Skip to main content

Advertisement

Log in

Discrepant illness perceptions, affect and expressed emotion in people with psychosis and their carers

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Illness perception, a measure of illness representations developed from physical medicine, has recently been applied to psychosis. We investigated how illness perceptions relate to affect and expressed emotion (EE) in carer-patient dyads, particularly if their perceptions differed.

Method

We interviewed 82 carer-patient dyads, after a relapse of psychosis. Carers were assessed for illness perceptions, distress, self-esteem and EE; patients for illness perceptions, depression, anxiety and self-esteem, in a cross sectional study.

Results

Carers were more pessimistic than patients about illness persistence and consequences, and carers with low mood were particularly pessimistic about persistence and controllability. Discrepant views about illness consequences were related to greater anxiety, depression, and lower self-esteem in patients, while discrepant views on controllability were associated with greater distress, depression, and lower self-esteem in carers. Illness perceptions did not relate directly to EE.

Conclusions

In this sample, meta-cognitive carer representations of illness in psychosis are related to negative affective reactions in carers, but not to EE. Resolving discrepant illness perceptions between carers and patients might provide a way of improving family reactions to the health threat of psychosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Addington D, Addington J, Maticka-Tyndale E (1993) Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psych 163(s22):39–44

    Google Scholar 

  2. Addington J, McCleery A, Addington D (2005) Three-year outcome of family work in an early psychosis program. Schizophrenia Res 79:107–116

    Article  Google Scholar 

  3. Addington J, Burnett P (2004) Working with families in the early stages of psychosis. In: Gleeson JFM, McGorry PD (eds) Psychological interventions for early psychosis. Wiley and Sons, Chichester

  4. Anderson C, Reiss D, Hogarty GE (1986) Schizophrenia in the family: a practical guide. Guilford Press, New York

    Google Scholar 

  5. Barrowclough C, Lobban F, Hatton C, Quinn J (2001) Investigation of models of illness in carers of schizophrenic patients using the Illness Perception Questionnaire. Br J Clin Psychol 40:371–385

    Article  PubMed  CAS  Google Scholar 

  6. Barrowclough C, Tarrier N, Humphreys L, Ward J, Gregg L (2003) Self-esteem in schizophrenia: Relationships between self-evaluation, family attitudes, and symptomatology. J Abnorm Psychol 112/1:92–99

    Article  Google Scholar 

  7. Barrowclough C, Hooley JM (2003) Attributions and expressed emotion: a review. Clin Psychol Rev 23(6):849–880

    Article  PubMed  Google Scholar 

  8. Barrowclough C, Tarrier N (1992) Families of schizophrenic patients: cognitive behavioural intervention. Chapman & Hall, London

    Google Scholar 

  9. Bebbington P, Kuipers L (1994) The predictive utility of EE in schizophrenia: an aggregate analysis. Psychol Med 24:707–718

    Article  PubMed  CAS  Google Scholar 

  10. Beck AT, Epstein N, Brown G, Steer R (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consulting Clin Psychol 56:893–897

    Article  CAS  Google Scholar 

  11. Beck AT, Steer RA, Brown GK (1996) BDI-II Manual. The psychological corporation, San Antonia

    Google Scholar 

  12. Bentsen H, Boye B, Munkvoid OG, et al. (1996) Emotional overinvolvement in parents of patients with schizophrenia or related psychosis: demographic and clinical predictors. Br J Psych 169:622–630

    CAS  Google Scholar 

  13. Birchwood M, Iqbal Z, Chadwick P, Trower P (2000) Cognitive approach to depression and suicidal thinking in psychosis: I Ontogeny of post-psychotic depression. Br J Psych 177:516–528

    Article  CAS  Google Scholar 

  14. Brewin CR, MacCarthy B, Duda K, Vaughn CE (1992) Attribution and expressed emotion in the relatives of patients with schizophrenia. J Abnorm Psychol 101(2):313

    Google Scholar 

  15. Bustillo JR, Lauriello J, Horan WP, Keith SJ (2001) The psychosocial treatment of schizophrenia: an update. Am J Psych 158:163–175

    Article  CAS  Google Scholar 

  16. Butzlaff RL, Hooley JM (1998) Expressed emotion and psychiatric relapse: a meta-analysis. Arch General Psych 55:547–552

    Article  CAS  Google Scholar 

  17. Cuijpers P, Stam H (2000) Burnout among relatives of psychiatric patients attending psychoeducational support groups. Psychiatric Services 51(3):375–379

    Article  PubMed  CAS  Google Scholar 

  18. Falloon IRH (1985) Family management of schizophrenia. John Hopkins University Press, Baltimore

    Google Scholar 

  19. Figueiras MJ, Weinman J (2003) Do similar patient and spouse perceptions of myocardial infarction predict recovery? Psychol Health 18(2):201–216

    Article  Google Scholar 

  20. Foldemo A, Gullberg M, Ek AC, Bogren L (2005) Quality of life and burden in parents of outpatients with schizophrenia. Social Psych Psychiatric Epidemiol 40(2):133–138

    Article  Google Scholar 

  21. Fortune DG, Smith JV, Garvey K (2005) Perceptions of psychosis, coping, appraisals, and psychological distress in the relatives of patients with schizophrenia: An exploration using self-regulation theory. Br J Clin Psychol 44:319–331

    Article  PubMed  Google Scholar 

  22. Goldberg DP, Williams P (1988) A user’s guide to the General Health Questionnaire. NFER Nelson, Windsor

    Google Scholar 

  23. Haggar M, Orbell S (2003) A meta-analytic review of the common-sense model of illness representations. Psychol Health 18(2):141–184

    Article  Google Scholar 

  24. Heijmans M, de Ridder D, Bensing J (1999) Dissimilarity in patients, and spouses representations of chronic illness; exploration of relations to patient adaption. Psychol Health 14(3): 451–466

    Google Scholar 

  25. Jolley S, Garety PA (2004) Insight and delusions: a cognitive psychological approach. In: Amador X, David A (eds) Chapter in insight and psychosis, 2nd edn. OUP, Oxford

  26. Kay SR (1991) Positive and negative syndromes in schizophrenia: assessment and research. Brunner/Mazel, New York, NY, USA

    Google Scholar 

  27. Kuipers E, Leff J, Lam D (2002) Family work for schizophrenia: a practical guide, 2nd edn. Gaskell Press, London

    Google Scholar 

  28. Kuipers E, Bebbington P, Dunn G, Fowler D, Freeman D, Watson P, Hardy A, Garety P (2006) The influence of carer expressed emotion and affect on relapse in non-affective psychosis. Br J Psych 188: 173–179

    Article  CAS  Google Scholar 

  29. Leventhal H, Nerenz DR, Steele DF (1984) Illness representations and coping with health threats. In: Baum A, Singer J (eds) Handbook of psychology and health vol IV, Erlbaum, Hillsdale, NJ

  30. Lobban F, Barrowclough C, Jones S (2003) A review of the role of illness models in severe mental illness. Clin Psychol Rev 23:171–196

    Article  PubMed  Google Scholar 

  31. Lobban F, Barrowclough C, Jones S (2004) The impact of beliefs about mental health problems and coping on outcome in schizophrenia. Psychol Med 37(7):1165–1174

    Article  Google Scholar 

  32. Lobban F, Barrowclough C, Jones S (2006) Does expressed emotion need to be understood within a more systemic framework? An examination of discrepancies in appraisals between patients diagnosed with schizophrenia and their relatives. Social Psych Psychiatric Epidemiol 41: 50–55

    Article  Google Scholar 

  33. Lysaker PH, Davis LW, Lightfoot J, Hunter N, Stasburger A (2005) in press. Association of neurocognition, anxiety, positive and negative symptoms with coping preference in schizophrenia spectrum disorders. Schizophrenia Research 80:163–171

    Google Scholar 

  34. Magliano L, Fiorillo A, De Rosa C, Maj M (2006) Family burden and social network in schizophrenia vs. physical diseases: preliminary results from an Italian national study. Acta Psychiatrica Scandinavica 113(Suppl 429):60–63

    Article  Google Scholar 

  35. NICE (National Institute for Clinical Excellence) (2003) Schizophrenia; full National Clinical Guideline for schizophrenia. Gaskell Press

  36. Patterson P, Birchwood M, Cochrane R (2005) Expressed emotion as an adaptation to loss. Prospective study in first-episode psychosis. Br J Psych 187(48):s59-s64

    Article  Google Scholar 

  37. Pitschel-Walz G, Leucht S, Bauml J, Kissling W, Engel RR (2001) The effect of family interventions on relapse and rehospitalization in schizophrenia–a meta-analysis. Schizophrenia Bull 27(1):73–92

    CAS  Google Scholar 

  38. Richards HL, Fortune DG, Chong SLP, Mason DL, Sweeney SKT, Main CJ, Griffiths CEM, et al. (2004) Divergent beliefs about psoriasis are associated with increased psychological distress. J Investigative Dermatol 123:49-56

    Article  CAS  Google Scholar 

  39. Rosenberg M (1965) Society and the adolescent self-image. Princeton University Press, Princeton

    Google Scholar 

  40. Scazufca M, Kuipers E (1996) Links between EE and burden of care in relatives of patients with schizophrenia. Br J Psych 168:580–587

    CAS  Google Scholar 

  41. Scazufca M, Kuipers E (1999) Coping strategies in relatives of people with schizophrenia before and after psychiatric admission. Br J Psych 174:154–158

    Article  CAS  Google Scholar 

  42. Tennakoon L, Fannon D, Doku V, Santamaria M, O’Ceallaigh Kuipers E, Sharma T (2000) The experience of caregiving: relatives of first episode psychotic people. Br J Psych 117:529–533

    Article  Google Scholar 

  43. Thompson SC, Pitts JS (1992) In sickness and in health: chronic illness, marriage, and spousal care-giving. In: Spacapan S, Oskamp S (eds) Helping and being helped: naturalistic studies. Sage publications, Newbury Park, pp 115–151

    Google Scholar 

  44. Vaughn CE, Leff J (1976) The influence of family and social factors on the course of psychiatric illness. Br J Psych 129:125–137

    Article  CAS  Google Scholar 

  45. Watson P (2006) The role of illness perception in psychosis. Unpublished PhD thesis, University of London

  46. Wearden AJ, Tarrier N, Barrowclough C (2000) A review of expressed emotion research in health care. Clin Psychol Rev 20(5):633–666

    Article  PubMed  CAS  Google Scholar 

  47. Weinman J, Petrie K, Moss-Morris R, Horne R (1996) The illness perception questionnaire: a new method for assessing the cognitive representation of illness. Psychol Health 11:431–445

    Google Scholar 

  48. Weinman J, Heijmans M, Figueiras M (2003) Carer perceptions in chronic illness. In: Cameron LD, Leventhal H (eds) The self-regulation of Health and Illness Behaviour. Harwood Academic Publishers, London

Download references

Acknowledgements

This study was supported by a Wellcome programme grant no: 06452.

We are grateful to all the participants and carers who consented to take part in the study, and to the clinical teams in the South London and Maudsley NHS Trust, Camden and Islington Mental Health and Social Care Trust, North East London Mental Health Trust and Norwich Mental Health Trust. We are also grateful to Louise Isham and Katherine Ruffell who helped with EE ratings.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elizabeth Kuipers.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kuipers, E., Watson, P., Onwumere, J. et al. Discrepant illness perceptions, affect and expressed emotion in people with psychosis and their carers. Soc Psychiat Epidemiol 42, 277–283 (2007). https://doi.org/10.1007/s00127-007-0165-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-007-0165-4

Key words

Navigation