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Publication Metadata only Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East(F1000 Research Ltd, 2024) Woodward, Aniek; Fuhr, Daniela C.; Barry, Alexandra S.; Balabanova, Dina; Sondorp, Egbert; Dieleman, Marjolein A.; Pratley, Pierre; Schoenberger, Samantha F.; McKee, Martin; Burchert, Sebastian; Knaevelsrud, Christine; Brown, Felicity L.; Steen, Frederik; Spaaij, Julia; Morina, Naser; de Graaff, Anne M.; Sijbrandij, Marit; Cuijpers, Pim; Bryant, Richard; Akhtar, Aemal; Roberts, Bayard; Department of Psychology; İlkkurşun, Zeynep; Acartürk, Ceren; Department of Psychology; ; Graduate School of Social Sciences and Humanities; College of Social Sciences and Humanities;Background: Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems Methods: A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis. Results: We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided to address these issues. Conclusions: All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial. Copyright: © 2024 Woodward A et al.Publication Metadata only Intimate partner violence and HIV treatment adherence in urban South Africa: mediating role of perinatal common mental disorders(Elsevier, 2022) Hatcher, Abigail M.; Stöckl, Heidi; Woollett, Nataly; García-Moreno, Claudía M.; Christofides, Nicola Joan; N/A; Turan, Janet Molzan; Other; School of Medicine; N/ABackground: Antiretroviral therapy (ART) has potential to eliminate perinatal HIV infections, but adherence to ART in late pregnancy and postpartum is often suboptimal. Intimate partner violence (IPV) may influence non-adherence among perinatal women living with HIV (WWH), but few quantitative studies have examined this over time or explored mechanisms for this association. Methods: We used secondary data from a parent trial in Johannesburg comprising WWH from the control arm (n=63) and WWH ineligible for the trial (n=133). Trained nurse researchers administered questionnaires at first antenatal visit on past-year psychological, physical, and/or sexual IPV (WHO instrument), socio-demographics (age, food security, education), and perinatal common mental symptoms of depression (Hospital Anxiety and Depression Screener-d); anxiety (HADS-a); post-traumatic stress disorder (PTSD; Harvard Trauma Questionnaire). At endline visit 2-4 months postpartum, nurse researchers assessed self-reported ART adherence using a visual analog scale (with ≥95% considered “good”). We fitted structural equation models (SEM) in MPlus to explore direct and indirect effects of IPV on ART adherence. Results: Of 196 perinatal WWH, 53.1% reported IPV exposure at baseline. The majority of participants (85.7%) had good perinatal ART adherence. In adjusted models, IPV at baseline was associated with halved odds of good adherence (aOR=0.51, 95%CI=0.20-0.96). IPV was associated with higher adjusted odds of probable depression (aOR=4.64), anxiety (aOR=2.85), and PTSD (aOR=3.42). In SEM, IPV had a direct (standardized coef=-0.22) and indirect effect (coef=-0.05) on ART via common mental disorders. The total effect of IPV on perinatal adherence was of moderate size (coef= -0.27) and the model had good fit (CFI=0.972; TLI=0.969; RMSEA=0.045; SRMR=0.076). Conclusion: IPV was longitudinally associated with perinatal ART non-adherence in part due to its relationship with mental health symptomology. Addressing IPV within clinical care has potential to improve perinatal mental health, maternal HIV outcomes, and HIV-free infant survival.Publication Metadata only Investigation of the relationship between physical problems and aberrant behavior categories in autism spectrum disorder(Galenos Yayınevi, 2020) N/A; N/A; N/A; Mutluer, Tuba; Doenyas, Ceymi; Faculty Member; PhD Student; Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM); School of Medicine; Graduate School of Social Sciences and Humanities; 305311; 277852Objectives: Autism spectrum disorder is a neurodevelopmental conditiona that manifests with impairments in social interactions and communication and repetitive behaviors and restricted interests. It is known that autism spectrum disorder is accompanied by medical comorbidities, and as the number of accompanying comorbidities increase, the intensity of aberrant behaviors also increases in individuals with autism spectrum disorder. Yet, how subgroups of aberrant behaviors relate to physical complaints with unknown primary etiology in autism spectrum disorder has not yet been investigated. Understanding and solving these physical problems can improve the quality of life of individuals with autism spectrum disorder, as interventions should not only address core autism spectrum disorder symptoms but also all physical complaints affecting an individual’s life. Additionally, an examination of such a relation may help better understand the underlying mechanisms of autism spectrum disorder. Materials and Methods: In this study, in 64 individuals with autism spectrum disorder (11 girls) aged between 6 and 18 years, the relationship between the physical complaints subcategory of Child Behavior Checklist and the severity of autism spectrum disorderaccording to Childhood Autism Rating Scale was examined. Additionally, the relationship between physical complaints and the subgroups of the Aberrant Behavior Checklist was evaluated. Results: A significant positive correlation was found between physical symptoms and autism spectrum disorder severity. Among the five factors of this checklist (irritability, agitation, crying; lethargy, social withdrawal; stereotypic behavior; hyperactivity, non-compliance; inappropriate speech), only hyperactivity/non-compliance and inappropriate speech correlated with physical complaints. This relationship was independent of sociodemographic factors such as child age, parental age, and parental education. Conclusion: These findings indicate that children with autism spectrum disorder who exhibit extreme mobility and disobedience are at risk of physical discomfort. In addition to psychiatric and psychologic examinations, a comprehensive and holistic approach should be adopted for individuals with autism spectrum disorder, especially for those individuals experiencing physical problems. / Amaç: Otizm spektrum bozukluğu sosyal beceri eksikliği ve yineleyen davranışlar ile kısıtlı ilgi alanlarını içeren nörogelişimsel bir durumdur. Bugüne kadar alanyazında fiziksel rahatsızlıklar ile otizm şiddeti arasındaki ilişki incelenmiş, ancak birincil nedeni bilinmeyen bedensel rahatsızlıkların otizme eşlik eden sorun davranış alt grupları ile ilişkisi araştırılmamıştır. Otizme eşlik eden fiziksel sorunların anlaşılması ve çözümlenmesi bu bireylerin hayat kalitelerinin iyileşmesini sağlayabilir. Ayrıca bu ilişkinin incelenmesi, otizmin altında yatan nedensel mekanizmaların daha iyi anlaşılmasına yardımcı olabilir. Gereç ve Yöntem: Çalışmada, 6-18 yaş arası 64 otizmli bireyde (11 kız), bedensel rahatsızlıkların otizm şiddeti ve otizmdeki sorunlu davranışlar ile ilişkisi araştırılmıştır. Bu amaç doğrultusunda, 4-18 Yaş Grubu Çocuk ve Gençler İçin Davranış Değerlendirme Ölçeği’nin alt ölçeklerinden biri olan bedensel rahatsızlık kategorisi ile Çocukluk Otizmi Derecelendirme Ölçeği aracılı ölçülen otizm şiddeti ve Otizm Sorun Davranış Listesi’nin alt başlıkları arasındaki olası ilişki incelenmiştir. Bulgular: Otizmin şiddeti ile bedensel şikayetler arasında anlamlı bir ilişki bulunmuştur. Ayrıca otizme eşlik eden sorun davranışlar olan huzursuzluk, atalet ve sosyal içe kapanıklık, yinelenen davranışlar, aşırı hareketlilik ve itaat etmeme ile uygun olmayan konuşma davranış alt grupları arasından sadece aşırı hareketlilik ve itaat etmeme ile bedensel şikayetler arasında anlamlı bir ilişki bulunmuştur. Bu ilişkinin çocuk yaşı, anne-baba yaşı ve anne-baba eğitimi gibi sosyodemografik etmenlerden bağımsız olduğu gösterilmiştir. Sonuç: Bu bulgular, otizmde aşırı hareketlilik ve itaatsizlik gösteren çocukların bedensel rahatsızlık yaşama riski taşıdığına işaret etmektedir. Psikiyatrik ve psikolojik incelemelerin yanı sıra bu davranışları gösteren otizmli bireylere kapsamlı bir yaklaşım ve bütüncül bir tedavi uygulanmasının önemi ortaya çıkmaktadır.Publication Metadata only Mental health in the mediterranean area(Bentham Science Publishers, 2020) Carta, Mauro Giovanni; Moussaouiand, Driss; Karam, Elie; Department of Psychology; Eskin, Mehmet; Faculty Member; Department of Psychology; College of Social Sciences and Humanities; 2210N/APublication Metadata only The (non)denial of torture, human rights and medical expertise(Edward Elgar Publishing Ltd., 2020) Department of Sociology; Can, Başak Bulut; Faculty Member; Department of Sociology; College of Social Sciences and Humanities; 219278This chapter addresses the issue of documenting state violence with a focus on the limitations of using forensic and amedical evidence in relation to human rights violations. Drawing on archival and ethnographic research into the documentation of state violence in Turkey, the chapter examines two case studies of state violence from the 1980s and the post-2014 Turkey to show how the use, misuse or non-use of forensic and medical evidence is carried out within the broader political climate in Turkey. The chapter shows that first the power of medical evidence to deny or prove torture allegations deteriorates as punishment-as-spectacle against the insurgent is normalized and tolerated with the help of legal framework. Second, the widespread use of medical and scientific expert knowledge has made human rights more dependent on the existing legal and bureaucratic framework rendering it all the more difficult to raise substantial and political questions about state violence.Publication Metadata only The perceived assessment of Covid-19 impact on mental functioning and suicidality in adult population of Serbia(Sciendo, 2024) Milena, Mladenović; Dušan, Marković; Radmanović, Olivera; Ceylan, Deniz; School of MedicineThe aim of the study was to determine the extent to which people in Serbia in the post-pandemic period assess the impact of coronavirus pandemic on their mental/professional functioning, and whether this assessment is correlated with the occurrence of suicidal ideation and behaviours. The retrospective-prospective study was conducted online via Google Forms during January 2023. The sample included 341 respondents from the general population, 250 women (73.3%) and 91 men (26.7%), aged from 19 to 72 (M=36.41, SD=14.72). Sociodemographic questionnaire, a questionnaire on the pandemic effects, and the Risk Assessment Suicidality Scale were used to obtain data. The respondents assessed the pandemic not to have exerted a significant effect on their mental life (M=1.19±0.84) and professional functioning (M=1.55±1.02). The women, university students, pensioners and single respondents reported a greater impact of the pandemic on mental functioning, while university students and single respondents reported a greater impact on professional functioning. The respondents who were assessed to be at suicide risk (15.8%) reported a higher effect of the pandemic on mental (U=5385, p<0.001) and professional functioning (U=5799, p<0.01). Multivariant binary logistic regression showed that having a family history of mental disorders (odds ratio 2.73), younger age (OR, 1.1) and not being in a relationship (OR, 0.49) increased suicide risk in this sample. Results are in line with previous findings indicating that women, university students and pensioners reported a higher effect of the pandemic on the level of stress, depression and anxiety symptoms. The study also speaks in favour of a specific vulnerability of people suffering from mental difficulties after the pandemic. © 2024 Mladenović Milena et al., published by Sciendo 2024.Publication Metadata only The Simplest way of assessing memory and attention function in daily clinical practice(Future Medicine, 2016) Arikan, Mehmet Kemal; Tarhan, Nevzat; Uysal, Omer; Gunay, Barlas; Küçük, Zeynep; N/A; Muradoğlu, Serra Küpçüoğlu; Doctor; N/A; Koç University Hospital; N/AAttention and memory are important parts of cognition that must be routinely examined in daily practice of psychiatry and neurology. Traditionally, their assessment has been done via anamnesis where the clinician simply asks the patient whether they are suffering from any cognitive difficulties in their daily lives. The present study investigated whether there is a significant association between the patient's simple anamnestic information about cognitive impairments and the scores in related subtests of Montreal Cognitive Assessment Test (MoCA). We found that there is a statistically significant correlation between the simple anamnestic information and the scores on the related subtests of the MoCA. These results suggest that patients can be quickly and accurately evaluated in terms of their attention and memory functions by using a basic "yes/no" question.