Expressed emotion and relapse of schizophrenia in Hong Kong

Objective: We examined the cross cultural relevance of expressed emotion in predicting relapse of schizophrenia in Hong Kong. Methods: A longitudinal prospective study was conducted. Thirty three patients with a Diagnostic and Statistical Manual of Disease IV diagnosis of schizophrenia were recruited. The Camberwell Family Interview was conducted with key relatives to evaluate the expressed emotion status. The patients were followed up for 9 months after their index discharge by a psychiatrist who was blind to the expressed emotion status. The psychiatrist evaluated the mental state of the patients with the Brief Psychiatric Rating Scale. Content analysis was also conducted on the critical comments of the relatives. Results: The relapse rate in the high expressed emotion group was 60.0% (p < 0.01) and that in the low expressed emotion group was 11.1% (p < 0.01). The 9-month relapse risk ratio for the high expressed emotion group compared with the low expressed emotion group was 5.4 (95% confidence interval, 1.38 to 21.1). In terms of the subscales, critical comments were found to be the most significant predictor of relapse. However, relapse did not seem to be significantly correlated with high emotional overinvolvement in this study. Conclusion: The predictive validity of expressed emotion construct for schizophrenic relapse is applicable to Hong Kong Chinese people.