Expressed Emotion, Depression, Burden, and Perceived Health in Family Caregivers of Older Adults with Dementia in Taiwan
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Expressed emotion (EE) is defined as the amount of intrusiveness, emotional response, negative attitude towards the illness, and tolerance/expectations conveyed by caregivers toward their patients. EE has been a useful construct for understanding the relationship between family interactions and caregivers' depression in patients with psychiatric disorders. A review of the literature yielded scant research investigating the relationship between EE and depression in caregivers of older adults with dementia in Chinese-speaking populations. In-depth examinations of the relationship between EE and depression in Taiwan are therefore needed. The purposes of this study were to: 1) explore the validity and cultural acceptability of two standardized measures, one measuring caregiver EE and the other measuring patient cognitive status; and 2) examine the relationships between caregiver EE and caregiver characteristics (e. g., gender and type of relationship), depression, burden, perception of health, and patient cognitive and functional status. This study consisted of two phases. In Phase I, a series of in-person interviews (n=5 participants) and a focus group (n=5 participants) were convened to examine the acceptability and face validity of Mandarin-translated measures of Level of Expressed Emotion (LEE) and Functional Assessment Staging (FAST). In Phase II, caregivers of patients with dementia (n=65) in southern Taiwan completed the Chinese version of these 2 translated scales and the measures of depression, burden, perception of health, and function. Results supported validity of the Chinese version of LEE and FAST scales; that EE is positively associated with levels of caregiver depressed mood (r=.518; p< .001) and burden (r=.526; p< .001); and that EE is negatively associated with caregiver perception of health (r=-.273; p=.028). The higher the caregivers' depressed mood and burden, the greater was their expressed emotion. Similarly, the lower the caregivers' perception of health, the greater was their expressed emotion. There were no significant relationships between caregiver EE and their gender, type of relationship, patient cognition, and ADL. As the first study to provide preliminary findings on EE in Taiwanese caregivers of older adults with dementia, this project was not without limitations. Additional research is warranted with a larger sample size and a longitudinal design.
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