THE ROLE OF RELATIVES' EXPRESSED EMOTION AND PERSONALITY TRAITS IN PREDICTING SCHIZOPHRENIA RELAPSE.
INTERNATIONAL CONFERENCE ON SOCIAL SCIENCES & HUMANITIES
THE ROLE OF RELATIVES’ EXPRESSED EMOTION AND PERSONALITY TRAITS IN PREDICTING SCHIZOPHRENIA RELAPSE
Authors: AbRahman Roseliza-Murni, Fatimah Yusooff, Asmawati Desa
ABSTRACT
Schizophrenia is characterized by debilitating effects and recurrent relapse of psychotic episodes, often causing confusion for family members who care for patients.
The study investigates the role of relatives' expressed emotion (EE) and personality traits in predicting schizophrenia relapse among patients.
Participants: 160 subjects (80 schizophrenia patients and 80 key relatives).
Methods:
Family Questionnaire (FQ) was utilized to measure relatives’ EE levels.
Eysenck Personality Questionnaire-Revised (EPQ-RS) was employed to assess personality traits.
Findings:
Relapse odds increased by 8 times when relatives exhibited high EE levels.
Critical Comments (CC) significantly predicted schizophrenia relapse (12% increase per unit increase in CC).
Personality traits such as lie scale and extraversion were significant predictors for relapse.
Elevated lie scale scores predicted relapse by almost 3 times; decreased extraversion predicted an increase in relapse odds by 29%.
Conclusions support global findings on EE’s impact on schizophrenia relapse.
KEYWORDS
Rehospitalization, Critical Comments, Emotional Over-Involvement, Extraversion, Lie Scale, Conformism, Extended Family, Modernization, Urbanization
INTRODUCTION
Schizophrenia in Malaysia often considered as "gila" (madness).
Characterized by loss of contact with reality and impairment in thought processes.
Psychosis is a state where individuals fail to care for themselves effectively (Nolen-Hoeksema, 2011).
Findings from Zubin et al. (1992) indicate that only 22% of those experiencing one psychotic episode recover fully; 78% face recurrent relapses.
Kaplan et al. (1994) reported more than 50% of schizophrenia patients have poor outcomes involving repeated hospitalizations.
Societal Context:
The National Mental Health Registry (NMHR) began to collect data on mental health conditions in Malaysia, revealing complexities in relapse cases.
RELAPSE PREDICTORS
Factors implicated in relapse include life events that induce stress and anxiety in predisposed individuals (Kingdon & Turkington, 2005).
Expressed Emotion (EE):
Concept refers to the emotional climate of familial interactions with patients (Barrowclough & Hooley, 2003).
EE is measured through critical comments, hostility, and emotional over-involvement (EOI).
Higher EE levels correlate with an increased relapse rate, particularly among patients returning to familial settings characterized by high EE (Butzlaff & Hooley, 1998; Kavanagh, 1992).
Notably, cultural differences substantially affect EE dynamics (Azhar & Varma, 1996).
RESEARCH OBJECTIVES
Investigate the predictive value of relatives’ EE index and components on schizophrenia relapse.
Assess the implication of relatives’ personality traits on the same outcome.
MATERIALS AND METHODS
PARTICIPANTS
80 patients with schizophrenia receiving inpatient treatment at Hospital Kuala Lumpur and University Malaya Medical Center, along with 80 identified key relatives.
Inclusion criteria based on DSM-IV diagnosis of schizophrenia.
Ethical approvals obtained prior to the study; informed consent from all participants.
MEASURES FOR RELATIVES’ EE
20-item Family Questionnaire (FQ) utilized to assess EE index and its components (CC and EOI).
Reliability: CC (Cronbach’s alpha = 0.90), EOI (Cronbach’s alpha = 0.88).
MEASURES FOR PERSONALITY TRAITS
Eysenck Personality Questionnaire-Revised short scale (EPQ-RS) consisting of 48 items testing subscales including extraversion, neuroticism, psychoticism, and lie scale.
Reliability values ranged from 0.30 to 0.90, with noted weaknesses in psychoticism scale reliability.
MEASURES FOR PATIENTS’ RELAPSE
Defined operationally as rehospitalization within 6 months post-discharge due to return or worsening of symptoms.
ANALYSIS
Utilized IBM SPSS Statistics 20.
Logistic regression applied to predict relapse outcomes based on relatives’ EE levels and personality traits.
RESULTS
PARTICIPANT CHARACTERISTICS
Patient Demographics: 70% males and 30% females, with a predominance of Malays (55%).
Marital status overview: 62.5% single, 23.8% married, and 13.8% widowed/divorced.
PREDICTIVE VALUE OF RELATIVES’ EE
Logistic regressions showed a strong association between high-EE levels and increased relapse likelihood (OR = 8.37).
RELATIVES’ EE COMPONENTS
Relative's CC measured notably predictive of relapse (OR = 1.12) while EOI showed no significant contribution.
RELATIVES’ PERSONALITY TRAITS
Model revealing lie scale (OR = 2.67) and decreased extraversion (OR = 0.71) significantly associated with relapse prediction.
DISCUSSION
Findings align with global literature enhancing understanding of EE and personality traits on patient outcomes.
Cultural influences on the role of EOI suggested further investigation needed.
Limitations: Study focused geographically on Klang Valley; results may not fully represent broader Malaysian demographic.
ACKNOWLEDGEMENT
This research is part of a PhD dissertation at Universiti Kebangsaan Malaysia and supported by a research grant. Authors express gratitude towards participating institutions and individuals.
REFERENCES
Comprehensive reference list provided including pivotal studies and literature.
CONTACT INFORMATION
AbRahman Roseliza-Murni, Universiti Kebangsaan Malaysia
INTERNATIONAL CONFERENCE ON SOCIAL SCIENCES & HUMANITIES
THE ROLE OF RELATIVES’ EXPRESSED EMOTION AND PERSONALITY TRAITS IN PREDICTING SCHIZOPHRENIA RELAPSE
This study primarily investigates the role of relatives' expressed emotion (EE) and personality traits in predicting schizophrenia relapse among patients, offering insights into environmental and social influential factors rather than biological or genetic ones. The findings align with global literature on EE's impact on schizophrenia relapse.
INTRODUCTION
Schizophrenia is characterized by debilitating effects, recurrent relapse of psychotic episodes, a loss of contact with reality, and impairment in thought processes. In Malaysia, it is often referred to as "gila" (madness).
Psychosis is a state where individuals fail to care for themselves effectively (Nolen-Hoeksema, 2011).
Research from Zubin et al. (1992) indicates that only 22% of individuals experiencing one psychotic episode recover fully, while 78% face recurrent relapses. Kaplan et al. (1994) reported that over 50% of schizophrenia patients experience poor outcomes, including repeated hospitalizations.
The National Mental Health Registry (NMHR) in Malaysia collects data on mental health conditions, highlighting the complexities of relapse cases.
RELAPSE PREDICTORS (Non-Genetic/Environmental Factors)
Factors contributing to relapse can include life events that induce stress and anxiety in predisposed individuals (Kingdon & Turkington, 2005).
Expressed Emotion (EE): This concept refers to the emotional climate of familial interactions with patients (Barrowclough & Hooley, 2003). It is a significant non-genetic factor.
EE is measured through critical comments (CC), hostility, and emotional over-involvement (EOI).
Higher EE levels are strongly correlated with an increased relapse rate, especially when patients return to family settings characterized by high EE (Butzlaff & Hooley, 1998; Kavanagh, 1992).
Cultural differences significantly influence EE dynamics, as noted by Azhar & Varma (1996).
Relatives’ Personality Traits: Specific personality traits of key relatives also serve as significant predictors of relapse.
STUDY FINDINGS (Relevant to Non-Genetic/Environmental Factors)
Participants: 160 subjects were involved, consisting of 80 schizophrenia patients and 80 identified key relatives, from Hospital Kuala Lumpur and University Malaya Medical Center. Inclusion was based on DSM-IV diagnosis.
Methods: The 20-item Family Questionnaire (FQ) was used to assess relatives’ EE levels (CC with Cronbach’s alpha = 0.90, EOI with Cronbach’s alpha = 0.88). The Eysenck Personality Questionnaire-Revised short scale (EPQ-RS), a 48-item questionnaire, assessed personality traits (extraversion, neuroticism, psychoticism, and lie scale).
Relapse Definition: Rehospitalization within 6 months post-discharge due to a return or worsening of symptoms.
Quantitative Results (using Logistic Regression):
Relapse odds increased by 8 times (OR = 8.37) when relatives exhibited high EE levels.
Critical Comments (CC) from relatives were a notable predictor of relapse (OR = 1.12), indicating a 12% increase per unit increase in CC. Emotional Over-Involvement (EOI) did not show a significant contribution in this specific study.
Relatives’ personality traits, specifically an elevated lie scale (OR = 2.67) and decreased extraversion (OR = 0.71), were significantly associated with relapse prediction. This means an elevated lie scale predicted relapse by almost 3 times, and decreased extraversion predicted a 29% increase in relapse odds.
DISCUSSION
The findings support global literature, enhancing the understanding of how EE and relatives' personality traits influence patient outcomes regarding schizophrenia relapse.
The study notes cultural influences on EOI warrant further investigation.
Limitations: The study's geographical focus on Klang Valley means its results may not fully represent the broader Malaysian demographic.