Cultural factors influencing content of delusions among schizophrenic patients in Saudi Arabia

Abstract

The present study aimed to investigate the influences of socio-cultural context on content of delusions within schizophrenic patients among three different geographical areas in Saudi Arabia and to estimate the prevalence of schizotypal personality within the non-clinical Saudi population. Methods: 148 patients meeting DSM-IV criteria of schizophrenia were drawn from in-patient sections of mental health hospitals in three areas of study (Riyadh, Jeddah, and the Eastern Province), and 364 participants were recruited for comparison groups from Saudi universities and general medical practices in the same areas. The study utilized the following instruments: Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), the MacArthur-Maudsley Delusions Assessment Schedule (MMDAS), the World Health Organization (WHO) Life Events Schedule, the Aetiological Beliefs Questionnaire (ABQ), and the Schizotypal-Personality Questionnaire (SPQ). Results: Firstly: there were significant main effects of residence and sex on the three dependent SPQ scales, and females and Riyadh area residents scored higher on all dependent SPQ scales especially on the cognitive scale. Secondly: persecutory delusions were the most common delusions among schizophrenic patients followed by delusions of being controlled, and the frequency of persecutory delusions was significantly higher in females and in the Riyadh area. Thirdly: only delusions of jealousy were specifically associated with violent behaviours among schizophrenic patients. Finally: ABQ showed that both supernatural and psychological explanations of illness were common among both control and clinical groups. Qualitative analysis of the content of delusions revealed socio-cultural and gender-related issues that were strongly reflected in the themes and content of delusions. Conclusion: Content analysis of delusions in a Saudi schizophrenic sample showed strong effects of the socio-cultural context and stress points such as racism and gender inequality, and gender and regional culture affected both the frequency with which persecutory delusions were observed, and the mean scores of schizotypal personality in a non-clinical sample.