[Assessing beliefs and attitudes of relatives of patients with schizophrenia: a study in a Tunisian sample]. / Évaluation des croyances et des attitudes d'une population tunisienne de proches de patients atteints de schizophrénie.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

[Stress and burnout among Tunisian teachers]. / Stress et épuisement professionnel des enseignants tunisiens.

INTRODUCTION: Burnout, or professional exhaustion syndrome, is defined as a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress at work. Despite the fact that it is not a recognized disorder in the DSM-IV, burnout has been widely described among medical and paramedical staff. In Tunisia, all the studies about this syndrome have only considered populations of doctors. However, professional exhaustion syndrome is not only limited to the medical sector, but can also be seen in any profession involving a relation of help. Thus, the teaching profession seems to be concerned with this syndrome. In fact, in our clinical practice, we are increasingly confronted with teachers' suffering. The latter face increasing difficulties in their work and moreover some of them can no longer resist and thus become vulnerable to the professional exhaustion syndrome. OBJECTIVE: The aim of this study was to evaluate burnout among a population of Tunisian teachers and to examine the professional stressors associated with teachers' burnout. METHODS: Our study was a transversal study conducted over five months (from October 2009 to February 2010) and it concerned teachers working in the public high schools of Manouba (Tunisia). The participants completed a self-questionnaire dealing with professional stressors. Five types of professional stressors were identified in the literature: bad working conditions, work overload, administrative difficulties, organizational factors and difficulties with pupils and their relatives. They were also explored by the scale of the burnout: the Maslach Burnout Inventory (MBI), which is the best-studied measurement of burnout in the literature. We used the French version of the MBI adapted to educational settings. It is a scale composed of 22 items and three dimensions: emotional exhaustion (nine items), dehumanization (five items) and reduced personal accomplishment (eight items). In our study, we considered a teacher was suffering from burnout when at least two among the three dimensions of this scale were pathological. RESULTS: From the total number of teachers working in public high schools of Manouba (n=876), only 398 teachers filled in our questionnaires. Hence the rate of participation was 45.4%. The mean age of those participants was 40.04 years. 52.3% of them were women (sex ratio=0.91) and the great majority was married (81.8%). The burnout syndrome was found in 21% of those teachers: Moderate professional exhaustion was found in 16.4% of cases and severe professional exhaustion was found in 4.6%. A high emotional exhaustion was found in 27.4% of cases. A percentage of 16.1 of participants had a high dehumanization and 45.5% of them were susceptible to reduced personal accomplishment. The majority of teachers (66.4%) declared being stressed at work. The professional stressors reported by the teachers were in decreasing order of rate: bad working conditions (80.3%), overload work (75.2%), administrative difficulties (70.4%), difficulties with pupils and their relatives (64.4%) and finally organizational factors (57.1%). In our study, we found a strong association between burnout syndrome among teachers and three types of professional stressors which were: bad working conditions (p=0.0017), administrative difficulties (p=0.005) and difficulties with pupils and their relatives (p=0.005). The organizational factors and the work overload were not associated with the burnout syndrome. CONCLUSION: The job of teaching accumulates many difficulties. Some Tunisian teachers cannot tolerate this professional stress and develop a burnout. This syndrome leads to a teachers' psychological distress with the risk of an increase in absenteeism at work. So, we hope that this study will give rise to future research on stress, coping and burnout among Tunisian teachers, with theoretical aims as well as practical applications to prevent and reduce the risk of this problem.