Plusieurs études s’intéressant aux croyances populaires sur la schizophrénie ont montré que les explications psychosociales et biologiques sont prédominantes dans les pays occidentaux alors que dans d’autres cultures les causes surnaturelles sont plus fréquentes. Qu’en est-il des types de croyances en Tunisie ?

Les objectifs de ce travail étaient de décrire les attitudes des proches ainsi que leurs croyances au sujet des causes, des symptômes et des moyens thérapeutiques de la schizophrénie.

Un total de 91 proches de patients atteints de schizophrénie ou de trouble schizo-affectif (DSM-IV) ont été inclus dans cette étude et ont été interviewés à l’aide d’un questionnaire semi-structuré comprenant 27 items.

Les parents interrogés ont évoqué des explications religieuses dans 70 cas (76,9 %), magiques dans 43 cas (47,3 %), socioenvironnementales dans 73 cas (80,2 %), biologiques dans 54 cas (59,3 %), familiales dans 49 cas (53,8 %) et héréditaires dans 31 cas (34,1 %). Pour le diagnostic, seuls 15 participants (16,5 %) ont employé le terme « schizophrénie ». Les autres ont employé différents termes dont « la folie » dans 20 cas (22 %). Concernant les moyens thérapeutiques, 87 (95,6 %) proches ont reconnu la nécessité des antipsychotiques et 74 (81,3 %) ont évoqué l’intérêt d’y associer une psychothérapie. Toutefois, 52 (57,1 %) proches approuvaient aussi l’intérêt des tradithérapies dont l’exorcisme des « djinns » dans 13 cas (14,3 %). La croyance en l’efficacité des tradithérapies, l’incapacité à nommer le nom exact de la maladie et la stigmatisation étaient plus fréquentes parmi les classes sociales peu instruites, ayant un faible niveau économique et issues d’un milieu rural.

L’établissement de programmes de psychoéducation et de déstigmatisation à l’attention des familles, voire de la population générale tunisienne, est nécessaire.

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.