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Öğe A Randomized-Controlled Trial of EMDR Flash Technique on Traumatic Symptoms, Depression, Anxiety, Stress, and Life of Quality With Individuals Who Have Experienced a Traffic Accident(Frontiers Media S.A., 2022-03-24) Uygun, ErsinAbstract: The Flash Technique of Eye Movement Desensitization and Reprocessing (EMDR) is widely recognized for its effectiveness in reducing the effects of emotional responses associated with traumatic memories. Using a randomized-controlled trial methodology, this study attempts to establish the efficacy of the EMDR Flash Technique. This study’s sample includes volunteers who were involved in traffic accidents and were given the randomized EMDR Flash Technique and Improving Mental Health Training for Primary Care Residents (mhGAP) Stress management module. The participants were given a socio-demographic data form, the Depression-Anxiety-Stress 21 scale (DASS-21), the Impact of Event Scale-Revised (IES-R), and the WHOQOL Quality of Life scale. Participants were evaluated using measurements taken before and after the application, as well as a one-month follow-up. The mean age of the participants was 36.20 (11.41) years and 82.1% (n = 32) were female. The DASS-21 Anxiety (?2 = 0.085), IES-R Intrusion (?2 = 0.101), Avoidance (?2 = 0.124), Total (?2 = 0.147), and WHOQOL-BREF Psychological (?2 = 0.106) score improvements of the EMDR Flash Technique group were shown to be statistically significant when compared to the mhGAP group. However, no statistically significant difference in the DASS-21 Depression, Stress, Impact of Event Scale-Revised Hyperarousal WHOQOL-BREF General Health, Physical, Social Relationships, and Environment component scores was reported between the two groups. The present study’s findings clearly demonstrate that the EMDR Flash technique, when applied to persons involved in traffic accidents, is successful in improving anxiety, intrusion, avoidance, total traumatic stress, and mental quality of life symptoms for at least 1 month. We believe that these findings will improve the reliability and applicability of the EMDR Flash Technique, which was tested for the first time in a clinical randomized-controlled trial (RCT). Copyright © 2022 Yaşar, Konuk, Kavakçı, Uygun, Gündoğmuş, Taygar and Uludağ.Öğe Addressing the mental health needs of those affected by the earthquakes in Türkiye(ELSEVIER SCI LTD, 2023-04) Kurt, Gülşah; Uygun, Ersin; Aker, A. Tamer; Acartürk, Ceren[Abstract Not Available]Öğe Being A Child Born After Loss: A Qualitative Research(Lut TAMAM, 2023) Boro, Fazilet Neslişah; Uygun, Ersin; Dikeç, GülThe loss of a child is one of the most traumatic experiences a person can go through. Parents who have suffered the loss of a child may bring another child into the world after or before completing the grieving process. Children born after the loss are referred to as subsequent children. The reality of loss and the attitudes of the bereaved parent affect the identity and mental state of the child born after loss. This study used the qualitative research method to understand the life experiences of children born after loss in depth. In line with the determined research method, semi-structured individual interviews were conducted with ten participants born after loss. The data obtained in the study were analyzed by thematic analysis. As a result of the thematic analysis, the main themes of "about the lost child", "the effect of being born after loss on life", "being a child born after loss", and "grief" were determined. The main theme "about the lost child" included information about the deceased sibling, objects and photographs, the cause and manner of death, images and fantasies about the sibling, emotions, and contact needs. Under the main theme of "the impact of being born after the loss of life", both the identity and psychological development of individuals, the impact on their career choices and their parents' attitudes were found. Under the main theme, "being a child born after loss", participants talked about being a scapegoat, a comforting child, or a gifted child. In the last main theme, "grief", participants gave information about their parents' grief, their grief, and their experiences of coping with this grief. It has been shown that coming into the world after loss affects individuals' identity, mental state, and choice of profession, and they may face negative parental attitudes. It may be recommended to monitor the grief processes of parents with child loss and to guide the planning of new children.Öğe Cost-effectiveness of the Self-Help Plus Intervention for Adult Syrian Refugees Hosted in Turkey(American Medical Association, 2022) Uygun, ErsinAbstract: Importance: The cost-effectiveness of the Self-Help Plus (SH+) program, a group-based, guided, self-help psychological intervention developed by the World Health Organization for people affected by adversity, is unclear. Objective: To investigate the cost-utility of providing the SH+ intervention combined with enhanced usual care vs enhanced usual care alone for Syrian refugees or asylum seekers hosted in Turkey. Design, Setting, and Participants: This economic evaluation was performed as a prespecified part of an assessor-blinded randomized clinical trial conducted between October 1, 2018, and November 30, 2019, with 6-month follow-up. A total of 627 adults with psychological distress but no diagnosed psychiatric disorder were randomly assigned to the intervention group or the enhanced usual care group. Interventions: The SH+ program was a 5-session (2 hours each), group-based, stress management course in which participants learned self-help skills for managing stress by listening to audio sessions. The SH+ sessions were facilitated by briefly trained, nonspecialist individuals, and an illustrated book was provided to group members. Th intervention group received the SH+ intervention plus enhanced usual care; the control group received only enhanced usual care from the local health care system. Enhanced usual care included access to free health care services provided by primary and secondary institutions plus details on nongovernmental organizations and freely available mental health services, social services, and community networks for people under temporary protection of Turkey and refugees. Main Outcomes and Measures: The primary outcome measure was incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the Turkish health care system. An intention-to-treat analysis was used including all participants who were randomized and for whom baseline data on costs and QALYs were available. Data were analyzed September 30, 2020, to July 30, 2021. Results: Of 627 participants (mean [SD] age, 31.3 [9.0] years; 393 [62.9%] women), 313 were included in the analysis for the SH+ group and 314 in the analysis for the enhanced usual care group. An incremental cost-utility ratio estimate of T£6068 ($1147) per QALY gained was found when the SH+ intervention was provided to groups of 10 Syrian refugees. At a willingness to pay per QALY gained of T£14831 ($2802), the SH+ intervention had a 97.5% chance of being cost-effective compared with enhanced usual care alone. Conclusions and Relevance: This economic evaluation suggests that implementation of the SH+ intervention compared with enhanced usual care alone for adult Syrian refugees or asylum seekers hosted in Turkey is cost-effective from the perspective of the Turkish health care system when both international and country-specific willingness-to-pay thresholds were applied.. © 2022 American Medical Association. All rights reserved.Öğe COVID-19 Döneminde Mültecilere Çevrim İçi Psikolojik Destek Sağlayan Ruh Sağlığı Profesyonellerinin Deneyimleri: Nitel Çalışma(2023) Kurşun, Şeyma Gök; Uygun, Ersin; Dikec, GulBu çalışmanın amacı, COVID-19 döneminde mültecilere yönelik ruh sağlığı desteği sunan profesyonellerin çevrim içi psikolojik destek deneyimlerinin incelenmesidir. Fenomenolojik desende yapılan bu çalışmada pandemi döneminde mültecilere çevrim içi psikolojik destek sağlayan ve Türkiye’de ikamet eden on ruh sağlığı profesyoneli ile derinlemesine çevrim içi görüşmeler yapıldı. Veriler tematik analiz yöntemi ile analiz edildi. Görüşmeden elde edilen veriler, beş ana tema ve on dokuz alt tema altında toplandı. Bu temalarda ruh sağlığı profesyonellerinin çevrim içi psikolojik desteğe yönelik ön yargıları ve bu sürece adaptasyon süreçleri; mültecilerle çalışırken çevrim içi psikolojik desteğin avantajları ve dezavantajları, çevrim içi psikolojik destek sürecinde yaşanan duygular ve bazı zor durumlardaki baş etme yöntemleri ile ilgili bulgular elde edildi. Ruh sağlığı profesyonellerinin bildirdiği zorlukların başında pandemi döneminde mültecilere sınırlı olanaklar dâhilinde çevrim içi psikolojik destek sunmaları ve dışsal sorunların psikolojik sorunların çevrim içi olarak çalışılmasında yarattığı güçlükler yer alırken; en önemli gereksinimleri çevrim içi ruh sağlığı hizmetini sürdürmenin inceliklerini öğrenme olduğu saptandı. Bu nedenle mültecilerle çalışan ruh sağlığı profesyonellerinin özellikle çevrim içi çalışırken daha fazla desteklenmeye ihtiyaçları olduğu ve alanda bu konuda gelecekte daha fazla çalışmanın yapılması gerektiği düşünülmektedir.Öğe "Doing What Matters in Times of Stress" to Decrease Psychological Distress During COVID-19: A Rammed Controlled Pilot Trial(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2022-11-27) Uygun, ErsinAbstract: Despite the increasing psychological distress during COVID-19, utilisation of face-to-face psychological interventions decreased profoundly. The aim of this study involving two parallel, two-armed pilot randomised controlled trials was to examine the effectiveness of a guided self-help intervention "Doing What Matters in Times of Stress" (DWM) in decreasing psychological distress in Turkish and Syrian participants. Seventy-four Turkish nationals and 50 Syrian refugee adults with psychological distress were randomly allocated to a DWM group or wait-list control group. The primary outcome measure was the Patient Health Questionnaire 9 postintervention. Secondary outcome measures were the Generalised Anxiety Disorder Scale, posttraumatic stress disorder (PTSD) Checklist for DSM-5, Generalized Self-Efficacy Scale and Acceptance and Action Questionnaire-II postintervention. Although this study was not powered to detect a significant effect for DWM postassessment between DWM and the control group, results showed a significant improvement in depression symptoms among Turkish participants in the DWM group (d = 0.46) and in PTSD symptoms among Syrian participants in the DWM group (d = 0.67) from pre- to postintervention assessment. These results indicate the potential of DWM to decrease mental health problems during the pandemic and importance of a fully powered, definitive controlled trial to examine its effectiveness both for the host community and refugees to reduce psychological distress during COVID-19.Öğe Effect of trauma on asylum seekers and refugees receiving a WHO psychological intervention: a mediation model(Taylor & Francis Ltd, 2024) Serra, Riccardo; Purgato, Marianna; Tedeschi, Federico; Acartuerk, Ceren; Karyotaki, Eirini; Uygun, Ersin; Barbui, CorradoBackground: Scalable psychological interventions such as the WHO's Self-Help Plus (SH+) have been developed for clinical and non-clinical populations in need of psychological support. SH+ has been successfully implemented to prevent common mental disorders among asylum seekers and refugees who are growing in number due to increasing levels of forced migration. These populations are often exposed to multiple, severe sources of traumatisation, and evidence of the effect of such events on treatment is insufficient, especially for non-clinical populations.Objective: We aim to study the effect of potentially traumatic experiences (PTEs) and the mediating role of symptoms of posttraumatic stress disorder (PTSD) on the improvement following SH+.Method: Participants allocated to SH+ who received at least three sessions (N = 345) were extracted from two large, randomised, European prevention trials involving asylum seekers and refugees. Measures of distress, depression, functional impairment, and post-traumatic stress symptoms were administered at baseline and 6 months post-intervention, together with measures of well-being and quality of life. Adjusted models were constructed to examine the effect of PTEs on post-intervention improvement. The possible mediating role of PTSD symptoms in this relationship was then tested.Results: Increasing numbers of PTEs decreased the beneficial effect of SH+ for all measures. This relationship was mediated by symptoms of PTSD when analysing measures of well-being and quality of life. However, this did not apply for measures of mental health problems.Conclusions: Exposure to PTEs may largely reduce benefits from SH+. PTSD symptomatology plays a specific, mediating role on psychological well-being and quality of life of participants who experienced PTE. Healthcare professionals and researchers should consider the role of PTEs and PTSD symptoms in the treatment of migrants and refugees and explore possible feasible add-on solutions for cases exposed to multiple PTEs. Increasing numbers of potentially traumatic experiences can decrease the beneficial effect of a manualized group psychotherapeutic intervention in migrants and refugees across multiple countries.In absence of a full threshold diagnosis of post-traumatic stress disorder, post-traumatic stress symptoms still mediate the relation between potentially traumatic experiences and some outcome improvements at follow-up.While the moderating role of number of potentially traumatic experiences applies to all outcomes (depression symptoms, psychological distress, functional impairment, well-being, and quality of life), the mediating role of post-traumatic stress symptoms in this relation only applies to well-being and quality of life. Antecedentes: Se han desarrollado intervenciones psicol & oacute;gicas escalables, como Self-Help Plus (SH+) de la OMS, para poblaciones cl & iacute;nicas y no cl & iacute;nicas que necesitan apoyo psicol & oacute;gico. SH+ se ha implementado con & eacute;xito para prevenir trastornos mentales frecuentes entre los solicitantes de asilo y refugiados, cuyo n & uacute;mero est & aacute; aumentando debido a los crecientes niveles de migraci & oacute;n forzada. Estas poblaciones a menudo est & aacute;n expuestas a m & uacute;ltiples y graves fuentes de traumatizaci & oacute;n, y la evidencia del efecto de tales eventos en el tratamiento es insuficiente, especialmente para las poblaciones no cl & iacute;nicas.Objetivo: Nuestro objetivo es estudiar el efecto de las experiencias potencialmente traum & aacute;ticas (EPTs) y el papel mediador de los s & iacute;ntomas del trastorno de estr & eacute;s postraum & aacute;tico (TEPT) en la mejora despu & eacute;s de SH+.M & eacute;todo: Los participantes asignados al programa de intervenci & oacute;n SH+ que recibieron al menos tres sesiones (N = 345) fueron extra & iacute;dos de dos grandes ensayos de prevenci & oacute;n europeos, aleatorizados, que involucraron a personas que solicitaron asilo y refugiados. Se administraron medidas de angustia, depresi & oacute;n, deterioro funcional y s & iacute;ntomas de estr & eacute;s postraum & aacute;tico al inicio del estudio y 6 meses despu & eacute;s de la intervenci & oacute;n, junto con medidas de bienestar y calidad de vida. Se construyeron modelos ajustados para examinar el efecto de las EPTs en la mejora posterior a la intervenci & oacute;n. A continuaci & oacute;n se comprob & oacute; el posible papel mediador de los s & iacute;ntomas del trastorno de estr & eacute;s postraum & aacute;tico en esta relaci & oacute;n.Resultados: Un n & uacute;mero creciente de EPTs disminuy & oacute; el efecto beneficioso de SH+ para todas las medidas. Esta relaci & oacute;n estuvo mediada por los s & iacute;ntomas del TEPT al analizar medidas de bienestar y calidad de vida. Sin embargo, esto no se aplica a las medidas de problemas de salud mental.Conclusiones: La exposici & oacute;n a EPTs puede reducir en gran medida los beneficios de SH+. La sintomatolog & iacute;a TEPT desempe & ntilde;a un papel mediador espec & iacute;fico en el bienestar psicol & oacute;gico y la calidad de vida de los participantes que experimentaron EPTs. Los profesionales de la salud y los investigadores deben considerar el papel de las EPTs y los s & iacute;ntomas de TEPT en el tratamiento de migrantes y refugiados, y explorar posibles soluciones factibles complementarias para los casos expuestos a m & uacute;ltiples EPTs.Öğe Effectiveness and cost-effectiveness of Self-Help Plus (SH plus ) for preventing mental disorders in refugees and asylum seekers in Europe and Turkey: study protocols for two randomised controlled trials(BMJ PUBLISHING GROUP, 2019-05) Uygun, ErsinIntroduction This article describes two randomised controlled trials that will evaluate the effectiveness and cost-effectiveness of Self-Help Plus (SH+), a group self-help intervention developed by the WHO to reduce distress. In these trials SH+ is being tested as a preventative intervention to lower the incidence of mental disorders in asylum seekers and refugees with psychological distress resettled in Europe and Turkey. Methods and analysis Two prospective, multicentre, randomised, rater-blinded, parallel-group studies will follow participants over a period of 12 months. One trial will be conducted in Europe and one in Turkey. In each trial, 600 asylum seekers and refugees screening positive on the General Health Questionnaire (>= 3), but without a formal diagnosis of any mental disorders according to the Mini International Neuropsychiatric Interview, will be randomly allocated to SH+ or to enhanced treatment-asusual. The primary outcome will be a lower incidence of mental disorders at 6 month follow-up. Secondary outcomes will include the evaluation of psychological symptoms, functioning, well-being, treatment acceptability and indicators of intervention cost-effectiveness. Ethics and dissemination The two trials received ethical clearance from the local Ethics Committees of the participating sites (seven sites), as well as from the WHO Ethics Committee. All participants will provide informed consent before screening and before study inclusion (a two-step procedure). The results of the trials will be disseminated in agreement with a dissemination plan that includes publication(s) in peer-reviewed journals and presentations at relevant national and international conferences and meetings.Öğe Effectiveness of a WHO self-help psychological intervention for preventing mental disorders among Syrian refugees in Turkey: a randomized controlled trial(WILEY, 2022-02) Uygun, ErsinAbstract: Refugees are at high risk of developing mental disorders. There is no evidence from randomized controlled trials (RCTs) that psychological interventions can prevent the onset of mental disorders in this group. We assessed the effectiveness of a selfhelp psychological intervention developed by the World Health Organization, called SelfHelp Plus, in preventing the development of mental disorders among Syrian refugees experiencing psychological distress in Turkey. A twoarm, assessormasked RCT was conducted in two Turkish areas. Eligible participants were adult Syrian refugees experiencing psychological distress (General Health Questionnaire ?3), but without a diagnosis of mental disorder. They were randomly assigned either to the SelfHelp Plus arm (consisting of SelfHelp Plus combined with Enhanced Care as Usual, ECAU) or to ECAU only in a 1:1 ratio. SelfHelp Plus was delivered in a group format by two facilitators over five sessions. The primary outcome measure was the presence of any mental disorder assessed by the Mini International Neuropsychiatric Interview at sixmonth followup. Secondary outcome measures were the presence of mental disorders at postintervention, and psychological distress, symptoms of posttraumatic stress disorder and depression, personally identified psychological outcomes, functional impairment, subjective wellbeing, and quality of life at postintervention and sixmonth followup. Between October 1, 2018 and November 30, 2019, 1,186 refugees were assessed for inclusion. Five hundred fortyfour people were ineligible, and 642 participants were enrolled and randomly assigned to either SelfHelp Plus (N=322) or ECAU (N=320). SelfHelp Plus participants were significantly less likely to have any mental disorders at sixmonth followup compared to the ECAU group (21.69% vs. 40.73%; Cramer’s V = 0.205, p<0.001, risk ratio: 0.533, 95% CI: 0.4080.696). Analysis of secondary outcomes suggested that SelfHelp Plus was not effective immediately postintervention, but was associated with beneficial effects at sixmonth followup in terms of symptoms of depression, personally identified psychological outcomes, and quality of life. This is the first prevention RCT ever conducted among refugees experiencing psychological distress but without a mental disorder. SelfHelp Plus was found to be an effective strategy for preventing the onset of mental disorders. Based on these findings, this lowintensity selfhelp psychological intervention could be scaled up as a public health strategy to prevent mental disorders in refugee populations exposed to ongoing adversitiesÖğe EMDR FLASH TEKNİK GRUP UYGULAMASININ TRAVMATİK STRES BELİRTİLERİ ÜZERİNE ETKİSİNİN İNCELENMESİ: BİR RANDOMİZE KONTROLLÜ PİLOT ÇALIŞMA(2021) Uygun, Ersin; Uludağ, Esra; Gündoğmuş, İbrahim; Toygar, Afra; Yaşar, Alişan Burak; Konuk, Emre; Kavakçı, Önder[Abstract Not Available]Öğe Experiences of Secondary Traumatic Stress and Coping Among Refugee Professionals: A Qualitative Study(2025) Küçüknane, Ayşegül; Dikec, Gul; Uygun, ErsinHumanitarian aid workers had adverse effects on their services and were exposed to intense and prolonged traumatic experiences. This study examined the secondary traumatic stress experiences and coping methods of humanitarian workers working with refugees in a nongovernmental organization in İstanbul, Türkiye. This is a qualitative study with a phenomenological design. Data were collected via in-depth interviews between July and August 2020 using a semistructured interview form. The sample consisted of 13 participants who were social workers, health educators, lawyers, field workers, case managers, and/or protection officers. Colazzi’s phenomenological interpretation method was used for data analysis, and results were classified under 5 themes (emotions, mental situation changes, satisfying aspects of the job, tiring aspects, and coping) and 15 subthemes. The study determined that humanitarian workers providing aid to refugees often experience sadness, anger, and fear; notice changes in their lives; often get tired of their work; are sometimes satisfied with work; and find ways to cope by approaching or getting away from themselves. Therefore, supervision and peer support for humanitarian aid workers should be provided and maintained.Öğe Group problem management plus (PM+) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial(BioMed Central Ltd, 2022-12) Uygun, ErsinAbstract: Background: Syrian refugees resettled in Turkey show a high prevalence of symptoms of mental disorders. Problem Management Plus (PM+) is an efective 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-efectiveness of the intervention. Methods: Refugees with psychological distress (Kessler Psychological Distress Scale, K10>15) and impaired psycho? social 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 fve 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-identifed problems (Psychological Outcomes Profles, PSY? CHLOPS) were included as secondary outcomes. A modifed 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 efect. No signifcant diference 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 inter? vention for Syrian refugees in Turkey with elevated levels of psychological distress. This pilot RCT sets the stage for a fully powered RCTÖğe İNFERTİLİTE OLGULARINDA EMDR TERAPİSİ: 3 OLGULUK SERİ(Fenerbahçe Üniversitesi, 2024) Yaraş, Hanım Özlem Kölan; Uygun, Ersin; Yaşar, Alişan Burak; Koyuncu, Egemen; Kavakçı, Önderİnfertilite ve ruh sağlığı ilişkisi düşünüldüğünde, infertilite ve tedavisi için geçirilen sürecin bireyler üzerinde yoğun stres oluşturduğu ve bu stresin de infertilite ile geçirilen süreci uzattığı ve olumsuz etkilediği gibi bir kısır döngü şeması öne sürmek mümkündür. Bu çalışmanın amacı, özellikle infertilite tedavisi sürecinde kişilerin yaşamış olduğu travmatik yaşantıların EMDR ile çalışılmasının bu süreçteki depresyon, stres ve kaygı belirtilerine etkisini incelemektir. Çalışmamızda özellikle infertilite tedavisi döneminde yaşanan stresör olayların etkilerinin azaltılmasında bu olayların EMDR ile hedeflenmesinin bir seçenek olabileceği düşünülmüştür. Ayrıca Danışanların kaygı, stres seviyelerinin azalabileceği de varsayılabilir. Anahtar Kelimeler: İnfertilite, EMDR, TravmaÖğe Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial(CAMBRIDGE UNIV PRESS, 2022-06-13) Uygun, ErsinAbstract: Aims As refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe. Methods Refugees and asylum seekers with psychological distress (General Health Questionnaire-12 > 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes. Results Of 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389-1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180-1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001). Conclusions The present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.Öğe The Relationship Between the Types of Traumatic Events and Well-Being, Post-Traumatic Stress Levels and Gender Differences in Syrian Patients: A Cross-Sectional Controlled Study(Springer, 2021) Uygun, ErsinThis study aims to compare the types and frequency of traumatic events in Syrian patients. Additionally, the study investigates the relationship between the types of traumatic events and post-traumatic stress and mental well-being based on gender differences among the Syrians. Sociodemographic form, the Stressful Life Events Screening Questionnaire, the WHO-5 Well Being Index, and the Impact of Event Scale-Revised were administered to the Syrian volunteers (n = 207) and a control group. The total number of traumatic experiences were higher in the patient (study) group and men compared to the healthy control group and women. The most significant predictors of the variables for the level of traumatic symptoms were total number of traumatic experiences and having lived in a war zone. Traumatic stress symptoms may be associated with the number and continuity of traumatic events. The number of traumatic events in Syrians could be higher in males. Mental well-being is more associated with daily stress factors than traumatic experiences. Therefore, post-migratory risk and protective factors need to be investigated to comprehend PTSD.Öğe Risk factors for mental disorder development in asylum seekers and refugees resettled in Western Europe and Turkey: Participant-level analysis of two large prevention studies(SAGE Publications Ltd, 2022-11) Uygun, ErsinAbstract: Background: In asylum seekers and refugees, the frequency of mental disorders, such as depression, anxiety and post-traumatic stress disorder, is higher than the general population, but there is a lack of data on risk factors for the development of mental disorders in this population. Aim: This study investigated the risk factors for mental disorder development in a large group of asylum seekers and refugees resettled in high- and middle-income settings. Methods: Participant-level data from two randomized prevention studies involving asylum seekers and refugees resettled in Western European countries and in Turkey were pooled. The two studies randomized participants with psychological distress, but without a diagnosis of mental disorder, to the Self-Help Plus psychological intervention or enhanced care as usual. At baseline, exposure to potentially traumatic events was measured using the Harvard Trauma Questionnaire-part I, while psychological distress and depressive symptoms were assessed with the General Health Questionnaire and the Patient Health Questionnaire. After 3 and 6 months of follow-up, the proportion of participants who developed a mental disorder was calculated using the Mini International Neuropsychiatric Interview. Results: A total of 1,101 participants were included in the analysis. At 3- and 6-month follow-up the observed frequency of mental disorders was 13.51% (115/851) and 24.30% (207/852), respectively, while the frequency estimates after missing data imputation were 13.95% and 23.78%, respectively. After controlling for confounders, logistic regression analysis showed that participants with a lower education level (p = .034), a shorter duration of journey (p = .057) and arriving from countries with war-related contexts (p = .017), were more at risk of developing mental disorders. Psychological distress (p = .004), depression (p = .001) and exposure to potentially traumatic events (p = .020) were predictors of mental disorder development. Conclusions: This study identified several risk factors for the development of mental disorders in asylum seekers and refugees, some of which may be the target of risk reduction policies. The identification of asylum seekers and refugees at increased risk of mental disorders should guide the implementation of focused preventative psychological interventions.Öğe Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis(BMJ Publishing Group, 2022-04-20) Uygun, ErsinAbstract: Introduction The World Health Organization's (WHO) scalable psychological interventions, such as Problem Management Plus (PM+) and Step-by-Step (SbS) are designed to be cost-effective non-specialist delivered interventions to reduce symptoms of common mental disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD). The STRENGTHS consortium aims to evaluate the effectiveness, cost-effectiveness and implementation of the individual format of PM+ and its group version (gPM+), as well as of the digital SbS intervention among Syrian refugees in seven countries in Europe and the Middle East. This is a study protocol for a prospective individual participant data (IPD) meta-analysis to evaluate (1) overall effectiveness and cost-effectiveness and (2) treatment moderators of PM+, gPM+ and SbS with Syrian refugees. Methods and analysis Five pilot randomised controlled trials (RCTs) and seven fully powered RCTs conducted within STRENGTHS will be combined into one IPD meta-analytic dataset. The RCTs include Syrian refugees of 18 years and above with elevated psychological distress (Kessler Psychological Distress Scale (K10>15)) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 (WHODAS 2.0>16)). Participants are randomised into the intervention or care as usual control group, and complete follow-up assessments at 1-week, 3-month and 12-month follow-up. Primary outcomes are symptoms of depression and anxiety (25-item Hopkins Symptom Checklist). Secondary outcomes include daily functioning (WHODAS 2.0), PTSD symptoms (PTSD Checklist for DSM-5) and self-identified problems (PSYCHLOPS). We will conduct a one-stage IPD meta-analysis using linear mixed models. Quality of evidence will be assessed using the GRADE approach, and the economic evaluation approach will be assessed using the CHEC-list. Ethics and dissemination Local ethical approval has been obtained for each RCT. This IPD meta-analysis does not require ethical approval. The results of this study will be published in international peer-reviewed journals. © Author(s) (or their employer(s)) 2022.Öğe The strategies for coping with stress of epilepsy patients(Springer-Verlag Italia Srl, 2021) Senadim, Songul; Baslo, Sezin Alpaydin; Uygun, Ersin; Erdogan, Mucahid; Balcik, Zeynep Ezgi; Tekin, Betul; Atakli, DilekObjective This study aims to compare the styles of coping with stress between patients with epilepsy and healthy individuals and to examine the effects of clinical features on methods of coping with stress. Methods The study enrolled 120 patients diagnosed with epilepsy. Forty healthy individuals were included as control group. Sociodemographic and clinical characteristics of the patients were recorded. The patients and controls completed the Coping Strategies with Stress Inventory (COPE), which comprises 60 items distributed into 15 scales. The COPE scores of the patients and controls were compared. Results Comparing the COPE scores of the patients and controls, the substance use score was higher in the controls. In terms of gender, seeking instrumental social support, active coping, seeking emotional social support, acceptance, and emotion-focused total coping scores were higher in women among patients. In terms of marital status, the positive reinterpretation and growth score of single patients was significantly higher than that of married patients. In patients with a history of febrile convulsions, the active coping, seeking emotional social support, and denial scores were higher. In terms of treatment, for the patients receiving polytherapy, the suppression of competing activities, focus on and venting of emotions, and dysfunctional total coping scores were higher than in patients receiving monotherapy. Conclusion Epilepsy and stress are intertwined conditions. Epilepsy patients, confronted with stress, avoided using alcohol and substances compared to healthy individuals. There were differences among epilepsy patients according to gender, marital status, febrile convulsion history, number of medications, and approaches to coping with stress.Öğe Testing the effectiveness and acceptability of online supportive supervision for mental health practitioners in humanitarian settings: a study protocol for the caring for carers project(BMC, 2023-11-28) Wells, Ruth; Acartürk, Ceren; Uygun, ErsinackgroundLocal humanitarian workers in low and middle-income countries must often contend with potentially morally injurious situations, often with limited resources. This creates barriers to providing sustainable mental health and psychosocial support (MHPSS) to displaced individuals. Clinical supervision is an often neglected part of ensuring high-quality, sustainable care. The Caring for Carers (C4C) project aims to test the effectiveness and acceptability of online group-based supportive supervision on the well-being of MHPSS practitioners, as well as service-user-reported service satisfaction and quality when working with displaced communities in Turkiye, Syria, and Bangladesh. This protocol paper describes the aim, design, and methodology of the C4C project.MethodA quasi-experimental, mixed-method, community-based participatory research study will be conducted to test the effectiveness of online group-based supportive clinical supervision provided to 50 Syrian and 50 Bangladeshi MHPSS practitioners working with Syrian and Rohingya displaced communities. Monthly data will be collected from the practitioners and their beneficiaries during the active control (six months) and supervision period (16 months over two terms). Outcomes are psychological distress (Kessler-6), burnout (the Copenhagen Burnout Inventory), compassion fatigue, compassion satisfaction, and secondary traumatic stress (Professional Quality of Life Scale), perceived injustice, clinical self-efficacy (Counseling Activity Self-Efficacy Scale), service satisfaction, and quality (Client Satisfaction Questionnaire and an 18-item measure developed in this project). A realist evaluation framework will be used to elucidate the contextual factors, mechanisms, and outcomes of the supervision intervention.DiscussionThere is a scarcity of evidence on the role of clinical supervision in improving the well-being of MHPSS practitioners and the quality of service they provide to displaced people. By combining qualitative and quantitative data collection, the C4C project will address the long-standing question of the effectiveness and acceptability of clinical supervision in humanitarian settings.Öğe The effectiveness of online Eye Movement Desensitization and Reprocessing 2.0 Group Protocol on post-traumatic stress disorders symptoms, depression, anxiety, and stress in individuals who have experienced a traffic accident: a randomized-controlled study(Frontiers Media Sa, 2025) Yasar, Alisan Burak; Gundogmus, Ibrahim; Kubilay, Derin; Tunca, Gorkem Alban; Uygun, Ersin; Ciftci, Zeynep Zat; Kavakci, OnderIntroduction EMDR 2.0, an innovative approach rooted in the conventional Eye Movement Desensitization and Reprocessing (EMDR), has garnered attention due to its promising outcomes. The application of EMDR, whether it is EMDR or EMDR 2.0 protocol, in a group format, especially for conditions like Post-Traumatic Stress Disorder, will provide significant opportunities in terms of economic feasibility and accessibility, ultimately leading to widespread use. Building on the established effectiveness of EMDR 2.0 in individual applications, this study examines its impact in group settings. This protocol is designed to provide a structured framework for implementing EMDR 2.0 within group contexts, paving the way for a nuanced understanding of its potential benefits in collective therapeutic settings. This study aims to investigate the efficacy of the online EMDR 2.0 Group Protocol(EMDR 2.0 GP) versus Improving Mental Health Training for Primary Care Residents(mhGAP) on individuals with a history of traffic accidents in a controlled way.Methods In this randomized-controlled study sample includes volunteers who were involved in traffic accidents and were given the randomized online EMDR 2.0 GP and mhGAP Stress management module. The participants were given a sociodemographic data form, Depression Anxiety Stress 21 scale (DASS-21) and Impact of Event Scale-Revised (IES-R). Participants were evaluated with measurements before, after and one month after the application.Results The mean age of the participants was 34.80(8.10) years and 88.0% (n=22) were female. The change in DASS-21 Anxiety (h2=0.136), Stress (h2=0.140), IES-R Avoidance (h2=0.134), Hyperarousal (h2=0.0148), Total (h2=0.223) scores of online EMDR 2.0 GP was determined to be statistically significant compared to the mhGAP group. However, no statistically significant difference was observed in DASS-21 Depression (h2=0.017), IES-R Intrusion(h2=0.094), scores between the two groups.Discussion The RCT of online EMDR 2.0 GP indicated that this newly developed protocol, when applied to groups, may be effective in reducing anxiety, stress, and traumatic symptoms among a non-clinical sample.Clinical trial registration https://clinicaltrials.gov/study/, identifier NCT05596903.
