Expressed emotion as an adaptation to loss: prospective study in first-episode psychosis.

BACKGROUND: The factors influencing the development of expressed emotion (EE) are still unclear. Understanding the carer and patient appraisals operating during the initial adaptation to psychosis may help to clarify the early ontogenesis of EE. METHOD: Fifty patients and key carers were followed-up over 9 months and their appraisals of loss and burden were measured in relation to the evolution of high emotional overinvolvement (EOI) and critical (CC) relationships. RESULTS: The appraisal of loss was linked to high EOI but not high CC relationships at baseline. Loss reduced by 9-month follow-up in those changing from high EOI to high CC or low EE. Subjective burden of carers was linked to loss but not to EE status. Patients' and relatives' appraisals of loss were strongly correlated, particularly in high EOI relationships. Longer duration of untreated psychosis was associated with high CC. CONCLUSIONS: The results are consistent with Bowlby's attachment theory, where EOI and coercive criticism may be understood as adaptive reactions to perceived loss. Implications for family intervention in first-episode psychosis and the prevention of high EE are discussed.

Depression in South Asian women living in the UK: a review of the literature with implications for service provision.

Research has shown that South Asian people in the UK underutilize health services compared with White people. Also, where services are accessed, they may not adequately meet cultural and religious needs. In exploring the relationship between the cultural and religious beliefs of South Asian service users about perceptions, beliefs about aetiology, cause and treatment of mental illness, past studies have illustrated a wide range of expectations, experiences, beliefs and attitudes. This article reviews research on depression in South Asian women in the UK, highlighting implications for services.

The ability of adult mental health services to meet clients' attachment needs: the development and implementation of the Service Attachment Questionnaire.

This study examined the relevance of adult attachment to the relationships between mental health services and their clients. The aim of the study was to develop a self-report measure with acceptable levels of reliability and validity and which was grounded in the experiences of service users, to assess the ability of adult mental health services to meet clients' attachment needs. A combination of qualitative and quantitative methodology was used. The Service Attachment Questionnaire (SAQ) was developed via focus groups of service users, followed by a grounded theory analysis of the group data to identify themes and potential items for inclusion. Two clinical trials were conducted to assess its reliability and validity. The grounded theory analysis produced six key themes forming the basis of the six-subscale, 25-item SAQ. It demonstrated good levels of internal and test-retest reliability. Factor analysis of the subscales revealed a single underlying construct. The SAQ is a reliable and usable self-report measure, and indicates that attachment is relevant to the relationships clients have with mental health services. As the measure is the first of its kind, further exploration of the measure's reliability and validity is recommended.