Expressed emotion and short-term treatment outcome of outpatients with major depression

Expressed emotion (EE) is the attitude of criticism and emotional overinvolvement of a key relative toward a patient, and is one of the family factors that contribute to the course of psychiatric illness. The relationship between EE and 6-month outcome in 40 outpatients with major depression was investigated in this study. In the nonremission group (n = 17, 43.7%), there was a higher prevalence of past history of depression (P < .01) and high-EE relatives (P < .05) than in the remission group (n = 23). On an EE profile based on a Five-Minute Speech Sample (FMSS), 15.0% (n = 6) of the cases were high-EE: three were rated as emotional overinvolvement (EOI), two as critical, and one as EOI and critical. On the critical subscale, the rate of nonremission increased gradually in response to the level of criticism (from pure low-EE, to borderline-Critical [b-critical], and then to high-critical). Multiple logistic regression analysis showed that the level of criticism and a past history of depression were significant predictors of poor outcome (P < .05). These results indicate that criticism from family members may be one factor that prolongs depressive episodes.