BackgroundTurkey is the country hosting the largest number of refugees from Syria, with currently 3 571 175 million persons. The general health needs of the refugees are being addressed; however, people with intellectual disabilities (IDs), particularly children, are relatively missed. The aim of this study was to identify medical, psychological and social needs of children with ID and their families, among the Syrian refugee population in Turkey, and to define psychosocial and cultural needs for planning of future services.MethodsOne hundred forty‐two children (67.6% men; mean age 90.5 months) diagnosed with intellectual disorders were included in the study. Family Needs Survey, with additional open‐ended and close‐ended questions, was used to evaluate family needs. Items from Developmental Disabilities Profile‐2 were used to evaluate and screen cognitive, motor and language development as well as medical concerns and behavioural problems. Data on sociodemographic characteristics were also collected.ResultsThe highest needs were identified in information and financial needs domains. Other indicated needs were on child care and community services domains. The least indicated items were on family and social support and explaining to others domains. An average of 63.5% of the respondents definitely agreed with the Family Needs Survey items. The overall level of identification of need items was higher than that in some previous studies, indicating the level of unmet needs of the studied population. Family income, parents' employment and parents' education were not significantly associated with unmet family needs. Special education services were unreachable for most of the families in the study.ConclusionsFamilies reported the highest needs in information and financial needs domains. The overall level of identification of needs was higher than that in some previous studies, indicating the level of unmet needs of the studied population. The majority of the parents reported that they had sufficient family and social support, which might be a protective factor for parental mental health. Parents' Turkish fluency was very significantly associated with every domain of unmet needs. Language barriers and translation problems had significant negative effects on families, as confirmed by the answers to open‐ended questions. Another important factor identified was access to service professionals. Special education services, sorely needed for most of the families, could not always be reached. Although the progress of children who had received special education was not very encouraging, it was better than those who did not receive it. The first implication of the study is that increasing Turkish proficiency or providing high‐quality and consistent translation services is vital for this category of children with ID. The second implication is that information and financial needs must be met with priority. Information must be tailored for each child's needs and developmental level. Special education and physical therapy must be more accessible and at higher quality.
ÖzetAmaç: Eş tarafından kadına yönelik şiddetin depresyonu tetiklediği bildirilmektedir. Bu çalışmada postpartum dönemde depresyon geçiren ve geçir-meyen kadınlardaki eş şiddetine maruziyetin postpartum depresyona etkisinin araştırılması amaçlandı. Gereç ve Yöntem: Aile hekimliğince gebelik takibi yapılan ve doğum sonrası izlemi yapılan postpartum döneminin 4. haftasın-da olan kayıtlı 128 kadın olgu çalışmaya dahil edildi. Daha önce ruhsal hastalık öyküsü ve ilaç kullanımı olmayan postpartum dönemindeki kadınların psikiyatrik değerlendirmesi yapıldı. Edinburgh doğum sonrası depresyon ölçeği (EDSDÖ) ve tarafımızca hazırlanan sosyodemografik form verildi. EDSDÖ'de depresyon saptanan ve saptanmayan olguların şiddete maruziyetleri ve sosyodemografik özellikleri uygun istatistiksel yöntemler ile karşılaştırıldı. Bulgular: EDSDÖ puanlarını 12 ve üzerinde olanları depresyon kabul ederek yapılan gruplamada, olguların %43.7'sinde (n=56) depresyon saptanmazken, olguların 72'sinde (%56.3) postpartum depresyon saptanmıştır. Depresyonu olan olguların yaş ortalaması ve evlilik süresi depresyonu olmayan olgulardan istatistiksel olarak anlamlı yüksek bulunmuştur (sırasıyla p=0.035 ve p=0.003). Postpartum depresyonu olan olguların duygusal ve fiziksel şiddete maruziyet oranı postpartum depresyona uğramayan olgulara göre istatistiksel olarak anlamlı yüksek bulundu (sırasıyla p<0.001 ve p=0.047). Gruplar arasında ekonomik ve cinsel şiddete maruziyet açısından anlamlı bir farklılık saptanmadı. Tartışma: Duygusal şiddet postpartum depresyon gelişiminde önemli bir risk faktörüdür. Evlilik ve duygusal şiddete maruziyet süresinin uzaması postpartum depresyon riskini arttırmaktadır. Ruh sağlığı çalışanları duygusal şidde-tin travmatik etkisine de odaklanarak, destekleyici yaklaşımlarda bulunmaları postpartum depresyon gelişme olasılığını azaltabilir. Gelecekte elde edilen bulguların daha geniş örneklemli ve uzunlamasına çalışmalarla desteklenmesi konunun netleşmesine katkı sağlayacaktır. depression were found to be statistically significantly higher than for those that did not score as depressed (respectively p=0.035 and p=0.003). Rates of exposure to emotional and physical abuse were statistically significantly higher for depressed women (respectively p<0.001 ve p=0.047). We did not find any significant differences between the groups in terms of their exposure to economic and sexual abuse. Discussion: Emotional abuse is an important risk factor in the development of postpartum depression. Greater length of marriage and exposure to emotional abuseboth increase the risk for postpartum depression. Mental health personnel should focus on the traumatic effects of emotional abuse. Larger sample sizes and longitudinal studies are needed to further support these finding. Anahtar Kelimeler
Background About 1468 Syrian and Turkish doctors, serving in primary health care, have received the mhGAP training during 2016–2019. As additional training needs were identified, MoH and WHO wanted to understand the usefulness of the training and its impact in responding to the mental health needs of Syrian refugees in Turkey. Methods A five component assessment was done in 2019, consisting of feedback of trainees, assessment of increase in knowledge; utilization of service; compliance to treatment guidelines and service user satisfaction. The purpose was to understand the perception of participants on the training; estimate the knowledge gained—attributable to the training; estimate the increase in mental health cases identified and treated; compliance with treatment guidelines; as well as perception of the services received by end-beneficiaries. Results Results indicate that most of the respondents were happy with the training, but preferred additional mhGAP training as a refresher course in the future. There was knowledge gained due to the training, 9% for the Syrian and 5% for Turkish doctors. The knowledge gained has helped the practicing doctors to be more attentive and increase the numbers of cases diagnosed after the training for almost all groups of diagnoses. Most doctors, observed during practice, comply with the guidelines shared during the training, but improvement is still needed when it comes to prescription and treatment of certain conditions. The average number of mental health cases identified increased by 38 (%27) cases in the year following the training. We observed over 70% compliance with guidelines for 9 out of 12 criteria in question. The results of the patient exit interviews indicate a high level of satisfaction with the MHPSS services provided. About 95% of beneficiaries were happy with the quality of the service, and 92% having their needs met. Conclusions The mhGAP training was found useful. More training should be conducted to fill in the gap in service provision and meet the mental needs of Syrian refugees in Turkey.
ÖzetSıklıkla hamilelikte meme bezinin büyümesi, laktasyon için süt sentezi ve hazırlanması gibi görevle-ri ile bilinen prolaktinin günümüzde, bu etkilerinin dışında da pek çok işleve sahip olduğu bilinmektedir. Psikiyatride sıklıkla kullanılan antipsikotikler ve antidepresanlar da hiperprolaktinemi yapabilmektedir. Özellikle tipik antipsikotiklerin ön hipofizdeki D2 reseptörlerini bloke ederek birincil olarak prolaktin seviyelerini yükselttikleri görüşü mevcuttur. Atipik antipsikotiklerin hiperprolaktinemi üzerine etkileri farklılık gösterir. Hiperprolaktinemi; oligomenore, polimenore ve amenore gibi menstrual düzensizliklere ek olarak galaktore, jinekomasti, cinsel işlev bozuklukları, infertilite, kadınlarda akne ve hirşutizm, kilo alımı, obezite ve duygudurum değişikliklerine yol açmaktadır. Uzun süreçte hiperprolaktinemi kemik yoğunluğunda azalma ve osteoporoza yol açabilir. Bu makalede antipsikotiklerin hiperprolaktinemi yan etkileri ve bu yan etkilere yönelik tedavi yaklaşımları gözden geçirilecektir. AbstractProlactin provides the growth of the mammary gland during pregnancy and synthesis and preparation of breast milk for lactation. Antipsychotics and antidepressants that are frequently used in psychiatry, cause hyperprolactinemia. The prevalent opinion is that especially typical antipsychotics increase prolactin levels primarily by blocking D2 receptors in the anterior pituitary. The effects of atypical antipsychotics on hyperprolactinemia vary. Hyperprolactinemia causes galactorrhea, gynecomastia, sexual dysfunction, infertility, acne, hirsutism in women, weight gain, obesity and mood changes in addition to menstrual irregularities such as oligomenorrhea, polymenorrhea and amenorrhea. In the long term, hyperprolactinemia may cause reduction in bone density and osteoporosis. Hyperprolactinemia as a side effect of antipsychotics drugs and its treatment will be reviewed in this article.
Aim The objectives of the study were to determine the level of satisfaction with Mental Health and Psycho-social Support Services (MHPSS) provided to Syrians under temporary protection (SuTP) in Turkey and identify predictors that significantly determine the satisfaction with the MHPSS. This study is part of an effort by Ministry of Health (MoH) and World Health Organization (WHO) to evaluate the improvement in the MHPSS following capacity strengthening of social and health providers. Methods 357 Syrians under temporary protection were interviewed as they exited the Refugee Health Training Centers in 7 provinces in Turkey (Adana, Gaziantep, Hatay, Istanbul, Izmir and Sanliurfa), using patient exit interviews during mid-Oct – mid-Nov 2019. Uni and bivariate analysis for association was done using Chi square test for categorical variables, looking for significance at p < 0.05. Multivariate analysis (logistic regression) was used to determine the profile of service users and the predictors of satisfaction with MHPSS. Results Overall satisfaction with services was 93%. The profile of the MHPSS user suggests that the odds of using the service are twice as much for people aged 40+ years (OR 2.016, CI95% [1.129–3.601]), and five times less for married women (OR 0.180, CI95% [0.083–0.391]). The service characteristics that can predict service satisfaction are “having the needs met” (OR 138.73, CI95% [27.99–687.54]) and “satisfaction with the length of the appointments” (OR 54.50, CI95% [6.07–489.57]). There was no multicollinearity detected between the predictors. Conclusions MHPSS services provided by professionals trained by MoH and WHO, have a high satisfaction rate and are serving the SuTP population in need. The high satisfaction rate is predicted by having MHPSS needs met, which is a key indication of the usefulness of these services.
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