title: Guilt, shame and expressed emotion in carers of people with long-term mental health difficulties: A systematic review.
abstract: Expressed emotion (EE) is a global index of familial emotional climate, whose primary components are emotional over-involvement (EOI) and critical comments (CC)/hostility. There is a strong theoretical rationale for hypothesising that carers' guilt and shame may be differentially associated with their EOI and CC/hostility respectively. This systematic review investigates the magnitude of these theorised associations in carers of people with long-term mental health difficulties. Electronic searches (conducted in May 2016 across Medline, CINAHL, Embase, PsycINFO and ProQuest) were supplemented with iterative hand searches. Ten papers, reporting data from eight studies, were included. Risk of bias was assessed using a standardised checklist. Relevant data were extracted and synthesised narratively. EOI was positively associated with both guilt and shame, whereas CC/hostility was positively associated with shame. The strength of associations varied depending on whether or not guilt and shame were assessed within the context of the caring relationship. Based on these data, an argument can be made for the refinement, development and evaluation of systemic and individual interventions designed to target carers' guilt and shame. However, more research is needed to clarify the strength of these associations and their direction of effect before firm conclusions can be drawn.
authors.affiliation: Division of Clinical Psychology, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK. Electronic address: gcherry@liv.ac.uk.
authors.forename: Mary Gemma
authors.initials: MG
authors.lastname: Cherry
authors.affiliation: Division of Clinical Psychology, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK. Electronic address: peter.taylor-2@manchester.ac.uk.
authors.forename: Peter James
authors.initials: PJ
authors.lastname: Taylor
authors.affiliation: Department of Psychological Sciences, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK. Electronic address: s.l.brown@liv.ac.uk.
authors.forename: Stephen Lloyd
authors.initials: SL
authors.lastname: Brown
authors.affiliation: Mersey Care NHS Trust, V7 Building, Kings Business Park, Prescot, Liverpool L34 1PJ, UK.
authors.forename: Jake Wilfred
authors.initials: JW
authors.lastname: Rigby
authors.affiliation: Division of Health Research, Furness Building, University of Lancaster, Bailrigg, Lancaster LA1 4YW, UK. Electronic address: b.sellwood@lancaster.ac.uk.
authors.forename: William
authors.initials: W
authors.lastname: Sellwood
mesh_terms: D017028:Caregivers / Q000523:psychology*; D004644:Emotions; D019260:Expressed Emotion; D006167:Guilt; D006791:Hostility; D006801:Humans; D001523:Mental Disorders; D008603:Mental Health; D012752:Shame
keywords: Clinical psychology; Critical comments; Emotional over-involvement; Family interventions; Hostility; Systemic practice