Differential correlates of prolonged grief and depression after bereavement in a population-based sample.

Bereavement can lead to prolonged grief disorder (PGD) as well as episodes of major depression. Studies on the prevalence of PGD and its differences from postbereavement depression have not been conclusive. This study compared the correlates of depression and prolonged grief (PG) symptoms in a population-based random sample (N = 535) using the Beck Depression Inventory, Inventory of Complicated Grief-Revised, Anxiety Sensitivity Index (ASI), and Adult Separation Anxiety Questionnaire (ASAQ). Correlates of PG and depressive symptoms were examined using linear regression in 328 bereaved respondents. The prevalence of probable PGD based on PGD-2009 criteria was 3.0% among bereaved respondents and 1.9% in the total sample. PG was related to bereavement-related features including sex of the deceased, ß = - .110, p = .026; time since loss, ß = - .179, p = .001; the number of lifetime losses experienced, ß = .157, p = .016; and perceived closeness with the deceased, ß = .214, p < .001. Only lower income of the bereaved predicted depression, ß = - .139, p = .018. In women, but not in men, the loss of a male family member (i.e., brother or son) was a significant predictor of PG symptoms, ß = - .180, p = .006. The results confirm the qualitative distinction between depression and PG in a nonclinical sample and show that PG is mainly related to the intrinsic and extrinsic characteristics of the deceased or of death, whereas depression relates only to the characteristics of the bereaved person.

Seeking New Meaning in the Shadow of the COVID-19 Pandemic: A Qualitative Research of Spiritual Issues and Experiences among Students in Turkish Society.

Spirituality is one aspect to consider given the COVID-19 pandemic. However, the number of in-depth qualitative studies on spirituality-related issues and experiences is limited. The present study investigated the spiritual problems and experiences of students during the COVID-19 pandemic. The study was carried out with 342 Muslim students undertaking a distance education program at a state university in Turkey. The study was carried out using the non-probability sampling method. The data was collected using Qualtrics through a questionnaire consisting of open-ended questions related to spirituality during COVID-19. The data was analyzed using MAXQDA. The findings consisted of three categories, including spirituality during the pandemic, attitudes and behaviors related to the pandemic with a focus on spirituality, and feelings and thoughts about spirituality during the pandemic. There were fourteen subcategories, including resilience, meaning of life, coping mechanisms, acceptance, doubts, cleanliness, solidarity, risky behaviors, digitalization, religious rituals, inner peace, death, emotions, and hope. To meet the spiritual needs of students, it can be recommended to provide a suitable place for worship, to maintain the relations of individuals with religious centers and to direct them to spiritual counseling services.

Geriatric competency and attitudes toward older adults among Turkish undergraduate social work students.

The need for social workers educated about aging and eager to work with older adults will increase significantly as the older adult population rises rapidly. It is essential to determine the attitudes and competencies of social workers prepared to work in this field. This study aimed to evaluate Turkish undergraduate social work students' attitudes toward older adults and their geriatric social work competency. A cross-sectional descriptive correlational research design was used in the study. The study included 308 fourth-year undergraduate students attending a social work program. Participants were selected by convenience sampling. The results indicated that students had slightly positive attitudes toward older people. As for the geriatric competency, the students rated highest in applying "values, ethics, and theoretical perspectives" and lowest in the "aging services, programs, and policies." Geriatric social work competence was strongly associated with positive attitudes toward older adults. These findings indicate the need to implement new learning opportunities early in academic programs to improve social work students' attitudes toward older adults and increase their knowledge and skills to address the aging population's needs.

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.

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.

Predictors of caregiver burden in mothers of children with leukemia and cerebral palsy.

OBJECTIVE: Caring for a sick child can lead to considerable burden in the caregiver. Comparative studies of burden in mothers of children with different types of disorders are rare. METHODS: We assessed levels of and risk factors for burden in mothers of children with leukemia (n: 70) or with cerebral palsy (CP) (n: 69). Subjects were recruited from two hospitals in Ankara. RESULTS: Levels of burden or depression were not different between groups. Burden was predicted by the presence of depression in the mother and severity of illness in both groups. In the leukemia group, mothers reported higher burden if the child was male or younger; no such relationship was observed in the CP group. CONCLUSION: Our results show that type of illness has an effect on levels of burden. Mothers of children with leukemia should receive more attention, especially if their child is male or younger, to take preventive measures against burden.

Association of serum cortisol and dehydroepiandrosterone sulfate (DHEAS) levels with psychological stress in patients with vitiligo

Background/aim: Vitiligo is a depigmentation disorder that leads to serious psychological burden in patients, who are frequently reported to have depression and anxiety. The aim of this study was to investigate the association between stress-related hormone levels and psychological stress in vitiligo. Materials and methods: In this study46 vitiligo patients and 46 controls were enrolled; their cortisol, dehydroepiandrosterone sulfate (DHEAS),and cortisol/DHEAS levels were measured. Psychological burden was assessed by the Beck Depression Inventory and Perceived Stress Scale. Results: Patients and controls did not differ in terms of cortisol, DHEAS, or cortisol/DHEAS. Patients had higher perceived stress than controls but did not differ in terms of depression scores. Correlation analyses revealed that cortisol/DHEAS correlated positively with perceived stress (P = 0.009, r = 0.272). The correlation between cortisol/DHEAS and perceived stress was stronger in the patient group (P = 0.013, r = 0.363) and close to zero among controls. In regression analyses, lower depression and higher perceived stress were shown to predict cortisol/DHEAS values. Conclusion: Vitiligo patients significantly differed from the healthy population in terms of hormones and psychological distress. There was also an association between perceived stress and cortisol/DHEAS ratio in vitiligo. Abnormality of hormonal response to distress lowers DHEAS, which is known for its antioxidant properties, a possible mechanism for vitiligo development. Another important finding is the significance of using the composite variable cortisol/DHEAS, which seems to be more sensitive to distress than each of its components. We suggest its use in future studies on psychological distress­hormone relationships.

Relationship of posttraumatic growth to symptoms of posttraumatic stress disorder and depression: A pilot study of Iraqi students.

Posttraumatic growth (PTG) and psychopathology are common outcomes following exposure to adversity and trauma. We examined the relationship of PTG to posttraumatic stress disorder (PTSD) and depression in a group of young Iraqi students with war trauma exposure. These young Iraqis had experienced an average of 13 different war-related adversities. The prevalence of probable PTSD was 17.2% and probable depression 23.1%. PTSD was associated with higher and depression with lower PTG. In addition, the relationship between PTG and PTSD was stronger among males than females. Although PTSD and depression were relatively common, they were related to PTG in opposite directions.

Posttraumatic growth after earthquake trauma is predicted by executive functions: a pilot study.

Although positive personal change after adverse events (posttraumatic growth [PTG]) is repeatedly shown to occur after a range of traumatic or distressing events, there is still a debate on the validity of the concept. Using the objective measurement of cognitive functions, we attempted to show that PTG is a scientifically valid construct in a group of earthquake survivors. This is the first study to associate PTG with cognitive functioning. We found that growth was predicted by executive functions and not by memory or processing speed, showing that the correlation between cognitive functions and growth is a specific one. In addition, a specific form of PTG, namely personal growth, was related to cognitive functions, whereas relational growth was not. Our findings provide support for the validity of the PTG concept.

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.

12 Psychiatrists who Shaped Psychiatry in Turkey in the Republic's First Century. / Cumhuriyetin 100 Yilinda Türkiye'de Psikiyatriyi Sekillendiren 12 Psikiyatr.

Who are the influential figures that molded Turkish Psychiatry into what it is today? This review introduces 12 psychiatrists who shaped psychiatry in Turkey during the first century of the Republic. The article presents Rasit Tahsin, the first neuropsychiatrist who establish an academic psychiatry department in Turkey; Mazhar Osman, who had so much influence that his name became a phrase to describe the mentally ill, and still lives on with the institutions he built; Ihsan Sukru, the founder of neuropathology in Turkey, a historical figure in viral encephalitis research; Fahrettin Kerim Gokay, famous for his political career and his fight against alcohol and tobacco; Rasim Adasal, a Cretian who is a cornerstone in Ankara psychiatry and a well-known figure in Turkish society life; Abdulkadir Ozbek, who introduced psychodrama to Anatolia-his 'earth'; Leyla Zileli, who disseminated psychoanalysis from Ankara to Turkey; Orhan Ozturk, a founding figure for the Journal, the Association, and Hacettepe; Ayhan Songar, a prominent figure in society and also in state bureaucracy; Ozcan Koknel, the amiable face of psychiatry in society and a respected voice; Oguz Arkonaç, a vigorous advocate for the establishment of contemporary psychiatry with DSM III in Bakirköy and then in Turkey; and Gunsel Koptagel-Ilal, who progressed the work in the psychosomatics as one of Turkey's first female psychiatry academics. As with any list, we acknowledge that absolute consensus is not possible; we are preparing a more extensive selection to be published as a book next year. We present our selection to your liking, hoping that one or more of our colleagues reading this article will be included in the selection for the next century, reflecting our collective conscious creation of psychiatry in Turkey. Keywords: Neuropsychiatry, History, Medicine, Turkey, Psychoanalysis, Psychosomatics.

Psychological factors responsible for low adherence to mask-wearing measures during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has led to >6 million deaths. Anti-mask movements may decrease the effects of preventive measures. Psychological factors that may be related to anti-mask behaviour are not well researched. AIMS: This study aims to determine the psychological correlates of anti-mask attitudes and behaviour in an online general population sample, focusing on the possible role of claustrophobia. METHOD: Data on attitudes and behaviour toward mask-wearing were collected from an online sample of 3709 people. Predictors of both anti-mask attitudes and behaviour were assessed with linear and logistic regression analyses. RESULTS: Few people (3.3%) were overtly opposed to mask-wearing; mask opposition was more common in men than women. Predictors of negative attitude toward mask-wearing and low adherence to mask-related measures were similar and included male gender, lower education, lower income, being employed, having had COVID-19 and lower COVID-19-related anxiety. Psychopathology measures did not show a prediction, whereas claustrophobia had a significant prediction that was over and above those of other predictors. Avoidance behaviour had similar predictors, except for higher COVID-19-related anxiety. CONCLUSIONS: Although low adherence to mask-wearing during the pandemic was not related to having a mental disorder, it may partly be caused by psychological factors. Those who had a negative attitude also reported lower adherence behaviour, and were characterised by being male, having lower education, being employed and having lower COVID-19-related anxiety; claustrophobia was a strong predictor of attitude. Understanding psychological factors responsible for low adherence may help to decrease morbidity and mortality in future pandemics.

Effect of relocation and parental psychopathology on earthquake survivor-children's mental health.

Earthquakes may increase the risk for psychopathology in children because the disaster may disrupt family functioning through causing psychopathology in the parents or disrupting social network through migration, school changes, or socioeconomic status changes caused by the job losses of the parents. This study aimed to investigate the effects of parental psychopathology on the traumatic stress and depression of earthquake survivor-children 4 years after the earthquake. A convenience sample of 104 earthquake survivor-children (43 boys, 61 girls) and their parents were assessed at their homes for earthquake experience and traumatic stress symptoms. The outcome variables were the factor scores of a child/adolescent traumatic stress questionnaire (Traumatic Stress Symptom Checklist for Children and Adolescents). The predictors of child's factor scores were examined using linear regression analyses. The traumatic stress factor score of the children was predicted two variables: the child's reported fear during the earthquake and the father's traumatic stress factor score. The depression factor score, on the other hand, was predicted using the depression factor score of the mother only. Demographic variables or relocation status were not predictive for either of children's factor scores. The results of the present study show that maternal and paternal psychopathologies have differential effects on the psychological status of earthquake survivor-children. Traumatic stress in the child is predicted using the traumatic stress of father, whereas depression in the child is predicted by mother's depression levels. Social network disruption does not seem to have a negative effect on children once parental psychopathology is taken into account.

Mental health disorders research in the countries of the Organisation of Islamic Cooperation (OIC), 2008-17, and the disease burden: Bibliometric study.

The 57 countries of the Organisation of Islamic Cooperation are suffering from an increasing burden from mental health disorders. We investigated their research outputs during 2008-17 in the Web of Science in order to compare them with the burden from different mental health disorders and in different countries. The papers were identified with a complex filter based on title words and journals. Their addresses were parsed to give fractional country counts, show international collaboration, and also reveal country concentration on individual disorders and types of research. We found 17,920 papers in the decade, with output quadrupling. Foreign contributions accounted for 15% of addresses; they were from Europe (7%), Canada + USA (5%) and elsewhere (3%). They were much greater for Qatar and Uganda (> 60%), but less than 10% for Iran and Turkey. Schizophrenia and bipolar disorder were over-researched, but suicide and self-harm were seriously neglected, relative to their mental health disorder burdens. Although OIC research has been expanding rapidly, some countries have published little on this subject, perhaps because of stigma. Turkey collaborates relatively little internationally and as a result its papers received few citations. Among the large OIC countries, it has almost the highest relative mental health disorders burden, which is also growing rapidly.

The prevalence and characteristics of misophonia in Ankara, Turkey: population-based study.

BACKGROUND: Misophonia is defined as significant distress (anger, distress or disgust) when exposed to certain sounds that would not affect most people, such as lip smacking or gum chewing. Although misophonia is common, the aetiology, prevalence and effective treatments are largely unknown. AIMS: Based on our proposed diagnostic criteria, we examined the prevalence of misophonia and its relationship with clinical and demographic variables in a large representative population sample. METHOD: We used a household sample (N = 541) of all residents aged >15 years, living in 300 homes randomly selected in Ankara city centre, Turkey. All participants were assessed at their homes by trained interviewers, for sociodemographic variables, misophonic sounds and related factors, using a semi-structured interview (the Misophonia Interview Schedule) developed for the current research. RESULTS: The current misophonia diagnosis prevalence was 12.8% (n = 69 of 541), although 427 (78.9%) participants reported at least one sound that was distressing. The mean number of misophonic sounds was 8.6 (s.d. 8.9, range 0-44); the figure was 17.6 in those with misophonia compared with 7.3 in those without misophonia. Of those with misophonia, only 5.8% contacted services for their condition. Predictors of misophonia diagnosis included younger age, family history of misophonia and previous contact with mental health services. CONCLUSIONS: Our study showed that misophonia is common in the general population, may cause significant disruption in daily life and is undertreated. Although more evidence is needed to classify misophonia as a psychiatric disorder, our findings support others who claim that the condition belongs to the group of mental disorders.

Is anxiety sensitivity a predictor of PTSD in children and adolescents?

OBJECTIVE: Anxiety sensitivity (AS) is the fear of the physical symptoms of anxiety and related symptoms. Longitudinal studies support AS as a vulnerability factor for development of anxiety disorders. This study aimed to investigate AS as a vulnerability factor in the development of childhood posttraumatic stress disorder (PTSD) following traumatic experiences. METHODS: The study included 81 children 8-15 years of age who experienced the 1999 earthquake in Bolu, Turkey. The earthquake survivors were compared to a randomized group of age- and sex-matched controls 5 years after the earthquake. Both the subject and control groups were administered the Childhood Anxiety Sensitivity Index (CASI), State and Trait Anxiety Inventory for Children (STAI-C), and Child Depression Inventory (CDI), while the PTSD symptoms of the subjects were assessed using the Child Posttraumatic Stress Reaction Index (CPTS-RI). RESULTS: Subjects and controls did not differ significantly in CASI, STAI-C, or CDI scores. Multiple regression analysis showed that both trait anxiety and CASI scores predicted CPTS-RI scores of the subjects; the prediction by CASI scores was over and above the effect of trait anxiety. CONCLUSION: The results of this study support the hypothesis that AS may be a constitutional factor, which might increase the risk of PTSD following traumatic experiences.

[Health services use for earthquake-related psychological problems: results from the 1999 earthquakes in Turkey]. / Depremzedelerde ruh sagligii hizmeti kullanimi.

OBJECTIVE: Although psychological disorders after traumas are associated with increased rates of services use, the majority of traumatized people do not receive psychological help. This study reports on the health services use of the survivors of the 1999 earthquake in Turkey. METHOD: A random sample of 2007 survivors was assessed in two sites, using self-report measures of traumatic stress, depression and use of health services. RESULTS: Less than half (42%) of those with a post-earthquake psychological problem (13.7% of the total sample) reported contacting services after the earthquake. Health services use for psychological problems was predicted by past psychiatric illness, depressive complaints after the earthquake and material loss, but not by demographic variables or traumatic stress symptoms. CONCLUSION: The results show that earthquake survivors who need treatment might not be receiving it. They also show the importance of outreach programs in post-disaster circumstances.

Does Gender Affect the Relationship Between Anxiety Sensitivity and Social Anxiety?

OBJECTIVE: Although there are studies on the effects of gender and time on social anxiety and anxiety sensitivity, there is no consensus on how these variables moderate the relationship between the two. The aim of this study was to examine the effect of the last year of medical school on social anxiety and to determine the predictors of social anxiety, focusing mainly on gender and anxiety sensitivity. METHODS: The study was conducted at two time points. Demographic Information Questionnaire, Liebowitz Social Anxiety Scale and Anxiety Sensitivity Index (ASI) were given to medical school students at Time 1 (n=153): beginning of 6th year of medical school; and at Time 2 (n=130): end of the 6th year. RESULTS: Male gender predicted social anxiety at Time 1 but not at Time 2. Maternal education negatively predicted social anxiety in males; no prediction was observed for females. Psychiatric illness in the family and ASI scores predicted social anxiety. The total scores of social anxiety and anxiety sensitivity did not change over a course of 10 months. ASI subscale scores were not uniform in predicting social anxiety. CONCLUSIONS: Our results have confirmed the strong relationship between anxiety sensitivity and social anxiety. Higher maternal education appeared to be a protective factor against social anxiety among males but not among females. It is apparent that a whole educational year of internship does not lead to a significant reduction in social anxiety. We also showed that the physical sensations scale of ASI is sufficient to explain the relationship between anxiety sensitivity and social anxiety.

[Cognitive Dysfunctions in Posttraumatic Stress Disorder]. / Travma Sonrasi Stres Bozuklugunda Bilissel Bozukluklar.

Posttraumatic stress disorder (PTSD) is a condition that occurs after a traumatic event, and its diagnostic criteria include attention and memory deficits as well as symptoms of anxiety. We aimed to review the literature related to attention, memory, and executive functions in PTSD. Although studies on the subject are limited (in that there is no uniformity in terms of trauma type, selection of the control groups or types of neuropsychological tests used), most reported similar deficits in PTSD subjects in terms of memory and executive functions including attention. Since the presence of psychiatric comorbidities may disrupt neuropsychological functions, results of studies that have not controlled comorbidity may be questionable. However, studies that excluded the comorbid conditions reported similar deficits in cognitive functions in PTSD patients. The relationship between recovery from PTSD symptoms and change in cognitive functions has been examined in only a few studies, and most have reported an improvement for both memory and executive functions in remitted patients. The improvement in executive functions, however, has been limited by the difficulty of task. Cognitive deficits have been among the major causes of disabilities in PTSD patients. Therefore, the amount of improvement in cognitive dysfunctions by current treatments of PTSD deserves more attention.