Psychological wellbeing in persons with dementia: the role of caregiver Expressed Emotion

Objectives: Dementia is a growing health concern. Persons with dementia experience higher levels of anxiety and depression, which correlates with poorer quality of life, disability and hospitalisation. This is one of the few studies to use a longitudinal design to assess the impact of Expressed Emotion (EE) on wellbeing in dementia over time.

Methods: Sixty-one people with dementia and their main informal caregiver were recruited from memory services. Caregiver EE was coded from a Camberwell Family Interview conducted at time one. Person with dementia’s outcome measures (quality of life, depression and anxiety) were collected at time one and at 6 months follow-up.

Results: Caregiver high-EE was associated with higher levels of depression in people with dementia and greater anxiety at follow-up. Emotional over involvement predicted greater anxiety and critical comments predicted greater depression. Low-EE appeared to have a protective effect on wellbeing in people with dementia. People with dementia with low-EE caregivers experienced a small reduction in depression and anxiety over time, whereas those with high-EE caregivers maintained baseline levels of depression and anxiety.

Conclusions: Caregiver high-EE is associated with poorer psychological outcomes for people with dementia over time. Psychological therapies, such as cognitive behavioural therapy informed family interventions should be used to reduce high-EE within carer and person with dementia relationships.