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Family interaction and the course of schizophrenic illness. Results of a multivariate prospective study
K Stricker1, H Schulze Mönking, G Buchkremer
1St. Rochus Hospital, Telgte, Germany.
Abstract:
The aim of the present study was to assess the prognostic relevance of relatives' interactive behaviour towards the patient, as covered by the Münster Family Interview (MFI), to the further course of the schizophrenic illness. The MFI is a family interview (of the whole family, including the patient) designed to record the emotional family atmosphere based on the concept of expressed emotion (EE). The ratings take place directly after the interview on five scales (criticism, hostility, overinvolvement, resignation and warmth), the resignation scale being added to the 'classic' EE scales. Ninety-nine families of outpatients diagnosed with schizophrenia according to the DSM-III were examined with the MFI during a home visit. The patients were seen 1 and 2 years after the first examination. The target criteria selected for the prognostic significance of the interaction measurements were: rehospitalisation within 2 years; extent of symptoms after 1 year, and psychosocial skills after 1 year. The significance of the interaction dimensions was verified in regression models. The control variable used in the regression models was the Strauss-Carpenter scale. Regression models were produced for the total group and for a subgroup of moderately ill patients. All target criteria yielded serviceable prediction models. The most important variable for prediction was the control variable, the Strauss-Carpenter scale. However the interaction variables made additional contributions to the prognosis, especially in the subgroup of moderately ill patients. The best MFI scale for all the outcome criteria was resignation; criticism predicted only the symptomatology, and emotional overinvolvement the level of social functioning after 1 year. In conclusion, practical work with families of schizophrenic patients should emphasise the protective function of relatives towards patients more strongly.
Insights
Family interactions significantly impact schizophrenia prognosis. Relatives' resignation was the strongest predictor, highlighting the need to emphasize their protective role in patient care.
Area of Science:
- Psychiatry and Clinical Psychology
- Family Studies
- Mental Health Research
Background:
- Schizophrenia prognosis is influenced by various factors, including patient-related and environmental elements.
- Family dynamics and expressed emotion (EE) are recognized as significant contributors to the course of schizophrenia.
- The Münster Family Interview (MFI) assesses family emotional atmosphere using EE concepts, including criticism, hostility, overinvolvement, resignation, and warmth.
Purpose of the Study:
- To evaluate the prognostic relevance of relatives' interactive behavior, as measured by the MFI, on the long-term course of schizophrenia.
- To determine the predictive power of specific MFI scales (criticism, hostility, overinvolvement, resignation, warmth) for schizophrenia outcomes.
- To assess the additional predictive contribution of family interaction variables beyond established prognostic indicators.
Main Methods:
- Ninety-nine families of outpatients diagnosed with schizophrenia (DSM-III) were assessed using the MFI during home visits.
- Patient outcomes, including rehospitalization, symptom severity, and psychosocial functioning, were assessed at 1 and 2 years post-initial evaluation.
- Regression models were employed to analyze the significance of MFI dimensions, with the Strauss-Carpenter scale used as a control variable.
Main Results:
- All target criteria (rehospitalization, symptoms, psychosocial skills) yielded serviceable prediction models.
- The Strauss-Carpenter scale was the most significant predictor overall, but MFI variables provided additional prognostic value, particularly for moderately ill patients.
- Resignation was the most effective MFI scale across all outcome criteria; criticism predicted symptomatology, and emotional overinvolvement predicted social functioning.
Conclusions:
- Family interaction variables, especially resignation, offer valuable prognostic insights into schizophrenia's course.
- The study underscores the importance of relatives' protective functions and suggests emphasizing these in clinical practice with families of schizophrenic patients.
- Targeted interventions focusing on family dynamics may improve outcomes for individuals with schizophrenia, particularly those with moderate illness severity.