Psikoterapide tek beden herkese uymuyor: Avrupa’da yaşayan Türkiye kökenli hastalarda depresyonu anlamak

PubMed ID: 28360770Over the last decades, Europe has become an immigration country hosting an estimated 56 million international immigrants. Yet, a large amount of literature suggests that migration is associated with a higher risk of common mental disorders, such as depression and anxiety. As representatives of one of the largest immigrant groups in Europe, various studies have shown that Turkish immigrants exhibit a higher prevalence of depression and anxiety disorders than do the background population. Nevertheless, it is also well demonstrated that this particular patient group is more likely to terminate treatment prematurely and displays lower rates of treatment compliance than their native counterparts. This reluctance for service utilization might be partially because of the fact that people from non-Western ethnocultural backgrounds (e.g., Turkey) often have a different notion and comprehension of mental health and illness as compared with those of the people from Western societies. Such mismatch often results in discrepancies between the needs and expectations of immigrant patients and clinicians, which attenuate the communication and effectiveness of treatment and lead to unexplained high dropout rates. To provide continued provision of culture-sensitive, high quality, evidence-based mental health care, the advancement of researches exploring such sociocultural differences between the patients’ and the clinicians’ notions of mental health must occur. In response to these problems, the current review aims to explore the interplay between culture and mental processes that associate with the etiology, maintenance, and management of depression among Turkish immigrant patients. This is to inform clinicians regarding culturespecific correlates of depression among Turkish patients to enable them to present interventions that fit the needs and expectations of this particular patient group.Son yıllarda Avrupa, yaklaşık olarak 56 milyon uluslararası göçmen barındıran bir göç bölgesi haline gelmiştir. Bunula birlikte, göçün, depresyon ve anksiyete bozuklukları gibi sık görülebilen psikiyatrik bozukluklarda artışa neden olduğunu belirten çalışmalar bulunmaktadır. Avrupa’da yapılan çalışmalar, en kalabalık göçmen gruplarından biri olan Türkiye kökenli göçmenlerde, depresyon ve anksiyete bozukluklarının yaygınlığının, genel nüfusa kıyasla daha yüksek olduğunu göstermektedir. Buna rağmen, yine bu grubun, Avrupalı hastalara kıyasla tedaviye uyum sağlamakta daha çok güçlük çektikleri hatta tedaviyi erken sonlandırma eğiliminde oldukları yapılan araştırmalarla ortaya konmuştur. Batılı olmayan toplumların (ör: Türkiye), ruh sağlığı ve hastalıkları ile ilgili nosyon ve anlayışlarının, batılı toplumlarınkinden farklı olması, göçmen hastaların sağlık hizmetlerinden yararlanmaktan kaçınmalarına yol açabilmektedir. Anlayışlar arasındaki bu farklılıklar ise, göçmen hastalar ve batılı klinisyenler arasındaki iletişimi dolayısıyla tedavinin etkinliğini zayıflatarak tedaviyi bırakma oranlarında açıklanamayan artışlara yol açabilmektedir. Kültüre duyarlı, kaliteli ve kanıta dayalı ruh sağlığı hizmetlerinin sağlanabilmesi adına, hasta ve klinisyenlerin ruh sağlığına ilişkin anlayışları arasındaki sosyokültürel farklılıkları keşfetmeye yönelik araştırmaların artması bir gerekliliktir. Buna yönelik olarak, bu makalede ruh sağlığı ve kültür arasındaki etkileşim ve bu etkileşimin Türk göçmen hastalarda depresyonu tetikleyen ve devam ettiren faktörler ile ilişkileri incelenmiştir. Buradaki amaç, bu hasta grubunun beklentilerine ve ihtiyaçlarına uygun müdahalelerin sunulabilmesi adına, klinisyenlere depresyonun kültürel öğeleri hakkında bilgi sağlamaktır.Publisher's Versio

Risiko- und Resilienzfaktoren von adoleszenten Kindern alkoholkranker Eltern: Ergebnisse der Greifswalder Familienstudie

"Kinder alkoholkranker Eltern (COA) weisen ein erhöhtes Risiko zur Entwicklung von Alkohol- und weiteren psychischen Störungen auf. Ziel dieser Studie war es, längsschnittlich zu überprüfen, ob auch beim Übergang von der Adoleszenz ins junge Erwachsenalter COAs ein erhöhtes Risiko für Alkohol- und weitere psychische Störungen aufweisen und welche Faktoren dabei eher verstärkend bzw. schützend wirken. Methode: 310 junge Erwachsene einer Allgemeinbevölkerungsstichprobe sowie deren Eltern wurden im Abstand von etwa 5 Jahren zu zwei Messzeitpunkten hinsichtlich Alkoholgebrauch, psychischen Störungen sowie soziodemografischen Variablen untersucht. Ergebnisse: Hinsichtlich Trinkmenge und Rauschtrinken zeigten sich keine Gruppenunterschiede zwischen COAs (n=83) und nonCOAs (n=227), jedoch berichteten COAs weniger regelmäßigen Alkoholkonsum (47.0% vs. 61.7%). Allerdings wiesen COAs ein 2.4fach erhöhtes Risiko für Alkoholstörungen (16.9 vs. 7.9%) auf, ebenso zeigten sie vermehrt affektive Störungen (18.1 vs. 8.8%) und tendenziell mehr Cluster-B-Persönlichkeitsstörungen (10.8% vs. 5.3%, p=.075). Gleichermaßen fanden sich erhöhte Psychopathologiewerte in der COA-Gruppe. Da nur etwa 17 Prozent der COAs eine Alkoholstörung aufwiesen, stellte sich die Frage, ob Persönlichkeitsdimensionen und Erziehungsverhalten das Risiko für Alkoholprobleme in der COA-Gruppe moderieren. Es fanden sich eine höhere emotionale Wärme der Eltern und höhere Werte im Temperamentsfaktor Belohnungsabhängigkeit der Kinder als Schutzfaktoren. Schlussfolgerungen: Es scheint eine besonders gefährdete Gruppe von COAs zu geben, die sich durch eine geringe Belohnungsabhängigkeit und ein als wenig warm wahrgenommenes Erziehungsverhalten charakterisieren lassen. Jedoch legen die Daten nahe, dass ein Großteil dieser Kinder sehr gute Regulationsmechanismen besitzt und nahezu abstinent bleibt. Dies sollte in zukünftigen Präventions- und Interventionsmaßnahmen berücksichtigt werden." (Autorenreferat)"In earlier studies, children of alcoholics (COA) had a higher risk of developing alcohol use disorders and other psychiatric disorders. The aim of this study was to examine longitudinally (from adolescence into young adulthood) if COAs have a higher risk for alcohol and other psychiatric disorders and which factors can be identified as risk or resilience factors. Method: 310 young adults of a community-based sample and their parents were examined at the time of early adolescence and about 5 years later in terms of alcohol use, psychiatric disorders, parenting styles and personality. Results: The authors found no group differences for drinking amount and binge drinking. COAs reported less regular alcohol use (47.0% vs. 61.7%). However, COAs showed an increased risk for alcohol use disorders (16.9 vs. 7.9%, OR=2.4) and affective disorders (18.1% vs. 8.8%, OR=2.3) as well as a trend towards more Cluster B personality disorders (10.8% vs. 5.3%). Similarly, COAs displayed higher levels of psychopathology. Since only 17 per cent of COAs showed an alcohol use disorder, this raised the question whether personality dimensions and parenting moderated the risk for alcohol problems in the COA group. Higher levels of a warm/ supportive parenting style and of the temperament factor reward dependence were related to a lower risk for alcohol use disorders. Conclusions: There seems to be a particularly vulnerable group of COAs which is characterized by low reward dependence and a perceived parenting style with low emotional warmth. On the other hand, the data suggest that a large proportion of these COAs have effective mechanisms of regulation and almost remain abstinent. This should be considered in future prevention and intervention measures." (author's abstract

Detaching from the negative by reappraisal: the role of right superior frontal gyrus (BA9/32)

The ability to reappraise the emotional impact of events is related to long-term mental health. Self-focused reappraisal (REAPPself), i.e., reducing the personal relevance of the negative events, has been previously associated with neural activity in regions near right medial prefrontal cortex, but rarely investigated among brain-damaged individuals. Thus, we aimed to examine the REAPPself ability of brain-damaged patients and healthy controls considering structural atrophies and gray matter intensities, respectively. Twenty patients with well-defined cortex lesions due to an acquired circumscribed tumor or cyst and 23 healthy controls performed a REAPPself task, in which they had to either observe negative stimuli or decrease emotional responding by REAPPself. Next, they rated the impact of negative arousal and valence. REAPPself ability scores were calculated by subtracting the negative picture ratings after applying REAPPself from the ratings of the observing condition. The scores of the patients were included in a voxel-based lesion-symptom mapping (VLSM) analysis to identify deficit related areas (ROI). Then, a ROI group-wise comparison was performed. Additionally, a whole-brain voxel-based-morphometry (VBM) analysis was run, in which healthy participant's REAPPself ability scores were correlated with gray matter intensities. Results showed that (1) regions in the right superior frontal gyrus (SFG), comprising the right dorsolateral prefrontal cortex (BA9) and the right dorsal anterior cingulate cortex (BA32), were associated with patient's impaired down-regulation of arousal, (2) a lesion in the depicted ROI occasioned significant REAPPself impairments, (3) REAPPself ability of controls was linked with increased gray matter intensities in the ROI regions. Our findings show for the first time that the neural integrity and the structural volume of right SFG regions (BA9/32) might be indispensable for REAPPself. Implications for neurofeedback research are discussed.Fil: Falquez, Rosalux. University of Heidelberg; AlemaniaFil: Couto, Juan Blas Marcos. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: Ibáñez Barassi, Agustín Mariano. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva. Fundación Favaloro. Instituto de Neurociencia Cognitiva; ArgentinaFil: Freitag, Martin T.. German Cancer Research Center; AlemaniaFil: Berger, Moritz. German Cancer Research Center; AlemaniaFil: Arens, Elisabeth A.. University of Heidelberg; AlemaniaFil: Lang, Simone. University of Heidelberg; AlemaniaFil: Barnow, Sven. University of Heidelberg; Alemani

Longitudinal Transmission Pathways of Borderline Personality Disorder Symptoms: From Mother to Child?

Background: There is evidence that the borderline symptomatology of the mother longitudinally predicts the number of borderline criteria met by the children. However, possible underlying mechanisms have rarely been examined. In line with transactional models of borderline personality disorder (BPD), we analyzed a broad concept of maladaptive mother-child interactions of mothers with BPD symptoms towards their children, including insensitive parenting and mother-child discrepancies, in reporting the child's psychopathological behavior. Sampling/Methods: The sample was drawn from the population-based Greifswald Family Study and consisted of 295 children and their biological mothers. Both were examined at two points in time, first when the children were about 15 years old (T₀) and again 5 years later (T1), using path analyses. Results: Maladaptive mother-child interactions (especially an overprotective and rejecting parenting style and high discrepancies regarding internalizing problems) mediate the longitudinal transmission of borderline symptoms from mother to child. Furthermore, our data revealed that this result is consistent for various youth symptoms which are associated with BPD such as impulsivity or dissociation. Conclusion: The data of the current study imply that the transmission of borderline symptoms from mother to child is mediated by maladaptive mother-child interactions. For this reason early and professional support may be useful to prevent these children from developing severe psychopathology

The Process-Outcome Mindfulness Effects in Trainees (PrOMET) study: protocol of a pragmatic randomized controlled trial

Background: Mindfulness has its origins in an Eastern Buddhist tradition that is over 2500 years old and can be defined as a specific form of attention that is non-judgmental, purposeful, and focused on the present moment. It has been well established in cognitive-behavior therapy in the last decades, while it has been investigated in manualized group settings such as mindfulness-based stress reduction and mindfulness-based cognitive therapy. However, there is scarce research evidence on the effects of mindfulness as a treatment element in individual therapy. Consequently, the demand to investigate mindfulness under effectiveness conditions in trainee therapists has been highlighted. Methods/Design: To fill in this research gap, we designed the PrOMET Study. In our study, we will investigate the effects of brief, audiotape-presented, session-introducing interventions with mindfulness elements conducted by trainee therapists and their patients at the beginning of individual therapy sessions in a prospective, randomized, controlled design under naturalistic conditions with a total of 30 trainee therapists and 150 patients with depression and anxiety disorders in a large outpatient training center. We hypothesize that the primary outcomes of the session-introducing intervention with mindfulness elements will be positive effects on therapeutic alliance (Working Alliance Inventory) and general clinical symptomatology (Brief Symptom Checklist) in contrast to the session-introducing progressive muscle relaxation and treatment-as-usual control conditions. Treatment duration is 25 therapy sessions. Therapeutic alliance will be assessed on a session-to-session basis. Clinical symptomatology will be assessed at baseline, session 5, 15 and 25. We will conduct multilevel modeling to address the nested data structure. The secondary outcome measures include depression, anxiety, interpersonal functioning, mindful awareness, and mindfulness during the sessions. Discussion: The study results could provide important practical implications because they could inform ideas on how to improve the clinical training of psychotherapists that could be implemented very easily; this is because there is no need for complex infrastructures or additional time concerning these brief session-introducing interventions with mindfulness elements that are directly implemented in the treatment sessions. Trial registration: From ClinicalTrials.gov, Identifier: NCT02270073 (registered October 6, 2014

Traumatization and mental distress in long-term prisoners in Europe

This article investigates the prevalence of traumatization and mental distress in a sample of 1055 male European long-term prisoners as part of a wider study of the living conditions of prisoners serving sentences of at least five years in Belgium, Croatia, Denmark, England, Finland, France, Germany, Lithuania, Poland, Spain and Sweden. Data were collected in a written survey using the Posttraumatic Diagnostic Scale (PDS), the Brief Symptom Inventory (BSI) as well as questions on attempted suicide and auto-aggressive behaviour. Participants experienced a mean of three traumatic events, with 14 per cent developing a Posttraumatic Stress Disorder (PTSD) subsequently. In each national sample, more than 50 per cent of the participants were in need of treatment because of psychological symptoms and nearly one-third had attempted suicide

The link between self-construal and mental distress in Turkish migrants and German women with depression implications for the psychotherapeutic work with Turkish immigrants

PubMed ID: 23508774Anliegen: Die Untersuchung kultureller Unterschiede im Zusammenhang zwischen Selbstkonzept und psychischer Belastung. Methode: Insgesamt wurden 56 türkische und deutsche stationäre Patientinnen mit Depression untersucht. Ergebnisse: Bei türkischen Frauen war ein interdependentes Selbstkonzept mit einer niedrigeren, bei deutschen Frauen mit einer höheren psychischen Belastung assoziiert. Schlussfolgerung: In der psychotherapeutischen Arbeit mit türkischen Migranten spielen kulturell bedingte Unterschiede im Selbstkonzept eine wichtige Rolle für die Ableitung von Therapiezielen und Interventionen.Objective: The current study aims to analyze cultural differences in the patterns of self-construals (interdependent vs. independent) and their relation to mental distress in a sample of depressed Turkish migrants and German women.Methods: A total number of 56 in-patients with a diagnosis of major depression were compared in terms of self-construals and their relations to different aspects of mental distress.Results: Turkish patients exhibited a stronger interdependent self-construal compared to Germans, whereas no group differences were observed with respect to independence. While for Turkish patients a higher level of interdependence was associated with lower levels of mental distress, the reverse was true for German patients. However, there were no significant ethnic differences in the associations between independence and mental distress.Conclusions: The current study provides evidence that the relation between self-construal and mental distress is moderated by patient's cultural background. The findings have implications for integrating self-construals into psychotherapy practice with culturally diverse populations, in order to adjust therapy goals and intervention techniques.Publisher's Versio

Neuroticism developmental courses - implications for depression, anxiety and everyday emotional experience; a prospective study from adolescence to young adulthood

Background: Neuroticism is frequently discussed as a risk factor for psychopathology. According to the maturity principle, neuroticism decreases over the course of life, but not uniformly across individuals. However, the implications of differences in personality maturation on mental health have not been well studied so far. Hence, we hypothesized that different forms of neuroticism development from adolescence to young adulthood are associated with differences in depression, anxiety and everyday emotional experience at the age of 25. Methods: A sample of 266 adolescents from the general population was examined three times over ten years (age at T0: 15, T1: 20 and T2: 25) using questionnaires, interviews and ecological momentary assessment (EMA). At all measurement points, neuroticism was assessed with the NEO inventory. At T2, diagnoses of major depression and anxiety disorders were captured with a structured clinical interview (M-CIDI). Phone-based EMA was used to assess emotional experience and affective instability over a two-week period at T2. Results: The best fitting model was a latent class growth analysis with two groups of neuroticism development. Most individuals (n = 205) showed moderate values whereas 61 participants were clustered into a group with elevated neuroticism levels. In both groups neuroticism significantly changed during the ten year period with a peak at the age of 20. Individuals with a higher absolute level were at 14-fold increased risk for depression and 7-fold risk for anxiety disorders at the age of 25. In EMA, increased negative affect and arousal as well as decreased positive emotions were found in this high group. Conclusions: Other than expected, personality did not mature in our sample. However, there was a significant change of neuroticism values from adolescence to young adulthood. Further, over 20% of our participants showed a neuroticism development which was associated with adverse outcomes such as negatively toned emotional experience and a heightened risk to suffer from depressive and anxiety disorders in young adulthood. These high-risk persons need to be identified early to provide interventions supporting continuous personality maturation

From Childhood Trauma to Adult Dissociation: The Role of PTSD and Alexithymia

Background: The mechanism of how childhood trauma leads to increased risk for adult dissociation is not sufficiently understood. We sought to investigate the predicting effects and the putatively mediating roles of PTSD and alexithymia on the path from childhood trauma to adult dissociation. Methods: A total of 666 day-clinic outpatients were administered the Childhood Trauma Questionnaire (CTQ), the Toronto Alexithymia Scale (TAS-20), the Posttraumatic Diagnostic Scale (PDS), and the Dissociative Experiences Scale (DES) and controlled for sex, age, and the Global Symptom Index (GSI). Linear regression analyses and mediation analyses were applied. Results: Independent predictive effects on dissociation were found for childhood trauma, alexithymia and PDS, even after adjusting for GSI. Effects of childhood neglect on dissociation were slightly stronger than of abuse. Alexithymia did not mediate the path from childhood trauma to dissociation. Mediation by PDS was specific for childhood abuse, with all PTSD symptom clusters being significantly involved. Conclusions: Childhood abuse and neglect are important predictors of dissociation. While the effects of abuse are mediated by PTSD, the mechanism of how neglect leads to dissociation remains unclear. The results further support the predictive value of alexithymia for adult dissociation above and beyond the effects of childhood trauma, PTSD, and GSI scores

Does Emotion Dysregulation Mediate the Relationship between Early Maltreatment and Later Substance Dependence? Findings of the CANSAS Study

Background/Aims: Maltreatment in childhood and adolescence is a risk factor for substance use disorders (SUDs) in adulthood. This association has rarely been investigated in the light of emotion dysregulation. To fill this gap, this study examines emotion dysregulation and SUDs among adults with a history of early maltreatment. Methods: Comparison of emotion dysregulation in adults with a history of early abuse and neglect who developed either an SUD (n = 105) or no mental disorder (n = 54). Further, a mediation model for the association between the severity of early maltreatment and SUDs was tested. Participants completed research diagnostic interviews for psychopathology, the Difficulties in Emotion Regulation Scale, and the Childhood Trauma Questionnaire. Results: By using hierarchical regression techniques and mediational analyses controlling for age and gender, it was possible to provide evidence for the mediating role of emotion dysregulation between early emotional and physical maltreatment and later SUDs. Conclusions: Emotion dysregulation is a potential mechanism underlying the relationship between early emotional and physical maltreatment and the development of SUDs. In light of these findings, focusing on the early training of adaptive emotion regulation strategies after childhood maltreatment might be of considerable relevance to prevent the development of SUDs