Expressed Emotions Among Caregivers of Schizophrenia Patients in Southern Ethiopia: Associations with Caregiver and Patient Characteristics

Background: Expressed Emotion (EE) measures family caregivers’ attitudes and behaviors toward mentally ill family members. This concept is crucial in mental health research, as it assesses criticism, unfriendliness, or support from immediate family. This study addresses a significant gap by evaluating caregivers of schizophrenia patients in Ethiopia. The findings aim to assist policymakers and healthcare professionals in enhancing mental health support in the region. Objective: To determine the magnitude of Expressed Emotions among caregivers of patients with schizophrenia and its association with caregivers’ and patients’ characteristics in Southern Ethiopia, 2022. Method and Materials: A cross-sectional study design was employed, involving 202 caregivers providing care to patients with schizophrenia at the psychiatry clinic of Dilla University Referral Hospital. Data collection utilized mobile software Epi.INFO version 7 through interviewer administration, supplemented by relevant chart reviews. Caregivers’ EE levels were evaluated using two domains: Critical Comment (CC) and Emotional Over-Involvement (EOI), using validated tools. A systematic random sampling technique was employed to select participants. Data were analyzed using SPSS version 22, with bivariate analysis conducted for potential EE predictors (P-value < 0.2). Variables meeting this criterion were further analyzed using multivariable logistic regression, with a P-value < 0.05 considered statistically significant. Results: High expressed emotion was observed in 50.5% (43.1-57.4) of respondents. Factors significantly associated with high expressed emotion included caring for patients with schizophrenia for 6-8 years (AOR=3.5; 95% CI: 2.1-6.3), being a female caregiver (AOR=1.2; 95% CI: 1.15-4.1), experiencing moderate to severe caregiver overload (AOR=2.0; 95% CI: 1.81-5.4), and a total duration of illness of 6-10 years (AOR=1.6; 95% CI: 1.42-3.9). Conclusion: The present study reported a high level of EE among nearly half of the family members. Factors such as being a female caregiver, caring for a patient for 6-8 years, experiencing moderate to severe overload, and a total illness duration of 6-10 years were significantly associated with elevated EE. This underscores the need for psychosocial nursing care for all family members of schizophrenia patients, which can help them effectively cope with the stress of managing a mentally ill family member at home.