Cultural Variations in Public Beliefs about Mental Disorders: A Comparison between Tunisia and Germany

Matthias C. Angermeyer1, 2, *, Mauro G. Carta2, Rym Ghachem3, Herbert Matschinger4, 5, Aurélie Millier6, Tarek Refaï7, Georg Schomerus8, #, Mondher Toumi6, 9, #
1 Center for Public Mental Health, Gösing am Wagram, Austria
2 Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
3 Razi Hospital, La Mannouba, Tunisia
4 Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
5 Institute of Health Economics and Health Services Research, University of Hamburg, Germany
6 Aurélie Millier, Creativ-Ceutical, Paris, France
7 Tarek Refaï, Creativ-Ceutical, Les Berges du Lac, Tunisia
8 Department of Psychiatry, Universitätsmedizin Greifswald, Greifswald, Germany
9 Mondher Toumi, Department of Public Health, Aix-Marseille University, France



In recent years there is a growing interest in public beliefs about mental disorders.

Numerous representative population-based studies have been conducted around the globe, also in European countries bordering on the Mediterranean Sea. However, relatively little is known about public beliefs in countries in Northern Africa.


To fill this gap by comparing public beliefs about mental disorders in Tunisia and Germany, focusing on causal beliefs, help-seeking recommendations and treatment preferences.


Representative national population-based surveys have been conducted in Tunisia in 2012 (N = 811) and in Germany in 2011 (N = 1852), using the same interview mode and the same fully structured interview starting with a vignette depicting a person suffering from either schizophrenia or depression.


In Tunisia, the public was more likely to adopt psychosocial and to reject biogenetic explanations than in Germany. Correspondingly, psychological treatments were more frequently recommended and biological ones more frequently advised against. There was also a strong inclination to share religious beliefs and to recommend seeking religious advice. Tunisians tended much more than Germans to hold moralistic views and to blame the afflicted person for his or her illness. In Tunisia, the public tended less to differentiate between schizophrenia and depression than in Germany.


Marked differences between Tunisia and Germany exist in public beliefs about the causes of mental disorders and their treatment, which correspond to differences in cultural orientations prevailing in these countries. Mental health professionals need to be sensitive to the particular cultural context in which they operate, in order to be able to reach those they intend to care for.

Keywords: Public beliefs, Mental illness, Tunisia, Population survey.

Abstract Information

Identifiers and Pagination:

Year: 2019
Volume: 15
Publisher Item Identifier: EA-CPEMH-2018-HT1-465

Article History:

Received Date: 08/10/2018
Revision Received Date: 01/01/2019
Acceptance Date: 02/01/2019
Electronic publication date: 17/05/2019
Collection year: 2019

© 2019 Angermeyer et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

# Both authors contributed equally
Correspondence: Address correspondence to this author at the Center for Public Mental Health, Untere Zeile 13, A-3482 Gösing am Wagram, Austria; Tel: +43 664 4353199; E-mail: