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
(Pergamon-Elsevier Science Ltd, 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; Graduate School of Social Sciences and Humanities; Yes; College of Social Sciences and Humanities; GRADUATE SCHOOL OF SOCIAL SCIENCES AND HUMANITIES
BAKILACAK
Post-traumatic growth and its predictors among Syrian refugees in Istanbul: a mental health population survey
(Elsevier B.V., 2020) Acartürk, Ceren; Wen, Karen; McGrath, Michael; İlkkurşun, Zeynep; Fuhr, Daniela C.; Sondorp, Egbert; Cuijpers, Pim; Sijbrandij, Marit; Roberts, Bayard; Department of Psychology; Yes; College of Social Sciences and Humanities
Aims: The negative mental health effects of exposure to trauma are well-documented. However, some individuals are theorized to undergo post-traumatic growth (PTG) after exposure to trauma, potentially experiencing positive psychological change across five domains: appreciation for life, relationships with others, new possibilities in life, personal strength, and spiritual change. PTG is less studied in forcibly displaced populations in low- and middle-income countries. This study aimed to explore levels of PTG and associated factors among Syrian refugee adults living in Istanbul, Turkey. Methods: A cross-sectional survey was conducted with 1678 respondents. This study analyzed PTG data from 768 individuals as measured by the Post-Traumatic Growth Inventory (PTGI). Descriptive analysis and univariate and multivariate least squares linear regression modeling were used. Factor analysis and Cronbach's alpha tests assessed the psychometric properties of the PTGI. Results: The sample exhibited a moderate level of PTG at 55.94 (SD=22.91, range 0–105). Factor analysis of PTGI revealed only four factors instead of five, and the PTGI yielded high internal reliability (Cronbach's α=0.90). PTG and post-traumatic stress disorder (PTSD) had a curvilinear relationship, with the highest PTG levels experienced by those with moderate PTSD levels. Five other variables were significantly associated with PTG: older age, less education, somatic distress, and history of an overnight stay at a health facility for mental health care were associated with lower PTG, while more years of education were associated with higher PTG. Conclusions: This study identified the role of the sociodemographic and psychological determinants that influence post-traumatic growth among Syrian refugees in Istanbul. These findings could be used to inform future research and programs seeking to understand PTG in refugees.
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.
