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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/6
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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 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 Adverse childhood experiences and global mental health: avenues to reduce the burden of child and adolescent mental disorders(Cambridge University Press (CUP), 2022) Ceccarelli, C.; Prina, E.; Muneghina, O.; Jordans, M.; Barker, E.; Miller, K.; Singh, R.; Sorsdhal, K.; Cuijpers, P.; Lund, C.; Barbui, C.; Purgato, M.; Department of Psychology; Acartürk, Ceren; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 39271Mental disorders are one of the largest contributors to the burden of disease globally, this holds also for children and adolescents, especially in low-and middle-income countries. The prevalence and severity of these disorders are influenced by social determinants, including exposure to adversity. When occurring early in life, these latter events are referred to as adverse childhood experiences (ACEs). In this editorial, we provide an overview of the literature on the role of ACEs as social determinants of mental health through the lenses of global mental health. While the relation between ACEs and mental health has been extensively explored, most research was centred in higher income contexts. We argue that findings from the realm of global mental health should be integrated into that of ACEs, e.g. through preventative and responsive psychosocial interventions for children, adolescents and their caregivers. The field of global mental health should also undertake active efforts to better address ACEs in its initiatives, all with the goal of reducing the burden of mental disorders among children and adolescents globally.Publication Open Access Symptoms of anxiety and depression during the COVID-19 pandemic in six European countries and Australia - differences by prior mental disorders and migration status(Elsevier, 2022) Gemes, K.; Bergstrom, J.; Papola, D.; Barbui, C.; Lam, A.I.F.; Hall, B.J.; Seedat, S.; Morina, N.; Quero, S.; Campos, D.; Pinucci, I.; Tarsitani, L.; Deguen, S.; van der Waerden, J.; Patane, M.; Sijbrandij, M.; Burchert, S.; Bryant, R.A.; Mittendorfer-Rutz, E.; Department of Psychology; Acartürk, Ceren; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 39271Background: little is known about changes of mental health during the COVID-19 pandemic in potentially disadvantaged groups. We investigated changes in anxiety and depression symptoms during the first year of the pandemic in six European countries and Australia by prior mental disorders and migration status. Methods: overall, 4674 adults answered a web-based survey in May-June 2020 and were followed by three repeated surveys up to February 2021. Information on psychosocial, financial and demographic, living conditions, prior mental disorders, depression and anxiety symptoms during the pandemic and migration status was collected. Weighted general estimation equations modelling was used to investigate the association between prior mental disorders, migration status, and symptoms over time. Results: most participants were <40 years old (48%), women (78%) and highly educated (62%). The baseline prevalence of depressive and anxiety symptoms ranged between 19%-45% and 13%-35%, respectively. In most countries, prevalence rates remained unchanged throughout the pandemic and were higher among people with prior mental disorders than without even after adjustment for several factors. We observed interactions between previous mental disorders and symptoms of anxiety or depression over time in two countries. No difference by migration status was noted. Limitations: convenience sampling limits generalizability. Self-assessed symptoms of depression and anxiety might involve some misclassification. Conclusions: depression and anxiety symptoms were worse among individuals with prior mental disorders than without, but there was no clear trend of worsening mental health in the observed groups during the observed period.Publication Open Access Prevalence of common mental disorders among Syrian refugee children and adolescents in Sultanbeyli district, Istanbul: results of a population-based survey(Cambridge University Press (CUP), 2020) Scherer, N.; Hameed, S.; Deniz, G.; Sheikhani, A.; Volkan, S.; Orucu, A.; Pivato, I; Akıncı, I; Patterson, A.; Polack, S.; Department of Psychology; Acartürk, Ceren; Faculty Member; Department of Psychology; College of Social Sciences and HumanitiesAims: research demonstrates elevated levels of common mental disorders among Syrian refugees, but the majority of studies have, to date, focused on adult populations. This study aims to estimate the prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) among Syrian children and adolescents living in Sultanbeyli district of Istanbul, Turkey. Methods: a population-based survey among Syrian children and adolescents aged 8-17 years living in Sultanbeyli district was conducted in 2019, as part of an all-age survey of disability. 80 clusters of 50 participants (all-ages) were selected from the local municipality's refugee registration database using probability proportionate to size sampling. Children aged 8-17 years were assessed for symptoms of common mental disorders using the Child Revised Impact of Event Scale (CRIES-8) and abbreviated versions of the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) and the Screen for Child Anxiety Related Disorders (SCARED). Results: of the 852 participants, 23.7% (95% CI 19.9-27.2) screened positive for symptomatic depression, PTSD and anxiety. The prevalence estimates for depression, PTSD and anxiety were 12.5% (95% CI 9.8-15.6), 11.5% (95% CI 9.1-14.4) and 9.2% (95% CI 6.8-12.1), respectively. Depression and PTSD were significantly more common in older adolescents, whilst anxiety and PTSD were significantly more common in girls. Depression was more common in children from poorer households and those who had received no education. Children coming from larger households were less likely to show symptoms of PTSD. Conclusions: Syrian refugee children and adolescents are vulnerable to common mental disorders, and culturally appropriate prevention and intervention support are needed for this population.Publication Open Access The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: a critical review across waves(Elsevier, 2022) Manchia, Mirko; Gathier, Anouk W.; Schmidt, Mathias, V; de Quervain, Dominique; van Amelsvoort, Therese; Bisson, Jonathan, I; Cryan, John F.; Howes, Oliver D.; Pinto, Luisa; Van der Wee, Nic J.; Domschke, Katharina; Branchi, Igor; Vinkers, Christiaan H.; Eser, Hale Yapıcı; Faculty Member; Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM); School of Medicine; 134359The global public health crisis caused by COVID-19 has lasted longer than many of us would have hoped and expected. With its high uncertainty and limited control, the COVID-19 pandemic has undoubtedly asked a lot from all of us. One important central question is: how resilient have we proved in face of the unprecedented and prolonged coronavirus pandemic? There is a vast and rapidly growing literature that has examined the impact of the pandemic on mental health both on the shorter (2020) and longer (2021) term. This not only concerns pandemic-related effects on resilience in the general population, but also how the pandemic has challenged stress resilience and mental health outcomes across more specific vulnerable population groups: patients with a psychiatric disorder, COVID-19 diagnosed patients, health care workers, children and adolescents, pregnant women, and elderly people. It is challenging to keep up to date with, and interpret, this rapidly increasing scientific literature. In this review, we provide a critical overview on how the COVID-19 pandemic has impacted mental health and how human stress resilience has been shaped by the pandemic on the shorter and longer term. The vast literature is dominated by a wealth of data which are, however, not always of the highest quality and heavily depend on online and self-report surveys. Nevertheless, it appears that we have proven surprisingly resilient over time, with fast recovery from COVID-19 measures. Still, vulnerable groups such as adolescents and health care personnel that have been severely impacted by the COVID-19 pandemic do exist. Large interindividual differences exist, and for future pandemics there is a clear need to comprehensively and integratively assess resilience from the start to provide personalized help and interventions tailored to the specific needs for vulnerable groups.Publication Open Access Parallel-distinct structures of internal world and external reality: disavowing and re-claiming the self-identity in the aftermath of trauma-generated dissociation(Frontiers, 2017) N/A; Şar, Vedat; Faculty Member; School of Medicine; 8542The nature of consciousness and the autonomy of the individual'smind have been a focus of interest throughout the past century and inspired many theories and models. Revival of studies on psychological trauma and dissociation, which remained outside mainstream psychiatry, psychology, and psychoanalysis for the most part of the past century, has provided a new opportunity to revisit this intellectual and scientific endeavor. This paper attempts to integrate a series of empirical and theoretical studies on psychological consequences of developmental traumatization, which may yield further insight into factors which threaten the integrity of human consciousness. The paper proposes that an individual's experience of distorted reality and betrayal precipitates a cyclical dynamic between the individual and the external world by disrupting the developmental function of mutuality which is essential for maintenance of the integrity of the internal world while this inner world is in turn regulated vis-a-vis external reality. Dissociation - the common factor in all types of post-traumatic syndromes-is facilitated by violation of boundaries by relational omission and intrusion as represented by distinct effects and consequences of childhood neglect and abuse. Recent research conducted on clinical and non-clinical populations shows both bimodal (undermodulation and overmodulation) and bipolar (intrusion and avoidance) neurobiological and phenomenological characteristics of post-traumatic response. These seem to reflect "parallel-distinct structures" that control separate networks covering sensori-motor and cognitive-emotional systems. This understanding provides a conceptual framework to assist explanation of diverse post-traumaticmental trajectories which culminate in a common final pathway comprised of partly overlapping clinical syndromes such as complex PTSD, dissociative depression, dissociative identity disorder (DID), or "borderline" phenomena. Of crucial theoretical and clinical importance is that thesemaladaptive post-traumatic psychological formations are regarded as processes in their own right rather than as a personality disorder innate to the individual. Such mental division may perform in that internal detachment can serve to preserve the genuine aspects of the subject until such time as they can be reclaimed via psychotherapy. The paper attempts to integrate these ideas with reference to the previously proposed theory of the "Functional Dissociation of Self" (Sar and Ozturk, 2007).Publication Open Access Preventing the mental health consequences of war in refugee populations(Cambridge University Press (CUP), 2022) Barbui, Corrado; Purgato, Marianna; Churchill, Rachel; Cuijpers, Pim; Koesters, Markus; Sijbrandij, Marit; Valimaki, Maritta; Wancata, Johannes; White, Ross G.; Department of Psychology; Acartürk, Ceren; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 39271The refugee experience is associated with several potentially traumatic events that increase the risk of developing mental health consequences, including worsening of subjective wellbeing and quality of life, and risk of developing mental disorders. Here we present actions that countries hosting forcibly displaced refugees may implement to decrease exposure to potentially traumatic stressors, enhance subjective wellbeing and prevent the onset of mental disorders. A first set of actions refers to the development of reception conditions aiming to decrease exposure to post-migration stressors, and a second set of actions refers to the implementation of evidence-based psychological interventions aimed at reducing stress, preventing the development of mental disorders and enhancing subjective wellbeing.Publication Open Access Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial(Cambridge University Press (CUP), 2022) Turrini, G.; Purgato, M.; Tedeschi, F.; Anttila, M.; Au, T.; Carswell, K.; Churchill, R.; Cuijpers, P.; Friedrich, F.; Gastaldon, C.; Klein, T.; Kosters, M.; Lantta, T.; Nose, M.; Ostuzzi, G.; Papola, D.; Popa, M.; Sijbrandij, M.; Tarsitani, L.; Todini, L.; Uygun, E.; Valimaki, M.; Walker, L.; Wancata, J.; White, R. G.; Zanini, E.; van Ommeren, M.; Barbui, C.; Department of Psychology; Acartürk, Ceren; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 39271Aims: as refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe. Methods: refugees and asylum seekers with psychological distress (General Health Questionnaire-12 > 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes. Results: of 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389-1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180-1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001). Conclusions: the present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.