Predictors of criticism and emotional over-involvement in relatives of early psychosis patients

Lídia Hinojosa-Marqués*, Tecelli Domínguez-Martínez, Thomas R Kwapil, Neus Barrantes-Vidal*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)


Mechanisms underlying the manifestation of relatives' expressed emotion (EE) in the early stages of psychosis are still not properly understood. The present study aimed to examine whether relatives' psychological distress and subjective appraisals of the illness predicted EE dimensions over-and-above patients' poor clinical and functional status. Baseline patient-related variables and relatives attributes comprising criticism, emotional over-involvement (EOI), psychological distress, and illness attributions were assessed in 91 early psychosis patients and their respective relatives. Relatives were reassessed regarding EE dimensions at a 6-month follow-up. Relatives' psychological distress and illness attributions predicted criticism and EOI over-and-above patients' illness characteristics at both time points. Relatives' increased levels of anxiety, attributions of blame toward the patients, an emotional negative representation about the disorder, and decreased levels of self-blame attributions predicted EE-criticism at baseline. Relatives' anxiety and negative emotional representation of the disorder were the only significant predictors of EE-criticism at follow-up, whereas anxiety, attributions of control by the relative and an emotional negative representation about the disorder predicted EE-EOI both at baseline and follow-up assessments. Understanding the components that comprise and maintain EE attitudes should guide early psychosis caregivers in family interventions, enhancing proper management of psychological distress and reduction of negative appraisals about the illness. The prevention of high-EE attitudes over time in a sensitive period such as early psychosis might be critical in shaping the health of caregivers and the outcome of the affected relatives.

Original languageAmerican English
Pages (from-to)e0234325
JournalPloS one
Issue number6
Publication statusPublished - 2020


  • Adaptation, Psychological/physiology
  • Adult
  • Anxiety/psychology
  • Attitude
  • Caregivers/psychology
  • Emotions/physiology
  • Expressed Emotion/physiology
  • Family/psychology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychotic Disorders/psychology
  • Social Perception


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