# Expressed Emotions in Families of Patients With Bipolar Disorder

## TL;DR

This study finds that caregivers of bipolar disorder patients in India show high levels of expressed emotions, which are linked to patient illness severity and caregiving duration.

## Contribution

The study provides empirical evidence on expressed emotions in Indian families of bipolar disorder patients and their associations with patient and caregiver factors.

## Key findings

- High expressed emotion levels were observed among caregivers of bipolar disorder patients in India.
- Expressed emotions correlated with caregiver age, years of cohabitation, and patient illness severity.
- Higher expressed emotions were linked to increased hospitalizations and longer hospital stays for patients.

## Abstract

Introduction

Bipolar affective disorder (BPAD) is a chronic psychiatric illness characterized by recurrent episodes of mania, hypomania, and depression, significantly impacting both patients and their caregivers. Expressed emotion (EE), which includes criticism, hostility, and emotional over-involvement, plays a crucial role in caregiver burden and patient outcomes. High EE environments have been linked to increased relapse rates and hospitalization, while low EE settings promote better adherence and stability. In India, where mental healthcare is predominantly family-driven, caregivers experience significant emotional, social, and financial strain. This study evaluates EE among caregivers of BPAD patients in an Indian setting and examines its association with patient and caregiver characteristics.

Methods

A cross-sectional study was conducted among 120 primary caregivers of BPAD patients attending a tertiary care psychiatry outpatient department in Central India. Participants were selected based on specific inclusion and exclusion criteria. The Family Attitude Scale (FAS) was used to assess expressed emotions, while socio-demographic and clinical variables were recorded. Pearson’s correlation coefficient was applied to examine associations between EE and patient characteristics. Data were analyzed using SPSS version 26 (IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05.

Results

Caregivers were predominantly male (72, 60%), married (116, 96.7%), and had an average age of 40.76 ± 13.9 years. The mean FAS score was 67.68 ± 7.4, indicating a high level of expressed emotions. FAS scores showed a significant positive correlation with caregiver age (r = 0.404, p < 0.001) and years of cohabitation (r = 0.239, p = 0.008). Among patients, higher FAS scores were associated with increased illness duration (r = 0.601, p < 0.001), number of hospitalizations (r = 0.433, p < 0.001), and time spent in the hospital (r = 0.306, p = 0.002). These findings indicate that prolonged caregiving and severe patient illness contribute to heightened EE levels.

Conclusion

Caregivers of BPAD patients in India experience high levels of EE, influenced by demographic factors and the severity of the patient’s illness. High levels of expressed emotion observed among caregivers highlight the importance of targeted psychoeducation and family-focused interventions aimed at reducing EE. Addressing EE within families may contribute to improved illness course and reduced relapse risk in patients with bipolar disorder. Future research should explore culturally appropriate strategies to manage EE and strengthen supportive family environments.