# Expressed emotions and caregiving appraisals among relatives of patients with psychotic disorders: a cross-sectional study

## TL;DR

This study explores how factors like patient health and family support affect emotions and caregiving experiences of relatives of people with psychotic disorders.

## Contribution

The study identifies specific factors influencing caregiving appraisals and expressed emotions in relatives of patients with psychotic disorders.

## Key findings

- Patient's mental health and duration of illness significantly affect relatives' emotional overinvolvement and negative caregiving appraisals.
- Relatives' perceived support from healthcare professionals reduces critical comments and negative caregiving appraisals.
- Household income and patient functioning influence positive caregiving appraisals among relatives.

## Abstract

Relatives’ expressed emotions (EE) and caregiving appraisals are associated with the prognosis of individuals with psychotic disorders as well as relatives’ own well-being. The main aim of the present study was to examine whether sociodemographic factors, patients’ clinical characteristics, relatives’ health and quality of life (QoL), and relatives’ perceived support explained a significant amount of the variance in expressed emotion (EE) and caregiving appraisals among relatives of patients with psychotic disorders.

Baseline data from The Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial were compiled from 231 patient-relative pairs across 15 Community Mental Health Centres (CMHC). Relatives completed assessments on EE; emotional overinvolvement (EOI) and critical comments (CC) (Family Questionnaire), negative and positive caregiving appraisals (Experience of Caregiving Inventory), health and QoL (Care Related Quality of Life), healthcare professional support (Caregiver Well-being and Support) and sociodemographic factors. Patients reported on their own difficulties with mental health and functioning (Behavior and Symptom Identification scale) while clinicians assessed patients’ functioning (Global Assessment of Functioning) and sociodemographic factors. Pearson and Spearman correlations and hierarchical multiple linear regressions were used for statistical analyses.

Duration since first psychosis diagnosis, patients’ mental health and functioning, and relatives’ health problems explained a substantial proportion of variance in relatives’ EOI and negative caregiving appraisals. Together with household income level, duration since first psychosis diagnosis explained a significant amount of the variance in positive caregiving appraisals. Relatives’ perceived support from healthcare professionals explained a significant amount of the variance in CC and negative caregiving appraisals, even after adjusting for contextual variables.

Psychotic disorders entail significant burdens and shape the family climate for both patients and their relatives. Negative caregiving appraisals and EOI may reflect normal reactions to the responsibilities and challenges relatives face. EOI and CC, however, may be associated with distinct factors, necessitating tailored psychoeducational and support interventions. The findings suggest that relatives’ perceived support from healthcare professionals could have a substantial positive impact on CC and negative caregiving appraisals, which is important for clinicians to recognise and address.