EXPRESSED EMOTION AND PSYCHIATRIC RELAPSE - A METAANALYSIS

Background: Expressed emotion (EE) is a measure of the family environm ent that has been demonstrated to be a reliable psychosocial predictor of relapse in schizophrenia. However, in recent years some prominent nonreplications of the EE-relapse relationship have been published. To more fully address the question of the predictive validity of EE, we conducted a meta-analysis of all available EE and outcome studies in s chizophrenia. We also examined the predictive validity of the EE const ruct for mood disorders and eating disorders. Methods: An extensive li terature search revealed 27 studies of the EE-outcome relationship in schizophrenia. Using meta-analytic procedures, we combined the finding s of these investigations to provide an estimate of the effect size as sociated with the EE-relapse relationship. We also used meta-analysis to provide estimates of the effect sizes associated with EE for mood a nd eating disorders. Results: The results confirmed that EE is a signi ficant and robust predictor of relapse in schizophrenia. Additional an alyses demonstrated that the EE-relapse relationship was strongest for patients with more chronic schizophrenic illness. Interestingly, alth ough the EE construct is most closely associated with research in schi zophrenia, the mean effect sizes for EE for both mood disorders and ea ting disorders were significantly higher than the mean effect size for schizophrenia. Conclusion: These findings highlight the importance of EE in the understanding and prevention of relapse in a broad range of psychopathological conditions.