CULTURE AND FAMILY REACTIONS TO SCHIZOPHRENIA

这项拟议中的研究扩展了一个研究项目，该项目旨在调查与家庭成员对精神分裂症的反应有关的因素。具体来说，本研究将测试一个概念模型，该模型旨在澄清观察到的英美和拉丁美洲亲属对患有精神分裂症的家庭成员的反应差异的潜在因素。了解对精神分裂症的反应是至关重要的，因为情感表达（EE）领域的研究强烈表明，与情感过度投入的亲属生活在一起的患者，会表达过多的批评意见，和/或表现出任何程度的敌意（被指定为高情感表达亲属）在结构化的临床访谈中谈论患者时，其疾病预后比那些亲属没有表现出这些不利情绪的患者更差。高情感表达与精神分裂症不良预后相关的研究已经在广泛的种族和民族群体（亚裔印度人、盎格鲁-美国人、西班牙人等）中得到了重复，但发现情感表达模式存在一定的文化差异。例如，与“传统”和/或“发展中”社会相比，来自“工业化”和/或不那么“传统”文化的亲属被认定为高情感表达的频率明显更高，他们的病人表现出较差的病程。事实上，在美国同一地理区域内，盎格鲁裔美国人被评为高情感表达的频率是墨西哥裔拉美裔美国人的三倍。通过对25名盎格鲁裔美国人和25名拉丁裔美国人亲属的一系列访谈，本研究将探讨情感表达模式的文化差异是否与亲属对精神分裂症的特定信仰、价值观和归因有关。据推测，与盎格鲁-美国人相比，拉丁裔的亲属（拉丁裔被认为代表了一个“传统”文化群体）将报告有更相互依赖的自我解释，更大的报告家庭凝聚力，在他们的家庭中更重视道德和宗教，反过来，这些价值观预计将与亲属减少对患者引起疾病和相关症状的指责有关，从而降低家庭中高情感表达的水平。本研究的发现将进一步加深我们对情感表达的理论理解，并将为治疗精神分裂症的有效的以家庭为中心的干预策略的发展提供信息。

The proposed study expands on a program of research examining factors associated with family members' reactions to schizophrenia. Specifically, this study will test a conceptual model designed to clarify factors underlying observed differences between Anglo- American and Latino-American relatives' reactions to a family member with schizophrenia. Understanding reactions to schizophrenia is crucial because research in the area of expressed emotion (EE) strongly suggests that patients who live with relatives who are emotionally overinvolved, express an excessive number of critical comments, and/or express any degree of hostility (designated as high-EE relatives) when talking about the patient during a structured clinical interview have a poorer illness prognosis than patients whose relatives do not express as many of these unfavorable emotions. Studies associating high-EE with poor prognosis for schizophrenia have been replicated with a wide range of racial and ethnic groups (Asian-Indians, Anglo-Americans, Spanish, etc.), yet certain cultural differences in EE patterns have been found to exist. For example, when compared with "traditional" and/or "developing" societies, relatives from "industrialized" and/or less "traditional," cultures have been found to be designated as high-EE significantly more often and their patients show a poorer course of illness. In fact within the same geographic area of the United States, Anglo-Americans have been rated as high-EE three times more often than Latino-Americans of Mexican descent. Through a series of interviews with 25 Anglo- American and 25 Latino-American relatives, this study will examine whether cultural differences in EE patterns relate to relatives specific beliefs, values, and attributions about schizophrenia. It is hypothesized that, when compared to Anglo-Americans, relatives of Latino descent (Latinos are thought to represent a "traditional" cultural group) will report having a more interdependent self- construal, greater reported family cohesion, and greater moral- religious emphasis in their families in turn these values are expected to be associated with relatives attributing less blame to patients for bringing on the illness and the associated symptoms and consequently to lower levels of high EE in families. Findings from this study will further our theoretical understanding of EE and will inform the development of effective family focused intervention strategies for treating schizophrenia.