Acceptation des « voix » chez les personnes avec ou sans troubles psychiatriques : validation francophone de l’échelle VAAS à 9 items

Cette recherche a pour objectif de valider et d’adapter l’échelle d’acceptation des voix Voices Acceptance and Actions Scale (VAAS) sur un échantillon d’une population francophone (n = 386) composée de patients atteints de schizophrénie et d’entendeur de voix issus de la population générale, et d’explorer le niveau d’acceptation des voix entre ces deux populations. Pour la population clinique, 65 patients souffrant de schizophrénie avec hallucinations auditives ont été évalués à l’aide des échelles de psychopathologie (BPRS) et de l’échelle des croyances à propos des voix (BAVQ-R). Pour les entendeurs de voix (population non-clinique), 321 personnes ont répondu à un bref questionnaire sociodémographique et ont rempli l’échelle VAAS en ligne, pour rendre compte de leur vécu et de l’acceptation de leurs voix. L’échelle VAAS, traduite à 9 items, montre des propriétés psychométriques similaires à l’outil original. Chez les personnes avec une schizophrénie (population clinique), le niveau d’acceptation des voix était faible, et fortement corrélé à la dépression contrairement aux personnes entendant des voix issues de la population générale (population non-clinique) qui semblaient mieux les vivre et les accepter. L’intérêt d’une évaluation régulière du niveau d’acceptation des voix dans le cadre de la pratique clinique en santé mentale y est discuté, du fait de la puissance prédictive de l’acceptation sur la dépression, et de son utilité pour l’évaluation des thérapeutiques et des recherches cliniques mesurant leurs effets sur le niveau d’acceptation des voix chez les sujets. Hearing voices is a common experience for people with schizophrenia. Perceived voices are in most cases a source of great distress for patients. This experience also exists in the general population and is considered as “non-clinical”. Much research has focused on the psychological and neuropsychological mechanisms behind the emergence of voices. With regard to voice persistence factors, the acceptance of the voice-hearing phenomenon is still relatively unexplored. In addition, there are few standardized tools that specifically assess this dimension of voice experience. The Voices Acceptance and Actions Scale (VAAS) is the only validated tool to address voice acceptance in individuals with schizophrenia. However, to date, there is no French version. The objective of this research was to validate the VAAS in a French speaking population. Our sample consisted of individuals with schizophrenia (N = 65) and voice hearers from the general population (N = 321). For the clinical population, individuals with schizophrenia and auditory hallucinations were assessed using the VAAS scale in its two abbreviated versions (9 and 12 items). In order to validate the measure in French, we administered psychopathology scales (BPRS) and voice belief scales (BAVQ-R) for convergent and divergent validity. For the non-clinical population, we administered the VAAS scale online (via LimeSurvey), accompanied by a brief sociodemographic questionnaire (age, sex, country of origin, existence of medical or psychological follow-up). The psychometric properties of the VAAS scale were satisfactory and similar to the original English-language tool for both versions, with a slight advantage for the one with 9-items. The convergent validity measured with the BAVQ-R scale, and the divergent one measured with the BPRS depression subscale, were found to be satisfactory. In addition, the re-test performed 6 weeks after the first test (N = 30) was satisfactory for both scales, with a Pearson correlation index greater than 70 (r = 0.70; P < 0.001 for the VAAS 9 items) and (r = 0.79; P < 0.001 for the 12 item version). In individuals with schizophrenia (clinical population), the level of voice acceptance was low and strongly correlated with depression. This point seems to corroborate the current data in the field suggesting that voice hearing in this population is associated with significant distress and has a significant impact on their lives. Conversely, the level of acceptance obtained from the non-clinical population was much higher, reflecting a higher level of acceptance in this population. People from the non-clinical population seemed to accept and experience their voices with less distress than people from the clinical population in this study. To date, a paucity of studies have investigated the acceptance of auditory hallucinations. Our results support the psychometric validity of the French version of the VAAS, particularly the 9-item version. Furthermore, our study supports the need to continue studying voice acceptance, as it appears to be strongly linked to depression in people with psychiatric disorders such as schizophrenia. In addition, our study is novel in that it also explored, with a standardized tool, the level of voice acceptance in a non-clinical population and found people to be more accepting of the voices they hear and better at living with them. These data provide new evidence to better understand the links between the level of acceptance of voices, their experiences, and depression. Clinically, it seems essential to conduct more systematic and regular evaluations of the level of voice acceptance in those hearing voices. Finally, in terms of rehabilitation, voice acceptance can become a therapeutic target in order to improve the psychological and behavioral functioning of the person.

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