Researcher: İlkkurşun, Zeynep
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İlkkurşun, Zeynep
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Publication Metadata only Experiences of accessing education among people with disabilities during the Covid-19 pandemic: evidence from five low- and middle-income countries1(Routledge Journals, Taylor and Francis Ltd, 2024) Hunt, Xanthe; McKenzie, Judith; Hameed, Shaffa; Khan, Rifat Shahpar; Luong-Anh, Ngoc; Ganle, John; Tetali, Shailaja; Huq, Lopita; Shakespeare, Tom; Department of Psychology; Department of Psychology; İlkkurşun, Zeynep; Acartürk, Ceren; ; Graduate School of Social Sciences and Humanities; College of Social Sciences and Humanities;The COVID-19 pandemic had profound impacts on education globally. The pandemic widened educational disparities between young people with and without disabilities, but accounts from low- and middle-income countries are missing from the literature. This article reports on a multi-country qualitative study of experiences of education in low- and middle-income countries during the pandemic. Interviews were conducted with primary, secondary, and tertiary-level young people with disabilities who were engaged in education, and caregivers, with 30-60 participants per country. Data were analysed using thematic analysis, organised according to three key topics: experiences accessing education prior to the pandemic, barriers to access during the pandemic, and the impact of poor access. The pandemic exacerbated the existing failure of education systems to cater to the needs of people with disabilities and their families. Beyond education, losses in functioning, mental health, and family wellbeing were acutely felt by caregivers.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; Department of Psychology; İlkkurşun, Zeynep; Acartürk, Ceren; ; 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 Traumatic experiences, acculturation, and psychological distress among Syrian refugees in Turkey: the mediating role of coping strategies(Pergamon-Elsevier Science Ltd, 2021) Acar, İbrahim Hakkı; Yurtbakan, Taylan; Uygun, Ersin; Department of Psychology; N/A; N/A; Department of Psychology; Department of Psychology; Kurt, Gülşah; İlkkurşun, Zeynep; Acar, Büşra; Acartürk, Ceren; Teaching Faculty; Master Student; PhD Student; Faculty Member; College of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; College of Social Sciences and Humanities; N/A; N/A; N/A; 39271Turkey hosts the largest number of refugees in the world. So far, many studies investigated the mental health problems among Syrian refugees in Turkey and other hosting countries. However, little attention has been paid to the acculturation process of Syrian refugees in Turkey. A crosssectional study was conducted with 409 Syrian refugees in Mardin, Turkey. Results showed that traumatic experiences depleted problem-focused, emotion-focused, and maladaptive coping strategies. Emotion-focused coping strategies mediated the relationship between traumatic experiences and maintenance of the heritage culture and adoption of the destination culture. To conclude, our findings underscore the importance of traumatic experiences and emotion-focused coping strategies for integration of Syrian refugees in Turkey. Psychosocial interventions enhancing emotion-focused coping capacities might mitigate the adverse impact of traumatic experiences on integration. We discussed the strengths and limitations of the study considering the current literature.Publication Metadata only “Doing What Matters in Times of Stress” to decrease psychological distress during Covid-19: a rammed controlled pilot trial(Wolters Kluwer Medknow Publications, 2022) Uygun, Ersin; Karaoğlan Kahiloğulları, Akfer; Department of Psychology; Department of Psychology; N/A; Department of Psychology; Acartürk, Ceren; Kurt, Gülşah; İlkkurşun, Zeynep; Faculty Member; Teaching Faculty; Master Student; College of Social Sciences and Humanities; College of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; 39271; 368619; N/ADespite the increasing psychological distress during Covid-19, utilisation of face-to-face psychological interventions decreased profoundly. The aim of this study involving two parallel, two-armed pilot randomised controlled trials was to examine the effectiveness of a guided self-help intervention "Doing What Matters in Times of Stress" (DWM) in decreasing psychological distress in Turkish and Syrian participants. Seventy-four Turkish nationals and 50 Syrian refugee adults with psychological distress were randomly allocated to a DWM group or wait-list control group. The primary outcome measure was the Patient Health Questionnaire 9 postintervention. Secondary outcome measures were the Generalised Anxiety Disorder Scale, posttraumatic stress disorder (PTSD) Checklist for DSM-5, Generalized Self-Efficacy Scale and Acceptance and Action Questionnaire-II postintervention. Although this study was not powered to detect a significant effect for DWM postassessment between DWM and the control group, results showed a significant improvement in depression symptoms among Turkish participants in the DWM group (d = 0.46) and in PTSD symptoms among Syrian participants in the DWM group (d = 0.67) from pre- to postintervention assessment. These results indicate the potential of DWM to decrease mental health problems during the pandemic and importance of a fully powered, definitive controlled trial to examine its effectiveness both for the host community and refugees to reduce psychological distress during Covid-19.Publication Metadata only Caring for carers: a virtual psychosocial supervision intervention to improve the quality and sustainability of mental health and psychosocial support in humanitarian contexts(Cambridge University Press (CUP), 2022) Wells, R.; Alokoud, M.; Beetar, A.; Eldardery, H.; Elshazly, M.; Faruk, O.; Ginem, M. R.; Hadzi-Paylovic, D.; Jahan, S.; Joshi, R.; Klein, L.; Kurdi, L.; Mastrogiovanni, C.; Mozumder, M.; Lekkeh, S.; Nemorin, S.; Perry, K. Nicholson; Orabi, M.; Qasim, J.; Steel, Z.; Utah, H.; Uygun, E.; Wong, S.; Yan, L. (Fischer); Yousselr, R. Said; Zarate, A.; Rosenbaum, S.; Department of Psychology; N/A; N/A; Department of Psychology; N/A; Department of Psychology; Acartürk, Ceren; Almeamari, Fatima; İlkkurşun, Zeynep; Kurt, Gülşah; Tavakol, Mehri; Faculty Member; Master Student; Master Student; Teaching Faculty; Other; College of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; College of Social Sciences and Humanities; N/A; 39271; N/A; N/A; 368619; N/AN/APublication Metadata only Somatic distress among Syrian refugees in Istanbul, Turkey: a cross-sectional study(Pergamon-Elsevier Science Ltd, 2020) McGrath, M.; Roberts, B.; Sondorp, E.; Sijbrandij, M.; Cuijpers, P.; Ventevogel, P.; McKee, M.; Fuhr, D. C.; Department of Psychology; N/A; Department of Psychology; Acartürk, Ceren; İlkkurşun, Zeynep; Faculty Member; Master Student; College of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; 39271; N/APublication 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; Department of Psychology; Acartürk, Ceren; İlkkurşun, Zeynep; Faculty Member; Master Student; 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 Trajectories of psychosocial symptoms and wellbeing in asylum seekers and refugees exposed to traumatic events and resettled in Western Europe, Turkey, and Uganda(Taylor _ Francis, 2022) Purgato, Marianna; Tedeschi, Federico; Turrini, Giulia; Anttila, Minna; Augustinavicious, Jura; Baumgartner, Josef; Bryant, Richard; Churchill, Rachel; Karyotaki, Eirini; Klein, Thomas; Koesters, Markus; Lantta, Tella; Leku, Marx R.; Nose, Michela; Ostuzzi, Giovanni; Popa, Mariana; Prina, Eleonora; Sijbrandij, Marit; Uygun, Ersin; Valimaki, Maritta; Walker, Lauren; Wancata, Johannes; White, Ross G.; Cuijpers, Pim; Tol, Wietse; Barbui, Corrado; Department of Psychology; Department of Psychology; Acartürk, Ceren; İlkkurşun, Zeynep; Faculty Member; Master Student; College of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; 39271; N/ABackground: longitudinal studies examining mental health trajectories in refugees and asylum seekers are scarce. Objectives: to investigate trajectories of psychological symptoms and wellbeing in refugees and asylum seekers, and identify factors associated with these trajectories. Method: 912 asylum seekers and refugees from the control arm of three trials in Europe (n = 229), Turkey (n = 320), and Uganda (n = 363) were included. We described trajectories of psychological symptoms and wellbeing, and used trauma exposure, age, marital status, education, and individual trial as predictors. Then, we assessed the bidirectional interactions between wellbeing and psychological symptoms, and the effect of each predictor on each outcome controlling for baseline values. Results: symptom improvement was identified in all trials, and for wellbeing in 64.7% of participants in Europe and Turkey, versus 31.5% in Uganda. In Europe and Turkey domestic violence predicted increased symptoms at post-intervention (ss = 1.36, 95% CI 0.17-2.56), whilst murder of family members at 6-month follow-up (ss = 1.23, 95% CI 0.27-2.19). Lower wellbeing was predicted by murder of family member (ss = -1.69, 95% CI -3.06 to -0.32), having been kidnapped (ss = -1.67, 95% CI -3.19 to -0.15), close to death (ss = -1.38, 95% CI -2.70 to -0.06), and being in the host country >= 2 years (ss = -1.60, 95% CI -3.05 to -0.14). In Uganda at post-intervention, having been kidnapped predicted increased symptoms (ss = 2.11, 95% CI 0.58-3.65), and lack of shelter (ss = -2.51, 95% CI -4.44 to -0.58) and domestic violence predicted lower wellbeing (ss = -1.36, 95% CI -2.67 to -0.05). Conclusion: many participants adapt to adversity, but contextual factors play a critical role in determining mental health trajectories. / Antecedentes: estudios longitudinales que examinan las trayectorias de la salud mental en losrefugiados y solicitantes de asilo son escasos. Objetivos: investigar las trayectorias de los síntomas psicológicos y el bienestar en refugiadosy solicitantes de asilo, e identificar factores asociados a estas trayectorias.Métodos:Se incluyeron 912 solicitantes de asilos y refugiados del brazo control de tresensayos clínicos en Europa (n= 229), Turquía (n= 320) y Uganda (n= 363). Describimos las trayectorias psicológicas de los síntomas y el bienestar, y utilizamos la exposición traumática, laedad, el estado marital, la educación y el juicio individual como predictores. Después,evaluamos las interacciones bidireccionales entre el bienestar y los síntomas psicológicos, yel efecto de cada uno de los predictores en cada resultado controlando por los valores iniciales.Resultados: se identificó una mejoría en los síntomas en todos los ensayos, y del bienestar en el64.7% de los participantes en Europa y Turquía, versus el 31.5% en Uganda. En Europa y en Turquía,la violencia doméstica predijo el incremento de síntomas de después de la intervención (ß= 1.36,95% CI 0.17 a 2.56), mientras que el homicidio de algún miembro familiar a los 6 meses deseguimiento (ß= 1.23, 95% CI 0.27 a 2.19). Un menor bienestar fue predicho por el homicidio dealgún miembro de la familia (ß=?1.69, 95% CI?3.06 a?0.32), haber sido secuestrado (ß=?1.67, 95% CI?3.19 a?0.15), haber estado próximo a la muerte (ß=?1.38, 95% CI?2.70 a?0.06), y estar en el país de acogida?2años(ß=?1.60, 95% CI?3.05 a?0.14). En Uganda,después de la intervención, haber sido secuestrado predijo un aumento de los síntomas(ß=2.11, 95% CI 0.58 a 3.65), y la falta de refugio (ß=?2.51, 95% CI?4.44 a?0.58) y laviolencia doméstica predijo un menor bienestar (ß=?1.36, 95% CI?2.67 a?0.05).Conclusión: muchos participantes se adaptan a la adversidad, pero los factores contextualesjuegan un papel crítico en determinar las trayectorias de la salud mental.Publication Open Access Group problem management plus (PM plus) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial(BioMed Central, 2022) Uygun, E.; Yurtbakan, T.; Adam Troian, J.; Şenay, I; Bryant, R.; Cuijpers, P.; Kiselev, N.; McDaid, D.; Morina, N.; Nişancı, Z.; Park, A. L.; Sijbrandij, M.; Ventevogel, P.; Fuhr, D. C.; Department of Psychology; Department of Psychology; Acartürk, Ceren; İlkkurşun, Zeynep; Kurt, Gülşah; Faculty Member; Master Student; Teaching Faculty; College of Social Sciences and Humanities; Graduate School of Social Sciences and Humanities; 39271; N/A; N/ABackground: Syrian refugees resettled in Turkey show a high prevalence of symptoms of mental disorders. Problem Management Plus (PM+) is an effective psychological intervention delivered by non-specialist health care providers which has shown to decrease psychological distress among people exposed to adversity. In this single-blind pilot randomised controlled trial, we examined the methodological trial procedures of Group PM+ (gPM+) among Syrian refugees with psychological distress in Istanbul,Turkey, and assessed feasibility, acceptability, perceived impact and the potential cost-effectiveness of the intervention. Methods: refugees with psychological distress (Kessler Psychological Distress Scale, K10 > 15) and impaired psychosocial functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0> 16) were recruited from the community and randomised to either gPM+ and enhanced care as usual (E-CAU) (n = 24) or E-CAU only (n = 22). gPM+ comprised of five weekly group sessions with eight to ten participants per group. Acceptability and feasibility of the intervention were assessed through semi-structured interviews. The primary outcome at 3-month follow-up was symptoms of depression and anxiety (Hopkins Symptoms Checklist-25). Psychosocial functioning (WHODAS 2.0), symptoms of posttraumatic stress disorder and self-identified problems (Psychological Outcomes Profiles, PSYCHLOPS) were included as secondary outcomes. A modified version of the Client Service Receipt Inventory was used to document changes in the costs of health service utilisation as well as productivity losses. Results: there were no barriers experienced in recruiting study participants and in randomising them into the respective study arms. Retention in gPM+ was high (75%). Qualitative analyses of the interviews with the participants showed that Syrian refugees had a positive view on the content, implementation and format of gPM+. No adverse events were reported during the implementation. The study was not powered to detect an effect. No significant difference between gPM+ and E-CAU group on primary and secondary outcome measures, or in economic impacts were found. Conclusions: gPM+ delivered by non-specialist peer providers seemed to be an acceptable, feasible and safe intervention for Syrian refugees in Turkey with elevated levels of psychological distress. This pilot RCT sets the stage for a fully powered RCT.Publication Open Access Cost-effectiveness of the Self-Help Plus intervention for adult Syrian refugees hosted in Turkey(American Medical Association (AMA), 2022) Park, A.L.; Waldmann, T.; Kösters, M.; Tedeschi, F.; Nose, M.; Ostuzzi, G.; Purgato, M.; Turrini, G.; Valimaki, M.; Lantta, T.; Anttila, M.; Wancata, J.; Friedrich, F.; Uygun, E.; Cuijpers, P.; Sijbrandij, M.; White, R.G.; Popa, M.; Carswell, K.; Au, T.; Kilian, R.; Barbui, C.; Department of Psychology; Department of Psychology; Acartürk, Ceren; İlkkurşun, Zeynep; Faculty Member; Master Student; College of Social Sciences and Humanities; 39271; N/A; N/AImportance: the cost-effectiveness of the Self-Help Plus (SH+) program, a group-based, guided, self-help psychological intervention developed by the World Health Organization for people affected by adversity, is unclear. Objective: to investigate the cost-utility of providing the SH+ intervention combined with enhanced usual care vs enhanced usual care alone for Syrian refugees or asylum seekers hosted in Turkey. Design, setting, and participants: this economic evaluation was performed as a prespecified part of an assessor-blinded randomized clinical trial conducted between October 1, 2018, and November 30, 2019, with 6-month follow-up. A total of 627 adults with psychological distress but no diagnosed psychiatric disorder were randomly assigned to the intervention group or the enhanced usual care group. Interventions: the SH+ program was a 5-session (2 hours each), group-based, stress management course in which participants learned self-help skills for managing stress by listening to audio sessions. The SH+ sessions were facilitated by briefly trained, nonspecialist individuals, and an illustrated book was provided to group members. Th intervention group received the SH+ intervention plus enhanced usual care; the control group received only enhanced usual care from the local health care system. Enhanced usual care included access to free health care services provided by primary and secondary institutions plus details on nongovernmental organizations and freely available mental health services, social services, and community networks for people under temporary protection of Turkey and refugees. Main outcomes and measures: the primary outcome measure was incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the Turkish health care system. An intention-to-treat analysis was used including all participants who were randomized and for whom baseline data on costs and QALYs were available. Data were analyzed September 30, 2020, to July 30, 2021. Results: of 627 participants (mean [SD] age, 31.3 [9.0] years; 393 [62.9%] women), 313 were included in the analysis for the 51-1+ group and 314 in the analysis for the enhanced usual care group. An incremental cost-utility ratio estimate of T 6068 pound ($1147) per QALY gained was found when the SH+ intervention was provided to groups of 10 Syrian refugees. At a willingness to pay per QALY gained of T 14 pound 831 ($2802), the SH+ intervention had a 97.5% chance of being cost-effective compared with enhanced usual care alone. conclusions and relevance: this economic evaluation suggests that implementation of the SH+ intervention compared with enhanced usual care alone for adult Syrian refugees or asylum seekers hosted in Turkey is cost-effective from the perspective of the Turkish health care system when both international and country-specific willingness-to-pay thresholds were applied.