Further validation of the Chinese version of the Level of Expressed Emotion Scale for research and clinical use

Chien, Wai-Tong and Chan, Sally W. C. (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. doi:10.1016/j.ijnurstu.2009.05.019

Author Chien, Wai-Tong
Chan, Sally W. C.
Title Further validation of the Chinese version of the Level of Expressed Emotion Scale for research and clinical use
Journal name International Journal of Nursing Studies   Check publisher's open access policy
ISSN 0020-7489
Publication date 2010-02
Sub-type Article (original research)
DOI 10.1016/j.ijnurstu.2009.05.019
Open Access Status
Volume 47
Issue 2
Start page 190
End page 204
Total pages 15
Place of publication Bromley, United Kingdom
Publisher Elsevier
Language eng
Formatted abstract
Background: Expressed emotion is a construct that has been used for the past three decades to describe family members’ criticism, hostility and emotional involvement with a mentally ill relative within the context of family interactions and caregiving. In Western countries this construct is used as an outcome measure of interventions for families of people with schizophrenia or other psychotic disorders, but the use of this construct in Chinese populations is somewhat limited.
Objective: To test the reliability and validity of a refined Chinese version of the 52-item Level of Expressed Emotion Scale (LEE).
Methods: A convenience sample of 405 outpatients with psychotic disorders in Hong Kong and one of their family caregivers were recruited. Patients were asked to complete a set of questionnaires twice over a 6-month period, including the Chinese version of the LEE, the Specific Level of Functioning scale and the Brief Psychiatric Rating Scale; while their caregivers completed the Family Assessment Device twice and a demographic data sheet at recruitment. This study was aimed at establishing the internal consistency, reproducibility, responsiveness, and construct validity of the LEE.
Results: Results indicated that the refined 50-item Chinese version of the LEE and its subscales demonstrated a high internal consistency and satisfactory correlations with patient and family functioning scores. Principal component analysis revealed the presence of four factors, explaining 70.8% of total variance and indicating high factor loadings as well as item-factor inter-correlations. The Chinese version not only indicated a satisfactory reproducibility in assessing change in patients’ symptom severity and family functioning but also showed an adequate responsiveness to the changes in patients’ symptoms over 6 months, especially for detecting symptom improvement.
Discussion: The findings of the psychometric evaluation of the Chinese version of the LEE established its potential as a research instrument in measuring the level of expressed emotion of family members as perceived by Chinese patients with psychotic disorders. Further testing of its psychometric properties is recommended, using larger samples from diverse socio-economic backgrounds and mental illnesses.
Keyword Expressed emotion
Psychotic disorders
Factor structure
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Nursing, Midwifery and Social Work Publications
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Created: Thu, 02 Oct 2014, 13:23:19 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work