Understanding Caregiving Processes in South Asian Families: Relationship between caregiver EE and clinical outcomes in first episode

Background: Expressed Emotion (EE) measures the quality of significant relationships in the family environment. High EE is considered to precipitate relapse in people with psychosis and thus is a target for intervention. However, research has questioned the cross-cultural validity of EE. Understanding EE within the South Asian population may lead to developments in interventions that better suit this population. Aims: The current study aims to explore EE characteristics of South Asian families in the presence of a first episode of psychosis (FEP) and whether there is a relationship between caregiver EE and clinical outcomes. Methods: Caregivers and individuals with FEP known to several Early Intervention in Psychosis Services were recruited. Clinical outcomes were collected for service users and caregiver EE was assessed using various measures of EE. The general profile of EE was examined using descriptive statistics. The relationship between caregiver EE and service user clinical outcomes was examined using correlation analyses and Mann-Whitney U tests. Results: The EE profile of the sample was dependent on which measure of EE was used. The Level of Expressed Emotion showed a 50% split in terms of high and low EE, whereas the Family Questionnaire categorised 68% of the sample as low-EE and 32% as high-EE. There were no significant relationships found between caregiver EE on a domain level or broader (high/low) level and clinical outcomes. Conclusion: This study adds to the existing argument that the current conceptualisation of EE may not be universally associated with poor outcomes for psychosis. The clinical and research implications for this are discussed, with consideration of the limitations of this study