Fekih-Romdhane Feten, Saguem Bochra Nourhène, Stambouli Manel, Hallit Souheil, Cheour Majda
The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, Manouba, Tunisia.
Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia.
PLoS One. 2025 May 30;20(5):e0323312. doi: 10.1371/journal.pone.0323312. eCollection 2025.
Family caregivers represent an integral part of the mental health care system in Tunisia, as well as in most of the low-to-middle-income countries and collectivist cultural backgrounds (i.e., communities that prioritizes the group over the individual). However, their task is burdensome, often associated with both experienced and perpetrated violence toward the patient. We aimed to shed light on the caregiver-patient relationship by investigating the prevalence and correlates of both violence victimization and violence perpetration in a Tunisian sample of caregivers of patients with schizophrenia.
A paper-and-pencil self-administered questionnaire was used to collect data from participants. Caregivers (N = 110, aged 39.7 ± 12.5 years, 63.6% females) were asked questions about their experience of violence perpetration and victimization involving their relative with schizophrenia in the past 12 months. The Depression Anxiety and Stress Scales (DASS-21) and the abridged version of the Zarit Burden Interview (ZBI) were administered to all participants.
Verbal violence was the most reported type of violence victimization (35.5%), followed by threat (25.5%), and physical violence (25.5%). In addition, 54.5% of caregivers disclosed having perpetrated verbal violence at least once against their ill relative. The most endorsed causes of violence victimization were symptoms of illness (57.3%) and refusal to adhere to treatment (49.1%). Multivariable analysis (logistic regression) revealed that caregivers' levels of burden remained significantly associated with violence victimization occurrence (OR = 1.48; 95% CI 1.05; 2.09; p = .026), while having another person in charge of caring represented a significant factor associated with perpetration of any form of violence against patients (OR = .17; 95% CI.05;.62; p = .007).
Although preliminary and based on cross-sectional data and a relatively small sample size, our findings draw attention to the high prevalence of both violence perpetration and victimization within the caregiver-patient relationship in schizophrenia. Findings also identified caregivers' burden and having another person in charge of caring as factors significantly associated with occurrence of any violence victimization and violence perpetration, respectively. These factors are potentially malleable, and may be helpful in targeting an at-risk population and developing appropriate prevention strategies.
在突尼斯，以及大多数低收入和中等收入国家及集体主义文化背景（即优先考虑集体而非个人的社区）中，家庭照顾者是心理健康护理系统的重要组成部分。然而，他们的任务繁重，且常常与对患者实施的暴力行为以及遭受的暴力行为相关联。我们旨在通过调查突尼斯精神分裂症患者照顾者样本中暴力受害和暴力实施的患病率及相关因素，来深入了解照顾者与患者之间的关系。
使用纸质自填问卷从参与者那里收集数据。向照顾者（N = 110，年龄39.7 ± 12.5岁，63.6%为女性）询问他们在过去12个月中涉及精神分裂症亲属的暴力实施和受害经历的问题。对所有参与者进行抑郁焦虑压力量表（DASS - 21）和 Zarit 负担访谈简版（ZBI）测试。
言语暴力是报告最多的暴力受害类型（35.5%），其次是威胁（25.5%）和身体暴力（25.5%）。此外，54.5%的照顾者透露至少有一次对生病亲属实施言语暴力。暴力受害最常见的原因是疾病症状（57.3%）和拒绝接受治疗（49.1%）。多变量分析（逻辑回归）显示，照顾者的负担水平仍然与暴力受害的发生显著相关（OR = 1.48；95%置信区间1.05；2.09；p = 0.026），而有其他人负责照顾是与对患者实施任何形式暴力相关的一个重要因素（OR = 0.17；95%置信区间0.05；0.62；p = 0.007）。
尽管我们的研究是初步的，基于横断面数据且样本量相对较小，但我们的发现提请人们注意精神分裂症患者照顾者与患者关系中暴力实施和受害的高患病率。研究结果还确定照顾者的负担以及有其他人负责照顾分别是与任何暴力受害和暴力实施发生显著相关的因素。这些因素可能具有可塑性，可能有助于确定高危人群并制定适当的预防策略。
