Alternative measures of expressed emotion: a methodological and cautionary note

Area of Science:

• Psychiatry
• Clinical Psychology
• Family Studies

Background:

• Expressed emotion (EE) is a measure of the emotional climate within a family environment.
• High EE, particularly criticism and hostility, is linked to relapse in patients with various mental health conditions.
• Assessing EE traditionally involves trained raters, which can be time-consuming and resource-intensive.

Purpose of the Study:

• To investigate the validity of using undergraduate raters to assess expressed emotion (EE) in relatives of depressed patients.
• To determine if undergraduate assessments of EE correlate with trained raters' assessments (concurrent validity).
• To examine if undergraduate assessments of EE predict patient relapse over a 9-month period (predictive validity).

Main Methods:

• Undergraduate students listened to Camberwell Family Interviews of spouses of depressed patients.
• Students used a rating scale to assess relatives' criticism, hostility, emotional overinvolvement, and warmth.
• These ratings were compared with EE assessments made by trained raters and correlated with patient relapse rates.

Main Results:

• Undergraduate ratings of relatives' criticism, hostility, emotional overinvolvement, and warmth showed significant correlations with trained raters' EE assessments.
• Despite concurrent validity, undergraduate assessments of relatives did not predict 9-month relapse rates in depressed patients.

Conclusions:

• While undergraduate raters can achieve concurrent validity in assessing expressed emotion (EE), their ratings lack predictive validity for patient relapse.
• This study underscores the critical need to establish both concurrent and predictive validity for any novel EE assessment method.
• Findings caution against assuming that correlates of EE are necessarily predictors of clinical outcomes like relapse.