|Ahead of print publication
Sociodemographic predictors of perceived expressed emotions and self-esteem in persons with obsessive-compulsive disorder
Lokesh Kumar Ranjan1, Nilesh Maruti Gujar2, Pramod Ramlakhan Gupta3
1 Department of Psychiatric Social Work, Central India Institute of Mental Health and Neuro Sciences, Rajnandgaon, Chhattisgarh, India
2 Department of Psychiatric Social Work, Centre of Excellence for Mental Health, INHS, Asvini, Colaba, Mumbai, India
3 Department of Psychiatry, Central India Institute of Mental Health and Neuro Sciences, Rajnandgaon, Chhattisgarh, India
|Date of Submission||29-Jul-2021|
|Date of Decision||23-Oct-2021|
|Date of Acceptance||07-Nov-2021|
|Date of Web Publication||03-Feb-2022|
Lokesh Kumar Ranjan,
Department of Psychiatric Social Work, Central India Institute of Mental Health and Neuro Sciences, G E Road, Dewada Chowk, Kopedih Road, Rajnandgaon - 491 441, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Background: The attitude and emotions of the family member toward persons with obsessive-compulsive disorder (OCD) have a negative effect on perceived experiences of expressed emotion and self-esteem. It is crucial to observe expressed emotion and self-esteem for better treatment outcomes in OCD. Aim: The aim of this study is to assess the sociodemographic predictors of perceived expressed emotion and self-esteem in persons with OCD. Materials and Methods: The present cross-sectional comparative study conducted among persons with OCD on treatment from the outpatient department of the Central India Institute of Mental Health and Neuro Sciences (CIIMHANS), Dewada, Chhattisgarh, India, and normal controls from neighboring areas (Dewada and Kopedih) of the CIIMHANS. A total of 150 persons with OCD and 150 normal controls were selected purposefully. The sociodemographic datasheet, clinical datasheet, family emotional involvement and criticism scale, and Rosenberg self-esteem scale were used for the comparative assessment. Results: Self-esteem was found to have a significant negative correlation with occupation and a positive correlation with family income. Expressed emotion (EE) showed a significant negative correlation with gender, family type, family income, and self-esteem. On the regression analysis, sociodemographic variables including gender, education, occupation, and family income were found to be significant predictors of EE, whereas occupation was found to be a significant predictor of self-esteem. Conclusion: The present study corroborates that sociodemographic factors are associated and had a predictive role in negative experiences of EEs and unfavorable self-esteem in persons with OCD.
Keywords: Expressed emotions, obsessive-compulsive disorder, self-esteem, sociodemographic factors
|How to cite this URL:|
Ranjan LK, Gujar NM, Gupta PR. Sociodemographic predictors of perceived expressed emotions and self-esteem in persons with obsessive-compulsive disorder. J Mental Health Hum Behav [Epub ahead of print] [cited 2022 Oct 7]. Available from: https://www.jmhhb.org/preprintarticle.asp?id=337225
| Introduction|| |
Obsessive-compulsive disorder (OCD) is characterized by the constant presence of an intrusive, repetitive, or pervasive idea and disturbing thoughts (such as the fear of being infected by germs when touching a door handle) that usually the individual perceives negative feelings. It is a fact that OCD has a lifetime prevalence of 2%–3%, often has a chronic course of illness and it has been associated with poorer quality of life in patients. The attitude and emotions of the family member toward persons with OCD have a negative effect on perceived experiences of expressed emotion and self-esteem.
Expressed emotions (EEs) are a common factor that contributes to relapse and recurrences in patients with OCD. EE refers to the effective attitudes and behaviors of caregivers toward a family member. It has both positive and negative elements. Positive EEs have been conceptualized as positive communication patterns that may facilitate a positive family climate. Whereas negative EE is associated with a higher rate of relapse. Persons with higher EE had a more psychiatric diagnosis, marital and familial conflicts. Higher EE may have a worse prognosis for obsession, whereas positive feelings of families toward the patient show more improvement in a long time. Perceived criticism (PC) and emotional over-involvement have been consistent predictors of relapse for OCD patients.
Self-esteem would be an important factor in the lives, functioning, and recovery of individuals with any psychiatric disorders. It refers to a singular or global construct that reflects a person's sense of his or her worthiness. It is also known to be an important factor in the psychological and social functioning of human beings in general. Individuals who were able to engage in social and interpersonal relationships were also able to develop and maintain a positive sense of self-worth and self-esteem. Patients who suffer from OCD have low social adequacy, self-confidence, and self-esteem. Low self-esteem was one of several symptoms reported as preceding the onset of OCD. It could also have the effect of predisposing people to the development of psychological problems regardless of type as a general vulnerability factor.
The Indian studies have clarified that the EE is high in persons with psychiatric disorders including OCD and its relation with relapse. Previous studies have raised the concern of high perceived EE among patients with OCD., There are no Indian studies describing sociodemographic predictors that contribute to the variance of the EEs and self-esteem among persons with OCD. We intent to look at the area of sociodemography to know the predictive role of sociodemographic variables in EE and self-esteem among persons with OCD.
| Materials and Methods|| |
The present cross-sectional comparative study was conducted among persons with OCD on regular treatment from the outpatient department of the Central India Institute of Mental Health and Neuro Sciences (CIIMHANS), Dewada, Chhatisgarh, and normal controls from neighboring areas (Dewada and Kopedih) of the CIIMHANS. A total of 150 persons with OCD and 150 normal controls were selected purposefully. Both the patient with OCD and normal controls were informed about the purpose of the study, those who were willing to participate, written informed consent was obtained from them. Both the groups were matched on age, education, marital status, family type, occupation, and family income. The Yale-Brown Obsessive Compulsive Scale was used to assess the severity of OCD symptoms. Those who scored <25 (moderate symptoms) were included in this study.
Patients diagnosed with OCD according to the ICD-10 DCR, both the gender age between 20 and 50 years and duration of illness at least 2 years. Normal controls were both the gender aged between 20 and 50 years.
Patients and normal controls with a neurological problem, head injury, intellectual disability, organicity, and history of major physical illness.
Sociodemographic and clinical datasheet
The sociodemographic datasheet was formulated to understand the details of demographic profile of the persons with OCD. The variables included in the sociodemographic datasheet were age, sex, education, occupation, family type, etc. The clinical datasheet included the details of diagnosis, duration of the illness, duration of the treatment, relapse, etc.
Family emotional involvement and criticism scale
It is a 14-item Likert-type questionnaire developed by Shields et al. to assess perceived EE. The items are clubbed to derive two subscales: Perceived Criticism (PC) and Intensity of Emotional Involvement (El). The 14 items are organized such that PC is assessed by even-numbered items, and EI is measured by odd-numbered items. A 5-point Likert-type scale includes response options of almost never, once in a while, some, often, and almost always. On this scale, high scores indicate greater levels of PC, EI, and overall EE.
Rosenberg self-esteem scale
Rosenberg's self-esteem scale measures global self-worth by measuring both positive and negative feelings about the self. The scale has 10 items scale has 4 point options (0, strongly disagree to 3, and strongly agree). The scale ranges from 0–30. Fifteen is a cutoff score in which those who score <15 considered to have low self-esteem and the scores 15–25 considered being normal self-esteem and a score >25 is high self-esteem. The scale demonstrated good internal consistency of high school students with alpha coefficients ranging from 0.72–0.87.
Ethics and informed consent
The present study was carried out with the approval of the Ethical Research Committee of the CIIMHANS, Dewada, Chhattisgarh. The participants were given opportunity to ask questions, and doubts were clarified before the study. Participation in the study was fully voluntary, and participants had opportunity to refuse to participate at any time. Participant's confidentiality, human rights, and other ethical issues were ensured during the study.
The statistical analyses were done with the help of the statistical package for the social sciences version 25.0 for Windows, Manufactured by IBM, New York, USA. The descriptive variables from demography were tested using mean, standard deviation (SD), and Chi-square. The difference between study variables in both the group was calculated using mean and SD (t-test). Person's correlation was used to see the correlation between self-esteem, expressed emotion, and selected demographic variables in persons with OCD. The multiple linear regression analysis was done to see the variance of sociodemographic variables on expressed emotion and self-esteem in persons with OCD. The statistical significance was considered to be P < 0.05 for the present study.
| Results|| |
[Table 1.1] shows the distribution of the sociodemographic details of persons with OCD and normal controls. The mean age of persons with OCD was 31.24 years (SD = 5.21) and 31.24 years (SD = 5.21) for the normal controls. More than half (58.7% of persons with OCD and 60.7% of normal controls) were male. The majority of 29% of persons with OCD and 32% of normal controls educated up to high secondary and undergraduate, respectively. More than half (54% of persons with OCD and 59% of normal controls) were unmarried. In occupation, the majority (74%) of persons with OCD was unemployed and 76% of normal controls were employed. In family type, the majority of (78% of persons with OCD and 76% of normal controls) them belonged to nuclear family. More than half (62% of persons with OCD and 52.6% of normal controls) belonged to middle family income status. There were no significant differences between the groups on most of the major demographic variables including age, gender, education, marital status, family types, and family income except occupation (χ2 = 75.030; P < 0.001).
[Table 1.2] reveals the clinical profile of the persons with OCD. The average age of onset of the illness (OCD) was 23.94 years (SD = 3.32). The average duration of illness (OCD) was 6.59 years (SD = 2.02). The persons with OCD were taking treatment for their illness for an average of 5.96 years (SD = 1.81).
[Table 2] shows a comparison of expressed emotion and self-esteem among persons with OCD and normal controls. The mean and SD score of PC was higher in persons with OCD (23.92 ± 3.35) compared to the normal controls (11.14 ± 4.60). The mean and SD scores of EIs were high in persons with OCD (24.34 ± 3.74) compared to the normal controls (12.06 ± 3.76). The overall mean and SD scores of EEs were high in persons with OCD (48.26 ± 2.64) compared to normal controls (23.20 ± 6.46). There was a significant difference found in means scores of PC (t = 27.477, P < 0.001), EIs (t = 28.307, P < 0.001), and overall EE (t = 43.937, P < 0.001) among persons with OCD and normal controls. The mean and SD score of self-esteem was lower in persons with OCD (14.20 ± 3.39) as compared to the normal controls (23.80 ± 4.90). There was a significant difference found in self-esteem among persons with OCD and normal controls (t = 19.842, P < 0.001).
|Table 2: Comparison of expressed emotion and self-esteem among persons with OCD and normal controls|
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[Table 3] shows expressed emotion showed significant negative correlation with gender (r = −0.191; P < 0.05), family type (r = −0.186; P < 0.05), family income (r = −0.187; P < 0.05), and self-esteem (r = −0.232; P < 0.01), and it showed significant positive correlation with occupation (r = 0.270; P < 0.01). Self-esteem was found to have significant negative correlation with occupation (r = −0.198; P < 0.05) and significant positive correlation with family income (r = 0.165; P < 0.05).
|Table 3: Correlation between sociodemographic variables, expressed emotion, and self-esteem in persons with OCD|
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The results of regression analysis found that in socio-demographic variables occupation was found to be a significant predictor of self-esteem (R2 = 0.073, F [7, 142) = 1.603, P < 0.001). The effect size of occupation (B = −1.315; P < 0.05; adjusted R2 = 0.028) indicating that it accounts for about 2.8% of the variance in overall self-esteem in the present study population [Table 4].
|Table 4: Regression analysis of sociodemographic factors (age, gender, education, marital status, occupation, family type, and family income) as predictors of the self-esteem in persons with obsessive-compulsive disorder|
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The results of regression analysis found that socio-demographic variables like gender, education, occupation, and family income were found to be significant predictors of EEs (R2 = 0.226, F (7, 142) = 5.932, P < 0.001). The effect size of gender (B = −0.981; P < 0.05), education (B = 0.672, P < 0.01), occupation (B = 1.429; P < 0.01), and family income (B = −1.258; P < 0.01) with adjusted R2 = 0.188, indicating that it accounts for about 22.6% of the variance in overall expressed emotion in present study population [Table 5].
|Table 5: Regression analysis of sociodemographic factors (age, gender, education, marital status, occupation, family type, and family income) as predictors of the expressed emotion in persons with OCD|
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| Discussion|| |
The present study reported that patients with OCD had a higher level of expressed emotion compared to the normal controls. There was a significant difference in PC, EIs, and overall EEs among persons with OCD and normal controls. Some previous studies are supported it, Koujalgi et al. reported that the EEs had significantly increased in OCD patients comparison controls. There was an increase in both subscales of PC and EI in patients with OCD than controls. Similarly, Shanmugiah et al. revealed the patients with OCD had a higher level of EEs with an increase in both subscales of PC and EI, as compared to the normal group. Koujalgi et al. reported that patients with OCD are more significantly impaired in multiple domains of family dynamics than those without suffering from OCD persons. Saei et al. reported the perceived high expressed emotion in patients who suffer from OCD in their families.
The present study reported that there was a significant difference in self-esteem among persons with OCD and normal controls. The results are in line with previous studies; Husain et al. revealed the significant difference in self-esteem between the patients with OCD and the controls group and also indicated the reduced levels of self-esteem in the OCD patients compared to the normal controls. Rahman and Husain revealed that patient with OCD suffer a significant degree of lowered self-esteem than the control group and statistically, a significant difference was found between the OCD patients and normal control. Amor et al. reported that patients with OCD had a lower level of self-esteem, and there was some evidence of specific effects with depressive cognitions altered significantly self-esteem in OCD patients. The present study reported that a negative significant correlation was found between self-esteem, PC, and EI among OCD patients. Some earlier studies also support similar results in which reported the significant negative relationship between self-esteem, EEs, and OCD.,
To the best of our knowledge, this is the first study investigating the relationship between the expressed emotion, self-esteem, and demographic variables in patients with OCD. The present study reported that occupation emerged as the significant predictor of expressed emotion among OCD patients. Occupation explained the largest portion of variance in the level of expressed emotion. Saei et al. reported that OCD patients perceive over-involvement, criticism, neglect, lack of emotional support, and hostility due to feeling of lack of self-confidence and lack of privacy. Hollander et al. reported that patients were unable to work due to OCD symptoms and face expressed emotion. Demographic variables including employment affect the self-esteem in patients with psychiatric disorder. The present study reported that in sociodemographic variables, occupation found to be a predictor of self-esteem contributing about 2.8% of the variance. This was the preliminary finding shows occupation has a predictive role in self-esteem among persons with OCD.
The findings from the present study are helpful for the mental health professionals to recognize the perceived problems of the expressed emotion and self-esteem in patient with OCD. Therefore, the integrated plan of intervention can be considered to include patients and their caregivers for better outcomes. The rehabilitation process can become effective for the patients with OCD after enhancement of occupation to improve self-esteem and reduce perceived EEs. The present study findings urge mental health professionals, especially social work professionals to work on psychosocial aspects that can play a crucial role in the improvement of persons with OCD.
Limitations and scope
The results of the present study are confined to the small sample size therefore, for the greater understanding further studies can consider a larger sample from the community. The present study considers the limitation of the self-report assessment measures, therefore we suggest in-depth interviews can be used to know different aspects involved in high expressed emotion and self-esteem. We did not include family member's viewpoint on EEs; hence, further studies can be done to identify other psychosocial factors contributing (family accommodation, burden, etc.).
| Conclusion|| |
The negative experiences of EEs and unfavorable attitudes toward self were found to be damaging in persons with OCD. In the present study, sociodemographic factors was found to be predictive factors in defining expressed emotion and self-esteem in persons with OCD. Mental health professional can use an integrative psychosocial rehabilitation program for effective outcomes in persons with OCD.
The author acknowledges all the relevant sources involved in the completion of the present study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]