The Level of Expressed Emotion Scale: preliminary Italian validation

Introduction The concept of expressed emotion (EE), a measure of the attitudes and behavioural patterns of relatives towards patients, has been shown to be a good predictor of relapse in patients with schizophrenia as well as in patients with other diagnoses, including eating and mood disorders. Patients who live in high-EE home environment have a risk of relapse three to four-fold greater than those who live in low-EE families. Expressed Emotion is commonly assessed by the Camberwell Family Interview 1, a semi-structured interview, that requires the availability of a key relative and a considerable time for training, administration and scoring. Alternative to the CFI is The Level of Expressed Emotion Scale 2, also developed on the basis of the EE theory, which has been shown to bear good correlations with the EE ratings of the Camberwell Family Interview. As this instrument seems to provide advantages in terms of feasibility and economy, the present study describes the preliminary Italian validation of the Level of Expressed Emotion Scale. Methods 287 subjects recruited from general population and 89 patients with DSM-IV diagnoses of Eating Disorders (n = 63), Schizophrenia (n = 10), Major Depression (n = 10), Bipolar Disorder (n = 6) were studied. All subjects were female. The patients were recruited at the Department of Neurology and Psychiatry, University of Florence. The Statistical analysis was performed using Factor Analysis, KR-20, to determine the internal consistency of the overall scale and of the four subscales. The possible effect of others factors on the LEE scores was determined by Analysis of Variance. Results The test's original 4-factor structure has been confirmed, even though the Intrusiveness subscale seems to be independent from the other three, that correlated strongly with each other; this suggested that their underlying constructs may overlap. The KR-20 coefficient showed a good reliability for the overall scale (. 95) and subscales (. 94,.81,.89 and.84). The test-retest analysis indicated that the scale was stable over a 6-week period. Results indicated that the two samples (general population and psychiatric cases) were significantly different in their ratings (Table I). Conclusions The results indicate that the preliminary Italian version of the LEE has sound psychometric properties of construct validity, internal consistency, and reliability; its sensitivity permits to sharply distinguish patients from normal individuals. It is independent of age, amount of contacts, and duration of treatment. Nevertheless, CFI remain the conventional method used to assess EE and the only one that provides information about relatives, patient, his/her history and symptomatology.