No correlation among expressed emotion, anxiety, stress and weight loss in patients with overweight and obesity
Background: The onset of some types of obesity may correlate with specific familial relational patterns, and expressed emotion (EE), the family life’s ‘emotional temperature’, may play a role in obesity treatment compliance and outcome.
Objective: The aim of this study is to address the current gap in the literature about EE and obesity, assessing EE in a sample of patients with overweight or obesity and their relatives. A further objective is to assess patients’ weight loss, patients’ and relatives’ anxiety, perceived stress and their possible correlation with EE and diet compliance.
Design: A total of 220 patients with overweight or obesity and 126 relatives were recruited; their socio-demographic and clinical features were collected; and Level of Expressed Emotion Scale (LEE), State-Trait Anxiety Inventory 1 and 2 (STAI-Y1 and STAI-Y2) and Paykel Scale of Stressful Life Events were administered.
Results: Patients’ baseline body mass index (BMI) was negatively correlated with educational level, but we failed to find any correlation between BMI and the other variables assessed. We found a positive correlation between EE median and stressful life events, as well as between median EE and state and trait anxiety.
Conclusions: Our results seem to suggest that other factors than the psychological ones we investigated may play a role in treatment adherence and outcome in patients with overweight and obesity.
- Mota MC, Silva CM, Balieiro LCT, Fahmy WM, Crispim CA. Social jetlag and metabolic control in non-communicable chronic diseases: a study addressing different obesity statuses. Sci Rep 2017; 7(1): 6358. doi: 10.1038/s41598-017-06723-w.
- World Health Organization Regional Office for Europe. Obesity [Web page] Available from: http://www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity [cited 12 March 2019].
- Hoste RR, Lebow J, Le Grange D. A bidirectional examination of expressed emotion among families of adolescents with bulimia nervosa. Int J Eat Disord 2015; 48(2): 249–52. doi: 10.1002/eat.22306.
- Brown GW, Rutter M. The measurement of family activities and relationships: a methodological study. Hum Relat 1966; 19: 241–63. doi: 10.1177/001872676601900301.
- Kuipers L, Bebbington P. Expressed emotion research in schizophrenia: theoretical and clinical implications. Psychol Med 1988; 18(4): 893–909. doi: 10.1017/S0033291700009831.
- Kuipers L. Expressed emotion in 1991. Soc Psychiatry Psychiatr Epidemiol 1992; 27(1): 1–3. doi: 10.1007/BF00788948.
- Brown GW, Birley JL, Wing JK. Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry 1972; 121(562): 241–58. doi: 10.1192/bjp.121.3.241.
- Bruch H. Eating disorders. New York: Basic Books; 1973.
- Baldaro B, Balsamo A, Caterina R, Fabbrici C, Cacciari E, Trombini G. Decoding difficulties of facial expression of emotions in mothers of children suffering from developmental obesity. Psychother Psychosom 1996; 65(5): 258–61. doi: 10.1159/000289085.
- Taylor CB, Bryson S, Celio Doyle AA, Luce KH, Cunning D, Abascal LB, et al. The adverse effect of negative comments about weight and shape from family and siblings on women at high risk for eating disorders. Pediatrics 2006; 118(2): 731–8. doi: 10.1542/peds.2005-1806.
- Dingemans AE, Martijn C, Jansen AT, van Furth EF. The effect of suppressing negative emotions on eating behavior in binge eating disorder. Appetite 2009; 52(1): 51–7. doi: 10.1016/j.appet.2008.08.004.
- Abbate-Daga G, Marzola E, Gramaglia C, Brustolin A, Campisi S, De-Bacco C, et al. Emotions in eating disorders: changes of anger control after an emotion-focused day hospital treatment. Eur Eat Disord Rev. 2012; 20(6): 496–501. doi: 10.1002/erv.2199.
- Flanagan DA, Wagner HL. Expressed emotion and panic-fear in the prediction of diet treatment compliance. Br J Clin Psychol 1991; 30(Pt 3): 231–40. doi: 10.1111/j.2044-8260.1991.tb00941.x.
- Fischmann-Havstad L, Marston AR. Weight loss maintenance as an aspect of family emotion and process. Br J Clin Psychol 1984; 23(Pt 4): 265–71. doi: 10.1111/j.2044-8260.1984.tb01300.x.
- Di Paola F, Faravelli C, Ricca V. Perceived expressed emotion in anorexia nervosa, bulimia nervosa, and binge-eating disorder. Compr Psychiatry 2010; 51(4): 401–5. doi: 10.1016/j.comppsych.2009.10.002.
- Kroon Van Diest AM, Tylka TL. The Caregiver Eating Messages Scale: development and psychometric investigation. Body Image 2010; 7(4): 317–26. doi: 10.1016/j.bodyim.2010.06.002.
- Luppino FS, de Wit LM, Bouvy PF., Stijnen T, Cuijpers P, Penninx BW, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67(3): 220–229. doi: 10.1001/archgenpsychiatry.2010.2.
- Gariepy G, Nitka D, Schmitz N. The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. Int J Obes (Lond) 2010; 34: 407–19. doi: 10.1038/ijo.2009.252.
- Papadopoulos S, Brennan L. Correlates of weight stigma in adults with overweight and obesity: a systematic literature review. Obesity (Silver Spring) 2015; 23(9): 1743–60. doi: 10.1002/oby.21187.
- World Health Organization Expert committee on physical status: the use and interpretation of anthropometry. Physical status: the use and interpretation of anthropometry. Report of a WHO expert committee. World Health Organization Technical Report Series, 854. Geneva: World Health Organization; 1995.
- Cole JD, Kazarian SS. The Level of Expressed Emotion Scale: a new measure of expressed emotion. J Clin Psychol 1988; 44(3): 392–7. doi: 10.1002/1097-4679(198805)44:3<392::aid-jclp2270440313>3.0.co;2-3.
- Hooley JM, Parker HA. Measuring expressed emotion: an evaluation of the shortcuts. J Fam Psychol 2006; 20(3): 386–96. doi: 10.1037/0893-3126.96.36.1996.
- Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press; 1983.
- Julian LJ. Measures of Anxiety State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res 2011; 63 Suppl 11: S467–72. doi: 10.1002/acr.20561.
- Nejatisafa AA, Mortaz-Hedjri S, Malakoutian T, Arbabi M, Hakemi MS, Haghighi AN, et al. Quality of life and life events of living unrelated kidney donors in Iran: a multicenter study. Transplantation 2008; 86(7): 937–940. doi: 10.1097/TP.0b013e318186d945.
- Baratta S, Colorio C, Zimmermann-Tansella C. Inter-rater reliability of the Italian version of the Paykel Scale of stressful life events. J Affect Disord 1985; 8(3): 279–82. doi: 10.1016/0165-0327(85)90027-8.
- IBM Corp. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp; 2013.
- Hayes M, Baxter H, Müller-Nordhorn J, Hohls JK, Muckelbauer R. The longitudinal association between weight change and health-related quality of life in adults and children: a systematic review. Obes Rev 2017; 18(12): 1398–411. doi: 10.1111/obr.12595.
- Oh Y, Hass NC, Lim SL. Body weight can change how your emotions are perceived. PLoS One 2016; 11(11): e0166753. doi: 10.1371/journal.pone.0166753.
- Thompson AE, Anisimowicz Y, Miedema B, Hogg W, Wodchis WP, Aubrey-Bassler K. The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study. BMC Fam Pract 2016; 17: 38. doi: 10.1186/s12875-016-0440-0.
- Zeppegno P, Manzetti E, Valsesia R, Siliquini R, Ammirata G, De Donatis O, et al. Differences in suicide behaviour in the elderly: A study in two provinces of Northern Italy. Int J Geriatr Psychiatry 2005; 20(8): 769–75. doi: 10.1002/gps.1354.
- Epicentro La sorveglianza Passi [Web page] Available from: http://www.epicentro.iss.it/passi/rapporto2013/sovrappeso.asp [cited 12 March 2019].
- Flanagan DA. A retrospective analysis of expressed emotion (EE) and affective distress in a sample of relatives caring for traumatically brain-injured (TBI) family members. Br J Clin Psychol 1998; 37(Pt 4): 431–9. doi: 10.1111/j.2044-8260.1998.tb01400.x.
- Bressi C, Porcellana M, Pedrinazzi C, Manoussakis C, Marinaccio P, Magri L, et al. Expressed emotion in wives of myocardial infarction patients: an exploratory feasibility study. J Cardiovasc Med (Hagerstown) 2009; 10(10): 752–7. doi: 10.2459/JCM.0b013e32832cae71.
- Cutting LP, Aakre JM, Docherty NM. Schizophrenic patients’ perceptions of stress, expressed emotion, and sensitivity to criticism. Schizophr Bull 2006; 32(4): 743–750. doi: 10.1093/schbul/sbl001.
- Campbell SB, Renshaw KD, Klein SR. Sex differences in associations of hostile and nonhostile criticism with relationship quality. J Psychol 2017; 151(4): 416–30. doi: 10.1080/00223980.2017.1305324.
- Lebron-Milad K, Milad MR. Sex differences, gonadal hormones and the fear extinction network: implications for anxiety disorders. Biol Mood Anxiety Disord 2012; 2: 3. doi: 10.1186/2045-5380-2-3.
- Salzman C, Lebowitz B. Anxiety in the elderly: treatment and research. New York: Springer; 1991.
- McCleary R, Zucker EL. Higher trait- and state-anxiety in female law students than male law students. Psychol Rep 1991; 68(3 Pt 2): 1075–8. doi: 10.2466/pr0.1991.68.3c.1075.
- Perkins S, Schmidt U, Eisler I, Treasure J, Yi I, Winn S, et al. Why do adolescents with bulimia nervosa choose not to involve their parents in treatment? Eur Child Adolesc Psychiatry 2005; 14(7): 376–85. doi: 10.1007/s00787-005-0485-4.
- Thereaux J, Lesuffleur T, Païta M, Czernichow S, Basdevant A, Msika S, et al. Long-term follow-up after bariatric surgery in a national cohort. Br J Surg 2017; 104(10): 1362–71. doi: 10.1002/bjs.10557.
- Schmidt R, Tetzlaff A, Hilbert A. Validity of the Brief Dyadic Scale of Expressed Emotion in adolescents. Compr Psychiatry 2016; 66: 23–30. doi: 10.1016/j.comppsych.2015.12.002.
- Medina-Pradas C, Navarro JB, López SR, Grau A, Obiols JE. Dyadic view of expressed emotion, stress, and eating disorder psychopathology. Appetite 2011; 57(3): 743–8. doi: 10.1016/j.appet.2011.08.016.
- Lee CH, Wang TJ, Tang HP, Liu YH, Bell J. Familial expressed emotion among heroin addicts in methadone maintenance treatment: does it matter? Addict Behav 2015; 45: 39–44. doi: 10.1016/j.addbeh.2015.01.014.
- Eray S¸, Uçar HN, Çetinkaya F, Eren E, Vural P. The relationship between perceived family climate and glycemic control in type 1 diabetes mellitus adolescent patients. J Clin Res Pediatr Endocrinol 2017; 9(3): 253–9. doi: 10.4274/jcrpe.3825.
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