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Association Between Expressed Emotion and Relapse of Bipolar Disorder: A Systematic Review.
Sum Yu Tong1, Moses Chung Hei Dye1, Anthony Ho Tsun Yue2
1School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
Alpha Psychiatry
|July 8, 2026
Summary
High expressed emotion (EE) is linked to increased relapse risk in bipolar disorder (BD). This includes depressive episodes, critical comments, and emotional over-involvement, suggesting a need for family-based interventions.
Area of Science:
- Psychiatry
- Mental Health Research
- Clinical Psychology
Background:
- Expressed emotion (EE) is a known predictor of relapse in schizophrenia.
- Evidence linking EE to relapse in bipolar disorder (BD) requires further examination.
- This systematic review addresses the association between EE and relapse in BD.
Purpose of the Study:
- To systematically review and synthesize existing evidence on the relationship between expressed emotion and relapse in bipolar disorder.
- To provide an updated understanding of how EE impacts BD relapse rates.
Main Methods:
- Systematic search of seven databases and two registries.
- Critical appraisal of included studies using Joanna Briggs Institute checklists.
- Narrative synthesis of findings focusing on global EE and its subdomains' impact on BD relapse.
Main Results:
- Seven studies were included after reviewing 2963 records.
- Most studies had a low risk of bias.
- High EE, particularly critical comments and emotional over-involvement, significantly increases the risk of BD relapse, especially depressive episodes.
Conclusions:
- A potential association exists between high EE and relapse in BD.
- Findings support the development of family-based interventions for BD.
- Further large-scale, longitudinal studies are needed to confirm the EE-BD relapse relationship.
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