Further validation of the Chinese version of the Level of Expressed Emotion Scale for research and clinical use

BackgroundExpressed emotion is a construct that has been used for the past three decades to describe family members’ criticism, hostility and emotional involvement with a mentally ill relative within the context of family interactions and caregiving. In Western countries this construct is used as an outcome measure of interventions for families of people with schizophrenia or other psychotic disorders, but the use of this construct in Chinese populations is somewhat limited.ObjectiveTo test the reliability and validity of a refined Chinese version of the 52-item Level of Expressed Emotion Scale (LEE).MethodsA convenience sample of 405 outpatients with psychotic disorders in Hong Kong and one of their family caregivers were recruited. Patients were asked to complete a set of questionnaires twice over a 6-month period, including the Chinese version of the LEE, the Specific Level of Functioning scale and the Brief Psychiatric Rating Scale; while their caregivers completed the Family Assessment Device twice and a demographic data sheet at recruitment. This study was aimed at establishing the internal consistency, reproducibility, responsiveness, and construct validity of the LEE.ResultsResults indicated that the refined 50-item Chinese version of the LEE and its subscales demonstrated a high internal consistency and satisfactory correlations with patient and family functioning scores. Principal component analysis revealed the presence of four factors, explaining 70.8% of total variance and indicating high factor loadings as well as item-factor inter-correlations. The Chinese version not only indicated a satisfactory reproducibility in assessing change in patients’ symptom severity and family functioning but also showed an adequate responsiveness to the changes in patients’ symptoms over 6 months, especially for detecting symptom improvement.DiscussionThe findings of the psychometric evaluation of the Chinese version of the LEE established its potential as a research instrument in measuring the level of expressed emotion of family members as perceived by Chinese patients with psychotic disorders. Further testing of its psychometric properties is recommended, using larger samples from diverse socio-economic backgrounds and mental illnesses.