Évaluation de l’autonomie sociale et de ses facteurs associés chez des patients tunisiens suivis pour schizophrénie

Abstract

IntroductionSocial autonomy concerns specific areas that people with chronic psychiatric disorders, such as schizophrenia, face daily when they live in the community. The degree of social autonomy is one of the principal determinants of success of the therapeutic project for patients suffering from schizophrenia. However, the domains of social autonomy would depend on the socio-cultural context and the familial and professional environment of the country. ObjectivesThe objectives of this study were to evaluate the social autonomy level and to research its associated factors in a sample of Tunisian out-patients with schizophrenia. MethodsIt was a cross-sectional study of 115 out-patients (mean age: 37.6±10.2 years, 75.7% male), followed for schizophrenia according DSM-IV diagnostic criteria and treated with long-term antipsychotics, mainly first generation (81%), with a mean daily dosage of 1130±875mg in chlorpromazine equivalent. Data were collected during interviews with patients and their family members and supplemented by the review of medical records. Degree of social Autonomy was assessed by the Leguay's 17-items Social Autonomy Scale (EAS), exploring five dimensions: personal care, management of daily life, resource management, relationship with outside and affective and social relations. Global functioning level was assessed by the Global Assessment of Functioning (GAF) scale. ResultsThe total EAS score ranged from 14 to 90 with a mean score of 56.6±16.8. Higher sub-scores indicating a poor social autonomy concerned the dimensions of “relationship with the outside world”, “resource management” and “management of daily life”. A negative correlation was found between the EAS total score and the GAF score (r=−0.78, P<0.0001). Thus, the lower GAF score suggesting impaired global functioning was associated to the higher EAS score in favor of altered social autonomy. Altered social autonomy was associated with low school level (P=0.02), lack of regular professional activity (P=0.001), disorganized subtype (P=0.002), negative symptoms at the last hospitalization (P=0.03), continuous course (P<0.0001) and daily dosage of antipsychotic medication (P=0.02). However, age or gender of the patients, psychiatric family history, age of onset, duration of untreated psychosis, number and duration of previous hospitalizations, antipsychotic treatment generation were not associated with social autonomy in our sample. ConclusionsDespite therapeutic advances in recent decades, the social autonomy of our patients with schizophrenia remains precarious. Several socioeconomic and clinical factors seem to be involved. Further interventions will be needed to enable our patients to function more actively and autonomously in society.