Modes of action of family interventions in depression and schizophrenia: the same or different?

The role of relatives' expressed emotion (EE) in mediating the efficacy of family interventions has been studied in randomized controlled trials (RCTs) involving people with schizophrenia and depression. Reanalysis of two RCTs (n=48) by Leff (1989) indicated that lowering relatives’ EE and/or reducing social contact between the patient and family members accounted for the efficacy of the intervention for schizophrenia. However, this relationship has not been investigated previously with regard to depression, and this paper presents the results of a recent RCT which included measurement of EE and other possible mediating variables. In this study, amelioration of the critical attitude of the partner did not account for the superiority of couples therapy over antidepressant medication, since the same change occurred in the drug group. However, reducing the patient's exposure to the partner's hostility partially explained the efficacy of couples therapy. Further research on the process of change in families undergoing therapy is indicated to identify the variables that account for the efficacy of therapy.