Expressed emotion (EE) of family members is known to affect the course of mood disorders. Therefore, exploration of factors that increase the EE of family members may lead to improvement of the course of mood disorders. We conducted an Internet survey of 258 female spouses of patients with mood disorder. Through path analysis, we examined the influence of spousal burden and depression on EE, and the influence of age, employment status, presence of children, duration of illness, history of hospitalization, hypomanic traits, and spousal social support on EE via burden and depression. As a result, spousal burden and depression were found to significantly affect the level of EE. Patient unemployment, history of hospitalization, hypomanic traits, and spousal satisfaction with social support significantly affected the level of EE via spousal burden. Spousal unemployment and fewer sources of social support significantly affected the level of EE via spousal depression. The presence of children significantly affected the level of EE independent of other factors. The effects of spousal burden and depression on EE, those of patient unemployment, history of hospitalization, hypomania tendency, and social support satisfaction on family burden, and those of the number of social support sources on spousal depression are consistent with the findings of previous studies. This is the first report of the influence of spousal unemployment on spousal depression and presence of children on the level of EE. The relationships among EE, spousal burden, and depression, and the factors influencing EE, spousal burden, and depression have yet to be confirmed. Further studies with clinical cases are required.
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