Psychological well-being 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 hospitalization. This is one of the few studies to use a longitudinal design to assess the impact of expressed emotion (EE) on well-being 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 well-being 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.

Expressed Emotion in relatives of persons with dementia: a systematic review and meta-analysis.

OBJECTIVES: Expressed Emotion (EE) refers to a number of key aspects of interpersonal relationships which have been shown to relate to outcomes in relatives of people with health conditions. DESIGN: A systematic review and meta-analysis of EE and outcomes in relatives of persons with dementia is reported. Potential research studies were identified via a search of three electronic databases; PsychINFO, MEDLINE and the Web of Science between 1960 and 2015. RESULTS: We reviewed 12 studies investigating correlations between EE and well-being in relatives of patients with dementia. Factors hypothesised to influence EE including attributions, social support, coping strategies and relationship quality were also reviewed. CONCLUSION: High-EE relatives were found to have increased levels of burden (Z = 6.967, P < 0.001) and greater levels of depression (Z = 5.842, P < 0.001). Compared to low-EE relatives, high-EE relatives were more likely to attribute the patient's problems to factors that were personal to and controllable by the patient. Relatives with less social support, inefficient coping strategies and a poor relationship with the patients, were more likely to be classified as high-EE.

Critical comments mediate the association between carer distress and psychological symptoms in persons recently diagnosed with dementia.

INTRODUCTION: Carers of persons with dementia (PWD) experience high levels of burden and distress and may use criticism in an attempt to change the behavior of PWD and thereby reduce their distress. We hypothesized that carer distress and criticism would each have an impact on the psychological well-being of the PWD and examined whether criticism mediates the association between carer distress and PWD psychological well-being. METHODS: We recruited 61 persons with a recent diagnosis of dementia and their carer via U.K. dementia services and assessed at 2 time points 6 months apart. Carers completed questionnaire measures of burden and distress. We coded critical comments from a Camberwell Family Interview. PWD completed questionnaire measures of quality of life, depression, and anxiety. We conducted correlation, regression, and mediation analyses to explore the relationship between carer variables and PWD psychological outcomes and whether criticism mediated any relationship found. RESULTS: Carer distress, carer critical comments, and PWD anxiety and depression at 6-month follow-up were all significantly correlated. Baseline carer distress predicted poorer quality of life in PWD at 6-month follow-up. The number of carer critical comments significantly (p < .01) mediated the effect of carer distress on PWD quality of life. DISCUSSION: Interventions addressing carer burden and distress and offering coping strategies to help them to reduce criticism of the PWD would improve the quality of life of those affected by dementia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Expressed emotion, burden, and distress in significant others of people with dementia.

Significant others of people with dementia suffer high levels of burden and distress, creating the conditions for the negative attitudes and unhelpful responses described within the construct of Expressed Emotion (EE). It is not known however, whether EE then further enhances significant other burden and distress, and whether these processes operate early after symptoms of dementia have started. The current study used a longitudinal design to examine the potential influence of EE on burden and distress in significant others of people with a recent diagnosis of dementia. Sixty-one significant others of people with dementia were recruited. Significant other EE was coded from the Camberwell Family Interview. Significant other burden and distress, and relationship quality were collected through questionnaires at baseline and at 6-month follow-up. Significant other high-EE was associated with higher levels of burden and greater distress at both baseline and 6-month follow-up, when existing relationship quality was controlled for. High-EE significant others showed increases in burden and distress from baseline to follow-up not seen in low-EE significant others. Interventions aiming to modify significant other response styles and to reduce high-EE may potentially benefit significant others by reducing their levels of burden and distress. (PsycINFO Database Record