Appraisal, psychological adjustment and expressed emotion in relatives of patients suffering from schizophrenia

Background. It is argued that coping theory may be useful in attempting to understand how relatives adapt to the demands of living with a schizophrenia sufferer. Method. In a prospective study, univariate and multivariate relationships were explored between appraisal variables (appraisal of symptom threat (primary appraisal) and perceived symptom control (secondary appraisal)) and (a) expressed emotion, and (b) psychological distress in relatives of schizophrenic patients. The profile of relatives who showed sustained distress over time was also examined. Results. The appraisal variables were found to be related to both the concurrent distress (GHQ scores), EE ratings of relatives at the time of the patient's relapse and hospitalisation, as well as the subsequent GHQ scores of relatives when the patient was discharged back home. Relatives who showed sustained distress were likely to show high EE and have a longer caring history. Conclusions. The study gives some support to the theory that appraisal processes underlie how relatives react to having a family member with schizophrenia, and may have implications both for identifying those at risk of poor adaptation, and for understanding strategies that improve well-being.