Expressed Emotion among Family Caregivers of Persons with Schizophrenia: A Causal Model Study

The purpose of this cross-sectional correlational study was to test the Model of Expressed Emotion among Family Caregivers of Persons with Schizophrenia. A hypothesized casual model was developed based on Lazarus and Folkman’s theory of stress and coping, and empirical evidence from a literature review. Relevant factors integrated into the Model included severity of illness, mental health status of the family caregiver, caregiving burden, family functioning, and stigma. The study participants, recruited by means of purposive sampling, consisted of 385 primary family caregivers of adults with schizophrenia who had been followed up at outpatient units of two major psychiatric hospitals in central Thailand. Data were collected using the Thai Expressed Emotion Scale, the Behavior and Symptom Perception Scale, the Thai General Health Questionnaire-28: the Caregiving Burden Scale, the Chulalongkorn Family Inventory, and the Perceived Stigma Questionnaire. Structural equation modeling was used to test the hypothesized model. The study findings revealed that the modified model fitted the data and could explain 57% of variance of expressed emotion. In addition, severity of illness, mental health status, caregiving burden, and family functioning had a direct effect on expressed emotion. Meanwhile, stigma had an indirect effect on expressed emotion, mediated through caregiving burden and mental health status of the family caregiver. The Model can be used as a guideline for developing nursing interventions to reduce caregiving burden, as well as promote mental health status and family functioning among family caregivers of persons with schizophrenia.