Expressed emotion of families and the course of mood disorders: a cohort study in Japan.
BACKGROUND
Findings on expressed emotion (EE) of the family and the course of mood disorders have not been consistent. There has also been no report on these problems from Asia.


METHODS
The subjects were 32 patients diagnosed to have mood disorders on the basis of DSM-IV and ICD-10 and 36 principal members of their families. EE was evaluated using Camberwell Family Interview (CFI). A cohort study was conducted for 9 months after discharge of the patients. The patients were divided into a high-EE group and a low-EE group using a few cut-off points concerning the number of critical comments (CCs) and emotional over-involvement (EOI), the 9-month relapse risks were compared, and the relapse risk ratio and its 95% confidence interval were calculated. Also, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and the optimal cut-off point was evaluated. Multiple logistic regression analysis was performed to control the effects of potential confounding factors.


RESULTS
When the subjects with three or more CCs, or an EOI score of three or higher were regarded as a high-EE group, and the others as a low-EE group, the nine-month relapse risks were 83.3% (5/6) and 19.2% (5/26), respectively, and the relapse risk ratio (95% confidence interval) was 4.3 (1.8-12.2). The values of the validity parameters were the highest with these cut-off points. The effect of EE was also significant on multiple logistic regression analysis.


CONCLUSIONS
Small sample size and severity of the patients.


CONCLUSIONS
Families' EE based on CFI correlated with relapse also in Japan.
Department of Hygiene and Preventive Medicine, Okayama University Medical School, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. yoshmino@med.okayama-u.ac.jp
Y
Y
Mino
S
S
Shimodera
S
S
Inoue
H
H
Fujita
S
S
Tanaka
S
S
Kanazawa
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019260:Expressed Emotion; D005192:Family Health; D005260:Female; D006801:Humans; D007564:Japan / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000208:ethnology / Q000523:psychology*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012307:Risk Factors