EXPRESSED EMOTION, PERCEIVED CRITICISM, AND RELAPSE IN DEPRESSION - AREPLICATION IN AN EGYPTIAN COMMUNITY

Objective: The aims of this study were to determine the value of famil ies' expressed emotion and patients' perception of family criticism in predicting relapse in Egyptian depressed patients and to evaluate tra nscultural differences in assessment of these measures. Method: The su bjects were 32 consecutive depressed patients from psychiatric clinics in Cairo clad Ismailia, Egypt, who fulfilled the DSM-III-R criteria f or major depression or bipolar disorder. An Arabic version of the Camb erwell Family Interview was administered to key relatives of the depre ssed patients. Rating of expressed emotion was Performed blindly by a qualified rater to assess levels of criticism, hostility, emotional ov erinvolvement, warmth, and positive remarks. Patient perception of fam ily criticism (perceived criticism) was also assessed. All patients we re followed up for 9 months to assess relapse and compliance with trea tment. Results: The relation of family criticism to relapse was statis tically significant. Although this result replicates previous findings , the criticism level that best differentiated relapsers and nonrelaps ers was a score of 7, which is much higher than previously reported in Western studies. This relation was not observed for other expressed e motion components. Also, no association between perceived criticism an d relapse was detected. Conclusions: Expressed emotion is a prognostic factor that should be assessed with consideration of the specific cul ture and intrafamilial patterns. The use of perceived criticism in the Prediction of relapse in depression is questionable. There is a need for a simplified, less time-consuming assessment tool that takes cross -cultural differences and specificities into consideration.