Determinants of Mental Disorders in Syrian Refugees in Turkey Versus Internally Displaced Persons in Syria.

OBJECTIVES: To compare frequencies of some mental health disorders between Syrian refugees living in Turkey and internally displaced persons in Syria, and to identify factors associated with posttraumatic stress disorder and major depressive disorder. METHODS: We carried out a field survey in May 2017 among 540 internally displaced persons in Syria and refugees in Turkey. RESULTS: The study revealed that mental disorders were highly prevalent in both populations. Major depressive disorder was more frequent among refugees in Turkey than among internally displaced persons in Syria; other mental disorders, including posttraumatic stress disorder, were more prevalent in the latter than in the former. Posttraumatic stress disorder was also associated with postmigration factors. Major depressive disorder was more likely among refugees in Turkey. In addition, the likelihood of major depressive disorder was predicted by stopping somewhere else before resettlement in the current location. CONCLUSIONS: The resettlement locus and the context and type of displacement seem to be important determinants of mental health disorders, with postmigration factors being stronger predictors of conflict-related mental health. Internally displaced persons may benefit more from trauma-focused approaches, whereas refugees may derive greater benefit from psychosocial approaches.

PTSD, depression, and migration-related experiences among Syrian refugees living in camp vs urban settings.

Despite the increased heterogeneity of living conditions of refugees in recent years, there is a lack of robust epidemiological data about the relationship between refugees' mental health and their living contexts. The current study aims to compare frequencies of pre-migration traumatic events and post-migration difficulties between refugees living in camps and those living in cities; and to identify the prevalence of post-traumatic stress disorder (PTSD), depression, and factors associated with them. A field survey was conducted among 1,470 refugees living in camps and urban settings of Turkey. The survey instruments included a socio-demographic form, the Harvard Trauma Questionnaire, the Post-migration Living Difficulties Scale, and the PTSD and depression modules of the Mini-International Neuropsychiatric Interview. Both PTSD and depression were more common in urban settings than in camps. Both disorders were associated with living context and migration-related experiences. Pre-migration traumas were more frequent among refugees living in cities than in those living in camps, while post-migration difficulties were more common in the refugees living in camps. The living context is potentially a critical determinant of refugee mental health. Camp and urban refugees may have different experiences and needs. In particular, refugees living in some urban settings may be at higher risk for having psychological problems.

Determinants of the mental health condition of healthcare workers during the initial phase of the COVID-19 pandemic in Turkey.

Aim: Current study aimed to determine the stressors experienced by healthcare workers during the initial phase of the COVID-19 pandemic in Turkey. Subject and msethods: A cross-sectional design was utilized, and an online survey was conducted in early April 2020 among 2506 healthcare workers, using snowball sampling. A questionnaire highlighting the elements pertinent to the COVID-19 outbreak and General Health Questionnaire were used to collect data. Multiple linear regression analysis was performed to assess the impact of the early stages of the outbreak on the mental health condition of healthcare workers. Results: The mean of the General Health Questionnaire-12 was 6.03 (min = .00, max = 12.00). Participants reported high frequency of some variables, such as favorable relationships with their teammates (90.7%, n = 2274), striving to create a more hygienic home (84.6%, n = 2121), anger and hopelessness due to the community's neglect of precautions (84.2%, n = 2109) and fear of exposure to violence against healthcare workers (72.8%, n = 1825). The final regression model contained seven variables (gender, individual preparedness, perceived level of training related to COVID-19, meeting basic needs during the pandemic, fear of being infected, fear of infecting loved ones, and family relationships). Conclusion: Our study indicates that the management of the COVID-19 pandemic has to be planned and sustained by relevant measures maintaining the psychological wellbeing of healthcare workers. Psychological support should be provided for individuals and the teams; healthcare workers' families should also be involved in and benefit from sustained and intermittent psychological support.

Factors motivating individuals to take precautionary action for an expected earthquake in Istanbul.

Istanbul is expected to experience an earthquake in the near future, but individuals show limited interest in preparing for it. This study aims to identify the factors associated with taking action to prepare for an earthquake and mitigate its effects at the individual level. A field survey was carried out in 2007 in two districts of Istanbul with different levels of earthquake risk. Within these districts, three socioeconomic levels were considered. A total of 1,123 people were interviewed face to face. Analysis indicated that the educational level of the respondents was the leading factor associated with taking at least three measures, followed by living in a higher earthquake risk area, having participated in rescue and solidarity activities in previous earthquakes, a higher level of knowledge about earthquakes, home ownership, a higher score for action-stimulating attitudes, being younger, and a higher general safety score, in that order. The findings pointed to the role of knowledge about earthquakes and possible mitigation/preparedness measures, and thus the importance of developing effective awareness programs. Such programs should also consider the characteristics of different groups in the population. Motivated individuals, such as those who have participated in rescue and solidarity activities in previous earthquakes, could be involved in reaching other people.

Individual preparedness and mitigation actions for a predicted earthquake in Istanbul.

This study investigated the process of taking action to mitigate damage and prepare for an earthquake at the individual level. Its specific aim was to identify the factors that promote or inhibit individuals in this process. The study was conducted in Istanbul, Turkey--where an earthquake is expected soon--in May and June 2006 using qualitative methods. Within our conceptual framework, three different patterns emerged among the study subjects. Outcome expectancy, helplessness, a low socioeconomic level, a culture of negligence, a lack of trust, onset time/poor predictability, and normalisation bias inhibit individuals in this process, while location, direct personal experience, a higher education level, and social interaction promote them. Drawing on these findings, the paper details key points for better disaster communication, including whom to mobilise to reach target populations, such as individuals with direct earthquake experience and women.

A neglected issue in hospital emergency and disaster planning: Non-standard employment in hospitals.

Work organization and relationships have changed over recent decades. Following the recent COVID-19 pandemic, the norms concerning work-related standards will likely change even more significantly. There has been a shift away from standard employment to non-standard employment (NSE), which includes fixed-term, part-time, on-call, agency-related employment, dependent self-employment, dispatch, and temporary employment, etc. In nearly every sector. The health sector is no exception. However, the effects of non-standard employment on the disaster preparedness of health systems, particularly on hospitals' emergency and disaster plans, have not yet been adequately studied. Most crucial themes are engagement of non-standard employees in emergency and disaster planning and response, and the impact of non-standard employees in expanding hospitals' capacity in large-scale events. This short communication paper aims to discuss this neglected issue in hospital emergency and disaster planning. In order to see whether NSE is considered in hospital disaster and emergency plans, two hospital disaster and emergency planning guidelines-the Hospital Incident Command System, and the Hospital Emergency Response Checklist developed by the World Health Organization-were assessed regarding NSE in their respective contexts. Although these guidelines are comprehensive tools for hospital preparedness, NSE is not specifically considered in any of them. However, it is essential that NSE, with its trade-offs, is considered in disaster plans to maintain an effective implementation of them. Further research and actions are necessary, especially after the COVID-19 pandemic, to identify how this reflection should be conducted and to supply evidence for further measures and revising emergency and disaster planning guidelines.