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A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England

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Abstract

Expressed emotion (EE) research has been productive in investigating the influence of the interpersonal environment on a range of disorders. The majority of EE research on the influence of carers has been carried out in the west. This is the first EE study of the carers of people with dementia in Japan. The aim of this study was to investigate the relationships between EE status and aspect of burden through cross-cultural comparison of the two countries, Japan and England, with large cultural and linguistic differences. Comparisons were made between samples of EE of carers of dementia and schizophrenic patients. In total, data on 80 carer/relative–patient dyads were collected and examined: (1) 20 Japanese carers of people with dementia (JD), (2) 20 English carers of patients with Alzheimer’s disease (ED), (3) 20 Japanese relatives of patients with schizophrenia (JS), and (4) 20 English relatives of patients with schizophrenia (ES). The Camberwell Family Interview was administered in each country to ascertain levels of EE. Large differences between Japan and England were found in the frequency of critical comments, in which ES>ED>JS>JD. EE correlated significantly with burden in the JD sample alone. With an operational cut-off of 2CC (CC, critical comments), EE correlated significantly with cognitive impairment as well as with clinical severity in the JD sample. There was a tendency for lower expression of both positive and negative emotional reactions towards family members in the Japanese sample. The results of this study indicate that EE is an appropriate measure for use with carers of sufferers of dementia and can be utilized across different cultures. However, flexibility with the cut-offs may be required in Eastern cultures. This needs to be tested on larger samples with sensitivity to illness and cross-cultural differences.

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Acknowledgements

The authors wish to thank Christine Vaughn at the Institute of Psychiatry, London, and Catherine Donaldson in the Department of Psychology, Institute of Psychiatry, London, for providing reliability ratings of EE. The ED sample was drawn from a study funded by The Welcome Trust (PIs: Nicholas Tarrier and Alistair Burns). We are grateful to our colleagues Professor Alistair Burns and Professor Christine Barrowclough for permission to use the ED and ES databases. We are also grateful to the patients and their carers for taking part in each country.

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Authors and Affiliations

  1. Dept. of Neuropsychiatry, Kochi Medical School, Kochi, Japan

    Hiroko Nomura, Shimpei Inoue, Naoto Kamimura & Shinji Shimodera

  2. Dept. of Mental Health, College of Social Welfare, Osaka Prefecture University, Osaka, Japan

    Yoshio Mino

  3. Academic Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK

    Lynsey Gregg & Nicholas Tarrier

  4. Academic Division of Clinical Psychology, Wythenshawe Hospital, Education and Research Building (2nd Floor), Manchester, M23 9LT, UK

    Nicholas Tarrier

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  1. Hiroko Nomura
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  2. Shimpei Inoue
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  3. Naoto Kamimura
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  4. Shinji Shimodera
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  5. Yoshio Mino
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  6. Lynsey Gregg
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  7. Nicholas Tarrier
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Correspondence to Nicholas Tarrier.

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Nomura, H., Inoue, S., Kamimura, N. et al. A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England. Soc Psychiat Epidemiol 40, 564–570 (2005). https://doi.org/10.1007/s00127-005-0924-z

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  • DOI: https://doi.org/10.1007/s00127-005-0924-z

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