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Positive affect in the family environment protects against relapse in first-episode psychosis

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Abstract

Purpose

To evaluate the contribution of positive affect in the family environment to relapse in first episode psychosis.

Method

65 service users with a first episode of psychosis were recruited into the current study along with their key relatives. Relatives were interviewed and rated using the Expressed Emotion (EE) measure of warmth, whilst service users completed questionnaires about the positive and negative affects that they perceived from the family environment. Associations between these measures and relapse were examined in a one-year prospective design.

Results

Service users were less likely to relapse within 6 and 12-month follow-up periods when their relatives were rated high on EE warmth, or when they perceived more positive affect from the family. The relationships between service users’ perceived positive affect and relapse were preserved after controlling for baseline symptoms, substance use and employment status. Service users’ perceptions of positive affect and EE ratings of warmth appeared to be stronger predictors of relapse outcome than criticism and other EE variables.

Conclusions

Positive family environments may protect against relapse in first episode psychosis. Psychosocial interventions should aim to foster and maintain positive affect in families during the early stages of illness. Further research is needed to understand the mechanisms linking positive affect and outcomes for people recovering from psychosis.

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Notes

  1. The criteria for relapse meant that service users did not need to be experiencing an active relapse at the two end-points of the study to be classified as such.

  2. A criterion of p < 0.1 was set for removal of predictors from initial models.

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  3. It was deemed more appropriate to control for the PANSS total score, rather than individual PANSS subscales to reduce the number of predictors in the regression analyses.

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Acknowledgments

The authors would like to thank the Medical Research Council, UK for funding the doctorate studies of the first author, and also Merseycare Mental Health NHS Trust, for providing grant monies towards the RAP Study.

Conflict of interest

None.

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Authors and Affiliations

  1. School of Psychological Sciences, University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK

    Gary Lee & Christine Barrowclough

  2. Lancaster University, Spectrum Centre for Mental Health Research, Lancaster, UK

    Fiona Lobban

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  1. Gary Lee
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  2. Christine Barrowclough
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  3. Fiona Lobban
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Correspondence to Gary Lee.

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Lee, G., Barrowclough, C. & Lobban, F. Positive affect in the family environment protects against relapse in first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 49, 367–376 (2014). https://doi.org/10.1007/s00127-013-0768-x

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  • DOI: https://doi.org/10.1007/s00127-013-0768-x

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