| Summary: | Three studies are reported which investigate the relevance of the expressed emotion (EE) construct for families/patients from non-western backgrounds (Pakistani Muslims and Sikhs). The first study was concerned with the relationship between ethnicity and EE in patients with a diagnosis of schizophrenia, and also tested four hypotheses which looked at the association of ethnicity and EE with each of the following: the relative's experience of burden; the relative's perception of the amount of social support they received; the use of coping strategies by relatives; and patient's and relative's perceptions of one another. The results indicated a significant difference between ethnic groups in the number of relatives exhibiting high levels of EE: 55% of whites, 80% of Muslims and 30% of Sikhs were rated as high EE. High EE relatives were also more likely to report lower levels of social support, and were more likely to hold negative perceptions about the patient and believe that the patient also holds negative perceptions about them. The second study looked at the effect of EE on the course of schizophrenia. Course of the illness was not significantly different across the three ethnic groups. Using conventional criteria, low EE in whites was predictive of fewer relapses, but was not so for Asians. When the cut-off for emotional over-involvement was changed from 3 to 4 in the case of the Muslims, high EE then did predict relapse. The third study looked at the prevalence of high EE in non-clinical white and Muslim populations: Muslims were significantly more likely than whites to be rated high EE. The results suggest that Muslims are more likely to be classified as being high EE as judged by western cultural norms. Hence, in order to obtain better predictive validity of EE for relapse in schizophrenia in Pakistani culture, the cut-off point for high EE should be adapted to take this into account. Needless to say, further research must be conducted to establish the normative levels for the overt expression of emotion in Pakistani culture.
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