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Publication Open Access Self-Help Plus for refugees and asylum seekers; study protocol for a series of individual participant data meta-analyses(Taylor _ Francis, 2021) Karyotaki, Eirini; Sijbrandij, Marit; Purgato, Marianna; Lakin, Daniel; Bailey, Della; Peckham, Emily; Uygun, Ersin; Tedeschi, Federico; Wancata, Johannes; Augustinavicius, Jura; Carswell, Ken; Valimaki, Maritta; van Ommeren, Mark; Koesters, Markus; Popa, Mariana; Leku, Marx Ronald; Anttila, Minna; Churchill, Rachel; White, Ross; Al-Hashimi, Sarah; Lantta, Tella; Au, Teresa; Klein, Thomas; Tol, Wietse A.; Cuijpers, Pim; Barbui, Corrado; Department of Psychology; Acartürk, Ceren; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 39271Background: refugees and asylum seekers face various stressors due to displacement and are especially vulnerable to common mental disorders. To effectively manage psychological distress in this population, innovative interventions are required. The World Health Organization (WHO) Self-Help Plus (SH+) intervention has shown promising outcomes in reducing symptoms of common mental disorders among refugees and asylum seekers. However, individual participant differences in response to SH+ remain largely unknown. The Individual Participant Data (IPD) meta-analysis synthesizes raw datasets of trials to provide cutting-edge evidence of outcomes that cannot be examined by conventional meta-analytic approaches. Objectives: this protocol outlines the methods of a series of IPD meta-analyses aimed at examining the effects and potential moderators of SH+ in (a) reducing depressive symptoms at post-intervention and (b) preventing the six-month cumulative incidence of mental disorders in refugees and asylum seekers. Method: RCTs on SH+ have been identified through WHO and all authors have agreed to share the datasets of the trials. The primary outcomes of the IPD meta-analyses are (a) reduction in depressive symptoms at post-intervention, and (b) prevention of six-month cumulative incidence of mental disorders. Secondary outcomes include post-traumatic stress disorder symptoms, well-being, functioning, quality of life, and twelve-month cumulative incidence of mental disorders. One-stage IPD meta-analyses will be performed using mixed-effects linear/logistic regression. Missing data will be handled by multiple imputation. Conclusions: these results will enrich current knowledge about the response to SH+ and will facilitate its targeted dissemination. The results of these IPD meta-analyses will be published in peer-reviewed journals.Publication Open Access Fear of happiness among college students: the role of gender, childhood psychological trauma, and dissociation(Medknow Publications, 2019) Türk, Tuğba; Öztürk, Erdinç; N/A; Şar, Vedat; Faculty Member; School of Medicine; 8542Aims: this study aimed to evaluate the fear of happiness among college students and its relationship to gender, childhood psychological trauma, and dissociation. Setting and Design: College students were addressed as study population, and a relational screening method was implemented. Materials and Methods: among 184 participants, 93 (50.5%) were women. The Fear of Happiness Scale (FHS), the Childhood Trauma Questionnaire (CTQ), and the Dissociative Experiences Scale (DES) were administered to all participants. Statistical Analysis Used: MannuWhitney-U and Student's t-tests were implemented for comparison of groups. Pearson correlation and stepwise multiple regression analyses were conducted to identify associations between variables. Results: there were no differences on DES, FHS, and CTQ total scores between genders. DES was associated with CTQ total scores in both genders. Women had higher scores than men on childhood emotional abuse and fear of "cheerfulness ends up with bad faith." Compared to nonmembers, female dissociative taxon members had higher scores on all childhood trauma types except sexual abuse, and on all types of fear of happiness except "good fortune ends up with disaster" which was the only type of fear significantly elevated among male dissociative taxon members. A stepwise regression analysis revealed that depersonalization, childhood emotional neglect, and physical abuse predicted fear of happiness among women which was predicted by absorption among men. Conclusions: there is a relationship between childhood psychological trauma, dissociation, and fear of happiness. Women seem to be more vulnerable in this path of obsessional thinking which affects different realms in male and female genders.Publication Open Access Long-term prognosis of commercially sexually exploited youth in Turkey: brief report(Anadolu Psikiyatri Dergisi - Anatolian Journal of Psychiatry, 2017) Semerci, B.; Tufan, A. E.; Sanli, I.; N/A; Taşkıran, Ali Sarper; Other; School of Medicine; 195168Objective: Factors contribute to commercial sexual exploitation of youth (CSEY) and a variety of physical and psychological consequences of CSEY were previously discussed in the literature. The aim of the current study was to determine the long term prognosis of a sample of CSEY in Turkey. Methods: A sample of 108 CSEY (all females) with a mean age of 16.7 +/- 2.7 (range: 9-22) years living in a specialized center for protection against perpetrators were examined in terms of their sociodemographic variables, previous abuse history, family history and current psychopathology. Identified cases were referred for psychiatric evaluation. We obtained follow-up data 11 years after initial contact from this cohort (mean age 25.9 +/- 2.6 at time of follow-up) with the subjects and received information regarding their current functioning. Results: Follow up data revealed that recommendations during psychiatric follow up could not be acted upon. 71.4% of the initial sample (n= 76) could be reached via direct or indirect contacts. We found that good/superior functioning was very rare and that one-third of the sample that could be reached still was being sexually exploited. Important considerations derived from the results were discussed in the current article.Publication Open Access Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective(Dove Medical Press, 2017) Dorahy, Martin J; Krüger, Christa; N/A; Şar, Vedat; Faculty Member; School of Medicine; 8542Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societala and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry.Publication Open Access Depression and Parkinson disease: prevalence, temporal relationship, and determinants(TÜBİTAK, 2017) Bora, Hatice Ayşe; Kuruoǧlu, Aslı Çepik; N/A; Eser, Hale Yapıcı; Faculty Member; School of Medicine; 134359Background/aim: Comorbidity of depression in Parkinson disease (PD) is a major factor that changes patients' quality of life. However, the neurobiological and sociodemographic risk factors for this comorbidity are not well studied. In this study, we aimed to define the prevalence, temporal relationship, and psychosocial and clinical determinants of depression comorbid with PD. Materials and methods: Fifty-five PD patients were evaluated with SCID, a data form that assessed sociodemographic and PD-related variables, UPDRS III, HAM-D, HAM-A, MMSE, and the Apathy Evaluation Scale.Results: Depression (lifetime: 45.5%, last month: 25.5%, before PD: 20%) was the most frequent psychiatric diagnosis. The major determinants of depression in the last month and depression before PD were early onset of PD and young age. Patients on pramipexole treatment were less likely to be diagnosed with depression in the last month. Other sociodemographic and PD-related variables were not significantly different for lifetime, last month, and pre-PD depression diagnosis compared to their counterparts. Conclusion: Depression is prevalent both before and after patient gets a PD diagnosis. Depression is not only the result of PD-related life changes but it is also a preceding factor that may decrease the age of PD onset.Publication Open Access Parental sexual abuse and suicidal behaviour among women with major depressive disorder(Sage, 2012) Talbot, Nancy L.; Ward, Erin A.; Duberstein, Paul R.; Department of Psychology; Çankaya, Banu; Faculty Member; Department of Psychology; College of Social Sciences and HumanitiesObjective: Women with major depressive disorder (MDD) and childhood sexual abuse histories have an increased risk for suicidal behaviours, but it is unclear whether specific abuse characteristics contribute to risk. We aimed to examine the contributions of abuse characteristics to lifetime history of suicide attempts and multiple suicide attempts, independent of posttraumatic stress disorder and borderline personality disorder. Method: Women with MDD and sexual abuse histories (n = 106) were assessed regarding sexual abuse characteristics, psychiatric diagnoses, and suicide attempts. Results: In multivariate logistic regressions, the odds of having multiple suicide attempts increased 12.27-fold when childhood sexual abuse was perpetrated by a parent figure or a parent, compared with a nonparent. Conclusions: Parental perpetration of sexual abuse increases the likelihood of multiple suicide attempts among women outpatients. The relationship of the perpetrator to the abused woman is important in suicide risk evaluation and treatment planning.Publication Open Access Neuropsychological function at first episode in treatment-resistant psychosis: findings from the ÆsOP-10 study(Cambridge University Press (CUP), 2019) Kravariti, Eugenia; Demjaha, Arsime; Zanelli, Jolanta; Ibrahim, Fowzia; Wise, Catherine; MacCabe, James H.; Reichenberg, Abraham; Pilecka, Izabela; Morgan, Kevin; Fearon, Paul; Morgan, Craig; Doody, Gillian A.; Donoghue, Kim; Jones, Peter B.; Dazzan, Paola; Lappin, Julia; Murray, Robin M.; N/A; Kaçar, Anıl Şafak; PhD Student; Graduate School of Health SciencesBackground: neuropsychological investigations can help untangle the aetiological and phenomenological heterogeneity of schizophrenia but have scarcely been employed in the context of treatment-resistant (TR) schizophrenia. No population-based study has examined neuropsychological function in the first-episode of TR psychosis. Methods: we report baseline neuropsychological findings from a longitudinal, population-based study of first-episode psychosis, which followed up cases from index admission to 10 years. At the 10-year follow up patients were classified as treatment responsive or TR after reconstructing their entire case histories. Of 145 cases with neuropsychological data at baseline, 113 were classified as treatment responsive, and 32 as TR at the 10-year follow-up. Results: compared with 257 community controls, both case groups showed baseline deficits in three composite neuropsychological scores, derived from principal component analysis: verbal intelligence and fluency, visuospatial ability and executive function, and verbal memory and learning (p valuesâ 0.001). Compared with treatment responders, TR cases showed deficits in verbal intelligence and fluency, both in the extended psychosis sample (t =-2.32; p = 0.022) and in the schizophrenia diagnostic subgroup (t =-2.49; p = 0.017). Similar relative deficits in the TR cases emerged in sub-/sensitivity analyses excluding patients with delayed-onset treatment resistance (p values<0.01-0.001) and those born outside the UK (p values<0.05). Conclusions: Verbal intelligence and fluency are impaired in patients with TR psychosis compared with those who respond to treatment. This differential is already detectable-At a group level-At the first illness episode, supporting the conceptualisation of TR psychosis as a severe, pathogenically distinct variant, embedded in aberrant neurodevelopmental processes.Publication Open Access Trauma treatment across Europe: where do we stand now from a perspective of seven countries?(Taylor _ Francis Open, 2016) Gersons, B.P.R.; Javakhishvilli, J.; Kaslauskas, E.; Meewisse, M.; Merecz-Kot, D.; Schäfer, I.; Schnyder, U.; N/A; Şar, Vedat; Faculty Member; School of Medicine; 8542There is a lack of knowledge about the state of affairs of the trauma treatments in Europe. To start to fill in this gap, key persons from seven European countries—Georgia, Germany, Lithuania, the Netherlands, Poland, Switzerland, and Turkey—accepted the invitation to give their expert opinion on the state of affairs in their country at an invited panel discussion at the XIV 2015 ESTSS Conference in Vilnius, Lithuania. Brief reports from the seven countries reveal significant diversities among different European countries in terms of awareness of health problems related to trauma, the availability of trauma treatments, and treatment approaches. Political and economic differences across the European countries contribute to the diversities in the developments of trauma treatments. European national psychotrauma societies are active in establishing training curricula and dissemination of trauma-focused treatments. Despite the growing acknowledgment of trauma and dissemination of trauma-focused treatments, there is a lack of Europe-wide policies to ensure availability of trauma treatment in Europe for trauma survivors. The need for more detailed analysis of trauma treatment in all European countries and development of European-level trauma-informed health care policies is outlined.Publication Open Access Effectiveness of Self-Help Plus in preventing mental disorders in refugees and asylum seekers in Western Europe: a multinational randomized controlled trial(Karger Publishers, 2021) Purgato, Marianna; Carswell, Kenneth; Tedeschi, Federico; Anttila, Minna; Au, Teresa; Bajbouj, Malek; Baumgartner, Josef; Biondi, Massimo; Churchill, Rachel; Cuijpers, Pim; Koesters, Markus; Gastaldon, Chiara; Lantta, Tella; Nose, Michela; Ostuzzi, Giovanni; Papola, Davide; Popa, Mariana; Roselli, Valentina; Sijbrandij, Marit; Tarsitani, Lorenzo; Turrini, Giulia; Valimaki, Maritta; Walker, Lauren; Wancata, Johannes; Zanini, Elisa; White, Ross; van Ommeren, Mark; Barbui, Corrado; Department of Psychology; Acartürk, Ceren; İlkkurşun, Zeynep; Faculty Member; Master Student; Department of Psychology; College of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; 39271; N/AIntroduction: Self-Help Plus (SH+) is a group-based psychological intervention developed by the World Health Organization for managing stress. Objective: to assess the effectiveness of SH+ in preventing mental disorders in refugees and asylum seekers in Western Europe. Methods: we conducted a randomized controlled trial in 5 European countries. Refugees and asylum seekers with psychological distress (General Health Questionnaire score >= 3), but without a Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) or ICD/10 diagnosis of mental disorder, as assessed with the Mini International Neuropsychiatric Interview (MINI), were randomized to SH+ or enhanced treatment as usual (ETAU). The primary outcome was the frequency of mental disorders with the MINI at 6 months. Secondary outcomes included the frequency of mental disorders at postintervention, self-identified problems, psychological symptoms, and other outcomes. Results: four hundred fifty-nine individuals were randomly assigned to SH+ or ETAU. For the primary outcome, we found no difference in the frequency of mental disorders at 6 months (Cramer V = 0.007, p = 0.90, RR = 0.96; 95% CI 0.52-1.78), while the difference significantly favored SH+ at after the intervention (secondary outcome, measured within 2 weeks from the last session; Cramer V = 0.13, p = 0.01, RR = 0.50; 95% CI 0.29-0.87). Conclusions: this is the first randomized indicated prevention study with the aim of preventing the onset of mental disorders in asylum seekers and refugees in Western Europe. As a prevention effect of SH+ was not observed at 6 months, but rather after the intervention only, modalities to maintain its beneficial effect in the long term need to be identified.Publication Open Access Behavioral implications of the Covid-19 process for autism spectrum disorder, and individuals' comprehension of and reactions to the pandemic conditions(Frontiers, 2020) Mutluer, Tuba; Doenyas, Ceymi; Genç, Herdem Aslan; Faculty Member; PhD Student; Faculty Member; Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM); School of Medicine; Koç University Hospital; 305311; N/A; N/ADuring disasters and pandemics, vulnerable populations such as patients with mental conditions are known to be overly influenced. Yet, not much is known about how the individuals with autism spectrum disorder (ASD), one of the most common neurodevelopmental conditions globally with a prevalence of 1%, are affected from health-related disasters, especially the current Covid-19 pandemic. Therefore, we conducted an investigation of how individuals with ASD responded to Covid-19 in terms of comprehension and adherence to implemented measures; changes in their behavioral problems; and how their caregivers' anxiety levels relate with these behavioral changes. Our sample consisted of 87 individuals with ASD (15 girls; ages ranged from 3-29, with an average of 13.96 +/- 6.1). The majority of our sample had problems understanding what Covid-19 is and the measures it requires. They also had challenges in implementing social distance and hygiene-related regulations of the pandemic. The majority stopped receiving special education during this period. We observed a Covid-19-related clinical presentation that resembled PTSD in individuals with ASD in terms of increased stereotypies, aggression, hypersensitivity, behavioral problems, and sleep and appetite alterations. All subscales of Aberrant Behavior Checklist (ABC) differed significantly between before and after the pandemic conditions. The number of hours the children slept significantly decreased from before to during Covid-19. The anxiety levels of caregivers were high and correlated with the current behavioral problem levels of their children, but not with the level of their behavioral problems before the pandemic. The difference in ABC total score and specifically the lethargy/social withdrawal subscale score predicted parents' anxiety score. Our results suggest that the Covid-19 period inflicts specific challenges to individuals with ASD and their caregivers, underlining the need for targeted, distance special education interventions and other support services for this population.