Expressed emotion and depression in caregivers of older adults with dementia: results from Taiwan

Abstract

Objectives: The purpose of this study was to examine the relationship between (1) expressed emotion (EE) and characteristics of Taiwanese dementia patients and their family caregivers and (2) EE and depressed mood, burden, and perception of health in Taiwanese caregivers of elderly persons with dementia.

Methods: Sixty-five primary caregivers of elderly persons with mild to severe dementia were recruited from institutions in Taiwan and they completed four standardized questionnaires: Level of Expressed Emotion (LEE) scale, Center for Epidemiologic Studies Depression (CES-D) scale, Zarit Burden Inventory (ZBI), and General Health Perceptions subscale of the Medical Outcomes Study Short Form 36 Health Survey (MOS SF-36).

Results: EE was positively associated with caregiver depression (r = .543; p < .001) and burden (r = .532; p < .001), and negatively associated with caregivers’ perceived health (r = −.316; p = .010). The higher the caregivers’ depression and burden, the greater was their EE and the lower the caregivers’ perceived health, the higher was their EE. EE was negatively associated with caregiver education (r = −.279; p = .024) and income (r = −.261; p = .036). The lower the caregivers’ education and income, the higher was their EE.

Conclusion: The significant relationship between EE and caregivers’ mood and perceived burden suggests that caregivers with elevated mood or burden may put persons with dementia at greater risk for toxic, negative interactions from them. Although this study's design precludes attributing directionality, more depressed caregivers are at a greater risk of higher EE which may affect care of their elderly demented family members. Additional research is warranted with a larger sample size and/or a longitudinal design.

Keywords:

• expressed emotion
• depression
• family caregivers
• dementia

Funding for this project is provided by McLaws Scholarship and Fritz/Boeing Fellowship. Special thanks to Dr Stevan Harrell and Dr Robert Burr from the University of Washington, School of Nursing for their assistance with this study.