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International Journal of Methods in Psychiatric Research logoLink to International Journal of Methods in Psychiatric Research
. 2006 Mar 24;12(4):182–191. doi: 10.1002/mpr.155

Brief measure of expressed emotion: internal consistency and stability over time

Seija Sandberg 1,, Michael Rutter 2, Johanna Järvi 3
PMCID: PMC6878373  PMID: 14657974

Abstract

The study examined three methodological aspects of expressed emotion (EE) as assessed in the course of PACE (Psychosocial Assessment of Childhood Experiences) interviews with a parent. In a sample of 87 children, aged 6–13 years, enrolled in a prospective study examining the role of stress on the course of asthma, EE was assessed at three time points, 9 months apart. A high degree of agreement was found among the three concurrent measures of negative and positive EE (kappas from 0.74 to 0.97, and from 0.45 to 0.88, respectively; p ≤ 0.0001 in all instances). The temporal stability of all measures was lower, although statistically significant in all but 2 instances (kappas from 0.19 to 0.59, and from 0.11 to 0.39, respectively). The temporal stability across measures, as well as across interviewers and over time, was broadly similar (kappas from 0.21 to 0.56 for negative EE, and from 0.09 to 0.38 for positive EE, with all but three of the 36 statistically significant). The findings provide support for the underlying assumptions of the PACE‐EE and show the utility of measures based on just very brief periods of non‐directive interviewing, making them practical in a wide range of studies with EE just one of a larger set of measures. Copyright © 2003 Whurr Publishers Ltd.

Keywords: expressed emotion, PACE, children, temporal stability, across‐informant agreement

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References

  1. Asarnow JR, Goldstein MJ, Thompson M, Guthrie D. One‐year outcomes of depressive disorders in child psychiatric inpatients: evaluation of the prognostic power of a brief measure of expressed emotion. J Child Psychol Psychiatry 1993; 34: 129–37. [DOI] [PubMed] [Google Scholar]
  2. Asarnow JR, Thompson M, Hamilton EB, Goldstein MJ, Guthrie D. Family‐expressed emotion, childhood‐onset depression, and childhood‐onset schizophrenia spectrum disorders: Is expressed emotion a non‐specific correlate of childhood psychopathology or a specific risk factor for depression? J Abnorm Child Psychol 1994; 22: 129–46. [DOI] [PubMed] [Google Scholar]
  3. Baker BL, Heller TL, Henker B. Expressed emotion, parenting stress, and adjustment in mothers of young children with behavior problems. Unpublished manuscript, Department of Psychology, UCLA, 1998. [PubMed]
  4. Baker BL, Heller TL, Henker B. Expressed emotion, parenting stress, and adjustment in mothers of young children with behavior problems. J Child Psychol Psychiatry 2000; 41: 907–15. [PubMed] [Google Scholar]
  5. Barnes‐McGuire J, Earls F. Research note: the test‐retest stability of the Five Minute Speech Sample in parents of disadvantaged minority children. J Child Psychol Psychiatry 1994; 35; 971–9. [DOI] [PubMed] [Google Scholar]
  6. Brown GW, Birley JLT, Wing JK. Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry 1972; 121: 241–58. [DOI] [PubMed] [Google Scholar]
  7. Brown GW, Monck EM, Wing JK. Influence of family life on the course of schizophrenic illness. J Prev Soc Med 1962; 16: 55–68. [Google Scholar]
  8. Brown GW, Rutter ML. The measurement of family activities and relationships: a methodological study. Human Relations 1966; 19: 241–63. [Google Scholar]
  9. Cohen, J . Weighted Kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Med 1968; 70: 213–19. [DOI] [PubMed] [Google Scholar]
  10. Glen S, Simpson A, Drinnan D, McGuinness D, Sandberg S. Testing the reliability of a new measure of life events and experiences in childhood: The Psychosocial Assessment of Childhood Experiences (PACE). Eur Child Adolesc Psychiatry 1993; 2: 98–110. [DOI] [PubMed] [Google Scholar]
  11. Hahlweg K, Goldstein MJ, Nuechterlein K, Magana A, Mintz J, Doane J, Miklowitz D, Snyder K. Expressed emotion and patient‐relative interaction in families of recent onset schizophrenics. J Consult Clin Psychol 1989; 57: 11–18. [DOI] [PubMed] [Google Scholar]
  12. Hibbs ED, Hamburger SD, Lenane M, Rapoport JL, Kruesi MJP, Keysor CS, Goldstein MJ. Determinants of expressed emotion in families of disturbed and normal children. J Child Psychol Psychiatry 1991; 32: 757–70. [DOI] [PubMed] [Google Scholar]
  13. Hibbs ED, Hamburger SD, Kruesi MJP, Lenane M. Factors affecting expressed emotion in parents of ill and normal children. Am J Orthopsychiatry 1993; 63: 103–12. [DOI] [PubMed] [Google Scholar]
  14. Hirshfeld DR, Biederman J, Brody L, Faraone SV, Rosenbaum JF. Associations between expressed emotion and child behavioral inhibition and psychopathology: a pilot study. J Am Acad Child Adolesc Psychiatry 1997; 36: 205–13. [DOI] [PubMed] [Google Scholar]
  15. Hodes M, Dare C, Dodge E, Eisler I. The assessment of expressed emotion in a standardised family interview. J Child Psychol Psychiatry 1999a; 40: 617–25. [PubMed] [Google Scholar]
  16. Hodes M, Garralda ME, Rose G, Schwartz R. Maternal expressed emotion and adjustment in children with epilepsy. J Child Psychol Psychiatry 1999b; 40: 1083–93. [PubMed] [Google Scholar]
  17. Kavanagh DJ. Recent developments in expressed emotion and schizophrenia. Br J Psychiatry 1992; 160: 601–20. [DOI] [PubMed] [Google Scholar]
  18. Kershner JG, Cohen NJ, Coyne JC. Expressed emotion in families of clinically referred and non‐referred children: toward a further understanding of the expressed emotion index. J Fam Psychol 1996; 10: 97–106. [Google Scholar]
  19. King S. Is expressed emotion cause or effect? A longitudinal study. Int Clin Psychopharmacol 1998; 13: 107–8.9690976 [Google Scholar]
  20. Kraemer HC, Periyakoil VS, Noda A. Tutorial in biostatistics: kappa coefficients in medical research. Stat Med 2002; 21: 2109–29. [DOI] [PubMed] [Google Scholar]
  21. Liakopoulou M, Alifieraki T, Katideniou A, Peppa M, Maniati M, Tzikas D, Hibbs ED, Dacou‐Voutetakis C. Maternal expressed emotion and metabolic control of children and adolescents with diabetes mellitus. Psychother Psychosom 2001; 70: 78–85. [DOI] [PubMed] [Google Scholar]
  22. Leeb B, Hahlweg K, Goldstein MJ, Feinstein E, Mueller U, Dose M, Magana‐Amato A. Cross‐national reliability, concurrent validity, and stability of a brief method for assessing expressed emotion. Psychiatry Res 1991; 39: 25–31. [DOI] [PubMed] [Google Scholar]
  23. Leff J, Vaughn CE. Expressed Emotion in Families: Its Significance for Mental Illness. New York: Guilford Press, 1985. [Google Scholar]
  24. McCreadie RG, Robertson LJ, Hall DJ, Berry I. The Nithsdale schizophrenia surveys: XI. Relatives' expressed emotion: stability over five years and relation to relapse. Br J Psychiatry 1993; 162: 393–7. [DOI] [PubMed] [Google Scholar]
  25. McGuire JB, Earls F. The test‐retest stability of the five minute speech sample in parents of disadvantaged minority children. J Child Psychol Psychiatry 1994; 35: 38–41. [DOI] [PubMed] [Google Scholar]
  26. Magaña AB, Goldstein MJ, Karno M, Miklowitz DJ, Jenkins J, Falloon IRH. A brief method for assessing expressed emotion in relatives of psychiatric patients. Psychiatry Res 1986; 17: 203–12. [DOI] [PubMed] [Google Scholar]
  27. Malla A, Kazarian S, Barnes S, Cole J. Validation of the five‐minute speech sample in measuring expressed emotion. Can J Psychiatry 1991; 36: 297–9. [DOI] [PubMed] [Google Scholar]
  28. Miklowitz DJ, Goldstein MJ, Falloon IRH, Doane JA. Interactional correlates of expressed emotion in families of schizophrenics. Br J Psychiatry 1984; 144: 482–7. [DOI] [PubMed] [Google Scholar]
  29. Noda AM, Kraemer HC, Yesavage JA, Periyakoil VS. How many raters are needed for a reliable diagnosis? Int J of Methods in Psychiatric Res 2001; 10: 119–23. [Google Scholar]
  30. Nugter MA, Dingemans PM, Linszen AJ, Van der Does AJW, Gerson B. The relationship between expressed emotion, affective style and communication deviance in recent‐onset schizophrenia. Acta Psychiatr Scand 1997; 96: 445–51. [DOI] [PubMed] [Google Scholar]
  31. Patterson P, Birchwood M, Cochrane R. Preventing the entrenchment of high expressed emotion in first episode psychosis: early developmental attachment pathways. Aust N Z J Psychiatry 2000; 34: S191–7. [DOI] [PubMed] [Google Scholar]
  32. Peris TS, Baker BL. Applications of the expressed emotion concept to young children with externalising behavior: Stability and prediction over time. J Child Psychol Psychiatry 2000; 41: 457–62. [PubMed] [Google Scholar]
  33. Plomin R, Daniels D. Why are children in the same family so different from one another? Behav Brain Sci 1987; 10: 1–15. [Google Scholar]
  34. Rutter M. Children of Sick Parents: An Environmental and Psychiatric Study. Institute of Psychiatry Maudsley Monographs No.16 London: Oxford University Press; 1966. [Google Scholar]
  35. Rutter M, Brown GW. The reliability and validity of measures of family life and relationships in families containing a psychiatric patient. Social Psychiatry 1966; 1: 38–53. [Google Scholar]
  36. Rutter M, Quinton, D . Parental psychiatric disorder: effects on children. Psychol Med 1984; 14: 853–80. [DOI] [PubMed] [Google Scholar]
  37. Sandberg S, Paton JY, Ahola S, McCann DC, McGuinness D, Hillary CR, Oja H. The role of acute and chronic stress in asthma attacks in children. Lancet 2000; 356: 982–7. [DOI] [PubMed] [Google Scholar]
  38. Sandberg S, Rutter M, Giles S, Owen A, Champion L, Nicholls J, Prior V, McGuinness D, Drinnan D. Assessment of psychosocial experiences in childhood: Methodological issues and some illustrative findings. J Child Psychol Psychiatry 1993; 34: 879–97. [DOI] [PubMed] [Google Scholar]
  39. Scott S, Campbell C. Expressed emotion about children: reliability and validity of a Camberwell Family Interview for Childhood (CFI‐C). Int J of Methods in Psychiatric Res 2001; 9: 3–10. [Google Scholar]
  40. Schreiber JL, Breier AL, Pickar D. Expressed emotion: trait or state? Br J Psychiatry 1995; 166: 647–9. [DOI] [PubMed] [Google Scholar]
  41. Schwartz CE, Dorer DJ, Beardslee WR, Lavori PW, Keller MB. Maternal expressed emotion and parental affective disorder: risk for childhood depressive disorder, substance abuse, or conduct disorder. J Psychiatric Res 1990; 24: 231–50. [DOI] [PubMed] [Google Scholar]
  42. Stubbe DE, Zahner GEP, Goldstein MJ, Leckman JF. Diagnostic specificity of a brief measure of expressed emotion: a community study of children. J Child Psychol Psychiatry 1993; 34:139–54. [DOI] [PubMed] [Google Scholar]
  43. Tarrier N, Sommerfield C, Pilgrim H. Relatives' expressed emotion (EE) and PTSD treatment outcome. Psychol Med 1999; 29: 801–18. [DOI] [PubMed] [Google Scholar]
  44. Taylor E, Sandberg S, Thorley G, Giles S. Epidemiological Study of Hyperactivity of Childhood. Maudsley Monograph No 33 Oxford: Oxford University Press, 1991. [Google Scholar]
  45. Van Furth E, Van Strien D, Van Son M, Van Engeland H. The validity of the Five‐Minute Speech Sample as an index of expressed emotion in parents of eating disorder patients. J Child Psychol Psychiatry 1993; 34: 1253–60. [DOI] [PubMed] [Google Scholar]
  46. Vaughn C, Leff, J . The measurement of Expressed Emotion in families of psychiatric patients. Br J Soc Clin Psychol 1976; 15: 157–65. [DOI] [PubMed] [Google Scholar]
  47. Vostanis P, Nicholls J. Nine‐month changes of maternal expressed emotion in conduct and emotional disorders of childhood: a follow‐up study. J Child Psychol Psychiatry 1995; 36: 833–46. [DOI] [PubMed] [Google Scholar]
  48. Vostanis P, Nicholls J, Harrington R. Maternal expressed emotion in conduct and emotional disorders of childhood. J Child Psychol Psychiatry 1994; 35: 365–76. [DOI] [PubMed] [Google Scholar]
  49. Wamboldt FS, O'Connor SL, Wamboldt MZ, Gavin LA, Klinnert MD. The Five Minute Speech Sample in children with asthma: Deconstructing the construct of expressed emotion. J Child Psychol Psychiatry 2000; 41: 887–98. [PubMed] [Google Scholar]
  50. Wamboldt FS, Wamboldt MZ, Gavin LA, Roesler TA, Brugman SM. Parental criticism and treatment outcome in adolescents hospitalised for severe chronic asthma. J Psychosom Res 1995; 39: 995–1005. [DOI] [PubMed] [Google Scholar]

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