The Aftermath of the 1999 Earthquake in Turkey

The earthquake that took place on August 17, 1999, in the Marmara region of Turkey affected almost 20 million people with 18,000 killed and 50,000 injured. Medical and mental health professionals together with national and international relief and rescue teams had to meet the needs of the survivors. The mental health professionals had to serve in the disaster area and get training from experts at the same time. This article focuses on studies conducted from 1971 to 2003 with disaster survivors in Turkey. The results of these studies are discussed and conclusions are drawn to be integrated with the experience gained from the work onsite.     

Post-traumatic Stress Disorder Symptoms in Children After the 1999 Marmara Earthquake in Turkey

<P> Objective: The aim of this study is to evaluate the symptoms of post-traumatic stress disorder in different age groups of children after the 1999 Marmara earthquake in Turkey. </P><P>Method: The study included thirty-five patients, two to sixteen years old, who presented to the child and adolescent psychiatry department with symptoms of PTSD after the earthquake. An Earthquake Information Form and a Post-traumatic Stress Disorder Symptoms Checklist were filled out with clinical interviews of cases</P>     

Prevalence of psychiatric disorders three years after the 1999 earthquake in Turkey: Marmara Earthquake Survey (MES)

BACKGROUND: The objective of the study is to describe the community prevalence of psychiatric disorder, mainly posttraumatic stress disorder (PTSD) and Major Depressive Disorder (MDD) 3 years after a devastating earthquake. METHODS: Three years after the Marmara Earthquake, 683 individuals from the epicentre were randomly selected to form a representative sample and were assessed with Composite International Diagnostic Interview (CIDI), General Health Questionnaire (GHQ), Traumatic Stress Symptom Checklist (TSSC) and Beck Depression Inventory (BDI). RESULTS: The 36 months prevalence of PTSD and MDD after the Marmara Earthquake were 19.2% and 18.7% respectively. The current prevalence of PTSD and MDD in the affected community was found to be 11.7% and 10.5%, respectively. PTSD and MDD were the most prevalent disorders after the disaster and showed a decrease over time. However, only 38.9% of the PTSD cases identified at any time over the 3 years were in remission at the 3rd-year. The co-occurrence of MDD with PTSD resulted in a decrease in the rate of recovery from PTSD. MDD was also the most prevalent disorder accompanying PTSD. Of all the subjects 37.5% with PTSD still met the MDD criteria at the 3rd year postearthquake. CONCLUSIONS: In comparison with the data from pre-earthquake national mental health profile, the present study showed that the prevalence of MDD, panic disorder, OCD, GAD, social phobia and special phobias were still higher in the affected region 3 years after the earthquake.     

Psychological effects of the November 1999 earthquake in Turkey: an epidemiological study

OBJECTIVE: This study assessed the traumatic stress symptoms and related factors in two towns affected by two earthquakes, which killed 20000 people in 1999 in Turkey. METHOD: A total of 430 people in selected households were seen 18 months after the earthquake. They were given a self-report questionnaire assessing post-traumatic stress (PTSD) and depressive symptoms, demographics and trauma exposure. RESULTS: The rates of PTSD and depression were higher in the site closer to the epicenter. The traumatic stress symptom checklist scores were predicted by fear during earthquake, loss of friends and neighbours, female gender, lower education and living in rented accomodation. Depression was predicted by study site, death of relatives and past psychiatric illness. CONCLUSION: These results show that severe earthquakes can cause long-lasting morbidity. Our previous findings that showed a differential prediction for depressive and traumatic stress symptoms after earthquakes are also supported.     

Psychosocial determinants of relocation in survivors of the 1999 earthquake in Turkey

Large-scale earthquakes in urban areas displace many people from their homes. This study examined the role of conditioned fears in determining survivors' tendency to live in shelters after the 1999 earthquake in Turkey. A total of 1655 survivors living in prefabricated housing compounds or residential units in the epicenter zone were screened using a reliable and valid instrument. Among participants whose houses were rendered uninhabitable during the earthquake 87.7% relocated to shelters, whereas others remained in the community by moving to a new house. In contrast, 38.7% of the participants whose houses were still inhabitable after the earthquake lived in the shelters. Relocation was predicted by behavioral avoidance, material losses, and loss of relatives. These findings suggested that a multitude of factors played a role in survivors' displacement from their houses and the elevated rates of mental health problems could constitute a cause rather than an effect of relocation.     

Gender differences in psychological effect of the August 1999 earthquake in Turkey

Disasters traumatically expose normal populations to severe threats to life, deaths of relatives and massive environmental destruction. Epidemiological studies found that women would be more vulnerable to disaster than men. In this study, we examined gender differences in short-term psychological effect of the 1999 earthquake in Turkey on adult survivors. A total of 184 subjects (79 males and 105 females) who used a psychiatric service were interviewed within 6–10?weeks after the earthquake. All subjects were assessed using a modified version of the Mississippi Scale for Posttraumatic Stress Disorder, the Beck Depression Inventory, the Beck Hopelessness Scale, and four subscales (depression, anxiety, hostility and somatization) of the Symptom Check List (SCL-90-R). Women had higher mean total Mississippi Scale scores than men (84.29 vs. 78.72; P<0.05). Women scored higher on the Beck Depression Inventory and the Beck Hopelessness Scale than men (respectively 16.3 vs. 10.4; P<0.001 and 7.5 vs. 6.0; P<0.05). Women had significantly higher depression (1.40 vs. 0.94; P<0.001), anxiety (1.46 vs. 1.12; P<0.05) and somatization (1.31 vs. 0.84; P<0.001) subscale scores of the SCL-90-R than men. These findings indicate that women may experience more severe psychological reactions than men after a disastrous earthquake.     

Gender differences in psychological effect of the August 1999 earthquake in Turkey

Disasters traumatically expose normal populations to severe threats to life, deaths of relatives and massive environmental destruction. Epidemiological studies found that women would be more vulnerable to disaster than men. In this study, we examined gender differences in short-term psychological effect of the 1999 earthquake in Turkey on adult survivors. A total of 184 subjects (79 males and 105 females) who used a psychiatric service were interviewed within 6-10 weeks after the earthquake. All subjects were assessed using a modified version of the Mississippi Scale for Posttraumatic Stress Disorder, the Beck Depression Inventory, the Beck Hopelessness Scale, and four subscales (depression, anxiety, hostility and somatization) of the Symptom Check List (SCL-90-R). Women had higher mean total Mississippi Scale scores than men (84.29 vs. 78.72; P<0.05). Women scored higher on the Beck Depression Inventory and the Beck Hopelessness Scale than men (respectively 16.3 vs. 10.4; P<0.001 and 7.5 vs. 6.0; P<0.05). Women had significantly higher depression (1.40 vs. 0.94; P<0.001), anxiety (1.46 vs. 1.12; P<0.05) and somatization (1.31 vs. 0.84; P<0.001) subscale scores of the SCL-90-R than men. These findings indicate that women may experience more severe psychological reactions than men after a disastrous earthquake.     

Predictors of psychological distress in survivors of the 1999 earthquakes in Turkey: effects of relocation after the disaster

OBJECTIVE: Relocations after disasters are known to cause added distress in survivors. This study examined the effects of migration and other factors on psychological status of survivors 4 years after the two severe earthquakes in Turkey. METHOD: Five hundred and twenty-six adult survivors of the 1999 earthquakes currently living in Ankara were given self-report measures assessing traumatic stress, depression, earthquake experience and social support. RESULTS: The rates of current post-traumatic stress disorder (PTSD) and depression were 25% and 11%, respectively. Although both traumatic stress and depression factors were predicted by some demographic and trauma severity variables, relocation status predicted depression but not traumatic stress. CONCLUSION: The rates of psychological distress were higher than expected in a city considered to be safe in terms of earthquake risk. Relocation after the disaster may increase psychological distress by disrupting the social network.     

The Impact of Neuroscience and Genetics on the Law: A Recent Italian Case

The use of genetic testing and neuroscientific evidence in legal trials raises several issues. Often their interpretation is controversial: the same evidence can be used to sustain both the prosecution??s and defense??s argument. A recent Italian case confirms such concerns and stresses other relevant related questions.     

Factors Associated With Dementia Knowledge and Dementia Worry in the South Korean Elderly Population

ObjectiveSouth Korea is one of the countries with a very fast aging rate, and the prevalence of dementia is rapidly increasing. However, there are relatively few studies pertaining to sociodemographic and physical health-related factors associated with dementia knowledge and dementia worry. MethodsThis was a cross-sectional survey of a community in Seocho-gu, Seoul, Republic of Korea. Overall, 1,869 adults aged 60 years participated. Participants completed an online interview or face-to-face interview. Survey data comprised self-report questions including dementia knowledge, dementia worry, demographic, psychological, exercise, and cognitive activities. We conducted logistic regression analysis. ResultsThere was a significant positive association between dementia worry and knowledge. Family history of dementia, education, income, sleep problems, depressed mood and loss of volition, chronic diseases, and presence of a past job were associated with dementia knowledge or worry. Reading, art, or social cognitive activities had a significant positive association with dementia knowledge, and writing or musical cognitive activities had a negative association with dementia worry. ConclusionWe found that people with more dementia knowledge and less dementia worry engaged more in cognitive activities that could prevent dementia. Public education should be planned to improve dementia knowledge and reduce dementia worry.     

The Penn State Worry Questionnaire: psychometric properties of the Korean version

The factor structure and concurrent validity of the Penn State Worry Questionnaire (PSWQ) were examined in two college student samples in Korea. We demonstrated method effects due to the inclusion of negatively keyed items. Confirmatory factor analyses supported the single-factor model with method factor. This indicates that the Korean version of the PSWQ (K-PSWQ) can be contaminated by method effects and response patterns are different between positively worded and reverse-scored items. Thus, the relevance of negatively worded items in the K-PSWQ is questioned.     

The Impact of the Chi-Chi Earthquake on the Incidence of Hospitalizations for Schizophrenia and on Concomitant Hospital Choice

This study aimed to evaluate the impact of a catastrophic earthquake on the incidence of hospitalizations for schizophrenia, and on the choice of hospitals for patients thus hospitalized, using a quasi-experimental design. Results demonstrated post-catastrophe increases in the incidence of hospitalizations for schizophrenia by 11.0 and 21.6% in the first and second year after the disaster, respectively. Among index hospitalizations for schizophrenia, the earthquake was associated with decreases in the use of teaching and public hospitals. For patients with schizophrenia, aggravation of symptoms and the likelihood of being crowded out of the use of health care services by those with other physical or mental illnesses after a catastrophe warrant our attention.     

The Impact of Incentives on Exercise Behavior: A Systematic Review of Randomized Controlled Trials

Background

The effectiveness of reinforcing exercise behavior with material incentives is unclear.

Purpose

This study aims to conduct a systematic review of existing research on material incentives for exercise, organized by incentive strategy.

Methods

Ten studies conducted between January 1965 and June 2013 assessed the impact of incentivizing exercise compared to a non-incentivized control.

Results

There was significant heterogeneity between studies regarding reinforcement procedures and outcomes. Incentives tended to improve behavior during the intervention while findings were mixed regarding sustained behavior after incentives were removed.

Conclusions

The most effective incentive procedure is unclear given the limitations of existing research. The effectiveness of various incentive procedures in promoting initial behavior change and habit formation, as well as the use of sustainable incentive procedures should be explored in future research.     

Worry and rumination in older adults: Differentiating the processes

Objectives: This study examined the factor structure of the adapted Ruminative Response Scale in a large Australian older adult sample. Previously, the factor structure has only been explored in small UK sample and thus remains tentative. A further objective was to explore overlapping and distinct characteristics of worry, brooding and reflection in relation to coping behaviour which has not previously been examined in older adults.

Method: A total of 138 older adults aged between 65 and 97 years (M = 77, SD = 7.9) completed a number of instruments to measure worry, rumination, anxiety and coping behaviour.

Results: A three-factor structure comprised of worry, brooding and reflection emerged. However, no unique relationship was found between the rumination components (brooding and reflection) and worry and coping pathways.

Conclusion: The factor structure supports the idea that worry, brooding and reflection are distinguishable constructs in the elderly. However, the lack of differential associations between the rumination components and worry in relation to coping strategies provided evidence that rumination and worry are part of the same theoretical construct of repetitive thought. The implications of these findings for the management of anxiety and depression in the elderly are discussed.     

Parenting Stress and Externalizing Behavior Symptoms in Children: The Impact of Emotional Reactivity

This study investigated whether the parenting stress-child externalizing behavior link is moderated by children’s emotional reactivity, as indexed by skin conductance responses (SCRs). Participants were 61 children aged 9–12 years and their mothers. Mothers completed measures of parenting stress and their children’s externalizing symptoms; children also reported on their externalizing behavior. Children’s SCRs were assessed during the viewing of standardized pleasant, unpleasant, and neutral pictures. Cluster analysis on SCRs identified two groups, labeled Lower SCRs and Higher SCRs. Regression analyses indicated that among children with lower SCRs, those exposed to increased parenting stress reported more externalizing symptoms, whereas those who experienced low parenting stress reported similar rates of externalizing problems as children with higher SCRs. No effect of parenting stress emerged for children with higher SCRs. Findings suggest that higher parenting stress renders children with lower, as opposed to higher, SCRs to emotional stimuli more vulnerable to externalizing problems.