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The European voice for informal carers

A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England.

Nomura H, Inoue S, Kamimura N, Shimodera S, Mino Y, Gregg L, Tarrier N.

Dept. of Neuropsychiatry, Kochi Medical School, Kochi, Japan.


Expressed emotion (EE) research has been productive in investigating the influence of the interpersonal environment on a range of disorders. The majority of EE research on the influence of carers has been carried out in the west. This is the first EE study of the carers of people with dementia in Japan. The aim of this study was to investigate the relationships between EE status and aspect of burden through cross-cultural comparison of the two countries, Japan and England, with large cultural and linguistic differences. Comparisons were made between samples of EE of carers of dementia and schizophrenic patients. In total, data on 80 carer/relative-patient dyads were collected and examined: (1) 20 Japanese carers of people with dementia (JD), (2) 20 English carers of patients with Alzheimer’s disease (ED), (3) 20 Japanese relatives of patients with schizophrenia (JS), and (4) 20 English relatives of patients with schizophrenia (ES). The Camberwell Family Interview was administered in each country to ascertain levels of EE. Large differences between Japan and England were found in the frequency of critical comments, in which ES>ED>JS>JD. EE correlated significantly with burden in the JD sample alone. With an operational cut-off of 2CC (CC, critical comments), EE correlated significantly with cognitive impairment as well as with clinical severity in the JD sample. There was a tendency for lower expression of both positive and negative emotional reactions towards family members in the Japanese sample. The results of this study indicate that EE is an appropriate measure for use with carers of sufferers of dementia and can be utilized across different cultures. However, flexibility with the cut-offs may be required in Eastern cultures. This needs to be tested on larger samples with sensitivity to illness and cross-cultural differences.

More information on ‘A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England’


The Eurocarers’ Research Group has developed a framework: Quality outcomes for carers


First Eurocarers’ research project

Care Provision within Families and its Socio-Economic Impact on Care Providers

Report for the European Commission DG EMPL
Negotiated Procedure VT/2007/114
Social Policy Research Unit, University of York
in collaboration with
Vilans Centre of Expertise for Long-Term Care, Utrecht
Caroline Glendinning, Frits Tjadens, Hilary Arksey,
Marjolein Morée, Nicola Moran, Henk Nies
May 2009
Working Paper No. EU 2342

AIMS: Drawing on evidence from 8 member countries, to:

  • identify research evidence on the prevalence of and socio-economic consequences for, carers of older people and of other groups of disabled people
  • identify examples of good practice measures aimed at mitigating the adverse socio-economic impact of care-giving
  • identify gaps in available evidence, problems in synthesising data from different countries and opportunities for improving the range, quality and consistency of data collected across EU member states

The project team worked closely with expert informants drawn from the Eurocarers network of research and carers’ organisations, to identify relevant research data and examples of good practice measures.

Last Updated on October 28, 2019

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