Predictors of diabetic control: Expressed emotion and perceived criticism

Abstract

Investigations into the influence of family relationships upon the course of chronic illness have been impeded historically by inadequate measures. The Camberwell Family Interview (CFI) measures criticism, a component of Expressed Emotion (EE), which has been shown to be a valid predictor of illness in schizophrenia and other illnesses affected by emotional factors. The CFI is time-consuming to administer and score, and an alternative measure of criticism, the Perceived Criticism (PC) Scale, has recently been used to predict relapse in Unipolar depressives.;The current research was designed to extend the use of the CFI and PC to patients with insulin-dependent diabetes, an illness which is thought to be influenced by the psychosocial environment. Study goals were to determine whether the CFI and PC predicted metabolic control of diabetes and, if so, whether the streamlined PC measure might replace the lengthy CFI.;Eighty-six insulin-dependent diabetics enrolled in the Diabetes Complications and Control Trial (DCCT), a national study comparing groups receiving rigorous and conventional care for diabetes, and their relatives were interviewed with the CFI and the PC. Glycosylated hemoglobin levels of all patients were obtained for the nine months prior to the interviews.;Ratings of criticism derived from the CFI were strongly associated with blood glucose control, but only in rigorous care patients (p =.01). This finding extends the EE construct to diabetic patients in a tightly controlled treatment regimen. Discrepancies between self-reports of criticism concerning patients obtained from patients and their relatives were also associated with blood glucose control, but again only in rigorous care patients (p =.05). Diabetic patients' reports of criticism were found to be unrelated to glycosylated hemoglobin levels in both the rigorous (p =.41) and conventional care (p =.93) groups. A surprising finding was that relatives' self-reports of criticism directed toward diabetic patients in the rigorous care group were strongly associated with glycosylated hemoglobin (p =.02), and did a better job of predicting blood glucose levels (p =.04) than the CFI (p =.12). The results suggest that a link exists between family criticism and metabolic control, and that the PC scale, under certain conditions, has the potential to serve as a simple clinical measure to identify diabetic patients at risk for poor metabolic control.