Effect of caregivers’ expressed emotion and attachment patterns on the oxidative stress level in schizophrenic patients

Objective: The impact of caregiving on the schizophrenia prognosis has been investigated for a long time. However, there is no study that investigates the possible adverse effect of caregivers’ attachment style and expressed emotion on the schizophrenic patient’s objective measure of stress, one of which consists in oxidative stress parameters. The idea that oxidative stress has a significant role in development and prognosis of many diseases is being more widely accepted by leading researchers. This study aims to examine the relation between the oxidative stress level in schizophrenics and caregivers’ attachment patterns and expressed emotion.

Methods: Participants were 20 schizophrenic patients who consulted Marmara University Medical School Hospital outpatient clinic and their mothers and 21 healthy controls and their mothers. Patients were administered the Adult Attachment Scale (AAS), the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS). Expressed Emotion Scale (EES), AAS, and the Beck Depression Inventory (BDE) were given to the caregivers of the schizophrenics. AAS and BDE were given to the control group; EES and AAS were given to the control group’s caregivers. Blood and urine samples of patient group and control group were examined for oxidative stress parameters including reduced and oxidized forms of glutathione (GSH and GSSG), plasma lipid peroxidation (LP), urine malondialdehyde (MDA), glutathione transferase (GSH-Tr), and catalase (CAT) levels.

Results: Results indicate that reduced and oxidized forms of glutathione (GSH and GSSG), plasma lipid peroxidation (LP) and urine malondialdehyde (MDA) levels of patients are higher than those of the control group. Mothers of the patient group show higher levels of insecure attachment (anxious-ambivalent) and lower levels of expressed emotion (emotional over-involvement) compared to control group mothers. Regression analysis show that the main significant predictors of patients’ GSSG oxidative stress level is their mothers’ emotional over-involvement and mothers’ anxious-ambivalent attachment style.

Conclusion: Investigations of the nature of attachment styles and expressed emotion in psychosis and how they relate to cognitive, interpersonal and affective factors has been reviewed in recent studies. The usual implication of the association between insecure attachment and high expressed emotion and psychopathology was also found in our sample. The role of oxidative stress in schizophrenia was investigated by evaluating the relationship of oxidative stress markers with psychopathology in recent studies. Our findings regarding oxidative stress levels of schizophrenic patients are similar to those in the psychosis literature. Moreover, in our study, the relation between biological markers and attachment styles and expressed emotion were studied and significant results were reported. If supported by further studies and repeated with higher sample sizes, the relation between oxidative stress parameters and mothers’ attachment and expressed emotion levels in schizophrenia will contribute to future psychotherapeutic and psychopharmacological interventions.