Abstract:

Expressed emotion (EE) is a robust predictor of relapse in schizophrenia but research suggests that its effect varies cross culturally. The following study assessed whether acculturation moderates the relationship between expressed emotion (including its specific indices of criticism, emotional overinvolvement [EOI] and warmth) and relapse for Mexican-Americans receiving outpatient treatment. Additionally, the authors tested whether the patient's acculturation moderates the relationship between expressed emotion and symptom trajectory over time. The results indicate the association of global EE and relapse was moderated by acculturation such that EE was increasingly related to relapse as the patient's Mexican enculturation decreased. When considering the specific indices, EOI was the only independent predictor of relapse. As for symptom trajectory, global EE was positively correlated as the patient's U.S. acculturation increased. Criticism was the only index associated with symptom trajectory, specifically with a steeper positive slope trajectory. Our findings indicate that EE's relationship to outcome can vary given the family's sociocultural context. In addition, the results suggest that the specific EE indices may be differentially related to the clinical outcomes of relapse and symptom trajectory. These findings advance our understanding of the sociocultural context and how family factors relate to clinical outcomes and can serve to inform the cultural adaptation of family treatments for schizophrenia.