Expressed emotions among caregivers of individuals with schizophrenia and associated factors: a multihospital-based survey in Southern Thailand

BackgroundSchizophrenia is a multifactorial disorder influenced by various biological and psychosocial factors. This study aimed to determine the characteristics and associated factors of expressed emotion (EE) among caregivers of individuals with schizophrenia.MethodsFrom May to July 2024, a cross-sectional study was conducted with caregivers of individuals with schizophrenia across multiple hospitals in Southern Thailand. The study utilized four questionnaires: (1) Demographic inquiry, (2) The Thai Expressed Emotion Scale (TEES), (3) The Thai General Health Questionnaire (GHQ-12), and (4) The Zarit Burden Interview (ZBI). Data were analyzed using descriptive statistics. The groups analyzed were compared using the Analysis of Variance (ANOVA) or Kruskal-Wallis test, the Student t-test or Wilcoxon rank sum test, and the Chi-square test. Multiple logistic regression analysis was performed.ResultsIn a survey of 200 caregivers, 70.5% were female. They had a median caregiving duration of 108 months, with an interquartile range (IQR) of 36 to 180 months. Notably, 51.0% of caregivers reported no mental health problems, as assessed by the GHQ-12, while 29.0% indicated experiencing severe burden. The median score on the TEES was 99.0, with an IQR of 84.7 to 109.0. Furthermore, 46.0% of caregivers reported TEES above the median score, indicating high levels of EE. There was also a significant correlation between caregiver burden and EE scores. Those experiencing severe burden had an EE score of 110.5 compared to 94.0 for those with no burden, which was statistically significant (p = 0.001). Multiple logistic regression analysis revealed that high EE among caregivers was associated with factors such as the patient's duration of illness, caregiver occupation, and mental health status.ConclusionNearly half of the caregivers of individuals with schizophrenia reported high levels of EE, with increased caregiver burden associated with higher EE levels. Factors such as the duration of the patient's illness, caregiver occupation, and mental health status were also associated with higher EE. Moreover, caregivers' emotional responses and expressions are complex and dynamic. Thus, focusing on providing support to caregivers can have a positive impact on the well-being of both caregivers and individuals with schizophrenia.