DIAGRAMA DE COMUNICACIÓN: TODOS LOS DEPARTAMENTOS

important predictors: a higher rate of causal searching and a tendancy to attribute more outcomes to factors internal to the patient

discriminated high EE relatives from low EE. It was found that 71% of high EE relatives could be correctly classified on the basis of these two factors (see Table 36). They accounted for a small but significant amount of the variance (15%) between the groups' EE classification. 2. With prediction to low EE and high EE status with and without marked criticism, internality and rate of attributions also significantly predicted relatives' classification, and accounted for 17% of the variance between the groups. For hostility prediction personal to patient causes and the controllability of the patient were also important and the four attribution variables accounted for 34% of the variance between the three groups. From univariate analyses it was found that hostile relatives did not differ from high EE people without hostility in their rate of attributions; but gave more causes personal to and controllable by the patient than other

relatives; and had the highest proportion of internal to patient causes. 3. As regards discriminating between low and high EE relatives with and without marked EOI, internality, rate of attributions and

controllability were the best predictor variables. This combination of factors accounted for 29% of the variance between the three groups. The high EE relatives with EOI had the highest rate of attributions; as regards the nature of their beliefs they were similar to the low EE group: they gave more external and uncontrollable causes than high EE relatives without EOI (that is relatives with just

4

criticism and/or hostility).

Thus high EE relatives, irrespective of whether they are critical or overinvolved, make more attributions about events pertaining to the illness than do low EE relatives. For EOI relatives, the direction of their beliefs about the patient's role in outcomes is similar to the low EE relatives: proportionally just under half the causes they give are internal to the patient and most of the attributions suggest that the patient does not have control over outcomes. Their tendancy to give the illness itself as the reason for negative outcomes (see chapter 5) would seem to be important in understanding their attributions. The critical relatives, and particularly those with an hostility rating, show an opposite attributional pattern: critical relatives were found to indicate more frequently that reasons for negative outcomes were internal to the patients; and hostile relatives had a greater proportion of causes which were personal to and controllable by the patient.

8.3 DO ATTRIBUTIONS PREDICT RELAPSE?

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thought to be indicative of stress in the patient's home environment. The literature suggests that the high EE relatives' behaviours are the stimuli for chronic stress in the patient, and that consequent

increased arousal levels in the patient precipitate a relapse of positive symptoms. Assuming that attributions mediate relatives' behaviours in interaction with patients at home, this study

hypothesised that attributions would also be predictive of relapse. The patients of the relatives in the study sample were followed up for a nine month period following hospital discharge. Relapses were assesssed on the basis of their PSE scores by an independent psychiatrist as detailed in the method of study. The analyses for predicting relapse selected only one relative for each patient. In the case of a high and low EE status relative for one patient, the high EE relative was selected (excluding 3 low EE relatives); where both relatives were high EE or both low EE the mother was selected from the parents (excluding 4 W E E relatives and 2hijh). This reduced the subject numbers to 5 1 : 1 2 low EE and 39 high EE relatives.

The first discriminant analysis assessed the contribution of attribution variables to relapse prediction. The analysis is

summarised in Table 40A. The proportional attribution scores for patient internality, controllability and personal dimensions along with the rate of attributions were submitted for stepwise selection.

Controllability and internality were selected for the equation and together these scores accounted for 12% of the variance between

relapsers and 'survivors' (Wilks' Lambda = .88, p< . 05; F for group differences on discriminant scores = 7.51 ,p< .008). The discriminant coefficients indicated that high scores on the control dimension contributed to relapse prediction, and low scores on the internal dimension were predictive of no relapse. The correlations of the

variables with the function and the order of entry into the equation indicated that the control dimension scores were the strongest

relapse predictor. A second analysis sought to determine whether the two attributions variables were predictive of relapse when the EE status of the relative was controlled for. Since 18 of the high EE relatives had taken part in an intervention programme with the explicit aim of reducing relapse through decreasing the EE status of the relative, it was also necessary to partial out participation in the intervention. Accordingly, intervention was entered into the equation as a dichotomous variable.

The summary table for the analysis is given in Table 40B. The intervention was directly entered first into the equation, followed by the direct entry of EE status (high or low), then stepwise entry of the attribution variables: rate, internality, controllability and personal to the patient causes. It can be seen that the two attributional variables, patient controllability and internality, were selected for entry and contributed to the significance of the discriminant function after intervention and EE status variables were controlled. The discriminant function coefficients suggest that the controllability dimension contributed most to the function; followed by the

intervention, internality attributions and finally EE status. Univariate analyses of group differences on attribution predictor variables showed that relatives of patients who relapsed gave more

controllable by patient attributions than relatives of non relapsers (means 0. 54(s.d. .23) and 0.39(s.d. .23) (F = 4.12, p< .05); but that there was no difference between groups on the internality dimension (means 0.51 (s.d. .17) and 0.49 (s.d. .24) (F = 0.89,NS). Since the dimensions of control and internality are associated with criticism, hostility and marked emotional overinvolvement in relatives, a second

discriminant analysis was performed to assess whether these

specific dimensions of EE were better predictors of relapse than the attribution variables. Intervention was first entered into the

equation followed by stepwise entry of hostility scores, criticism scores, internality and controllability. Only the attribution variables were selected for entry. The analysis was repeated when criticism,

hostility and EOI were computed as dichotomous variables (high/low on each dimension) and the results were the same: after participation in the intervention aimed to reduce relapse was controlled for, only

4 the attribution variables contributed to relapse prediction.

8.4 W HAT FACTORS PREDICT THE NATURE AND RATE O F ATTRIBUTIONS? Given the evidence that attributions are important to expressed

emotion, and to the prediction of relapse, what factors influence the amount and kind of beliefs that relatives hold? The model tested in the study suggested that a number of patient and relative variables were important, and these may now be reviewed in the light of the results of the study: