The influential role of family in the outcome of chronic mental illness is well documented; however there has been relatively little research on the intrafamilial relationships of people experiencing their first episode of psychosis (FEP).

To investigate possible differences in family environment between FEP and chronic patients with schizophrenia and bipolar disorder.

To compare family measures between relatives of FEP and chronic psychotic patients.

Family functioning (FACES-IV), expressed emotion (FQ), family burden (FBS) and psychological well being (GHQ- 28) were assessed in relatives of 30 FEP and 30 chronic patients.

Multivariable linear regression models adjusted for confounders revealed that relatives of chronic patients scored significantly lower in balanced cohesion (β coefficient -4.27, 95% CI: -08.03, -1.71) and balanced flexibility (β coefficient -4.01, 95% CI: -6.91, -1.10), as well as communication (β coefficient -6.61, 95% CI: -11.70, -1.50) and satisfaction scales (β coefficient -7.32, 95% CI: -13.23, -1.41). Relatives caring for a chronic patient had significantly higher scores in critical comments (β coefficient 7.81, 95% CI: 3.95, 11.68) and emotional overinvolvement (β coefficient 3.70, 95% CI: 0.24, 7.16). They, also, reported higher objective (β coefficient 12.23, 95% CI: 3.76, 20.71) and subjective (β coefficient 2.79, 95% CI: 0.45, 5.14) burden, as well as poorer psychological well being (β coefficient 12.23, 95% CI: 3.76, 20.71).

These findings suggest that chronicity adversely affects patients’ family. Early intervention strategies are needed to reduce family burden which in turn may adversely affect the course of the patient’s illness.