Psychometric properties of a Chinese version of the Level of Expressed Emotion scale and expressed emotion of family members perceived by patients with severe mental illness.

Expressed emotion (EE) refers to the amount of (1) criticism, (2) hostility, (3) positive remarks, (4) warmth, and (5) emotional over-involvement expressed in family relationships, particularly among relatives of a psychiatric patient.1 Of the five components, criticism, hostility, and emotional over-involvement are most predictive of patient’s relapse and course of illness (particularly in patients with schizophrenia or mood disorders), and are associated with patient’s symptoms, compliance with medication, family burden, and functioning.2 The traditional measurement tools including Camberwell Family Interview (CFI) and Five-Minute Speech Samples rate the attitudes and feelings expressed towards a patient by a main caregiver. Nonetheless, their application is limited by the lengthy training and administration required, the complex scoring system, and the availability of a key relative.1 Patients should be the focus of assessment when trying to understand their perception of the relationship with and attitudes of their family.2 For example, comments and emotions expressed by family members may be perceived by the patient as signs of love and care or coercive attempts to restore his/her desirable social behaviour.2 A self-report, 60-item Level of Expressed Emotion (LEE) scale3 is the only valid instrument that addresses the EE perceived by patients about Hong Kong Med J 2016;22(Suppl 6):S28-34 HHSRF project number: 09101481