The relationship between family expressed emotion (EE) and caregiver burden in stroke and acquired brain injury (ABI)

Rooney, Clare and Sellwood, Bill and Cunningham, Roisin (2023) The relationship between family expressed emotion (EE) and caregiver burden in stroke and acquired brain injury (ABI). PhD thesis, Lancaster University.

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Abstract

Section one describes a narrative systematic literature review examining the relationship between expressed emotion (EE) and mental health in acquired brain injury (ABI) populations. Nine papers were identified through searching 5 electronic databases using MeSH terms for ABI and search terms for EE. Six of the nine studies reviewed found significant relationships between EE and some measure of psychological outcome. Studies gathered data from the ABI survivor, the caregiver or both. None of the nine were rated the highest score for quality. The results showed a lack of research in this area and evidence to support the relationship between EE and mental health in ABI but not consistently. Further higher quality and more focussed research is required. The review highlighted areas for improvement and directions of future research in this domain. Section two describes a research study which aimed to identify whether high EE predicted high levels of burden in stroke caregivers and if stroke knowledge moderated this relationship. Significant positive correlations were identified between EE and measures of caregiver burden. Regression analyses found EE significantly explained the variance in measures of caregiver burden, Stroke knowledge was not found to be a significant moderating effect between EE and caregiver burden in this study. Services should consider the impact of EE and how to support caregivers in order to facilitate good outcomes for both the stroke survivor and their caregiver. Further exploration of stroke knowledge and development of appropriate measures is indicated. Section three describes a critical appraisal of the thesis as a whole. This includes an overview of the main findings from the other papers and discussions of issues and limitations raised including terminology used, measures and the impact of culture. It also has reflections on the thesis journey as a whole and makes recommendations for further research.