Research Project: Fosterin responsive mental health systmes in the Syrian refugee crisis
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Contributors
Funders
ID
EC.00133
Authors
Acartürk, Ceren
Faculty Member
Publications
Somatic distress among Syrian refugees in Istanbul, Turkey: a cross-sectional study
(Elsevier Inc., 2020) İlkkurşun, Zeynep; Acartürk, Ceren; McGrath, M.; Roberts, B.; Sondorp, E.; Sijbrandij, M.; Cuijpers, P.; Ventevogel, P.; McKee, M.; Fuhr, D. C.; Department of Psychology; Yes; College of Social Sciences and Humanities
Background: Syrian refugees have experienced extensive trauma and ongoing post-displacement challenges, placing them at increased risk of both psychological and physical health problems. While depression, anxiety, and post-traumatic stress disorder (PTSD) have been widely investigated, somatic distress has received comparatively little attention, particularly among Syrian refugees living in Turkey.
Objective: This study aimed to determine the prevalence and patterns of somatic distress among Syrian refugees residing in Istanbul and to examine its associations with sociodemographic characteristics, post-displacement stressors, and common mental disorders.
Methods: A cross-sectional survey was conducted with 1,678 adult Syrian refugees registered for temporary protection in the Sultanbeyli district of Istanbul. Somatic distress was assessed using the Patient Health Questionnaire-15 (PHQ-15), while depression, anxiety, and PTSD symptoms were measured using the Hopkins Symptom Checklist-25 (HSCL-25) and the PTSD Checklist for DSM-5 (PCL-5). Descriptive statistics, correlation analyses, and multivariable logistic regression models were used to identify factors associated with somatic distress.
Results: High somatic distress was reported by 41.7% of participants, with moderate-to-severe symptom severity observed in a substantial proportion of the sample. The most frequently reported symptoms included pain in the arms, legs or joints, back pain, and headaches. Somatic distress was significantly more common among women and was strongly associated with symptoms of depression, anxiety, and PTSD. Greater somatic symptom severity was also associated with chronic illness or disability, lower educational attainment, poorer household economic conditions, and having a family member with mental health problems. In contrast, post-displacement perceived needs and previous mental health treatment were not independently associated with somatic distress after adjustment.
Conclusions: Somatic distress represents a major health burden among Syrian refugees living in Istanbul and is closely linked to common mental disorders and socioeconomic vulnerability. These findings highlight the importance of integrating mental health and primary healthcare services to improve early recognition, assessment, and treatment of somatic symptoms in refugee populations, ultimately reducing both individual suffering and pressure on healthcare systems.
The effectiveness of Problem Management Plus at 1-year follow-up for Syrian refugees in a high-income setting
(Cambridge University Press, 2024) Acartürk, Ceren; de Graaff, Anne M.; Cuijpers, Pim; Elsawy, Mariam; Hunaidy, Sam; Kieft, Barbara; Gorgis, Noer; Twisk, Jos W. R.; Zakarian, Yenovk; Bouman, Theo K.; Lommen, Miriam J. J.; Bryant, Richard; Mcdaid, David; Morina, Naser; A-La Park, A-La; Ventevogel, Peter; Sijbrandij, Marit; Department of Psychology; Yes; College of Social Sciences and Humanities
Aims. Problem Management Plus (PM+) has been effective in reducing mental health problems among refugees at three-month follow-up, but there is a lack of research on its long-term effectiveness. This study examined the effectiveness of PM+ in reducing symptoms of common mental disorders at 12-month follow-up among Syrian refugees in the Netherlands. Methods. This single-blind, parallel, controlled trial randomised 206 adult Syrians who screened positive for psychological distress and impaired functioning to either PM+ in addition to care as usual (PM+/CAU) or CAU alone. Assessments were at baseline, 1 week and 3 months after the intervention and 12 months after baseline. Outcomes were psychological distress (Hopkins Symptom Checklist [HSCL-25]), depression (HSCL-25 subscale), anxiety (HSCL-25 subscale), posttraumatic stress disorder symptoms (PCL-5), functional impairment (WHODAS 2.0) and self-identified problems (PSYCHLOPS). Results. In March 2019-December 2022, 103 participants were assigned to PM+/CAU and 103 to CAU of which 169 (82.0%) were retained at 12 months. Intention-to-treat analyses showed greater reductions in psychological distress at 12 months for PM+/CAU compared to CAU (adjusted mean difference -0.17, 95% CI -0.310 to -0.027;p = 0.01, Cohen's d = 0.28). Relative to CAU, PM+/CAU participants also showed significant reductions on anxiety (-0.19, 95% CI -0.344 to -0.047;p = 0.01, d = 0.31) but not on any of the other outcomes. Conclusions. PM+ is effective in reducing psychological distress and symptoms of anxiety over a period up to 1 year. Additional support such as booster sessions or additional (trauma- focused) modules may be required to prolong and consolidate benefits gained through PM+ on other mental health and psychosocial outcomes.
Problems after flight: understanding and comparing Syrians’ perspectives in the Middle East and Europe
(BioMed Central, 2021) İlkkurşun, Zeynep; Acartürk, Ceren; Drescher, A.; Kiselev, N.; Akhtar, A.; Bryant, R. A.; von Känel, R.; Miller, K. E.; Pfaltz, M. C.; Schick, M.; Schnyder, U.; Sijbrandij, M.; Spaaij, J.; Morina, N.; Department of Psychology; Yes; College of Social Sciences and Humanities
Background: Syrian refugees and asylum seekers (SRAs) face multiple stressors after flight, which may vary due to different geographic, economic, cultural and socio-political contexts in the host countries. Past research has recognised the importance of participants’ own perspectives. The aims of this multi-country study were to identify and compare self-reported problems of SRAs between various settings. Methods: a semi-structured client-generated outcome measurement was used to collect data among adult SRAs in Jordan (N = 61), Turkey (N = 46) and Switzerland (N = 57) between September 2018 and November 2019. Answers were analysed following thematic analysis. Results: over half of the participants reported practical problems with an emphasis on camp-related problems (Jordan), finances (Turkey), employment (Jordan and Switzerland) and government regulations (Switzerland), followed by psychological, and social issues. Conclusion: this study highlights the impact of local contextual factors on wellbeing. The findings emphasise that planning preventative procedures and mental health care services for SRAs need to consider local challenges affecting the population in specific countries.
Group problem management plus (PM plus) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial
(BioMed Central, 2022) İlkkurşun, Zeynep; Kurt, Gülşah; Acartürk, Ceren; 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; Graduate School of Social Sciences and Humanities; Yes; College of Social Sciences and Humanities; GRADUATE SCHOOL OF SOCIAL SCIENCES AND HUMANITIES
Background: 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.
Effectiveness of a peer-refugee delivered psychological intervention to reduce psychological distress among adult Syrian refugees in the Netherlands: study protocol
(Taylor _ Francis, 2020) Acartürk, Ceren; de Graaff, Anne M.; Cuijpers, Pim C.; Bryant, Richard A.; Burchert, Sebastian; Fuhr, Daniela Christina; Huizink, Anja C.; De Jong, Joop T.V.M.; Kieft, Barbara; Knaevelsrud, Christine; McDaid, David; Morina, Naser; Park, A. La; Uppendahl, Jana R.; Ventevogel, Peter; Whitney, Claire; Wiedemann, Nana; Woodward, Aniek; Sijbrandij, Marit; Department of Psychology; Yes; College of Social Sciences and Humanities
Background: syrian refugees face multiple hardships and adversities which put them at risk for the development of mental health problems. However, access to adequate mental health care in host countries is limited. The WHO has developed Problem Management Plus (PM+), a brief, scalable psychological intervention, delivered by non-specialist helpers, that addresses common mental disorders in people affected by adversity. This study is part of the STRENGTHS project, that aims to evaluate peer-refugee delivered psychological interventions for Syrian refugees in Europe and the Middle East. Objective: to evaluate the effectiveness and cost-effectiveness of the peer-refugee delivered PM+ intervention among Syrian refugees with elevated levels of psychological distress in the Netherlands. Methods: PM+ will be tested in a randomized controlled trial (RCT) among Arabic-speaking Syrian refugees in the Netherlands aged 18 years and above with self-reported psychological distress (Kessler Psychological Distress Scale; K10 >15) and impaired daily functioning (WHO Disability Assessment Schedule; WHODAS 2.0 >16). Participants (N = 380) will be randomized into care as usual with PM+ (CAU/PM+, n = 190) or CAU only (CAU, n = 190). Baseline, 1-week post-intervention, and 3-month and 12-month follow-up assessments will be conducted. Primary outcomes are symptoms of depression and anxiety. Secondary outcomes are functional impairment, posttraumatic stress disorder symptoms, self-identified problems, anger, health and productivity costs, and hair cortisol concentrations. A process evaluation will be carried out to evaluate treatment dose, protocol fidelity and stakeholder views on barriers and facilitators to implementing PM+. Results and Conclusions: PM+ has proved effectiveness in other populations and settings. After positive evaluation, the adapted manual and training materials for individual PM+ will be made available through the WHO to encourage further replication and scaling up. Trial registration: Trial registration Dutch Trial Registry, NL7552, registered prospectively on March 1, 2019. Medical Ethics Review Committee VU Medical Center Protocol ID 2017.320, 7 September 2017. / Antecedentes: los refugiados sirios atraviesan muchas dificultades y adversidades, las cuales los ponen en riesgo para el desarrollo de problemas de salud mental. Sin embargo, el acceso a servicios de salud mental en los países que albergan a refugiados es limitado. La Organización Mundial de la Salud (OMS) ha desarrollado la intervención de Gestión de Problemas Plus (PM+, por sus siglas en inglés), una intervención psicológica breve, en etapas, realizada por facilitadores no especialistas, y que está dirigido al abordaje de los trastornos mentales más comunes en personas afectadas por la adversidad. Este estudio es parte de un proyecto más grande llamado STRENGTHS, cuyo objetivo es evaluar las intervenciones psicológicas brindadas por un refugiado a otro adaptadas para refugiados sirios en Europa y Medio Oriente. Objetivo: evaluar la efectividad y costo-efectividad de la adaptación de la intervención PM+ brindada por un refugiado a otro, en refugiados sirios con niveles elevados de malestar psicologico en los Países Bajos. Métodos: la adaptación de la intervención PM+ será evaluada en un ensayo clínico aleatorizado en refugiados sirios de habla árabe en los Países Bajos, en mayores de 18 años, con malestar psicológico auto-reportado (mediante la Escala de Kessler para Malestar Psicológico, K10>15) y deterioro en el funcionamiento diario (Registro de Evaluación de Discapacidad de la OMS; WHODAS 2.0 >16). Los participantes (N=380) serán distribuidos aleatoriamente en un grupo de tratamiento usual con PM+ (TU/PM+, n=190) y en uno de solo tratamiento usual (TU, n=190). Se tomarán evaluaciones de base, luego de la primera semana de la intervención, luego de los tres meses, y luego de los 12 meses. Estas evaluaciones serán asistidas por una aplicación de auto-entrevista con soporte de audio para tablet. Los resultados primarios son los síntomas de depresión y ansiedad. Los resultados primarios son los síntomas de depresión y ansiedad. Los resultados secundarios son el deterioro funcional, síntomas de estrés traumático, problemas auto-identificados, ira, costos en salud y productividad, y concentraciones de cortisol en el cabello. Se realizará un proceso de evaluación para valorar las opiniones de los interesados respecto a las barreras y facilitadores para implementar la intervención PM+, así como la dosis del tratamiento y la adherencia al protocolo.Discusión: la intervención PM+ ha mostrado efectividad en otras poblaciones y escenarios. Luego de obtener una evaluación positiva de la PM+ en refugiados sirios, se harán disponibles manuales y material de entrenamiento para PM+ individual a través de la OMS, de manera que se incentive la posterior replicación de la intervención y se aumente progresivamente su aplicación.
