Ebru Salcioglu

Traumatic stress responses in earthquake survivors in Turkey.

This study examined the rates of posttraumatic stress disorder (PTSD) and depression and associated risk factors in earthquake survivors in Turkey. A group of 1,000 people from 3 camps and 2 prefabricated housing sites in the epicenter region was assessed using the Screening Instrument for Traumatic Stress in Earthquake Survivors. The estimated rates of PTSD and major depression were 43 and 31%, respectively. Traumatic stress symptoms related to more intense fear during the earthquake, female gender, having been trapped under rubble, death of a family member, past psychiatric illness, having participated in rescue work, and lower education. Avoidance of trauma reminders was the most common symptom and needs special attention in survivor care because of its mental health, social, and economic implications.

Long-term psychological outcome for non-treatment-seeking earthquake survivors in Turkey.

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 586 earthquake survivors living in prefabricated housing sites a mean of 20 months after the 1999 earthquake in Turkey. The estimated rates of PTSD and major depression were 39% and 18%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, older age, participation in rescue work, having been trapped under rubble, and personal history of psychiatric illness. More severe depression symptoms related to older age, loss of close ones, single marital status, past psychiatric illness, previous trauma experience, female gender, and family history of psychiatric illness. These findings suggest that catastrophic earthquakes have long-term psychological consequences, particularly for survivors with high levels of trauma exposure. These findings lend further support to the need for long-term mental health care policies for earthquake survivors. Outreach service delivery programs are needed to access non-treatment-seeking survivors with chronic PTSD.

Traumatic stress responses in treatment-seeking earthquake survivors in Turkey.

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 1027 earthquake survivors who were consecutively referred to a community center at a mean of 14 months after the August 1999 earthquake in Turkey. Seventy-seven percent of referrals were women. The estimated rates of PTSD and major depression were 63% and 42%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, lower education, loss of friends, shorter time since the earthquake, and material loss. More severe depression symptoms related to female gender, longer time since the earthquake, lower educational level, loss of a family member, and past psychiatric illness. In conclusion, long-term public mental health policies are needed for postearthquake psychological problems. These policies need to take into account the risk factors for traumatic stress and the gender differences in referral patterns. The differential stressor-response relationship may have important implications for treatment.

Factors associated with posttraumatic stress disorder and depression in war-survivors displaced in Croatia

Aim To examine the role of perceived stressfulness of trauma exposure and economic, social, occupational, educational, and familial adaptation after trauma in posttraumatic stress disorder (PTSD) and depression in displaced war survivors. Methods A cross-sectional survey was conducted between March 2000 and July 2002 with a sample of 173 internally displaced persons or refugees and 167 matched controls in Croatia. Clinical measures included Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale. Results Displaced war survivors reported the exposure to a mean ± standard deviation of 13.1 ± 8.3 war stressors, including combat, torture, serious injury, death of close persons, and loss of property. Compared to controls, they reported higher rates of marked to severe impact of war on family (16.2% vs 51.6%), social (7.2% vs 43.5%), economic (12.6% vs 55.4%), occupational (1.8% vs 15.9%), and educational (2.4% vs 8.8%) adaptation. In two logistic regression analyses, the strongest predictor of PTSD and depression was high level of perceived distress during trauma exposure. PTSD but not depression was associated with economic, social, occupational, educational, and familial adaptation after trauma. Conclusion Displaced survivors who experienced multiple war events perceived greater negative impact of war on their life domains compared to individuals who lived in a war setting but had no trauma exposure. The most important determinant of psychological outcomes was perceived stressfulness of war stressors. Although post-trauma adaptation in different life spheres had an impact, its effect was not robust and consistent across disorders. These findings suggest that it would be effective to use a trauma-focused approach in rehabilitation of war survivors.

Single-case experimental studies of a self-help manual for traumatic stress in earthquake survivors

Studies showed that earthquake-related posttraumatic stress disorder could be reduced by a single session of therapist instructions for self-exposure to fear cues. Eight single-case experimental studies examined whether such instructions were as effective when delivered through a self-help manual after an initial assessment. After two baseline assessments conducted at the participants homes, the manual was delivered to the participants, who were then assessed at week 10 (post-treatment) and at 1-, 3-, and 6-month post-treatment. After minimal improvement during the baseline, treatment achieved marked improvement in seven survivors, leading to effect sizes comparable to those obtained by therapist-delivered treatment. Self-help appears to be a promising approach in cost-effective survivor care.

A Mental Healthcare Model for Mass Trauma Survivors: Control-Focused Behavioral Treatment of Earthquake, War and Torture Trauma

Preface Acknowledgements Introduction Part I. Theory: 1. A learning theory formulation of earthquake trauma 2. A learning theory formulation of torture and war trauma Part II. Assessment and Treatment: 3. Assessment 4. Control-focused behavioural treatment 5. Assessment and treatment of prolonged grief 6. An overview of treatment efficacy and mechanisms of recovery Part III. Implications for Care of Mass Trauma Survivors: 7. A mental health care model for earthquake survivors 8. Issues in care of mass trauma survivors 9. Controversies in rehabilitation of torture and war survivors Appendix I. Questionnaires Appendix II. Helping people recover from earthquake trauma: control-focused behavioural treatment delivery manual Appendix III. Self-help manual for earthquake trauma Index.

The Role of Relocation Patterns and Psychosocial Stressors in Posttraumatic Stress Disorder and Depression Among Earthquake Survivors.

Abstract The psychological impact of relocation within and outside of a disaster region was examined in 541 survivors of the 2011 Van earthquake in Turkey at 16.5 months postdisaster. Relocation out of the region was determined by disaster-related property/financial losses and fear during the earthquake. Anticipatory fear of future earthquakes and less sense of control over life were the strongest predictors of posttraumatic stress disorder (PTSD) and depression symptoms. Relocation within the disaster region predicted PTSD but not depression. Dissatisfaction with emotional support received from close ones was significantly associated with depression, but it was associated with PTSD at a marginally significant level. Survivors who experienced more intense fear during the earthquake displayed higher levels of anticipatory fear in the long term, whereas avoidance of trauma reminders and fear-evoking situations sustained anticipatory fear of future earthquakes. These findings suggest that interventions that reduce fear and avoidance behaviors would help survivors overcome traumatic stress and depressive symptoms.

A Mental Healthcare Model for Mass Trauma Survivors: Frontmatter

Preface Acknowledgements Introduction Part I. Theory: 1. A learning theory formulation of earthquake trauma 2. A learning theory formulation of torture and war trauma Part II. Assessment and Treatment: 3. Assessment 4. Control-focused behavioural treatment 5. Assessment and treatment of prolonged grief 6. An overview of treatment efficacy and mechanisms of recovery Part III. Implications for Care of Mass Trauma Survivors: 7. A mental health care model for earthquake survivors 8. Issues in care of mass trauma survivors 9. Controversies in rehabilitation of torture and war survivors Appendix I. Questionnaires Appendix II. Helping people recover from earthquake trauma: control-focused behavioural treatment delivery manual Appendix III. Self-help manual for earthquake trauma Index.

A Mental Healthcare Model for Mass Trauma Survivors: Contents

Preface Acknowledgements Introduction Part I. Theory: 1. A learning theory formulation of earthquake trauma 2. A learning theory formulation of torture and war trauma Part II. Assessment and Treatment: 3. Assessment 4. Control-focused behavioural treatment 5. Assessment and treatment of prolonged grief 6. An overview of treatment efficacy and mechanisms of recovery Part III. Implications for Care of Mass Trauma Survivors: 7. A mental health care model for earthquake survivors 8. Issues in care of mass trauma survivors 9. Controversies in rehabilitation of torture and war survivors Appendix I. Questionnaires Appendix II. Helping people recover from earthquake trauma: control-focused behavioural treatment delivery manual Appendix III. Self-help manual for earthquake trauma Index.