A study on the concurrent and predictive validity of the concise Chinese level of expressed emotion scale in Chinese persons with schizophrenia

Abstract

Expressed Emotion (EE) is a robust psychosocial indicator that has a significant association with schizophrenic relapse. The original measurement of EE is by Camberwell Family Interview (CFI) which has long been criticized for being too time-consuming and inconvenient to administer. Many alternative measuring tools have been developed to expand the use of EE concept in academic and clinical settings. The Concise Chinese Level of Expressed Emotion (CCLEE) scale is developed to measure EE in the local Hong Kong context. It stems from the original EE concept which evolved into the Level of Expressed Emotion (LEE) scale, translated into the Chinese Level of Expressed Emotion scale and then consolidated into the CCLEE scale. Being a short scale of only 12 items, and without requirements on the training of the raters and cooperation of the relatives as in CFI, the CCLEE promises a swift and convenient measurement of EE.

This study is targeted at validating this CCLEE scale, particularly in its concurrent validity with CFI and predictive validity on schizophrenic relapse for 12 months, by quantitative analysis. Valid measurements included 101 CCLEE and 10 pairs of CFI and CCLEE scores. Confirmatory Factor Analysis revealed a robust factor structure and excellent psychometric properties of the scale. The Optimal Cut-off Point for differentiating high EE from the low was examined with the criterion to achieve best predictive power and odds ratio on schizophrenic relapse. Statistical analysis showed a significant concurrent validity with CFI (p = 0.033) and significant predictive validity (p = 0.0015) of schizophrenic relapse with a high odds ratio of 6.3000 (p = 0.0019).

Limitation of this study included a not very large sample size for CCLEE and a small size for CFI, subjects not aligned in their illness course, an overall lower percentage of EE and a lower relapse rate when compared with other studies. Despite these limitations, the present study has confirmed that the CCLEE is a valid and reliable tool to measure EE and to predict schizophrenic relapse. The scale is suitable for use in clinical and social work settings, possibly in screening patients for early intervention and relapse prevention, as well as outcome measurement in psychosocial interventions.