The effects of expressed emotion in adjustment to long term health conditions and its role in post stroke depression

This research portfolio is divided into three parts:Part one is a systematic literature review of the literature titled ‘Expressed Emotion (EE) in long term health conditions including those with a neurological basis’. A great deal of research has been carried out looking at the role of EE in psychiatric conditions where EE is now seen as a well established strong predictor of relapse in schizophrenia. More recently, research has turned its focus onto the effects of EE within the domain of chronic health conditions, however, whether this maintains the same significance as shown in psychiatric illnesses remains unclear. This review examines the concept of EE in relation to adjustment, course of illness and functional outcomes in long term health conditions. Broadly it explores the individual components of EE (criticism, emotional over-involvement, hostility, warmth and positive remarks) to identify which have been most associated with outcome. Furthermore, this review has also focused upon how EE has been operationalized and measured in to relation long term health conditions. Clinical and research implications are discussed further in this review.Part two is an empirical research study titled ‘Post stroke depression and expressed emotion’. The causes of PSD remain controversial, particularly regarding the location of lesion that could be linked to depression. What remains clear, however, is that depression after a stroke injury is commonly experienced and has been evidenced as one of the key factors influencing adjustment and rehabilitation outcomes. Given the potential of the impact of EE in long term health conditions, particularly on psychological distress, understanding the causes of PSD in terms of how organic and psycho-social factors might relate to each other is vital for recovery. A cross-sectional design was used to investigate the extent to which EE might interact with lesion laterality to determine levels of post stroke depression (PSD) in stroke survivors. It was hypothesised that stroke survivors with a left lesion stroke injury living in a high EE climate would experience higher levels of PSD compared to those with a right lesion stroke injury living in a low EE climate. Secondary aims of this research explored the relationship between lesion laterality and levels of PSD; and levels of EE and PSD. Additional exploratory research was also carried out to examine the extent to which stroke survivors’ perceptions of EE may interact with lesion laterality to determine levels of PSD. Clinical implications and scope for further research are discussed further.Part three contains the appendices which provide further information in relation to the systematic literature review, empirical paper and a reflective statement of the process on this research