Depression and anxiety disorders are important public health problems in high-income countries and in low- and middle-income countries (LMIC). Psychological treatments for depression and anxiety disorders can play a major role in reducing the disease burden of these disorders. Most psychological treatments that are evidence-based have been developed in Western countries, and these include a range of cognitive behavioral therapies, interpersonal psychotherapy, psychodynamic approaches, and counseling. A growing number of studies show that these therapies are at least as effective in non-Western countries as they are in Western countries. Adaptation of the interventions to other cultures is needed in order for therapies to be effective. Implementation of some therapies may be facilitated through the use of nonprofessional or lay health counselors instead of fully trained psychotherapists or psychiatrists. New technologies may also offer new opportunities to reduce the disease burden of depression and anxiety disorders in LMIC.

Psychotherapy for depression and anxiety in low- and middle-income countries

Identity development can be challenging for adolescents, particularly those from immigrant families who are required to make sense of their identity whilst accommodating themselves into different cultures. For second-generation ethnic minority adolescents, these identity formation processes may range from harmony/effectiveness to conflict/stress, having consequences for acculturation and for mental health. Focusing on an underexplored area of research, the present study aimed to examine the relationships between ethnic identity, acculturation orientations, and mental health outcomes among second-generation Turkish adolescents (16-18 years old) in England. Data were collected using a self-report survey (N = 220) and analyzed using structural equation modelling. Results demonstrated that ethnic identity was positively associated with positive mental health and that each ethnic identity component (exploration, resolution, affirmation) was differently associated with life satisfaction, self-esteem, psychological well-being, and depression. Ethnic identity was also positively related to separation and negatively to marginalization whilst no relationships were observed between integration, separation or marginalization, and mental health. Mediation analysis determined that ethnic identity was negatively associated with assimilation and in turn, more positive mental health. Findings demonstrate the complexity of understanding the nature and effects of ethnic identity for second-generation adolescents and have important implications for theory and practice.

Mental health outcomes of ethnic identity and acculturation among British-born children of immigrants from Turkey.

The evidence for the effectiveness of e-mental health interventions among ethnic minorities is still preliminary. This mixed methods study investigates the feasibility of a culturally adapted, guided online intervention with the intention to understand how it works and for whom to inform refinement. It also examines its likely effectiveness in reducing suicidal ideation when compared with the treatment as usual. Turkish migrants with mild to moderate suicidal thoughts were recruited from the general population using social media and newspaper advertisements. The intervention group obtained direct access to a 6-week guided online intervention while participants in the waiting list condition had to wait for 6 weeks. The intervention is based on an existing online intervention and was culturally adapted. Participants in both conditions completed baseline, post-test, and follow-up questionnaires on suicidal ideation (primary outcome), depression, worrying, hopelessness, suicide attempt and self-harm, acculturation, quality of life, and usability. In addition, participants were interviewed to examine the feasibility and mechanisms of action in more depth. The responses were analysed by inductive thematic analysis. Eighty-five people signed up via the study website, and we included 18 (10 intervention, 8 waitlist control). While the therapeutic benefits were emphasised (e.g. feeling connected with the intervention), the feasibility was judged to be low. The main reasons given were not having severe suicidal thoughts and not being represented by the culturally adapted intervention. No suicide attempts were recorded during the study. The suicidal ideation, depression, and hopelessness scores were improved in both groups. Although intended to be a definitive trial, the current study became a feasibility study with process evaluation to understand the components and how they operate. The online intervention was not superior to the control condition. Future studies need to attend the implementation issues raised including measures of stigma, acculturation, and careful cultural adaptations alongside more attention to coaching and relational support. They should also consider how to improve engagement alongside selection of those who are motivated to use online interventions and offer alternatives for those who are not. Netherlands Trial Register, NTR5028
 . Registered on 1 March 2015

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Reducing suicidal ideation among Turkish migrants in the Netherlands and in the UK: the feasibility of a randomised controlled trial of a guided online intervention.

This study describes a successful community-based partnership project between statutory and third-sector services in East London; The City and Hackney Black and Minority Ethnic (BME) Access Service [East London NHS Foundation Trust (ELFT)] collaborated with Derman, a local community organization supporting the well-being of Turkish-speaking communities, to explore the cultural adaptability of an empirically supported, third-wave cognitive behavioural intervention, Acceptance and Commitment Therapy (ACT). The aim was to develop a culturally acceptable group that was responsive to the therapeutic needs of participants from Turkish-speaking communities. The study implemented a mixed-method analysis with a one group pre/post-test design to examine the effectiveness of a 7-session culturally adapted ACT group intervention and a descriptive approach was implemented to assess usefulness, relevance and acceptability. Results demonstrated an overall positive effect of the culturally adapted ACT intervention in terms of both symptoms and patient-reported outcomes. Participants showed significant improvements on measures of depression (p = 0.014), anxiety (p = 0.041) and psychological distress (p = 0.003). The magnitude of these changes was categorized as large, with effect sizes from 0.90 to 2.03. Qualitative responses indicated that the group was experienced as enjoyable and useful and was considered to be an accessible and acceptable therapeutic format. Although a pilot within clinical practice, the findings provide preliminary support for the clinical utility of ACT as an effective, culturally acceptable therapeutic approach for Turkish-speaking communities living in an urban UK setting. The study highlights the importance of culturally appropriate service development and a need for further research within this area.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/798534C85786484A3D2514B671DCA463/S1754470X18000041a.pdf/div-class-title-exploring-the-cultural-flexibility-of-the-act-model-as-an-effective-therapeutic-group-intervention-for-turkish-speaking-communities-in-east-london-div.pdf

Exploring the cultural flexibility of the ACT model as an effective therapeutic group intervention for Turkish speaking communities in East London

More suicidal ideation and higher rates of attempted suicide are found in Turkish people when compared with the general population in Europe. Acculturation processes and related distress may explain an elevated risk of suicide. The current study investigates the association between acculturation and suicidal ideation among Turkish migrants in the Netherlands. The mediating effect of hopelessness and moderating effect of secure attachment are also examined. A total of 185 Turkish migrants living in the Netherlands were recruited through social media and through liaison with community groups. They completed an online survey including validated measures of suicidal ideation, hopelessness, acculturation and attachment style. Mediation and moderation analyses were tested using bootstrapping. Higher participation was associated with less hopelessness and less suicidal ideation. Greater maintenance of one's ethnic culture was associated with higher hopelessness and higher suicidal ideation. Greater participation was associated with less suicidal ideation particularly amongst those with less secure attachment styles. Turkish migrants who participate in the host culture may have a lower risk of developing suicidal thinking. Participation may protect against suicidal thinking, particularly among those with less secure attachment styles.

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Acculturation and suicidal ideation among Turkish migrants in the Netherlands

Currently, little is known about the views that Turkish migrants hold towards suicide, which may differ from the narratives held by native inhabitants of their host countries. Central to improving the provision of mental health services, furthering our knowledge of these views is important. The aim of this research was to explore Turkish cultural understandings on suicide and help-seeking for suicide. A qualitative study included data from 6 focus groups and 7 individual interviews with 38 Turkish-speaking lay people and 4 key informants living in the Netherlands or the UK during the year 2014/2015. Through the analysis of participants’ stories and narratives, the following key themes emerged in relation to suicide: suicide as an escape from failure and as a failure in itself; acculturation orientation; parenting style; and shame and stigma. There were more similarities than differences between the themes among laypersons and key informants from two countries. Canina kiymak (crushing life energy) was a strong metaphor for personal distress. Suicide was perceived as a failing of responsibilities towards the family and community. Future research should aim to give voice to all ethnocultural groups to further the present understanding of suicide and help-seeking processes in these communities.

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Canına kıymak – ‘crushing life energy’: a qualitative study on lay and professional understandings of suicide and help-seeking among Turkish migrants in the UK and in the Netherlands

D. D. van Bergen

Papers

Canına kıymak – ‘crushing life energy’: a qualitative study on lay and professional understandings of suicide and help-seeking among Turkish migrants in the UK and in the Netherlands