title: Cross-cultural validation of expressed emotion in caregivers of Chinese patients with first episode psychosis in Singapore: a qualitative study.
abstract: BACKGROUND
  The concept of Expressed Emotion (EE; Brown et al., 1972), a measure of criticism, over-involvement and hostility in families, has been shown to be a robust predictor of relapse in schizophrenia (Parker & Hadzi-Pavlovic, 1990). Recent criticism of using Western instruments in Asian countries has led to more stringent procedures for validation of scales.
  
  
  OBJECTIVE
  The first aim was to establish that the concept of Expressed Emotion exists in Singapore. The second aim was to examine the Level of Expressed Emotion (LEE; Cole & Kazarian, 1988, Gerlsma & Hale, 1997) scale to ascertain the conceptual and construct operationalisation of this instrument in this culture.
  
  
  METHODS
  This was a qualitative study. The concept of EE was examined using a Singaporean population; 10 patient-caregiver pairs were recruited and interviewed using a semi-structured interview format. Regarding the LEE, small focus-group interviews were conducted with a cross-section of Singaporeans to gain their views on the concepts in the scale and the relevance of the items in this culture.
  
  
  RESULTS
  The interviews were analysed in light of attitudes found to discriminate between high and low EE families (Leff & Vaughn, 1985). A clear distinction between high and low EE groups was found. With regard to the LEE, the data from the focus groups, for the most part, supported the cross-cultural conceptual and operational equivalence of the scale and suggestions for additional items were made.
  
  
  CONCLUSIONS
  There is support for the existence of EE among families in Singapore, and the LEE was found, for the most part, to be applicable in Singapore, with the addition of several emic items.
authors.affiliation: Department of Psychology, National University of Singapore. healey@singnet.com.sg
authors.forename: Frances
authors.initials: F
authors.lastname: Healey
authors.forename: Vicky L M
authors.initials: VL
authors.lastname: Tan
authors.forename: S A
authors.initials: SA
authors.lastname: Chong
mesh_terms: D000328:Adult; D044466:Asian People; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data*; D002681:China / Q000208:ethnology; D003431:Cross-Cultural Comparison; D019260:Expressed Emotion; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000523:psychology*; D015203:Reproducibility of Results; D012846:Singapore; D011795:Surveys and Questionnaires