Race Matters in Assessment of Familial Criticism

Abstract

Introduction: Two findings in the Expressed Emotion (EE) literature fail to hold for Black psychiatric patients: EE (predominantly criticism) fails to predict treatment outcome, and measures of EE fail to correlate with patients' perceptions of relatives' criticism. To understand these findings, we tested whether non-Black coders of observable criticism (a) rate Black relatives higher in criticism than White relatives, or (b) are generally less accurate when rating Black relatives. Method: Familial dyads [31 Black; 87 White] participated in video recorded problem-solving interactions. Each interaction was reliably coded for observed criticism by two-four non-Black coders; participants rated perceived criticism (the criterion measure) post-interaction. Results: Coders were less accurate in rating criticism from Black than White relatives. Discussion: These data suggest patients' ratings of perceived criticism might be the measure of choice for identification of Black families who should be engaged in the treatment process to help reduce criticism-associated treatment failure