ideas are hotly debated and not all researchers believe in them.

This current study was designed to extend attribution theory by looking at the relationship between families' attributions of control, families' negative and positive emotions and patients' relapse. They looked at interviews and questionnaire data from two previous studies involving Anglo American and Mexican American families. They found that the relationship between families and the course of schizophrenia is quite diverse. The data indicated that for Mexican Americans, family warmth is a significant protective factor, whereas for Anglo Americans, family criticism is a significant risk factor. As such they suggest that family warmth can be just as significant to the course of schizophrenia as family criticism, depending on the sociocultural context. They also suggest that family warmth can serve as an important buffer and family interventions that focus on prosocial family factors can potentially balance the emphasis of past research on negative family functioning, and focus on family strengths.

There are limitations in this line of work due to small sample sizes, and lack of determination of how attributions and affective reactions relate to families' behavior. While this line of work provides helpful information about the role of cognitive appraisal in perceptions of illness and response to it, it is also important to note that there are other studies showing that expressed emotion does not necessarily influence the course of schizophrenia. Nevertheless, this research can help highlight family intervention strategies that are based on self and illness psychoeducation, communication, and problem-solving skills training.

This research was supported by Grants R03-MH53589 and K08-MH01499 from the National Institute of Mental Health. Preparation of this article was supported in part by a Minority International Research Training grant (TW00061) from the Fogarty International Center of the National Institute of Health awarded to UCLA-Instituto Mexicano de Psiquiatria.

Click here to find this article on PubMed

Author: Farzin Irani