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Background: This study examined whether levels of parental reflective function (RF), parental expressed emotion (EE) and children’s attachment styles are significantly related in a sample of children with high levels of conduct disorder (CD) symptoms. Method: The sample (n = 143) consisted of children aged 5-7 years at risk of behaviour problems. Participants were recruited from a borough of London and a unitary authority in the south west of England. Data for the three main variables and confounders were collected using semi-structured interview, direct observation and questionnaires from both parents and children. The Parent Development Interview (PDI) was used to assess RF; the Five-Minute Speech Sample to assess EE and the Manchester Child Attachment Story Task (MCAST) to assess child attachment. Results: Global levels of maternal RF did not significantly differ between the securely and insecurely attached groups of children. Mothers of securely attached children, however, had higher RF ratings on the negative interactions and anger subscales of the PDI compared to mothers of insecurely attached children. No significant difference was found in parental EE between secure and insecurely attached children. High EE-warmth was associated with high global RF, but there was no significant relationship between EE-criticism and RF. Multiple logistic regression found no significant relationships between parental RF, parental EE and child attachment. Conclusions: These findings may suggest that attachment classification influences the levels of maternal RF in specific negative situations. Conversely it is possible that high maternal RF in such situations enables mothers to respond more sensitively to their child, leading to more secure attachment. The finding that maternal RF and EE were not associated with child attachment may suggest these variables are not strongly related, the sample is too small to detect any effect or that the specific sample lacks variability in scores. To the author’s knowledge this is the first study to test for these relationships with confounders included in the model, which may explain the null findings.

Background: Maternal postnatal depression (MPND) has been associated with child emotional, behavioural and cognitive problems, placing them at greater risk for later psychopathology. Therefore research into mechanisms of risk transmission is important. This longitudinal study considers the emotional quality of the mother-child relationship, using a measure of Expressed Emotion (EE), as a potential mechanism explaining the link between MPND and child emotional and behavioural problems in the postnatal period. It was predicted mothers with higher depressive symptoms at 3-months would show more negative EE and their child would have more internalising and externalising problems at 2-years, with maternal EE acting as a mediator. Methods: Data from the longitudinal Oxford Father’s Project for 130 (of 192 originally recruited) mother-child dyads was used. Mother’s depressive symptoms were measured using the Edinburgh Postnatal Depression Scale at 3-months. Maternal EE, specifically critical and positive comments, was coded from the Preschool Five Minute Speech Sample measured at 2-years. Maternal, paternal and independently rated child outcomes were measured at 2-years using the Child Behaviour Checklist for ages 1.5-5. Results: Mothers, fathers and “others” rated child problems similarly. EE-positive comments showed stability from 1-2 years. Mothers with more depressive symptoms at 3-months showed more EE-criticism at 2-years especially towards boys and rated their children higher in internalising and externalising problems. Maternal EE-criticism predicted child internalising and externalising problems at 2-years. EE was not a significant mediator between maternal depressive symptoms and child problems. Conclusions: Children of mothers with more depressive symptoms 3-months post-birth experience more maternal EE-criticism and show more internalising and externalising problems aged 2-years. Given the long-term consequences of early childhood problems, postnatal depression should be screened and treated early to reduce EE-criticism and negative child outcomes. Research should consider why mothers experiencing postnatal depression may be more critical of male children and how this may impact on development.

Although schizophrenia is a biologically-based disorder, environmental stress (including stress within familial relationships) plays a major role in the onset and maintenance of symptoms. This study examined family variables that have implications for psychotherapeutic treatment of schizophrenia. Previous research has found Communication Deviance (CD), Expressed Emotion (EE), and family cohesion (FC) to be related to symptom severity. However, the exact nature of the relationship between these constructs is unclear. The current study tested a model whereby the tone and content of family member’s communication (EE) and the sense of family unity (FC) are hypothesized to mediate the relationship between CD and psychiatric symptoms. This model stems from the theory that high CD is likely to be experienced as frustrating because it hinders relatives’ communication goals. Thus, relatives may resort to more critical and hostile methods of expressing their thoughts (High EE). Simultaneously, inability to share experiences in a clear manner may lead patients and family members to feel more disconnected (low FC). High EE and low FC in turn were hypothesized to lead to increased symptoms. This study did not find support for the above model. Communication Deviance was not related to severity of psychiatric symptoms, and Expressed Emotion and family cohesion were also unrelated to communication deviance and psychiatric symptoms in the larger model. Higher family cohesion was related to fewer psychiatric symptoms when looking at individual correlations, but this relationship disappeared once other variables were included in analyses. The largely null study findings may be due to limited variance in many of our primary study variables (e.g., CD, family cohesion). Other explanations are also entertained.

Mild cognitive impairment (MCI) is a medical diagnosis that is conceptualized as existing on a continuum between normal cognitive aging and dementia. While a growing body of research has established the impact of this condition on family members' emotional well-being, as well as the quality of family relationships, the reciprocal impact of family dynamics and the family environment on illness course has received much less attention. Expressed emotion (EE) is a measure of the family emotional climate that has been established as being highly predictive of relapse and symptom exacerbation for a variety of mental health disorders. The recent integration of attribution theory with EE has offered new insights into the underlying attitudes and beliefs that give rise to it. This mixed methods study applied the attribution model of EE to test the validity of EE in predicting the illness course of MCI, and to identify family members' attributions regarding MCI-related behaviors and symptoms that underlie their EE status. The study sample included 57 family dyads consisting of a person with MCI and a family member providing primary care or assistance. The results of the ANCOVA did not support the hypothesis that EE status would predict changes in the non-cognitive features of MCI over time. However, methods of thematic analysis revealed four major themes, or care partner attributional stances: (a) non-blaming, (b) blaming, (c) variable, and (d) no identified. The analysis also revealed three subthemes, or attributional styles, within the variable stance: (a) ambivalent, (b) mixed, and (c) complex. These attributional stances and styles intersected with family EE status in notable ways and form the basis for future research in this area, as well as clinical interventions with these families that promote adaptation to the illness. / Ph. D.

The main aim of this study is to investigate the effects of a brief psycho-educational intervention for the key relatives of schizophrenic patients, on perceived expressed emotion of patients, and the expressed emotion and burn out of their key relatives. Seventy five schizophrenic patients and their key relatives were included in the study. They were assigned into three groups randomly. The key relatives in the first experimental group were given a one-day psychoeducational workshop and written material package about schizophrenia were provided for them. In the second experimental group, key relatives were only given the written material package about schizophrenia which was the same as that of the Experimental Group I. The third group was the control group received no intervention or any material. All of the participants including patients and key relatives were given the instruments of the study as pre-test. Two weeks after pre-test, the relatives in Experimental Group I and Experimental Group II were invited to the hospital without their patients. The first group participated in the psychoeducational workshop and they were given written material package and the second group was only given the written material package. Pre test was given to Control Group without any intervention. Two months later, the post&ndash / tests were applied to all of the key relatives and their patients. Overall the results indicated that a one day intensive psycho-educational workshop enriched with audiovisual components, written material package about schizophrenia and an interactive discussion part has a positive impact on the key relatives&rsquo / burnout levels, expressed emotion levels and knowledge about schizophrenia. Furthermore, although no direct intervention was conducted with the patients, the results showed that patients&rsquo / perceived expressed emotion levels were reduced as well. The results also showed that simply providing written material about schizophrenia does not have an effect on burnout levels, expressed emotion levels and knowledge of relatives and the perceived expressed emotion of their patients.

Few studies currently exist which examine expressed emotion in depressed fathers, despite considerable evidence linking expressed emotion and depression in mothers. These findings are important as they indicate that mothers’ depressed mood is associated with an increase in child-directed critical comments and a decrease in positive comments, which have been linked to poorer child emotional and behavioural outcomes. There are limited findings exploring how depressed mood may impact fathers’ expressed emotion, and how this is in turn may impact upon the child. This paper reports findings from part of a longitudinal study examining fathers with depression in the postnatal period. The aim of this study was to determine whether child emotional and behavioural problems at age 2 years were associated with increased critical comments and decreased positive comments made by fathers (N = 143). It was predicted that fathers who were depressed when their child was 3 months or 12 months old would make more critical comments and fewer positive comments about their children at age 24 months, and that fathers’ critical comments would predict child emotional and behavioural problems at 24 months. Fathers’ depression at 12 months was found to be significantly related to child emotional and behavioural problems at 24 months. The children of fathers who made more positive comments had fewer reported emotional and behavioural difficulties at 24 months. Fathers’ positive comments were found to remain stable from 12 months to 24 months. There were no significant relationships found between fathers’ depression and the frequency of positive or critical comments. This study has implications for increasing fathers’ child-directed positive comments in order to prevent the development of child emotional and behavioural difficulties.