Am J Psychiatry 1994; 151:1001-1005
Copyright © 1994 by American Psychiatric Association
Expressed emotion, perceived criticism, and relapse in depression: a replication in an Egyptian community
A Okasha, AS el Akabawi, KS Snyder, AK Wilson, I Youssef and AS el Dawla
Department of Neuropsychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
OBJECTIVE: The aims of this study were to determine the value of families'
expressed emotion and patients' perception of family criticism in
predicting relapse in Egyptian depressed patients and to evaluate
transcultural differences in assessment of these measures. METHOD: The
subjects were 32 consecutive depressed patients from psychiatric clinics in
Cairo and Ismailia, Egypt, who fulfilled the DSM- III-R criteria for major
depression or bipolar disorder. An Arabic version of the Camberwell Family
Interview was administered to key relatives of the depressed patients.
Rating of expressed emotion was performed blindly by a qualified rater to
assess levels of criticism, hostility, emotional overinvolvement, warmth,
and positive remarks. Patient perception of family criticism (perceived
criticism) was also assessed. All patients were followed up for 9 months to
assess relapse and compliance with treatment. RESULTS: The relation of
family criticism to relapse was statistically significant. Although this
result replicates previous findings, the criticism level that best
differentiated relapsers and nonrelapsers was a score of 7, which is much
higher than previously reported in Western studies. This relation was not
observed for other expressed emotion components. Also, no association
between perceived criticism and relapse was detected. CONCLUSIONS:
Expressed emotion is a prognostic factor that should be assessed with
consideration of the specific culture and intrafamilial patterns. The use
of perceived criticism in the prediction of relapse in depression is
questionable. There is a need for a simplified, less time-consuming
assessment tool that takes cross-cultural differences and specificities
into consideration.
