The low prevalence of high levels of expressed emotion in Bali

The present study contrasts the expressed emotion (EE) status in family members of schizophrenic patients between Bali (Indonesia) and Tokyo (Japan), the former being a non-industrialized society and the latter an industrialized society in Asia. The EE ratings of each key relative for 62 consecutively hospitalized schizophrenic patients at the Bangli State Mental Hospital (Bali) and 33 consecutively admitted schizophrenics at Komagino Hospital (Tokyo) were obtained using the Five Minute Speech Sample (FMSS) method. A significantly lower prevalence of high EE (12.9%) was observed in Bali compared with Tokyo (36.4%) (P<0.01). This result may explain the better social adjustment of schizophrenics in Bali. In addition, in Bali, to clarify the EE effect in this non-industrialized society, we examined the relationship between each key relative's EE and the patient's psychotic symptoms at admission, as assessed by the Brief Psychiatric Rating Scale (BPRS) and the Scales for the Assessment of Negative Symptoms (SANS). Moreover, the association between each family member's EE and a patient's rate of re-admission over the 1-year period following discharge was evaluated. The EE value was significantly related to the anxious-depression factor score in the BPRS, but not to either of the other factor scores in the BPRS or SANS subscales. Furthermore, EE status was not a reliable predictor of patient re-admission over the 1-year period following discharge in Bali.