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Power and Perceived Expressed Emotion of Voices: Their Impact on Depression and Suicidal Thinking in Those Who Hear Voices

Authors

  • Charlotte Connor,

    Corresponding author
    • School of Psychology, University of Birmingham, Birmingham, UK
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    • Professor Birchwood and Dr. Connor were part-funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC).
  • Max Birchwood

    1. School of Psychology, University of Birmingham, Birmingham, UK
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    • Professor Birchwood and Dr. Connor were part-funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC).

  • The views expressed in this publication are not necessarily those of the NIHR, the Department of Health, NHS Partner Trusts, University of Birmingham or the CLAHRC-BBC Theme 3 Management Group.

Correspondence to: Charlotte Connor, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK.

E-mail: c.s.connor@bham.ac.uk

Abstract

Considerable focus has been given to the interpersonal nature of the voice-hearing relationship and how appraisals about voices may be linked with distress and depression (the ‘cognitive model’). Research hitherto has focused on appraisals of voice power, but the supportive and affiliative quality of voices, which may act to mitigate distress, is not understood. We explored appraisals of voices' power and emotional support to determine their significance in predicting depression and suicidal thought. We adapted the concept of expressed emotion (EE) and applied it to measure voice hearers' perception of the relationship with their voice(s). In a sample of 74 voice hearers, 55.4% were moderately depressed. Seventy-eight who rated their voices as high in both power and EE had a large and significant elevation in depression, suggesting that co-occurrence of these appraisals impacts on depression. Analysis of the relationship between power and EE revealed that many voices perceived as low in power were, nevertheless, perceived as high in EE. Those rating their voices as emotionally supportive showed the lowest levels of depression and suicidal thinking. These findings highlight the protective role that the supportive dimension of the voice/voice-hearer relationship may have. Copyright © 2011 John Wiley & Sons, Ltd.

Key Practitioner Message

  • Appraisals of social rank and EE impact on the depressive and suicidal status of voice-hearers.
  • The emotionally supportive dimension of the voice-hearing relationship may have a protective role in the affective response of voice hearers.
  • Therapeutic interventions should consider the emotionally supportive needs of voice-hearers,

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