A concise self-report scale can identify high expressed emotions and predict higher relapse risk in schizophrenia

Abstract

Purpose: Although high expressed emotions (EE) is one of the most significant predictors for schizophrenic relapse, the assessment of EE is often impeded by the demanding Camberwell Family Interview (CFI) that is required to be conducted by specifically trained staff. To enable a more efficient assessment of EE, we developed the 12-item Concise Chinese Level of Expressed Emotion Scale (CCLEES) and reported its predictive and concurrent validity in this study. Methods: A one-year prospective study design was adopted. Totally 101 participants diagnosed with schizophrenia were recruited from the department of psychiatry of a major acute hospital in Hong Kong. CCLEES was administered and subsequent relapse information was collected from all participants. At baseline, 10 family members of the participants were also administered CFI. Results: Participants who scored above the optimal cut-off point (Score 13 on Criticism, and/or 13 on Hostility, and/or 15 on emotional over-involvement) showed a 6.3 times elevated 12-month schizophrenic relapse rate compared to those who scored below cut-off. The CCLEES also demonstrated excellent correspondence with CFI, the widely-recognized golden benchmark of EE assessment. Conclusions: The results support the CCLEES as a brief and psychometrically sound self-report measurement for EE in Chinese people with schizophrenia. Keywords: schizophrenia; expressed emotion; relapse; psychological testing; predictive validity