Factors Predicting Negative Expressed Emotion among Family Caregivers of Persons with Major Depressive Disorder

Main Article Content

Pattraporn Worrasirinara
Wandee Suttharangsee
Vineekarn Kongsuwan


Purpose: This research aimed to study factors predicting negative expressed emotion in family caregivers of persons with Major Depressive Disorder (MDD).

Design: Descriptive predictive design.

Methods: The sample comprised 110 primary caregivers of persons with MDD from psychiatric hospitals in southern Thailand. A set of questionnaires consisted of negative expressed emotion, subjective caregiver burden, family functioning, social support, and perception on severity of illness, and social desirability scales with content validity index as .94 - 1.00 and reliability as .80 - .85. The researcher collected data at outpatient department of psychiatric hospitals. Descriptive statistics and multiple linear regression were used for data analysis.

Main findings: The findings showed that negative expressed emotion among family caregivers of persons with MDD was at a moderate level (gif.latex?\bar{X} = 1.49, SD = .83). The predictive factors could explain 68.4 percent of negative expressed emotion (R2 = .684, p = .01). The factors that significantly predicted negative expressed emotion included subjective burden (β = .532, p < .001), perceptions of illness severity (β = .227, p < .01), and social support (β = -.197, p < .01).

Conclusion and recommendations: This study showed that only subjective burden, perceptions of illness severity, and social support can significantly predict negative expressed emotion. The findings could be used for psychiatric nurses and mental health personnel in designing a plan to decrease negative expressed emotion for caregivers of persons with MDD.

Article Details

How to Cite
Worrasirinara, P., Suttharangsee, W., & Kongsuwan, V. (2019). Factors Predicting Negative Expressed Emotion among Family Caregivers of Persons with Major Depressive Disorder. Nursing Science Journal of Thailand, 37(1), 17–31. Retrieved from https://he02.tci-thaijo.org/index.php/ns/article/view/183574
Research Papers


1. World Health Organization. Depression: a global crisis [Internet]. 2012 [cited 2018 Jun 2]. Available from: https://www.searo.who.int/entity/mental_health/documents/depression-a-global-crisis/en/

2. Kongsuk T, Kittirattanapaiboon P, Kenbubpha K, Sukawaha S, Leejongpermpoon J. The prevalence of major depressive disorder in Thailand: results from the epidemiology national survey 2008 [Internet]. 2008 [cited 2018 Jan 10]. Available from: prasri.go.th/upic/ie.php/9a177a07fd2b9b9f.pdf. (in Thai).

3. van Krugten FC, Kaddouri M, Goorden M, van Balkom AJ, Bockting CL, Peeters FP, et al. Indicators of patients with major depressive disorder in need of highly specialized care: a systematic review. PLoS One. 2017 Feb 8;12(2):e0171659. doi: 10.1371/journal.pone.0171659. PubMed PMID: 28178306; PubMed Central PMCID: PMC5298252.

4. Hurley K. Caring for someone who is depressed [Internet]. Montclair, NJ: Vertical Health, LLC; 2018 [cited 2019 Feb 10]. Available from: https://www.psycom.net/helpingsomeone-depressed.

5. Prompakdee T, Udomratn P. Natural course and outcome of depressive disorder patients in Songklanagarind Hospital: ten years of follow-up. Journal of the Psychiatric Association of Thailand. 2008;53(1):81-97. (in Thai).

6. Chaowararak N, Soonthornchaiya R. Experiences of elderly caregivers in caring for elderly depressed patients. The Journal of Psychiatric Nursing and Mental Health. 2016;30(1):110-22. (in Thai).

7. Muscroft J, Bowl R. The impact of depression on caregivers and other family members: Implications for professional support. Couns Psychol Q. 2000;13(1):117-34.

8. van Wijngaarden B, Schene AH, Koeter MW. Family caregiving in depression: Impact on caregivers’ daily life, distress, and help seeking. J Affect Disord. 2004;81(3):211-22.

9. Mahakittikun K, Thapinta D, Sethabouppha H, Kittirattanapaiboon P. Predicting factors of relapse among persons with a major depressive disorder. Pac Rim Int J Nurs Res Thail. 2013;17(1):68-82.

10. Brown GW, Birley JL, Wing JK. Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry. 1972;121(2):241-58.

11. Hooley JM. Expressed emotion and relapse of psychopathology. Annu Rev Clin Psychol. 2007;3:329-52.

12. Sunpaweravong J, Weiss SJ, Suttharangsee W, Isaramalai S. Expressed emotion of family caregivers of persons with schizophrenia: a study in a Southern Province of Thailand. Thai Journal of Nursing Research. 2007;11(3):188-202.

13. Tompson MC, O Connor EE, Kemp GN, Langer DA, Asarnow JR. Depression in childhood and early adolescence: parental expressed emotion and family functioning. Ann Depress Anxiety. 2015;2(7). pii: 1070. PubMed PMID: 27347564; PubMed Central PMCID: PMC4917222.

14. Kulrattanamaneeporn C, Suwankiri D, Borvornsompong P, Sripong C, Tuntideelert M, Sanitya R, et al. Strengthening of social value: an extensive review literature and research approach of Thai values in the future [Internet]. Bangkok: Department of Cultural Promotion, Ministry of Culture; 2012 [cited 2018 Mar 5]. Available from: https://research.culture.go.th/index.php/interest/item/886-s104.html. (in Thai).

15. Srikhachin P, Thapinta D, Sethabouppha H, Thungjaroenkul P. Expressed emotion among family caregivers of persons with schizophrenia: a causal model study. Pac Rim Int J Nurs Res Thail. 2013;20(4):337-49. (in Thai).

16. Sadath A, Muralidhar D, Varambally S, Gangadhar BN, Jose JP. Do stress and support matter for caring? The role of perceived stress and social support on expressed emotion of carers of persons with first episode psychosis. Asian J Psychiatr. 2017;25:163-8.

17. Sompradit T, Kertchok R. Predicting factors of expressed emotion in family caregivers of schizophrenic patients. The Journal of Psychiatric Nursing and Mental Health. 2015;29(2):89-102. (in Thai).

18. Pongjantarasatien C. Factors predicting expressed emotion of family caregiver of schizophrenic patients, upper part of southern region. Journal of Somdet Chaopraya Institute of Psychiatry. 2009;3(2):42-56. (in Thai).

19. Srisatidnarakul B. The methodology in nursing research. 5th ed. Bangkok: You and I Intermedia; 2010. (in Thai).

20. Chedkhunthod P. Caregivers’ expressed emotion towards schizophrenia patients: comparison between caregivers of schizophrenia patients with and without relapse in a psychiatric hospital, Southern Thailand [master’s thesis]. Songkhla: Prince of Songkla University; 2008. 84 p. (in Thai).

21. Chaichumni N. Effects of using holistic caring program for caregiver on burden and capabilities in caring for schizophrenic patients [master’s thesis]. Bangkok: Chulalongkorn University; 2001. 173 p. (in Thai).

22. Trungkasombat U. Family therapy and family counseling. 5thed. Bangkok: Sunta Press; 2001. (in Thai).

23. Hongtrakul J. Relationships among selected basic conditioning factors social support and self-care agency in essential hypertensive patients [master’s thesis]. Bangkok: Mahidol University; 1989. 78 p. (in Thai).

24. Stoeber J. The Social Desirability Scale-17 (SDS-17): convergent validity, discriminant validity and relationship with age. Eur J Psychol Assess. 2001;17(3):222-32.

25. Pitikultang S. Family situations and trends. In: 6th International Conference of Public Health Science; 2013 Aug 23; Bangkok: Mahidol University; [2013]. p.3. (in Thai).

26. Carra G, Cazzullo CL, Clerici M. The association between expressed emotion, illness severity and subjective burden of care in relatives of patients with schizophrenia. Findings from an Italian population. BMC Psychiatry. 2012;12:140.

27. Alvarez-Jimenez M, Gleeson JF, Cotton SM, Wade D, Crisp K, Yap MB, et al. Differential predictors of critical comments and emotional over-involvement in first-episode psychosis. Psychol Med. 2010;40(1):63-72.

28. Dominguez-Martinez T, Medina-Pradas C, Kwapil TR, Barrantes-Vidal N. Relatives’ expressed emotion, distress and attributions in clinical high-risk and recent onset of psychosis. Psychiatry Res. 2017;247:323-9.

29. Chinnawong T. The influences of Thai Buddhist culture on cultivating compassionate relationships with equanimity between nurses, patients and relatives: a grounded theory approach [dissertation]. Lismore, NSW: Southern Cross University; 2007. 345 p.

30. Krinnoi S, Leuboonthavatchai O. Selected factors related to family functioning as perceived by family caregivers of schizophrenic patients. The Journal of Psychiatric Nursing and Mental Health. 2012;26(1):62-73. (in Thai).

31. Gogoi K. Assessment of expressed emotion in family members of patients with schizophrenia in a selected Medical College Hospital, Assam. Open J Psychiatry Alied Sci. 2017;8(1):62-70.