Bouhlel S, Ben Haouala S, Klibi A, Ghaouar M, Chennoufi L, Melki W, El-Hechmi Z
416, rue El Maari Msaken, 4070, Tunisie.
Encephale. 2013 Jun;39(3):165-73. doi: 10.1016/j.encep.2012.06.012. Epub 2012 Jul 12.
Investigating and understanding family member's causal beliefs and attitudes about schizophrenia is an important step in the management of the illness. They likely influence the family's help-seeking decisions and affect both adherence with biomedical interventions and social integration of the patients. The aim of this study was to describe Tunisian families' beliefs about the causes, the symptoms and the treatments of schizophrenia.
We led a transversal study including 91 relatives of patients with schizophrenia or schizoaffective disorder (DSM-IV). We excluded patients with mental retardation or neurological diseases. For family members, we excluded participants with a history of mental disorders or cognitive impairments. We collected basic socio-demographic data for both patients and relatives. We asked relatives to respond by "yes/no/I am not certain" to a three-part questionnaire including 27 items dealing with causal explanations, symptoms and optimal cures for schizophrenia.
The mean age of the relatives was 49.8 (±13.7) years; 54.9% were men; 49.4% were parents, 8.8% spouses, 39.6% brothers or sisters; 25.3% had not attended school, 24.2% had attended primary school, 37.4% junior high school or high school and 13.2% had a university degree; 63.7% lived in an urban area; 33% had low economic status and 41.8% reported having another family member with mental disorder. Only 46.2% of participants had asked psychiatrists about the diagnosis of their sick relatives and only 16.5% were able to label the term "schizophrenia". Among the cited etiologies of schizophrenia, religious causes were found in 76.9% of cases, they first cited God's will or fate and secondly God's punishment. Magical explanations such as witchcraft and possession by "djinns" were found in 47.3% of cases. The biological causes were cited by 59.3% of participants. The majority of participants (95.6%) proved the need for drugs and 81.3% the utility of psychotherapies. However, 30.8% believed in non-medical practices such as reading Holy Koran verses, charity and exorcism. Significant correlations were found between relatives' low level of education, low economic status, living in a rural area and supernatural beliefs, traditional practices, stigma and the use of the term 'madness'. Significant correlations were also found between family history of mental disorders and beliefs on family and hereditary causes.
In this study, opinions and attitudes regarding schizophrenia were related to education level, economic status and geographic origin. Few persons recognized the term "schizophrenia" despite a long contact with the mental health system. This fact points out the need to improve the psychoeducation of family members of persons with schizophrenia.
调查并了解家庭成员对精神分裂症的因果信念和态度是该疾病管理中的重要一步。这些信念可能会影响家庭的求助决策，并对生物医学干预措施的依从性以及患者的社会融合产生影响。本研究的目的是描述突尼斯家庭对精神分裂症的病因、症状及治疗的信念。
我们开展了一项横断面研究，纳入了91名精神分裂症或分裂情感性障碍（DSM-IV）患者的亲属。我们排除了患有智力障碍或神经系统疾病的患者。对于家庭成员，我们排除了有精神障碍或认知障碍病史的参与者。我们收集了患者和亲属的基本社会人口学数据。我们要求亲属以“是/否/不确定”回答一份包含三部分的问卷，问卷包括27个关于精神分裂症因果解释、症状及最佳治疗方法的问题。
亲属的平均年龄为49.8（±13.7）岁；54.9%为男性；49.4%为父母，8.8%为配偶，39.6%为兄弟姐妹；25.3%未上学，24.2%上过小学，37.4%上过初中或高中，13.2%拥有大学学位；63.7%生活在城市地区；33%经济状况较差，41.8%报告称家中还有其他患有精神障碍的家庭成员。只有46.2%的参与者曾向精神科医生询问过其患病亲属的诊断情况，只有16.5%的人能够说出“精神分裂症”这个词。在被提及的精神分裂症病因中，76.9%的案例提到了宗教原因，他们首先提到上帝的意志或命运，其次是上帝的惩罚。47.3%的案例中提到了巫术和被“精灵”附身等神奇的解释。59.3%的参与者提到了生物学原因。大多数参与者（95.6%）认可药物治疗的必要性，81.3%认可心理治疗的作用。然而，30.8%的人相信非医学方法，如诵读《古兰经》经文、慈善活动和驱魔仪式。亲属的低教育水平、低经济状况、生活在农村地区与超自然信念、传统做法、污名化以及使用“疯癫”一词之间存在显著相关性。精神障碍家族史与对家庭和遗传原因的信念之间也存在显著相关性。
在本研究中，关于精神分裂症的观点和态度与教育水平、经济状况和地理来源有关。尽管与心理健康系统有长期接触，但很少有人能认出“精神分裂症”这个词。这一事实表明有必要加强对精神分裂症患者家庭成员的心理教育。
