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The predictive power of expressed emotion and its components in relapse of schizophrenia: a meta-analysis and meta-regression

Published online by Cambridge University Press:  11 February 2021

Chak Fai Ma ,
Sherry Kit Wa Chan Open the ORCID record for Sherry Kit Wa Chan [Opens in a new window] ,
Yik Ling Chung ,
Siu Man Ng ,
Christy Lai Ming Hui ,
Yi Nam Suen  and
Eric Yu Hai Chen
Chak Fai Ma
Affiliation:
Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR Department of Psychiatry, Kwai Chung Hospital, Hong Kong SAR
Sherry Kit Wa Chan*
Affiliation:
Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
Yik Ling Chung
Affiliation:
Department of Psychiatry, Kowloon Hospital, Hong Kong SAR
Siu Man Ng
Affiliation:
Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR
Christy Lai Ming Hui
Affiliation:
Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
Yi Nam Suen
Affiliation:
Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
Eric Yu Hai Chen
Affiliation:
Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
*
Author for correspondence: Sherry Kit Wa Chan, E-mail: [email protected]
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Abstract

Background

Schizophrenia is a longstanding condition and most patients experience multiple relapse in the course of the condition. High expressed emotion (HEE) has been found to be a predictor of relapse. This meta-analysis and meta-regression examined the association of global EE and relapse specifically focusing on timing of relapse and EE domains.

Methods

Random-effects model was used to pool the effect estimates. Multiple random-effects meta-regression was used to compute the moderator analysis. Putative effect moderators including culture, EE measurements, age, length of condition and study quality were included.

Results

Thirty-three prospective cohort studies comprising 2284 patients were included in the descriptive review and 30 studies were included for meta-analysis and meta-regression. Findings revealed that global HEE significantly predicted more on early relapse (⩽12 months) [OR 4.87 (95% CI 3.22–7.36)] than that on late relapse (>12 months) [OR 2.13 (95% CI 1.36–3.35)]. Higher level of critical comments (CC) significantly predicted relapse [OR 2.22 (95% CI 1.16–4.26)], whereas higher level of warmth significantly protected patients from relapse [OR 0.35 (95% CI 0.15–0.85)]. None of the moderators included significantly change the results.

Conclusions

These findings indicate that there is a dynamic interaction between EE-relapse association with time, and CC and warmth are the two important EE domains to influence relapse among patients with schizophrenia. Results also confirmed the foci of family interventions on reducing CC and improving warmth in relationship.

Keywords

Express emotionfamily caregiverpsychosisrelapse
Type
Review Article
Information
Psychological Medicine , Volume 51 , Issue 3 , February 2021 , pp. 365 - 375
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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