Barriers To Accessing Mental Health Services Among Syrian Refugees: A Mixed-Method Study. / Suriye Kökenli Siginmacilarin Ruh Sagligi Hizmetlerine Ulasmasini Engelleyen Etmenler: Karma Yöntemli Bir Çalisma.

OBJECTIVE: Although Syrian refugees have high rates of mental health problems due to war trauma, little is known on their degree of need for and contact with mental health services. Using a population sample of Syrian refugees living in Ankara, we assessed the perceived need for and contact with mental health services, as well as the barriers to access these services. METHOD: This was a cross-sectional mixed-method study of 420 Syrian refugees living in Ankara city center, using face to face interviews administered at the respondents' home by trained, Arabic-speaking interviewers. PTSD and depression were assessed using Harvard Trauma Questionnaire and Beck Depression Inventory, respectively. RESULTS: Of all the refugees in our sample, 14,8% (N=62) stated that they felt the need for mental healthcare since arriving in Turkey. The actual number contacting any mental health service was very low (1,4%, N=6). The most important barriers to accessing mental health services were reported by the respondents to be language problems and lack of information on available mental health services. Service providers and policymakers also reported similar topics as the most important barriers: low awareness about mental health problems, daily living difficulties, and language and cultural barriers. Multivariate analyses revealed that presence of medical or mental disorders and female gender predicted the perceived need for contacting services. CONCLUSION: Our results show that, although refugees report high rates of mental health problems, the perceived need for and actual contact with services are very low. To address this treatment gap, and to provide adequate care for refugees with mental health problems, common barriers (language and awareness) should be identified and dealt with.

Challenges and lessons learned in mental health research among refugees: a community-based study in Turkey.

BACKGROUND: Turkey hosts nearly four million refugees and 99% live in urban areas. Research in urban settings pose different challenges and opportunities than research in refugee camps. In this article, we aimed to share the challenges and experiences we encountered in a mixed-methods study to assess mental health problems and barriers to accessing mental health care among refugees in urban areas of Turkey. DISCUSSION: In our case, the main challenges in conducting research with refugees were collecting data from a highly traumatized population, difficulties with contacting undocumented asylum seekers including trust issues and the fear of deportation, the risk of secondary traumatization among data collectors, and the bureaucracy during study approval processes. Targeting a representative sample was not feasible, because of the lack of publicly available demographic data on a district level, presence of undocumented asylum seekers and high mobility among the refugees. Although respondents with significant psychological symptoms were routinely referred to available mental health services, we were able to do less for unregistered refugees with problems in accessing health care. Language/alphabet differences and differing dialects of Arabic posed another challenge in both translation and administration of the scales. Based on cultural characteristics, a gender-balanced team was used and the interviewers were gender-matched whenever needed. Also, the research team had to work after work hours and during weekends to be able to interview male refugees, since most refugee men were at work during working hours and most days of the week. CONCLUSIONS: The research team's experience showed that refugee population characteristics including level of trauma, language, culture, gender, legal status, and urban setting characteristics including places of living, mobility, availability of publicly available demographic data, and outreach-related barriers lead to different challenges and ethical responsibilities of researchers and affect the research costs in terms of time, human resources and finance. Even in a host country with geographical, religious and cultural proximity to the refugees, profound challenges exist in conducting mental health research in urban settings. Learning from previous experience and collaborating with local researchers and institutions are vital for better public health research and practice outcomes.

Analysis of Gender Sensitivity of Turkey's Disaster Legislation to Create a Disaster-Resilient Society.

Disasters frequently occur in Turkey. Although there is comprehensive disaster legislation in Turkey, it has not been well studied in terms of gender sensitivity. This study aimed to evaluate the disaster legislation of Turkey in the context of gender equality. We investigated 17 non-technical disaster legislations to determine in what context and to what level disaster management is gender-sensitive in Turkey. We also carried out a workshop with experts from governmental bodies and nongovernmental organizations (NGOs), and academics to discuss the gender sensitivity of the legislations. We found that only two of the 17 legislations included a gender perspective. One legislation addressed gender equality and equity very well, while one was partially gender-sensitive and the others 5 were gender blind. The workshop was conducted in collaboration with the Disaster and Emergency Management Presidency (AFAD) and 33 participants from 19 organizations. The participants agreed that the disaster legislation did not include a gender perspective and acknowledged the importance of integrating a gender perspective into the disaster policies of Turkey. They recommended that the AFAD and emergency response units should have at least one female president or vice president, gender equality training should be provided to officers and managers of government and non-governmental disaster institutions, and a working group should be established to develop strategies that integrate gender perspectives into disaster and emergency policies. The disaster legislation of Turkey is not gender sensitive. It is important to incorporate language terminologies, understanding, and approaches that are sensitive to gender into disaster-related legislation and regulations.

Health care students' willingness to work during disasters in Turkey.

INTRODUCTION: Disasters place a substantial burden on the health care workforce; as such, it is important to understand whether members of the health care workforce might be willing to work during disasters. The aim of this study is to explore the willingness of health care students in nursing, emergency and disaster management (EDM) departments to work during disasters and to examine sociodemographic and disaster-related factors that affect their willingness to work during disasters. METHODS: A cross-sectional survey was conducted among 839 students enrolled in a Turkish University Faculty of Health Science (619 nursing students and 220 EDM students). Chi-square tests and binary logistic regressions were used to determine predictors of willingness to respond to disasters. RESULTS: The majority of students (62.2%) were willing to work during disasters; however, approximately 31.2% of students were uncertain, and 6.7% were unwilling to work during disasters. Approximately 85.0% of EDM students and 54.0% of nursing students were willing to work during disasters. Overall, participants were more willing to work during earthquake (71.1%) and traffic accident disasters (66.2%) but were less willing to work during contagious disease (35.1%) and gas leak disasters (33.5%). Students' willingness to work during disasters was predicted by program type, educational level and membership in a disaster-related nongovernmental organization. CONCLUSION: The majority of students were willing to work during disasters, although these numbers varied according to program and disaster types. These findings have significant implications for disaster education programs and interventions.

Posttraumatic Stress and Depression Among Syrian Refugees Living in Turkey: Findings From an Urban Sample.

Although most of the 3.6 million Syrian refugees in Turkey live outside refugee camps, most mental health research is on camp residents and few are on those living in cities. We aimed to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and depression in Syrian refugees living in an urban area in Turkey. A total of 420 adult Syrians living in Ankara were assessed using the Harvard Trauma Questionnaire and the Beck Depression Inventory. Probable PTSD and depression rates were 36.5% and 47.7%, respectively. Female sex, physical illness, and greater number of potentially traumatic events predicted both PTSD and depression. PTSD was additionally predicted by past psychiatric illness, and depression was predicted by lower economic status. Interestingly, lower economic status predicted depression among men, but not among women. Studies on refugees should be sensitive to factors that could have a significant effect on mental health such as sex or residence.

Willingness of Firefighting Program Students to Work in Disasters-Turkey.

Introduction Firefighting is an important profession during disasters. Firefighters are on duty for many vital functions, including fire extinguishing, search and rescue work, and evacuation of disaster victims to a safe zone. In case of a disaster situation, it is vital to have willing personnel to work in disasters. In the literature, type of disaster, individual demographic factors, family factors, and workplace factors have been identified as factors that influence health care personnel's willingness to work during a disaster. However, little is known about firefighters and firefighter candidates' willingness to work in a disaster. Hypothesis/Problem This study was aimed to identify the willingness of civil defense and firefighting program students to work in different disasters after graduation and the factors associated with their willingness. METHODS: The universe of this descriptive, epidemiological study was 1,116 students of civil defense and firefighting programs in Turkey. They were from 11 different universities. In the research study, a sample was not chosen as it was aimed at reaching the whole universe. A standardized survey form of 58 questions, prepared by researchers, was used to gather data. RESULTS: The rate of participation was 65.5%. Of the students, 82.8% said that after graduation they would like to work in disasters, whereas 16.2% were indecisive. The students were less willing to work in nuclear accidents (42.4%) and epidemic disasters (32.1%). In chi-square analysis, "willingness of students to work in disasters after graduation" (dependent variable) and the independent variables: "university of student," "exercising regularly," "having a hobby related to disaster," "having been educated about disaster," and "being satisfied from the received education" were found statistically significant. When students' willingness to work in disasters after graduation (ref=unwilling) was analyzed with multi-variate analysis, only "university of students" and "having a hobby related to disasters" were found statistically significant. CONCLUSION: Overall, 16.2% of the students stated that they were indecisive to work in disasters in the future, and 1.0% of them stated that they did not want to work in disasters. Moreover, willingness of students to work in nuclear accident and contagious disease disasters has been found to be lower compared to other disaster types. Kaya E , Altintas H . Willingness of firefighting program students to work in disasters-Turkey. Prehosp Disaster Med. 2018;33(1):13-22.