ABSTRACT

Background: Schizophrenia, is the most severe psychotic illness and impacts the life of the patient and their families. Expressed emotions (EE), is the index of quantity and quality of negative emotions of family caregivers shown toward the patients with schizophrenia. Attitudes and behaviors of several specific emotions expressed by family caregivers those are a potential risk to the patient with schizophrenia and affect their health outcomes including the symptom. A limited study has identified the interplay between psychotic symptoms of patients with schizophrenia in Indonesia and their family caregiver’s expressed emotion.
Purpose: The purpose of this study is to explore the correlates and predictors of family caregiver’s expressed emotion in Indonesia, and to examine the role of psychotic symptoms in patients with schizophrenia.
Method: A retrospective, predictive and cross-sectional study design used convenience sampling conducted in the mental hospital of Dr. Arif Zainudin Surakarta Indonesia (RSJD Surakarta) Indonesia. Measurement of Level of Expressed Emotions (LEE) and Brief Psychiatric Rating Scale (BPRS) used to collect the data from the family caregiver and primary nurse respectively. A researcher approached the study participants to give them inform consents, questionnaires and gathered the data.
Results: A total of 150 dyadic data of paired schizophrenic patients and their family caregivers participated in the study. The association result showed the domain of family caregiver’s LEE, emotional response to patients, had a significantly positive association with psychotic symptom (Beta =1.28, p =<.01) but other three domains. The higher the caregivers’ emotional response to patients, the greater was patient’s psychotic symptoms. The negative predictor of psychotic symptoms of patients was the family caregiver’s educational level (Beta = −6.96, p =.02) and the positive predictor were the patient’s marital status (Beta = 7.05, p =.02) and the domain of family caregivers LEE, emotional response to patients (Beta = 2.08, p= <.01) showed even stronger predict the psychotic symptoms. The three of the domain of family caregivers LEE did not encounter for predictor.
Conclusion: This study is the first to explore factors related to Indonesian schizophrenic of family caregiver’s EE. Compared to family caregiver’s in other countries, Indonesian family caregivers tended to respond their EE emotional response with more inappropriate strategies. We also identified significant predictors of psychotic symptoms consist of the patient’s marital status, family caregiver’s educational level and emotional response to patients. Future research and education programs are needed to enhance family caregiver’s EE toward schizophrenic patients.
Keywords: Expressed Emotion, Psychotics Symptoms, Family caregivers, Schizophrenia, Predictive Study

REFERENCES
Adha, N. K. (2015). Hubungan Dukungan Emosional Keluarga Terhadap Skor Brief Psychiatric Rating Scale Pada Pasien Skizofrenia di Instalasi Rawat Inap RSJ Grhasia DIY (Doctoral Dissertation, Fakultas Kedokteran Dan Ilmu Kesehatan Universitas Muhammadiyah Yogyakarta).
Aguilera, A., López, S. R., Breitborde, N. J., Kopelowicz, A., & Zarate, R. (2010). Expressed emotion and sociocultural moderation in the course of schizophrenia. Journal of Abnormal Psychology, 119(4), 875
APA. (2001). The Association of Psychologist of America (APA) Report of the Task Force on Mental Disability and the Death Penalty. USA: APA.
APA. (2013). Diagnostic and statistical manual of mental disorders fifth edition DSM-V American psychiatric association. USA: APA American Psychiatric publishing. ISBN 978-0-89042-554-1.
APA. (2013). The Association of Psychologist of America (APA) Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists. USA: APA.
APA. (2017). The Association of Psychologist of America (APA). Guidelines on mental health illness. USA: APA.
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186-3191.
Bellack, A.S., Haas, G.L., Schooler, N.R., & Flory D.J. (2009). Effect of family behavior family management on family communication and patient outcomes in schizophrenia. British Journal of Psychiatry 177, 434-439.
Benazon, N., Foster, M., & Coyne, J. (2006). Expressed emotion, adaptation, and patient survival among couples coping with chronic heart failure. Journal of Family Psychology: JFP: Journal Of The Division Of Family Psychology Of The American Psychological Association (Division 43), 20(2), 328-334
Berry, K., Barrowclough, C., & Haddock, G. (2009). The role of expressed emotion in relationships between psychiatric staff and people with a diagnosis of psychosis: a review of the literature. Schizophrenia Bulletin, 37(5), 958-972.
Bressi, C., Cornaggia, C., Beghi, M., Porcellana, M., Iandoli, I., & Invernizzi, G. (2007). Epilepsy and family expressed emotion: results of a prospective study. Seizure: The Journal of The British Epilepsy Association, 16(5), 417-423.
Brown G.W, Birley J.L.T & Wing J.K. (1972). Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry. 121, 241-258121, 241–258.
Brown, G. W., & Rutter, M. (1996). The measurement of family activities and
Relationships: A methodological study. Human Relations, 19, 241–263.
Butzlaff, R. L., & Hooley, J. M. (1998). Expressed emotion and psychiatric relapse. Archives of General Psychiatry, 55(6), 547-552.
Callaghan, P., & Waldock, H.(2010). Oxford Handbook of Mental Health Nursing.British: Oxford University
Caqueo-Urízar, A., Rus-Calafell, M., Urzúa, A., Escudero, J., & Gutiérrez-Maldonado, J. (2015). The role of family therapy in the management of schizophrenia: challenges and solutions. Neuropsychiatric disease and treatment, 11, 145.
Cechnicki, A., Bielańska, A., Hanuszkiewicz, I., & Daren, A. (2013). The predictive validity of expressed emotions (EE) in schizophrenia. A 20-year prospective study. Journal of psychiatric research, 47(2), 208-214.
Chang, H. J., Chen, W. X., Lin, E. C. L., Tung, Y. Y., Fetzer, S., & Lin, M. F. (2014). Delay in seeking medical evaluations and predictors of self-efficacy among women with newly diagnosed breast cancer: a longitudinal study. International journal of nursing studies, 51(7), 1036-1047.
Chen, C. K. (2006). The relationship between attachment quality and expressed emotion among adult children caring for parents with dementia. The University of North Carolina at Chapel Hill.
Cheng, S. C., Hsu, W. S., Shen, S. H., Hsu, M. C., & Lin, M. F. (2017). Dose–Response Relationships of Multisensory Intervention on Hospitalized Patients with Chronic Schizophrenia. Journal of Nursing Research, 25(1), 13-20. doi:10.1097/jnr.0000000000000154
Chien, W. T., & Chan, S. W. (2009). Testing the psychometric properties of a Chinese version of the Level of Expressed Emotion Scale. Research in nursing & health, 32(1), 59-70.
Chien, W. T., & Chan, S. W. (2010). Further validation of the Chinese version of the Level of Expressed Emotion Scale for research and clinical use. International journal of nursing studies, 47(2), 190-204.
Claxton, M., Onwumere, J., & Fornells-Ambrojo, M. (2017). Do family interventions improve outcomes in early psychosis? A systematic review and meta-analysis. Frontiers in psychology, 8, 371.
Cole, J. D., & Kazarian, S. S. (1988). The Level of Expressed Emotion Scale: a new measure of expressed emotion. Journal of clinical psychology, 44(3), 392-397.
Cole, J. D., & Kazarian, S. S. (1993). Predictive validity of the Level of Expressed Emotion (LEE) Scale: Readmission follow-up data for 1, 2, and 5-year periods. Journal of Clinical Psychology, 49, 216–218.
Davidson, L., Schmutte, T., Dinzeo, T., & Andres-Hyman, R. (2007). Remission and recovery in schizophrenia: practitioner and patient perspectives. Schizophrenia Bulletin, 34(1), 5-8.
Dazzi, F., Shafer, A., & Lauriola, M. (2016). Meta-analysis of the Brief Psychiatric Rating Scale-Expanded (BPRS-E) structure and arguments for a new version. Journal of psychiatric research, 81, 140-151.
Demir, S. (2018). The Relationship between Expressed Emotion and the Probability of Suicide among Turkish Psychiatric Outpatients: A Descriptive Cross-sectional Survey. Family & community health, 41(2), 111-116.
Dewi, R., & Marchira, C. R. (2009). Riwayat Gangguan Jiwa pada Keluarga dengan Kekambuhan Pasien Skizofrenia di RSUP Dr Sardjito Yogyakarta. Berita Kedokteran Masyarakat, 25(4), 176.
Doenges. M.E, Townsend. A.C & Moorhouse. M.F (2007). Nursing Care Plan (6th edition). USA: Elsevier, F.A Davis Publisher.
Domínguez-Martínez, T., Medina-Pradas, C., Kwapil, T. R., & Barrantes-Vidal, N. (2014). Relatives׳ illness attributions mediate the association of expressed emotion with early psychosis symptoms and functioning. Psychiatry research, 218(1), 48-53
Doris, S. F., Kwok, T., Choy, J., & Kavanagh, D. J. (2016). Measuring the expressed emotion in Chinese family caregivers of persons with dementia: Validation of a Chinese version of the Family Attitude Scale. International journal of nursing studies, 55, 50-59.
Edition, F. (2013). Diagnostic and statistical manual of mental disorders. American Psychiatric Publishing, Arlington, VA.
Endley, L., & Berry, K. (2011). Increasing awareness of expressed emotion in schizophrenia: an evaluation of a staff training session. Journal of psychiatric and mental health nursing, 18(3), 277-280.
Fles, R., Bos, A. C. R. K., Rachmawati, D., Waliyanti, E., Tan, I. B., Haryana, S. M., ... & Dewi, F. S. T. (2017). The role of Indonesian patients’ health behaviors in delaying the diagnosis of nasopharyngeal carcinoma. BMC public health, 17(1), 510. DOI : 10.1186/s12889-017-4429-y
Fortinash, K.M., & Holoday P.A. (2007). Psychiatric Nursing Care Plans (5th ed). Canada: Mosby Elsevier.
Frey, S. (2014). The economic burden of schizophrenia in Germany: a population-based retrospective cohort study using genetic matching. European Psychiatry, 29(8), 479-489. doi: 10.1016/j.eurpsy.2014.04.003.
Friedman, M.S., & Goldstein, M.J. (1988). Relatives' awareness of their own expressed emotion as measured by a self-report adjective checklist. Family Process, 32, 459-479.
Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., ... & McGuire, P. (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of general psychiatry, 69(3), 220-229.
Giacco, D., McCabe, R., Kallert, T., Hansson, L., Fiorillo, A., & Priebe, S. (2012). Friends and symptom dimensions in patients with psychosis: a pooled analysis. PLoS One, 7(11), e50119.
Goldenberg, Herbert & Goldenberg, Irene. (2008). Family therapy: an overview. Belmont, CA: Thomson Brooks/Cole. ISBN: 978049509759.
Gómez-de-Regil, L., Kwapil, T. R., & Barrantes Vidal, N. (2014). Predictors of expressed emotion, burden and quality of life in relatives of Mexican patients with psychosis. Journal of psychiatric and mental health nursing, 21(2), 170-179.
Grandón, P., Jenaro, C., & Lemos, S. (2008). Primary caregivers of schizophrenia outpatients: Burden and predictor variables. Psychiatry Research, 158(3), 335-343.
Gray, R., Leese, M., Bindman, J., Becker, T., Burti, L., David, A., ... & Schene, A. (2006). Adherence therapy for people with schizophrenia: European multicentre randomized controlled trial. The British journal of psychiatry, 189(6), 508-514.
Haidl, T., Rosen, M., Schultze-Lutter, F., Nieman, D., Eggers, S., Heinimaa, M., ... & Salokangas, R. (2018). Expressed emotion as a predictor of the first psychotic episode—Results of the European prediction of psychosis study. Schizophrenia research.
Hale, W. W., Raaijmakers, Q. A., Gerlsma, C., & Meeus, W. (2007). Does the level of expressed emotion (LEE) questionnaire have the same factor structure for adolescents as it has for adults?. Social Psychiatry and Psychiatric Epidemiology, 42(3), 215-220.
Hansen J.C., Berman S.P. & Babcock C.W. (1991). The relationship of
family and staff expressed emotion to residents’ functioning in community residences. Psychosocial Rehabilitation Journal 14(4), 85-89.
Helgeland, M. I., & Torgersen, S. (2005). Stability and prediction of schizophrenia from adolescence to adulthood. European child & adolescent psychiatry, 14(2), 83-94.
Hooley, J. M., & Campbell, C. (2002). Control and controllability: Beliefs and behavior in high and low expressed emotion relatives. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 32(6), 1091-1099.
Hooley, J. M., & Campbell, C. (2002). Control and controllability: Beliefs and behavior in high and low expressed emotion relatives. Psychological Medicine, 32, 1091–1099.
Hooley, J. M., & Parker, H. A. (2006). Measuring expressed emotion: an evaluation of the shortcuts. Journal of Family Psychology, 20(3), 386. Doi: 386–396 0893-3200/06/$12.00
Hooley, J. M., & Teasdale, J. D. (1989). Predictors of relapse in unipolar depressives: Expressed emotion, marital distress, and perceived criticism. Journal of Abnormal Psychology, 98(3), 229-235
Humbeeck, Van G., & Van Audenhove, C. (2003). Expressed emotion of professionals towards mental health patients. Epidemiology and Psychiatric Sciences, 12(4), 232-237.
IICB Laporan Riset Kesehatan Dasar/ Riskesdas (Basic Health Research) in Indonesia. (2012). Severe mental illness. Indonesia : Ministry of health Republic of Indonesia.
Ivernizzi, G., Bressi, C., Bertrand, P., Passerini, A., Giannelli, A., Clerici, M., & ... Cazzullo, C. (1991). Emotional profiles of families with a heart-operated patient: a pilot study. Psychotherapy and Psychosomatics, 55(1), 1-8.
Jang, S. N., Avendano, M., & Kawachi, I. (2012). Informal caregiving patterns in Korea and European countries: a cross-national comparison. Asian Nursing Research, 6(1), 19-26.DOI doi:10.1016/j.anr.2012.02.002
Jansen, J. E., Harder, S., Haahr, U. H., Lyse, H. G., Pedersen, M. B., Trauelsen, A. M., & Simonsen, E. (2015). The Role of Metacognitions in Expressed Emotion and Distress: A Study on Caregivers of Persons with First‐Episode Psychosis. Clinical psychology & psychotherapy, 22(6), 525-532.
Jones, P., McGuire, P. K., Harvey, I., Williams, M., McGuffin, P., & Murray, R. M. (1995). Morbid risk of schizophrenia for relatives of patients with cannabis-associated psychosis. Schizophrenia research, 15(3), 277-281.
Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing: Theory, practice, and research. FA Davis
Kaplan, A., DeRosse, P., Burdick, K. E., Lencz, T., & Malhotra, A. K. (2010). Cannabis use disorders in schizophrenia: effects on cognition and symptoms. Schizophrenia research, 120(1), 95-100.
Kazarian, S. S., Malla, A. K., Cole, J. D., & Baker, B. (1990).Comparisons of two expressed emotion scales with the Camberwell Family Interview. Journal of Clinical Psychology, 46, 306–309.
King, S., Ricard, N., Rochon, V., Steiger, H., & Nelis, S. (2003). Determinants of expressed emotion in mothers of schizophrenia patients. Psychiatry research, 117(3), 211-222. doi:10.1016/S0165-1781(03)00018-0
Kirkbride J.B, Errazuriz A, Croudace T.J, Morgan C, Jackson D, McCrone P, … & & Jones P.B.(2012).Systematic Review of the Incidence and Prevalence of Schizophrenia and Other Psychoses in England. England: Department of Health and Policy Research Program.
Koschorke, M., Padmavati, R., Kumar, S., Cohen, A., Weiss, H. A., Chatterjee, S., ... & Balaji, M. (2017). Experiences of stigma and discrimination faced by family caregivers of people with schizophrenia in India. Social Science & Medicine, 178, 66-77.
Koutra, K., Triliva, S., Roumeliotaki, T., Basta, M., Lionis, C., & Vgontzas, A. N. (2014). Family functioning in first-episode and chronic psychosis: The role of patient’s symptom severity and psychosocial functioning. Community mental health journal, 52(6), 710-723.
Kunnamo (2015). Evidenced based guidelines. Finland: john wiley & sons ltd.
Kvig, E. I., Brinchmann, B., Moe, C., Nilssen, S., Larsen, T. K., & Sørgaard, K. (2017). Geographical accessibility and duration of untreated psychosis: distance as a determinant of treatment delay. BMC Psychiatry, 17(1), 176.
Leeuw, J. (2015). Making Marriages Work: Common Factors of Marriage Theories.
Leff, J. P., & Vaughn, C. E. (1985). Expressed emotion in families. New York: Guilford Press.
Leff. J & Vaughn. C. (1985). Expressed Emotion in Families: Its Significance for Mental Illness. The Guilford Press, New York.
Lehman, A. F., Lieberman, J. A., Dixon, L. B., McGlashan, T. H., Miller, A. L., Perkins, D. O., ... & Cook, I. (2004). Practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry, 161(2 SUPPL.).
Leucht, S., Kane, J. M., Kissling, W., Hamann, J., Etschel, E. V. A., & Engel, R. (2005). Clinical implications of brief psychiatric rating scale scores. The British Journal of Psychiatry, 187(4), 366-371.
Levene, J. E., Lancee, W., Seeman, M. V., Skinner, H., & Freeman, S. J. (2009). Family and patient predictors of symptomatic status in schizophrenia. The Canadian Journal of Psychiatry, 54(7), 446-451.
Li, C. Y., & Lewis, F. M. (2013). Expressed emotion and depression in caregivers of older adults with dementia: results from Taiwan. Aging Mental Health, 17(8), 924-929. doi:10.1080/13607863.2013.814098
Li, C. Y., & Murray, M. (2015). A review of conceptualization of expressed emotion in caregivers of older adults with dementia. Journal of clinical nursing, 24(3-4), 332-343. doi: 10.1111/jocn.12619.
Lin, M. F., Lee, A. Y., Chou, C. C., Liu, T. Y., & Tang, C. C. (2017). Factors predicting emotional cue‐responding behaviors of nurses in Taiwan: An observational study. Psycho‐oncology, 26(10), 1548-1554.
MacCourt, P. (2013). National guidelines for a comprehensive service system to support family caregivers of adults with mental health problems and illnesses. Mental Health Commission of Canada.
Macgregor, A., Norton, J., Bortolon, C., Robison, M., Rolland, C., Boulenger, J.-P., . . . Capdevielle, D. (2015). The insight of patients and their parents into schizophrenia: Exploring agreement and the influence of parental factors. Psychiatry Research, 228(3), 879-886.
Meneghelli, A., Alpi, A., Pafumi, N., Patelli, G., Preti, A., & Cocchi, A. (2011). Expressed emotion in first-episode schizophrenia and in ultra high-risk patients: results from the Programma2000 (Milan, Italy). Psychiatry research, 189(3), 331-338. doi:10.1016/j.psychres.2011.03.02
Mino, Y., Shimodera, S., Inoue, S., Fujita, H., Tanaka, S., & Kanazawa, S. (2001). Expressed emotion of families and the course of mood disorders: a cohort study in Japan. Journal of affective disorders, 63(1), 43-49.
Mohamad, M. S., Zabidah, P., Fauziah, I., & Sarnon, N. (2012). Mental health literacy among family caregivers of schizophrenia patients. Asian Social Science, 8(9), 74.
Munro, B. H. (2005). Statistical methods for health care research. Philadelphia: Lippincott Williams & Wilkins.
Naheed, R. (2011). The effects of expressed emotion in adjustment to long-term health conditions and its role in post-stroke depression (Doctoral dissertation, University of Hull).
Nakanishi, M., Setoya, Y., Kodaka, M., Makino, H., Nishimura, A., Yamauchi, K., ... & Amagasa, T. (2007). Symptom dimensions and needs of care among patients with schizophrenia in the hospital and the community. Psychiatry and clinical neurosciences, 61(5), 495-501.doi : 10.1111/j.1440-1819.2007.01698.x
NAMI, MacCourt, P. (2013). National guidelines for a comprehensive service system to support family caregivers of adults with mental health problems and illnesses. Mental Health Commission of Canada.
Nieman, D. H., Velthorst, E., Becker, H. E., de Haan, L., Dingemans, P. M., Linszen, D. H., ... & Heinz, A. (2013). The Strauss and Carpenter Prognostic Scale in subjects clinically at high risk of psychosis. Acta Psychiatrica Scandinavica, 127(1), 53-61.DOI : 10.1111/j.1600-0447.2012.01899.x
Nomura, H., Inoue, S., Kamimura, N., Shimodera, S., Mino, Y., Gregg, L., & Tarrier, N. (2005). A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England. Social psychiatry and psychiatric epidemiology, 40(7), 564-570.
Norman, R. M., Malla, A. K., Manchanda, R., Harricharan, R., Takhar, J., & Northcott, S. (2005). Social support and three-year symptom and admission outcomes for first episode psychosis. Schizophrenia Research, 80(2), 227-234.
O’Brien, M. P., Miklowitz, D. J., Candan, K. A., Marshall, C., Domingues, I., Walsh, B. C., ... & Cannon, T. D. (2014). A randomized trial of family focused therapy with populations at high clinical risk for psychosis: Effects on interactional behavior. Journal of consulting and clinical psychology, 82(1), 90
Ogbolu, R. E., Adeyemi, J. D., & Erinfolami, A. R. (2013). Expressed emotion among schizophrenic patients in Lagos, Nigeria: a pilot study. African journal of psychiatry, 16(5), 329-329, 331.
Okpokoro, U., Adams, C. E., & Sampson, S. (2014). Family intervention (brief) for schizophrenia. The Cochrane Library
Öksüz, E., Karaca, S., Özaltın, G., & Ateş, M. A. (2017). The Effects of Psychoeducation on the Expressed Emotion and Family Functioning of the Family Members in First-Episode Schizophrenia. Community mental health journal, 53(4), 464-473.
Otong. D. A (2008). Psychiatric nursing: biological and behavioral concepts (2nd edition). Canada: Thomson Delmar Learning. ISBN-13 : 978-1-4180-3872-4.
Overall, J. E. (1974). The brief psychiatric rating scale in psychopharmacology research. In Psychological measurements in psychopharmacology (Vol. 7, pp. 67-78). Karger Publishers.
Overall, J. E., & Gorham, D. R. (1962). The brief psychiatric rating scale. Psychological Reports, 10(3), 799-812. doi : 10.2466/pr0.1962.10.3. 799
Overall, J. E., & Gorham, D. R. (1962). The brief psychiatric rating scale. Psychological reports, 10(3), 799-812.
Park, Y. C., Kanba, S., Chong, M. Y., Tripathi, A., Kallivayalil, R. A., Avasthi, A., ... & Yang, S. Y. (2017). To use the brief psychiatric rating scale to detect disorganized speech in schizophrenia: Findings from the REAP-AP study. The Kaohsiung Journal of Medical Sciences.
Peris, T. S., & Miklowitz, D. J. (2015). Parental expressed emotion and youth psychopathology: New directions for an old construct. Child Psychiatry & Human Development, 46(6), 863-873.
Plichta, S. B., & Kelvin, E. A. (2013). Munro’s statistical methods for health care research. Philadelphia: Lippincott Williams & Wilkins.
Ponizovsky, A. M., Nechamkin, Y., & Rosca, P. (2007). Attachment patterns are associated with symptomatology and course of schizophrenia in male inpatients. American Journal of Orthopsychiatry, 77(2), 324-331.
Potter S. R (2000). Schizophrenic Rehospitalisation and Expressed Emotion in Zulu South Africans: A pilot Study. Journal of Clinical Psychology. University of Natal. 20(2).
Potter, Halter Margareth Jordan. (2014). Varcarolis’ Foundations of Psychiatric Mental Health Nursing a clinical approach (7th Edition). United States of America: Elseivers Saunders. ISBN: 978-1-4557-5358-1
Pourmand, D., Kavanagh, D. J., & Vaughan, K. (2005). Expressed emotion as predictor of relapse in patients with comorbid psychoses and substance use disorder. Australian & New Zealand Journal of Psychiatry, 39(6), 473-478.
Quah, S. (2014). Caring for persons with schizophrenia at home: Examining the link between family caregivers' role distress and quality of life. Sociology of health & illness, 36(4), 596-612.
Rafiyah, I., Suttharangsee, W., & Sangchan, H. (2011). Social support and coping of Indonesian family caregivers caring for persons with schizophrenia. Nurse Media Journal of Nursing, 1(2), 159-168.
Ran, M. S., Wong, Y. L. I., Yang, S. Y., Ho, P. S., Mao, W. J., Li, J., & Chan, C. L. W. (2017). Marriage and outcomes of people with schizophrenia in rural China: 14-year follow-up study. Schizophrenia research, 182, 49-54.
Reeves, W. C., Strine, T. W., Pratt, L. A., Thompson, W., Ahluwalia, I., Dhingra, S. S., ... & Morrow, B. (2011). Mental illness surveillance among adults in the United States. MMWR Surveill Summ, 60(Suppl 3), 1-29.
Reinhard, S. C., Given, B., Petlick, N. H., & Bemis, A. (2008). Supporting family caregivers in providing care.
Riskesdas, Riset Kesehatan Dasar/ Riskesdas (basic health research) in Indonesia. (2013). Schizophrenia and mental health disease. Retrieved from www.academia.edu/RISET_KESEHATAN_DASAR_RISKESDAS_2013 at October 18th, 2016
Roseliza-Murni, A., Oei, T. P., Fatimah, Y., & Asmawati, D. (2014). Schizophrenia relapse in Kuala Lumpur, Malaysia: Do relatives’ expressed emotion and personality traits matter?. Comprehensive Psychiatry, 55(1), 188-198
Rumah Sakit Jiwa Daerah (RSJD) Surakarta (Surakarta Mental health hospital). (2017). Rekam Medis Rumah Sakit Januari – Mei 2017. Indonesia : RSJD Press.
Safavi, R., Berry, K., & Wearden, A. (2017). Expressed emotion in relatives of persons with dementia: a systematic review and meta-analysis. Aging & mental health, 21(2), 113-124.
Safavi, R., Berry, K., & Wearden, A. (2017). Expressed emotion in relatives of persons with dementia: a systematic review and meta-analysis. Aging & mental health, 21(2), 113-124. DOI: 10.1080/13607863.2015.1111863
Sajatovic, Martha & Ramirez. Luis F. (2012). Rating scales in mental health. Baltimore: Johns Hopkins University Press. ISBN: 9781421406664/1421406667.
Sepúlveda, A. R., Anastasiadou, D., del Río, A. M., & Graell, M. (2012). The Spanish validation of level of expressed emotion scale for relatives of people with eating disorders. The Spanish journal of psychology, 15(2), 825-839.
Sharma, N., Chakrabarti, S., & Grover, S. (2016). Gender differences in caregiving among family-caregivers of people with mental illnesses. World journal of Psychiatry, 6(1), 7.
Shiu-Man. M., & Sun, Y. S. (2011). Validation of the concise chinese level of expressed emotion scale. Social Work in Mental Health, 9(6), 473-484.
Singh, S. P., Harley, K., & Suhail, K. (2011). Cultural specificity of emotional overinvolvement: a systematic review. Schizophrenia bulletin, 39(2), 449-463. doi:10.1093/schbul/sbr170
Srikhachin, P., Thapinta, D., Sethabouppha, H., & Thungjaroenkul, P. (2016). Expressed Emotion among Family Caregivers of Persons with Schizophrenia: A Causal Model Study. Pacific Rim International Journal of Nursing Research, 20(4), 337-349.
Subandi, M. A. (2011). Family expressed emotion in a Javanese cultural context. Culture, Medicine, and Psychiatry, 35(3), 331.
Suryani, S. (2015). Caring for a Family member With Schizophrenia: The Experience of Family Carers in Indonesia. Malaysian Journal of Psychiatry, 24(1).
Tandon, R., Keshavan, M.S., & Nasrallah, H.A. (2008). Schizophrenia, just the facts: what we know in 2008, Part 2: Epidemiology and etiology. Schizophrenia research, 102 (1-3), 1-18.
Townsend , Mary. C. (2015). Psychiatric mental health nursing: concepts of care in evidence-based practice. Philadelphia: F.A. Davis Company. ISBN: 9780803640924.
Tsai, K. H., López, S., Marvin, S., Zinberg, J., Cannon, T. D., O'brien, M., & Bearden, C. E. (2015). Perceptions of family criticism and warmth and their link to symptom expression in racially/ethnically diverse adolescents and young adults at clinical high risk for psychosis. Early intervention in psychiatry, 9(6), 476-486.
Uehara, T., Yokoyarna, T., Goto, M., & Ihda, S. (1996). Expressed emotion and short-term treatment outcome of outpatients with major depression. Comprehensive Psychiatry, 37(4), 299-304.
Van Humbeeck, G., & Van Audenhove, C. (2003). Expressed emotion of professionals towards mental health patients. Epidemiology and Psychiatric Sciences, 12(4), 232-237.
Van Noppen, B., & Steketee, G. (2009). Testing a conceptual model of patient and family predictors of obsessive compulsive disorder (OCD) symptoms. Behaviour Research and Therapy, 47(1), 18-25.
Vaughn, C. E., & Leff, J. P. (1991). The influence of family and social factors on the course of psychiatric illness: A comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry, 129125-137.
Vaughn, C. E., & Leff, J. P.(1985). Expressed Emotions in Families : Its Significance for mental illness. The Guildford Press, New York.
Vaughn, C., Leff, J., & Sarner, M. (1999). Relatives' expressed emotion and the course of inflammatory bowel disease. Journal of Psychosomatic Research, 47(5), 461-469.
Videbeck, S., & Videbeck, S. (2013). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.
Videbeck, S., & Videbeck, S. (2013). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.
Von Polier, G. G., Meng, H., Lambert, M., Strauss, M., Zanotti, G., Karle, M., ... & Bürgin, D. (2014). Patterns and correlates of expressed emotion perceived criticism, and rearing style in first admitted early-onset schizophrenia spectrum disorders. The Journal of nervous and mental disease, 202(11), 783-787.
Warsini, S., Buettner, P., Mills, J., West, C., & Usher, K. (2015). Psychometric evaluation of the Indonesian version of the Impact of Event Scale‐Revised. Journal of psychiatric and mental health nursing, 22(4), 251-259.
Wearden, A., Tarrier, N., Barrowclough, C., Zastowny, T., & Rahill, A. (2000, August). A review of expressed emotion research in health care. Clinical Psychology Review, 20(5), 633-666.
Wearden, A.J., Tarrier, N., Barrowclough, C., Zastowny, T.R. and Rahill, A.A., 2000. A review of expressed emotion research in health care. Clinical psychology review, 20(5), pp.633-666.
Weinberger, Daniel. R. & Harrison, Paul .J. (2011). Schizophrenia (3rd edition). West Sussex, UK; Hoboken, NJ: Wiley-Blackwell. ISBN: 9781405176972.
Weintraub, M. J., Hall, D. L., Carbonell, J. Y., Weisman de Mamani, A., & Hooley, J. M. (2017). Integrity of literature on expressed emotion and relapse in patients with schizophrenia verified by AP‐curve analysis. Family Process, 56(2), 436-444.
WHO. 2013. Schizophrenia and public health nation for mental health 1.Geneva 27, Switzerland: WHO.
WHO. 2014. Schizophrenia and mental health illness.Geneva. Switzerland: WHO.
Williams, J. R. (2008). The Declaration of Helsinki and public health. Bulletin of the World Health Organization, 86(8), 650-652.
Wood, M. J., Kerr, J. C., & Ross-Kerr, J. (2011). Basic steps in planning nursing research: From question to the proposal. Canada: Jones & Bartlett Publishers.
Wuerker, A., Fu, V., Haas, G., & Bellack, A. (2002). Age expressed emotion and interpersonal control patterning in families of persons with schizophrenia. Psychiatry Research, 109(2), 161-170.
ZamZam, R. (2011). Schizophrenia in Malaysian families: A study of factors associated with quality of life of primary family caregivers. International Journal of Mental Health Systems, 5(1), 16.
Zanello, A., Berthoud, L., Ventura, J., & Merlo, M. C. (2013). The Brief Psychiatric Rating Scale (version 4.0) factorial structure and its sensitivity in the treatment of outpatients with unipolar depression. Psychiatry research, 210(2), 626-633.
Zaumseil, M., & Lessmann, H. (1995). Dealing with schizophrenia in central java. In Forum Gemeindepsychol (Vol. 12).