Factors Influencing Expressed Emotion Found Between Chinese Caregivers and Their Relatives with Schizophrenia in Hong Kong: A Qualitative Analysis

Objectives: Based on the concept of Expressed Emotion (EE), this study attempted to explore the underlying socio-cultural factors that were related to the unique patterns of communication found between Chinese caregivers and their relatives with schizophrenia. Methods: Twelve caregivers were given in-depth interviews, and the transcripts were content-analyzed to delineate the unique communication patterns found between caregivers and their relatives with schizophrenia. Thematic analyses were also performed to extricate the possible underlying factors associated with such unique communication patterns. Results: While certain themes such as the lack of knowledge of mental illness, attribution of symptoms to personality causes and feelings of psychological burdens were closely associated with negative communication patterns of critical comments, hostility and emotional over-involvement, parental commitment, knowledge of mental illness and recognition of positive attributes in relatives were linked to positive communication patterns of warmth and optimism towards illness. Discussions: Socio-cultural factors such as stigma of mental illness, Confucian work ethics, parental self-sacrificing and devoted behaviors, and acceptance of fate were put forward to explain the findings. Implications for social work practices were discussed.