A. Okasha et al., EXPRESSED EMOTION, PERCEIVED CRITICISM, AND RELAPSE IN DEPRESSION - AREPLICATION IN AN EGYPTIAN COMMUNITY, The American journal of psychiatry, 151(7), 1994, pp. 1001-1005
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.