Over-time changes in PTSD and depression among children surviving the 1999 Istanbul earthquake.

OBJECTIVE: To follow-up on child and adolescent victims with full criteria of PTSD and depression, and to examine the impact of treatment. METHOD: One to two months following a 7.4-magnitude quake in Turkey, 160 students were examined by self-report questionnaire, psychiatric interview, clinician-administered post-traumatic stress disorder scale (CAPS), and depression and anxiety inventories. At baseline, 96 students were diagnosed with PTSD, and 49 had comorbid depression with anxiety symptoms. After 18-20 months, 74 of 96 students were found and reassessed by psychiatric interview and CAPS; 25 had been treated with cognitive-behavioral therapy (CBT) and pharmocotherapy, and 49 did not have any treatment. Binary logistic regression was used to identify significant predictors of persistent PTSD. Variables entered included pre-quake, quake and post-quake factors, having co-morbid depression upon initial interview, receipt of drug therapy, and number of months of CBT. RESULTS: At follow-up, many had symptoms of PTSD with anxiety, but only 14 subjects met the full criteria of PTSD, and four students had major depression with anxiety symptoms. Only one variable--having been in serious personal danger during the quake (e.g., trapped in the house or under rubble)--was significantly associated with being symptomatic at follow-up. CONCLUSION: Regardless of receipt of treatment, diagnoses of PTSD and depression were much reduced. More research is needed about resiliency factors.

[The psychopathology of immigrants and refugees]. / Siginmaci ve göçmenlerde psikopatoloji.

The twentieth century witnessed major waves of emigration, exile and taking refuge abroad. In this paper, a review of the psychiatric literature published between 1990 and 2000 in English and Turkish is presented. Although refugees are considered to differ from economic migrants in a number of respects, they both experience culture and language change and may experience family disruption, social isolation, and hostility from the population of the host country. Accordingly, all refugees and immigrants go through stages of resettlement and need to integrate their past cultural experiences into their new life and culture. The process of integration depends on the subjects' age, mental integrity, and on the conditions he/she lives in. Research indicates that children acculturate more quickly and learn language faster than elders; but they may suffer from role reversal when they are expected to be linguistic and cultural translators for their parents. Young adults at the stage of identity formation can be cut off and feel alienated. Elderly persons have a higher risk of culture shock as they leave behind more memories and connections. These trigger different types of anxieties. The literature shows high levels of acculturative distress, and psychiatric disorders such as post-traumatic stress disorder, anxiety and depression, and refugees are considered to be at risk for suicidal behavior. The complex social and psychological needs of refugee and immigrant families place demands on special services for children, adolescents and adults.

Risk factors for the development of PTSD and depression among child and adolescent victims following a 7.4 magnitude earthquake.

Objective. PTSD and major depression occur frequently following traumatic exposure, both as separate disorders and concurrently. Although much of Turkey is under threat of severe earthquakes, risk factors for developing psychiatric disorders among Turkish children have not yet been studied. The aim of the study was to examine risk factors for PTSD and depression develpoment in children. Method. A total of 160 survivors (102 girls and 58 boys) severely impacted by Turkey's 7.4-magnitude quake participated in a psychiatric interview 6-20 weeks after the disaster. The mean age was 14.43. Logistic regression was used to test effects of pre-disaster, disaster-related and post-disaster factors on diagnoses, yielding odds ratios (OR). Results. CAPS indicated that 96 (60%) had PTSD, and psychiatric interview found 49 (31%) with depression. Children diagnosed with PTSD were more likely to have witnessed death (OR=2.47) and experienced an extreme parental reaction (OR=3.45). Children with depression were more likely to be male (OR=4.48), have a higher trait anxiety score (OR=1.12 for every additional point), sustain injury (OR=4.29), and have lost a family member in the quake (OR=10.96). Focusing on the 96 children with PTSD, those with comorbid depression were more likely male, have a higher trait anxiety score, and have lost of family member. Conclusions. Mental health professionals should offer support to children witnessing death or losing a family member in a disaster. The ability of the family to remain calm and reassuring also may be a key factor in preventing PTSD.

Suicide ideation after the 1999 earthquake in Marmara, Turkey.

This study aims to investigate the psychological effects of the earthquake. We investigated the psychological conditions of 3,609 students survived from the Marmara Earthquake, which occurred on 17 August 1999. The Beck Depression Inventory (BDI) was employed to assess the levels of depression and other psycho-pathological states. The BDI was classified as mild depression if the score was < or = 13, moderate depression (14-24) and serious depression (> or = 25). Depression level was estimated as mild in 71.5% of the students, and serious depression in 9.6% of the students. The prevalence of suicidal tendency/thought was 16.7% in this study. The prospect of suicidal thought was 1.76-time (95% Confidence interval [CI]: 1.40-2.22) higher in the students who were injured or whose relatives were injured seriously enough to require medical treatment. Suicidal thought was higher by 1.57 times (95% CI: 1.28-1.92) in students who lost their relatives and by 1.35 times (95% CI: 1.13-1.63) in those who saw extensive damage or destruction occurred in their home or property. According to logistic regression analyses, the gender influenced the thought of suicide; suicide thought was 0.71 (95% CI: 0.60-0.85) time lower in females than males. The present study indicates that injury to the self or to the loved ones, damage to home or property, or the loss of family members as a result of the earthquake enhances the suicidal tendencies.