ORIGINAL PAPER Nicholas J.K. Breitborde Æ Steven R. Lo ´pez Æ Christina Chang Æ Alex Kopelowicz Æ Roberto Zarate Emotional over-involvement can be deleterious for caregivers’ health Mexican Americans caring for a relative with schizophrenia Received: 12 August 2008 / Revised: 23 December 2008 / Published online: 3 February 2009 j Abstract The study of emotional over-involve- ment (EOI) has focused primarily on its relationship with patients’ course of illness. We know little about the predictors and possible consequences of EOI for caregivers. Based on past research, we tested the hypotheses that EOI is associated with worse physical and psychological health among caregivers and examined whether caregiver burden and social sup- port may mediate this relationship. Method In a sample of 37 Mexican American caregivers and their ill relatives recruited from two outpatient clinics, we examined the relationships between EOI, caregiver burden, caregivers’ level of social support, and care- givers’ health. Additionally, we examined whether caregiver burden and social support may mediate the relationship between EOI and caregivers’ health. Cross-sectional analysis indicates that at baseline EOI was not associated with caregiver burden or social support, but was related to worse current health. Longitudinal analysis, however, indicates that EOI at baseline was associated with greater burden, less instrumental support, and worse health among care- givers at follow-up. Moreover, objective burden and instrumental support mediated the relationship between EOI and several health outcomes. Conse- quently, EOI may be a marker of poor current health status and predicts worse future health among Mexican–American caregiving relatives of individuals with schizophrenia. Moreover, changes in burden and social support associated with EOI appear to mediate the relationship between EOI and several health out- comes among caregivers. These findings suggest that it might be important for family interventions to not only address the functioning of individuals with schizophrenia but also their caregiving relatives. j Key words expressed emotion – schizophrenia – caregiver health – caregiver burden – social support Introduction It is clear from past research that family factors influence the course of schizophrenia. The strongest support for this claim comes from studies of ex- pressed emotion (EE) [5]. To date, a plethora of studies have demonstrated that individuals with schizophrenia who are exposed to familial environ- ments characterized by high levels of criticism, emo- tional over-involvement, and/or hostility (high EE) are more likely to suffer a relapse than individuals who are exposed to familial environments in which the presence of these variables is low (low EE) [6]. Although, the association between EE and relapse exists among individuals from a variety of ethnic and cultural backgrounds, the nature of this association appears to vary across different ethnic and cultural populations [14]. For example, although the dichot- omous EE variable (high EE vs. low EE) predicts re- lapse among Mexican-Americans with schizophrenia [16, 20], there is an important caveat with regard to the relationship. Specifically, whereas the EE index of criticism has traditionally been thought to play the predominant role in the association between the SPPE 492 N.J.K. Breitborde (&) Dept. of Psychiatry, STEP Program Yale University 34 Park St, Room B38 New Haven (CT) 06519, USA S.R. Lo ´pez Dept. of Psychology University of Southern California Los Angeles (CA), USA C. Chang Æ A. Kopelowicz Æ R. Zarate Dept. of Psychology University of California Los Angeles (CA), USA Soc Psychiatry Psychiatr Epidemiol (2009) 44:716–723 DOI 10.1007/s00127-008-0492-0