title: Do stress and support matter for caring? The role of perceived stress and social support on expressed emotion of carers of persons with first episode psychosis.
abstract: BACKGROUND
  Caring for a person with first episode psychosis (FEP) is a challenging and distressing task for the carers. The carers' stress in the early stage of psychosis can increase their expressed emotion (EE) while social support is hypothesized to decrease EE. However, the influence of stress and social support on carers' EE is not well understood in FEP.
  
  
  OBJECTIVE
  To examine how the stress and social support shape expressed emotion in the carers of FEP.
  
  
  METHODS
  Seventy one carers of the patients with non-affective FEP were recruited from the inpatient psychiatry ward of a tertiary mental health care center in South India. The family questionnaire, perceived stress scale and multidimensional scale of perceived social support were used to measure their EE, stress and social support respectively.
  
  
  RESULTS
  Carers experienced high level of perceived stress, EE and poor social support. Perceived stress significantly increased EE (β=0.834; p<0.001) and social support did not significantly influence EE (β=-0.065; p>0.05). Perceived stress predicted 76 percent of the variance on EE (Adjusted R2=0.761).
  
  
  CONCLUSIONS
  The results emphasize high level of stress and EE in carers of patients with FEP that implies the need for appropriate psychosocial interventions to manage their stress.
authors.affiliation: Institute of Mental Health and Neurosciences, Kozhikode, Kerala 673 008, India. Electronic address: ani00711@yahoo.com.
authors.forename: Anvar
authors.initials: A
authors.lastname: Sadath
authors.affiliation: Department of Psychiatric Social Work, National Institute of Mental Health & Neuro-Sciences, Bangalore, 560 029, India.
authors.forename: D
authors.initials: D
authors.lastname: Muralidhar
authors.affiliation: Department of Psychiatry, National Institute of Mental Health& Neuro-Sciences, Bangalore, 560 029, India.
authors.forename: Shivarama
authors.initials: S
authors.lastname: Varambally
authors.affiliation: Department of Psychiatry, National Institute of Mental Health& Neuro-Sciences, Bangalore, 560 029, India.
authors.forename: B N
authors.initials: BN
authors.lastname: Gangadhar
authors.affiliation: Institute of Development Studies, Kolkata, India.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Jose
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D019260:Expressed Emotion; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000451:nursing*; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D055815:Young Adult
keywords: Carers of psychosis; Expressed emotion; First episode psychosis; Perceived stress