UNIVERSITÉ TUNIS EL MANAR

FACULTÉ DE MÉDECINE DE TUNIS

ANNÉE UNIVERSITAIRE 2021/2022

THÈSE 
En vue de l‘obtention du Diplôme National
de Docteur en Médecine

Présentée et soutenue publiquement

le 27/05/2022
Par : Olfa SMAOUI

TEACHERS’ ATTITUDES AND BELIEFS REGARDING

SCHIZOPHRENIA

Directeur de thèse : Dr Feten FEKIH-ROMDHANE

Président : Pr Mejda CHEOUR
Membres : Pr Rym GHACHEM Rapporteur : Pr Ag Zeineb Salma ABBES
Pr Faten ELLOUZE

Pr Ag Wided HOMRI
INTRODUCTION
Schizophrenia affects about 7 per
1000 people worldwide.

Schizophrenia often emerges in

adolescence.

The school system represents a

prime setting for early access to
care for youth with mental health
problems.

Teachers represent a
cornerstone in early referring
students to the specialized health
care resources.

 Teachers’ attitudes and beliefs toward mental illness have been so far a critical
and neglected area of research. No research has targeted teachers in Tunisia.
 Aims of the study

2
Determine the potential effects of
vignette gender on teachers’
perceptions.

1 Assess attitudes and beliefs toward

schizophrenia among higher secondary
school teachers in Tunis, Tunisia.
 STUDY DESIGN STUDY SAMPLE

Descriptive cross- Nine higher secondary

sectional study. schools in TUNIS.

The period between 304 high school teachers.

January and June 2021.
 Non Exclusion
Inclusion
inclusion criteria
criteria
criteria
• Have
• Classroom responded
• Non- inadequately to
teachers in the classroom the
academic year of teachers questionnaire
2020-2021 • Have
• Administrative responded
• >= 1 year of staff incompletely to
teaching the
• Refused to questionnaire
experience participate
• Have chosen
to interrupt the
interview
 DATA COLLECTION
A SELF-ADMINISTERED ANONYMOUS
QUESTIONNAIRE

SOCIODEMOGRAPHIC STRUCTURED
CHARACTERISTICS INTERVIEW
 The condition of the person
 Gender described in the vignette represented
 Age a mental illness in the medical sense
 Emotional reactions
Work duration
 Stereotypes of the condition
 Marital status  Prognosis of the condition
Socioeconomic level  Social distance with the person in
Psychiatric history the vignette
 Help-seeking recommendations.
 Psychiatric training
willingness to have psychiatric training
 Demographics of participants

 304 Copies  56,2% female teachers

K

 Response rate of 84,4%

Y

H
 DEMOGRAPHIC CHARACTERISTICS OF
PARTICIPANTS
Vignette gender
Statistics
Male Female p value
t or 2
(N=140) (N=164)
Gender, N (%)
Male 68 (48.6%) 65 (39.6%) 2.45 .132
Female 72 (51.4%) 99 (60.4%)
Age (years), Mean ± SD 47.6 ± 8.2 47.9 ± 7.9 -.288 .774
Work duration (years), Mean ± SD 20.9 ± 8.9 21.3 ± 9.0 -.389 .698
Family or close circle of friends
ever had consulted a psychiatrist
Yes 59 (42.1%) 57 (34.8%)
.22 .894
No 71 (50.7%) 77 (47.0%)
Do not remember/do not want
20 (14.3%) 20 (12.2%)
to answer
Monthly family income (TD)
500-1000 6 (4.3%) 4 (2.4%) 1.37 .504
>3000 56 (40.0%) 60 (36.6%)
THE LABELING OF SCHIZOPHRENIA 140
CAUSAL BELIEFS REGARDING SCHIZOPHRENIA
EMOTIONAL REACTIONS TO THE PERSON WITH SCHIZOPHRENIA
 EMOTIONAL REACTIONS TO THE PERSON WITH
SCHIZOPHRENIA ACCORDING TO VIGNETTE GENDER
STEREOTYPES OF SCHIZOPHRENIA
EXPECTED PROGNOSIS OF SCHIZOPHRENIA
DESIRE FOR SOCIAL DISTANCE FROM PERSONS
WITH SCHIZOPHRENIA
HELP-SEEKING RECOMMENDATIONS FOR SCHIZOPHRENIA
OUR STUDY LITERATURE

IN ACCORDANCE

Negative attitudes
attached to schizophrenia Parikh et al. (2016):
among teachers 63.6% prevalence of
mental health stigma
among high school
teachers
OUR STUDY LITERATURE

IN ACCORDANCE
Latifeh et al. (2021): Syrian teachers
endorsed bad parenting as a cause of
mental illness.

Kamel et al.(2020): 13.4% of Saudi

Psychosocial teachers assumed magic and eye as
factors. the cause of psychiatric illness.

Angermeyer et al. (2016): Tunisians tended

to approve psychosocial and religious causes
Religious and
supernatural CONTRACDICTORY RESULTS
factors
Angermeyer et al. (2016): German
participants tended to approve
neurobiological origin of mental
illness.
OUR STUDY LITERATURE

IN ACCORDANCE
Kamel et al.(2020): 21.4% agreed that
“psychiatric patient is a dangerous
Teachers negatively person and one should be taken with
care”.
stereotyped
schizophrenia.
Sniatecki et al. (2015): The
least positive attitudes were
towards students with mental
health disabilities.
OUR STUDY LITERATURE

IN ACCORDANCE

Feelings of
discomfort, Gur et al.(2012): Teachers
incomprehension and stigmatized mental illnesses,
insecurity. particularly schizophrenia.
OUR STUDY LITERATURE

IN ACCORDANCE
Fekih-Romdhane et al.(2021):
Tunisian students tended to
accept distant relationships with
people with mental illness more
than close relationships .
Accept distant Parkih et al.(2016): About half of
relationships. Indian teachers stated that they
would try to avoid approaching a
psychiatric patient.
47% of them revealed that they
would not discuss mental illness in
class.
OUR STUDY LITERATURE

IN ACCORDANCE

Pessimistic views Javed et al.(2006): Teachers

regarding the outcome and students tended to hold
of patients with the most negative outcome
schizophrenia. expectancies toward
schizophrenia.
OUR STUDY LITERATURE

IN ACCORDANCE
Psychiatrist or the
psychotherapist are a Kamel et al. (2020) ; Gur
preferred source of et al. (2012) ; Latifeh et
help. al. (2021).

Angermeyer et al. (2016): 75%

Teachers relay on
of Tunisian community
informal sources of
participants recommended
help.
seeking help from an Imam for
mental health problems.
OUR STUDY
Unable to make her own
decisions and to be
dependent on others more
than males.
Recommended to seek help
from a family physician or to
consult a psychiatric hospital
for schizophrenia
significantly less than males.
LITERATURE
IN ACCORDANCE
Gearing et al.(2013): MIDDLE
EAST female vignette less
likely to have successful lives.
CONTRACDICTORY
RESULTS
Gagné et al. (2014): WESTERN
POPULATION people being less
likely to support men in their
help-seeking behavior.
STUDY LIMITATIONS
 Cross-sectional study

Longitudinal studies

 The private sector of high-schools and high-schools in

rural areas were not represented

Wider samples and in various

setting

 Self reflected questionnaire

 Missing variables
 NEGATIVE
STEREOTYPES

SOCIAL
DISTANCE

PSYCHOSOCIAL
CAUSES

PESSIMISTIC
OUTCOME
EXPECTANCIES
TUNISIAN TEACHERS

GENDER
STIGMA
 RECOMMENDATIONS

Training programs on mental health for teachers

in collaboration with psychiatrists, school doctors
and psychologists.

Implementing school-based mental health programs.

The integration of mental health

literacy into high school curriculum.
 UNIVERSITÉ TUNIS EL MANAR
FACULTÉ DE MÉDECINE DE TUNIS
ANNÉE UNIVERSITAIRE 2021/2022

THÈSE 
En vue de l‘obtention du Diplôme National
de Docteur en Médecine

Présentée et soutenue publiquement

le 27/05/2022
Par : Olfa SMAOUI

TEACHERS’ ATTITUDES AND BELIEFS REGARDING

SCHIZOPHRENIA

Président : Pr Mejda CHEOUR Directeur de thèse : Dr Feten FEKIH ROMDHANE

Membres : Pr Rym GHACHEM Rapporteur : Pr Ag Zeineb Salma ABBES

Pr Faten ELLOUZE
Pr Ag Wided HOMRI