The Influence of Expressed Emotion, Family Dynamics, and Symptom Type on the Social Adjustment of Schizophrenic Young Adults

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Abstract
Background: The goal of this study was to test a path analytic model that reflects the hypothesis that family cohesion and family adaptability underlie family members' expressed emotion (critical comments and emotional overinvolvement), that these family variables underlie the preponderance of positive symptoms in a patient with schizophrenia 9 months after relatives are interviewed, and that all of these variables influence the patient's social adjustment at follow-up. Methods: The subjects were 69 patients who met the DSM-III-R criteria for schizophrenia and 108 of their relatives. Relatives were assessed with the Camberwell Family Interview and the Family Adaptability and Cohesion Evaluation Scales III. Patients were interviewed 9 months later with the Brief Psychiatric Rating Scale and the Social Adjustment Scale II. Results: Significant amounts of variance were explained by the model for three of the five social adjustment components. Neither family cohesion nor adaptability was associated with either critical comments or emotional overinvolvement. Family cohesion was negatively associated and emotional overinvolvement was positively associated with a preponderance of positive symptoms. Greater family adaptability was associated with lower social adjustment scores, and greater emotional overinvolvement was associated with higher social adjustment. Cohesion had a significant positive indirect effect on social adjustment through its association with symptom type. Conclusions: Critics of expressed emotion will be pleased to see that one component of high expressed emotion (emotional overinvolvement) is actually associated with a better social outcome in patients. Proponents of the expressed emotion concept will be pleased to see the applicability of expressed emotion to other facets of schizophrenic outcome. The results highlight the importance of using the expressed emotion scales in their continuous rather than dichotomized state and of analyzing critical comments and emotional overinvolvement separately.