Association between perceived family expressed emotion and quality of life in depression and the role of self-stigma: a cross-sectional study.

Objectives: To explore the association between perceived family expressed emotion (EE), self-stigma, and quality of life (QoL) in Chinese patients with depression in Hong Kong, validate the factor structure of the Concise Chinese Level of Expressed Emotion Scale (CCLEES), and examine the factors associated with perceived family EE to aid early identification and intervention.

Methods: Chinese patients with a lifetime diagnosis of major depressive episode or recurrent depressive disorder who could communicate in Chinese and lived with at least one family member, relative, or partner aged ≥18 years were invited to participate. Patients were assessed using the CCLEES for perceived family EE, the Self-Stigma Scale-Short Form for self-stigma, the Short Form of Quality of Life Enjoyment and Satisfaction Questionnaire for QoL, the Social and Occupational Functioning Assessment Scale for social and occupational functioning, and the Hamilton Depression Rating Scale for the severity of depressive symptoms. Confirmatory factor analysis was used to validate the CCLEES factor structure. Structural equation modelling examined the associations between perceived family EE, self-stigma, and QoL. Multiple linear regression analysis was used to identify predictors for perceived family EE.

Results: In total, 124 female and 36 male patients with depression (median age, 47 years) and 76 male and 84 female family members (median age, 48.5 years) were included in the analysis. Confirmatory factor analysis supported the three-factor structure of the CCLEES; internal consistencies of the CCLEES and its three dimensions were satisfactory (ω = 0.733-0.893). Perceived family EE, self-stigma, and QoL were intercorrelated. Perceived family EE was negatively associated with overall QoL (β = -0.316, p < 0.001); self-stigma partially mediated the association between perceived family EE and overall QoL (β = -0.030, 95% confidence interval = -0.066 to -0.003). Predictors for family EE were self-stigma, single status, parents being key family members, and severity of depressive symptoms.

Conclusion: Perceived family EE is negatively associated with QoL, and self-stigma mediates this association. Thus, addressing both family EE and self-stigma is important in the treatment of depression. Clinicians should consider incorporating family psychoeducation that involves knowledge about depression, problem-solving skills, and coping skills.