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    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.
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    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/A
    Background: 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.
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    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 Medicine
    The 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.
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    PublicationOpen Access
    The profile of psychiatric nurses in Turkey: academic field
    (Kare Yayıncılık, 2020) Yılmaz, Sevil; Boyacıoğlu, Nur Elçin; Sukut, Özge; Doğan, Nareg; Oflaz, Fahriye; Faculty Member; School of Nursing; 185160
    Objectives: there is no current data on the number and qualifications of the academic nursing work force in the mental health and psychiatric field in Turkey. The purpose of this research, therefore, is to construct a profile of academics who are working in the field of mental health and psychiatric nursing in Turkey. Methods: this descriptive and cross-sectional study was conducted between January–May 2018 via a digital questionnaire form. Of the 227 teaching staff with internet access who were invited to participate in the study, 177 filled out the questionnaires. The questionnaire consists of 42 questions about personal and professional experience. Descriptive statistics were used in the analysis of the data. Results: among the participants, 5.6% were professors; 16.9% were associate professors; 31.3% were doctoral faculty members, 14.6% were faculty members and 31.6% were research assistants. The percentage of those with master of science degrees in Mental Health and Psychiatric Nursing was 73.4%, while those with a doctorate in this field was 55.4%. It was further found that 89.8% of the participants worked full time, 34.5% had 1–5 years of academic experience, 45.2% taught outside the field of mental health, 20.9% had clinical experience in the field of mental health and 12.4% had never worked in a clinical area before. Finally, 34.5% stated that they had visited or studied in an institution abroad and 63.8% had participated in congresses abroad, with the mean number of international congresses attended being 3.92 (Max:43). Conclusion: the fact that about one-third of the academics were at the beginning of their academic experience and that half had no doctorate degree can be seen as characteristics posing possible risks to reaching goals. In contrast, the high number of those with clinical experience in the field of mental health can be viewed as a strong quality of the academic profile. / Amaç: ülkemizde, ruh sağlığı ve psikiyatri hemşireliği insan gücünü yetiştiren öğretim elemanlarının sayı ve niteliklerine ilişkin güncel veri bulunmamaktadır. Bu bağlamda araştırmanın amacı, Türkiye’de ruh sağlığı ve psikiyatri hemşireliği alanında görev yapmakta olan akademisyenlerin profilini ortaya koymaktır. Gereç ve yöntem: tanımlayıcı-kesitsel nitelikteki çalışmada veriler, Ocak–Mayıs 2018 tarihlerinde, dijital anket formu aracılığı ile toplanmıştır. İnternet erişimi olan 227 öğretim elemanı çalışmaya davet edilmiş olup, anketleri dolduran 177 kişi ile çalışma tamamlanmıştır. Anket formu, kişisel ve mesleki deneyime ilişkin 42 sorudan oluşmaktadır. Verilerin analizinde tanımlayıcı istatistikler kullanılmıştır. Bulgular: katılımcıların %5.6’sı profesör; %16.9’u doçent; %31.3’ü doktor öğretim üyesi, %14.6’sı öğretim ve %31.6’sı araştırma görevlisidir. Ruh Sağlığı ve Psikiyatri Hemşireliği yüksek lisans mezunu olanların oranı %73.4 olup, bu alanda doktora yapmış olma oranı %55.4’dür. Katılımcıların %89.8’i tam zamanlı çalışmaktadır, %34.5’i 1-5 yıl arası akademik deneyime sahiptir ve %45.2’si ruh sağlığı alanı dışında da ders vermektedir. Katılımcıların %20.9’unun ruh sağlığı alanında klinik deneyimi olduğu, %12.4’ünün ise daha önce herhangi bir klinik alanda çalışmadığı bulunmuştur. Akademisyenlerin %34.5’i yurtdışında bir kurumda çalışma ya da gözlem yapmak için bulunmuş olup, %63.8’i yurt dışında kongreye katılmıştır. Yurt dışı kongreye katılım sayısı ortalaması 3.92’dir (max. 43). Sonuç: psikiyatri hemşireliği akademisyenlerinin yaklaşık olarak üçte birinin akademik deneyiminin başında olması ve yarısının doktora derecesine henüz sahip olmaması hedeflere ulaşmada risk yaratabilecek bir özellik olarak değerlendirmiştir. Ruh sağlığı alanında klinik deneyimi olanların sayısının yüksek olması ise güçlü bir özelliktir.