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Direct adjusted comparison of expressed emotion towards patients with schizophrenia between halfway houses and family settings

Published online by Cambridge University Press:  27 August 2024

P. Ferentinos*
Affiliation:
12nd Department of Psychiatry, “Attikon” University General Hospital, National and Kapodistrian University of Athens
S. Douki
Affiliation:
2Department of Psychiatry, Evangelismos” General Hospital
E. Kourkouni
Affiliation:
3Center for Clinical Epidemiology and Outcomes research, Athens, Greece
D. Dragoumi
Affiliation:
2Department of Psychiatry, Evangelismos” General Hospital
N. Smyrnis
Affiliation:
12nd Department of Psychiatry, “Attikon” University General Hospital, National and Kapodistrian University of Athens
A. Douzenis
Affiliation:
12nd Department of Psychiatry, “Attikon” University General Hospital, National and Kapodistrian University of Athens
*
*Corresponding author.

Abstract

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Introduction

Rates of high expressed emotion (EE) towards patients with schizophrenia have only indirectly been compared between families and community residential facilities, since studies including patients in both settings are unfortunately lacking. High EE rates in staff-patient studies are typically lower than in families, with negligible rates of high emotional overinvolvement (EOI). However, indirect comparisons can suffer from many biases.

Objectives

This study directly compared patients with schizophrenia living in halfway houses or with their families on the EE of their caregivers, adjusting for patient- and caregiver-related confounders.

Methods

We included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the EE of the caring staff (N=22 nurses) or parents (N=56), respectively, through Five Minutes Speech Sample interviews. Each nurse rated 1-12 inpatients and each inpatient was rated by 2-5 nurses, totaling 155 nurse ratings. Each outpatient was rated by one or both parents. Due to the multilevel structure of EE ratings, generalized linear mixed models were fitted. We first adjusted only for differences in patient-related confounders between groups and then added basic caregiver-related demographics.

Results

Compared to outpatients, inpatients were older (p=0.001), less well educated (p=0.002), had a longer disease duration (p=0.047), more hospitalizations (p=0.012), lower severity of psychotic (p=0.027) and, specifically, negative symptoms (p=0.015), and lower perceived criticism (p=0.001). Nurses were younger (p<0.001) and better educated (p=0.001) than parents. After adjusting for patient-related confounders only, EOI was significantly higher in parents (p=0.027) while criticism did not significantly differ between groups. However, after also adjusting for caregiver demographics (age, gender and education), criticism was significantly higher in nurses (p=0.027) while differences in EOI became non-significant.

Conclusions

Differences in EE, when directly compared between parents and professional caregivers, may be explained by differences in patient-related characteristics, caregiver demographics as well as other caregiver characteristics to be investigated in future studies.

Disclosure of Interest

None Declared

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of European Psychiatric Association
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