Relatives׳ illness attributions mediate the association of expressed emotion with early psychosis symptoms and functioning.
The mechanisms underlying the association between expressed emotion (EE) and the prognosis in early psychosis are still not well understood. Based on the attributional model, this study investigated the association of criticism and Emotional Over-Involvement (EOI) with symptoms and functioning in At-Risk Mental State (ARMS) and First-Episode Psychosis (FEP) patients, and whether these associations were mediated by relatives׳ attributions of control and blame. Forty-four patients (20 ARMS and 24 FEP) and their relatives were included. Findings indicated that relatives׳ criticism was associated with positive, negative, and general symptoms. EOI was related to negative and general symptoms. Both indices were related with impaired functioning. Most of the relations between EE indices and illness severity were mediated by relatives׳ attributions of blame toward the patient. Relatives׳ self-blaming attributions and attributions of control over the disorder by either relatives or patients were not associated with patients׳ variables or EE. Findings highlight the importance of family emotional environment in the early stages of psychosis, as well as the mediating role that relatives׳ beliefs can exert in those relationships. Family interventions aimed to assist relatives to change attributions that blame patient should be included in clinical protocols in order to prevent the entrenchment of high-EE.
Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico; Coordinación de Investigación Científica, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico.
Tecelli
T
Domínguez-Martínez
Departamento de Psicología Biológica y de la Salud, Universidad Autónoma de Madrid, Madrid, Spain.
Cristina
C
Medina-Pradas
Department of Psychology, University of North Carolina at Greensboro, Greensboro, USA.
Thomas R
TR
Kwapil
Department of Psychology, University of North Carolina at Greensboro, Greensboro, USA; Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Spain; Departament de Salut Mental, Sant Pere Claver-Fundació Sanitària. Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain. Electronic address: neus.barrantes@uab.cat.
Neus
N
Barrantes-Vidal
D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology; D003469:Culture; D019260:Expressed Emotion; D005190:Family / Q000523:psychology*; D005195:Family Relations; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000523:psychology*; D055815:Young Adult
At-Risk Mental States; Criticism; Early psychosis; Emotional Over-Involvement; Family; First-Episode Psychosis; Illness perceptions