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Ruhsal Bozukluğu olan Suriye Uyruklu Göçmenlerde İçselleştirilmiş Damgalanma ve Tedaviye Uyum Arasındaki İlişki

Yıl 2025, Cilt: 17 Sayı: Supplement 1, 201 - 208, 16.12.2025
https://doi.org/10.18863/pgy.1666021

Öz

Amaç: Türkiye’deki Suriye uyruklu göçmenler, depresyon ve travma sonrası stres bozukluğu gibi yüksek oranda ruhsal bozukluklarla karşı karşıya olup, bu durum içselleştirilmiş damgalanma ve tedaviye uyum engelleriyle daha da karmaşık hale gelmektedir. İçselleştirilmiş damgalanma ile tedaviye uyum arasındaki ilişkinin anlaşılması, bu nüfus için etkili ruhsal sağlık müdahalelerinin geliştirilmesi açısından kritik öneme sahiptir. Bu çalışma, Türkiye’deki psikotrop ilaç kullanan Suriye uyruklu göçmenlerin içselleştirilmiş damgalanma ve tedaviye uyum düzeylerini değerlendirmeyi ve bu iki değişken arasındaki ilişkiyi incelemeyi amaçlamıştır.
Yöntem: Kesitsel ve ilişki arayıcı bir çalışma, Ocak-Mayıs 2024 tarihleri arasında İstanbul’da, ruhsal bozukluk tanısı almış ve psikotrop ilaç kullanan 110 Suriye uyruklu göçmenle gerçekleştirilmiştir. Veriler, gelişigüzel örnekleme yöntemiyle Bilgi Formu, Ruhsal Hastalıkların İçselleştirilmiş Damgalanması Ölçeği (RHİDÖ) Arapça Formu ve İlaç Uyumu Bildirim Ölçeği (İUBÖ) kullanılarak toplanmıştır.
Bulgular: İçselleştirilmiş damgalanma (RHİDÖ) ile tedaviye uyum (İUBÖ) arasında anlamlı bir korelasyon bulunmamıştır (r = -0.16, p = 0.96). Ancak, cinsiyet ve çocuk sahibi olma durumu, içselleştirilmiş damgalanmanın anlamlı belirleyicileri olarak saptanmıştır (R² = 0.21, p < 0.001); kadınlar ve çocuk sahibi olan katılımcılar daha yüksek damgalanma düzeyleri bildirmiştir. Tedaviye uyum orta düzeyde olup, sosyodemografik veya ruhsal sağlıkla ilgili özelliklerle anlamlı bir ilişki bulunmamıştır.
Sonuç: İçselleştirilmiş damgalanma ile tedaviye uyum arasında anlamlı bir ilişki bulunmamakla birlikte, cinsiyet ve ebeveynlik durumu damgalanmanın temel belirleyicileri olarak öne çıkmıştır. Ruh sağlığı uzmanları, tedaviye uyumu etkileyen faktörleri belirlemeye odaklanmalı ve özellikle kadın göçmenler ile çocuk sahibi olanlar için içselleştirilmiş damgalanmayı azaltmaya yönelik hedefe yönelik müdahaleler uygulamalıdır.

Kaynakça

  • Acarturk C, Uygun E, Ilkkursun Z, Carswell K, Tedeschi F, Batu M et al. (2022) Effectiveness of a WHO self‐help psychological intervention for preventing mental disorders among Syrian refugees in Turkey. World Psychiatry, 21:88-95.
  • Bar J, Pabst A, Rohr S, Luppa M, Renner A, Nagl M et al. (2021) Mental health self-stigma of Syrian refugees with post-traumatic stress symptoms. Front Psychiatry, 12:642618.
  • Bawadi H, Al-Hamdan Z, Khader Y, Aldalaykeh M (2022) Barriers to the use of mental health services by Syrian refugees in Jordan. East Mediterr Health J, 28:197-203.
  • Boettcher VS, Nowak AC, Neuner F (2021) Mental health service utilization and perceived barriers to treatment among adult refugees in Germany. Eur J Psychotraumatol, 12:1910407.
  • Byrow Y, Pajak R, Specker P, Nickerson A (2020) Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees. Clin Psychol Rev, 75:101812.
  • DiComo RA, Mychailyszyn M (2021) The relationship between stigma and helping-seeking behaviors among refugee, asylum seeker, immigrant (RASI) populations specifically of Muslim origin. J Muslim Ment Health, 15: doi:10.3998/jmmh.130
  • Dikeç G, Timarcioğlu K (2023) Medication adherence to psychotropic medication and relationship with psychiatric symptoms among Syrian refugees in Turkey. Trauma Care, 3:37-45.
  • Doğan N, Dikeç G, Uygun E (2019) Syrian refugees' experiences with mental health services in Turkey: "I felt lonely because I wasn't able to speak to anyone." Perspect Psychiatr Care, 55:673-680.
  • Erdoğan S, Nahcivan N, Esin N (2014) Hemşirelikte Araştırma Süreç, Uygulama ve Kritik. 4. Baskı. Ankara, Nobel Tıp Kitapevleri.
  • Fauk NK, Ziersch A, Gesesew H, Ward P, Green E, Oudih E et al. (2021) Migrants and service providers’ perspectives of barriers to accessing mental health services in South Australia. Int J Environ Res Public Health, 18:8906.
  • Horne R (2004) The Medication Adherence Report Scale (MARS). APA PsycTests.
  • Karadağ O, Kılıç C, Kaya E, Üner S (2021) Challenges and lessons learned in mental health research among refugees: a community-based study in Turkey. BMC Public Health, 21:1537.
  • Kane JM, Correll CU (2019) Optimizing treatment choices to improve adherence and outcomes in schizophrenia. J Clin Psychiatry, 80:10-4088.
  • Kira IA, Ramaswamy V, Lewandowski L, Mohanesh J, Abdul-Khalek H (2015) Psychometric assessment of the Arabic version of the Internalized Stigma of Mental Illness (ISMI) measure in a refugee population. Transcult Psychiatry, 52:636-658.
  • Moses S, Holmes D (2022) What mental illness means in different cultures: perceptions of mental health among refugees from various countries of origin. Mental Health: Global Challenges Journal, 5: doi:10.56508/mhgcj.v5i2.126.
  • Renner A, Jackle D, Nagl M, Hoffmann R, Rohr S, et al. (2021) Predictors of psychological distress in Syrian refugees with post-traumatic stress in Germany. PLoS One, 16:e0254406.
  • Ritsher JB, Otilingam PG, Grajales M (2003) Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res, 121:31-49.
  • Sacha M, Sandahl H, Harck L, Carlsson J (2022) Treatment adherence to psychotropic drugs among non-Western refugees: a systematic review. Nord J Psychiatry, 76:250-262.
  • Satinsky E, Fuhr DC, Woodward A, Sondorp E, Roberts B (2019) Mental health care utilisation and access among refugees and asylum seekers in Europe. Health Policy, 123:851-863.
  • Shahin W, Kennedy GA, Cockshaw W, Stupans I (2020) The role of refugee and migrant migration status on medication adherence: mediation through illness perceptions. PLoS One, 15:e0227326.
  • Sandahl H, Lindberg LG, Mortensen EL, Carlsson J (2024) Factors affecting adherence to psychotropics in trauma-affected refugees: data from a randomized controlled trial. J Psychiatr Res, 169:272-278.
  • Şen ET, Berk OS, Sindel D (2019) İlaç Uyumunu Bildirim Ölçeğinin Türkçe uyarlamasının geçerlik ve güvenirlik çalışması. İstanbul Tıp Fakültesi Dergisi, 82:52-61.
  • Tahir R, Due C, Ward P, Ziersch A (2022) Understanding mental health from the perception of Middle Eastern refugee women. SSM Ment Health, 2:100130.
  • Taipale H, Niederkrotenthaler T, Tanskanen A, Cullen AE, Helgesson M, Berg L et al. (2021) Persistence of antidepressant use among refugee youth with common mental disorder. J Affect Disord, 294:831-837.
  • UNHCR (2024) Global Trends Reports 2023. Copenhagen, United Nations High Commissioner for Refugees.
  • WHO (2003) Adherence to Long-Term Therapies. Geneva, World Health Organization .
  • Xin H (2020) Addressing mental health stigmas among refugees: a narrative review from a socio-ecological perspective. Univers J Public Health, 8:57-64.

Relationship between Internalized Stigmatization and Treatment Adherence among Syrian Refugees with Mental Disorders

Yıl 2025, Cilt: 17 Sayı: Supplement 1, 201 - 208, 16.12.2025
https://doi.org/10.18863/pgy.1666021

Öz

Objective: Syrian refugees in Türkiye face significant mental health challenges, including high rates of disorders such as depression and post-traumatic stress disorder, compounded by internalized stigma and barriers to treatment adherence. Understanding the relationship between internalized stigma and treatment adherence is critical for developing effective mental health interventions for this population. This study aimed to assess the levels of internalized stigma and treatment adherence among Syrian refugees in Türkiye using psychotropic medication and to investigate the relationship between these variables.
Methods: A cross-sectional, correlational study was conducted in Istanbul from January to May 2024, involving 110 Syrian refugees diagnosed with mental disorders and prescribed psychotropic medication. Data were collected using random sampling through the Information Form, the Arabic version of the Internalized Stigma of Mental Illness Scale (ISMI), and the Medication Adherence Reporting Scale (MARS).
Results: No significant correlation was found between internalized stigma (ISMI) and treatment adherence (MARS) (r = -0.16, p = 0.96). However, gender and having children were significant predictors of internalized stigma (R² = 0.21, p < 0.001), with females and participants with children reporting higher stigma levels. Treatment adherence was moderate, with no significant associations with sociodemographic or mental health-related characteristics.
Conclusion: While internalized stigma did not significantly correlate with treatment adherence, gender and parental status were key determinants of stigma. Mental health professionals should focus on identifying factors affecting treatment adherence and implement targeted interventions to reduce internalized stigma, particularly for female refugees and those with children, to improve mental health outcomes.

Kaynakça

  • Acarturk C, Uygun E, Ilkkursun Z, Carswell K, Tedeschi F, Batu M et al. (2022) Effectiveness of a WHO self‐help psychological intervention for preventing mental disorders among Syrian refugees in Turkey. World Psychiatry, 21:88-95.
  • Bar J, Pabst A, Rohr S, Luppa M, Renner A, Nagl M et al. (2021) Mental health self-stigma of Syrian refugees with post-traumatic stress symptoms. Front Psychiatry, 12:642618.
  • Bawadi H, Al-Hamdan Z, Khader Y, Aldalaykeh M (2022) Barriers to the use of mental health services by Syrian refugees in Jordan. East Mediterr Health J, 28:197-203.
  • Boettcher VS, Nowak AC, Neuner F (2021) Mental health service utilization and perceived barriers to treatment among adult refugees in Germany. Eur J Psychotraumatol, 12:1910407.
  • Byrow Y, Pajak R, Specker P, Nickerson A (2020) Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees. Clin Psychol Rev, 75:101812.
  • DiComo RA, Mychailyszyn M (2021) The relationship between stigma and helping-seeking behaviors among refugee, asylum seeker, immigrant (RASI) populations specifically of Muslim origin. J Muslim Ment Health, 15: doi:10.3998/jmmh.130
  • Dikeç G, Timarcioğlu K (2023) Medication adherence to psychotropic medication and relationship with psychiatric symptoms among Syrian refugees in Turkey. Trauma Care, 3:37-45.
  • Doğan N, Dikeç G, Uygun E (2019) Syrian refugees' experiences with mental health services in Turkey: "I felt lonely because I wasn't able to speak to anyone." Perspect Psychiatr Care, 55:673-680.
  • Erdoğan S, Nahcivan N, Esin N (2014) Hemşirelikte Araştırma Süreç, Uygulama ve Kritik. 4. Baskı. Ankara, Nobel Tıp Kitapevleri.
  • Fauk NK, Ziersch A, Gesesew H, Ward P, Green E, Oudih E et al. (2021) Migrants and service providers’ perspectives of barriers to accessing mental health services in South Australia. Int J Environ Res Public Health, 18:8906.
  • Horne R (2004) The Medication Adherence Report Scale (MARS). APA PsycTests.
  • Karadağ O, Kılıç C, Kaya E, Üner S (2021) Challenges and lessons learned in mental health research among refugees: a community-based study in Turkey. BMC Public Health, 21:1537.
  • Kane JM, Correll CU (2019) Optimizing treatment choices to improve adherence and outcomes in schizophrenia. J Clin Psychiatry, 80:10-4088.
  • Kira IA, Ramaswamy V, Lewandowski L, Mohanesh J, Abdul-Khalek H (2015) Psychometric assessment of the Arabic version of the Internalized Stigma of Mental Illness (ISMI) measure in a refugee population. Transcult Psychiatry, 52:636-658.
  • Moses S, Holmes D (2022) What mental illness means in different cultures: perceptions of mental health among refugees from various countries of origin. Mental Health: Global Challenges Journal, 5: doi:10.56508/mhgcj.v5i2.126.
  • Renner A, Jackle D, Nagl M, Hoffmann R, Rohr S, et al. (2021) Predictors of psychological distress in Syrian refugees with post-traumatic stress in Germany. PLoS One, 16:e0254406.
  • Ritsher JB, Otilingam PG, Grajales M (2003) Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res, 121:31-49.
  • Sacha M, Sandahl H, Harck L, Carlsson J (2022) Treatment adherence to psychotropic drugs among non-Western refugees: a systematic review. Nord J Psychiatry, 76:250-262.
  • Satinsky E, Fuhr DC, Woodward A, Sondorp E, Roberts B (2019) Mental health care utilisation and access among refugees and asylum seekers in Europe. Health Policy, 123:851-863.
  • Shahin W, Kennedy GA, Cockshaw W, Stupans I (2020) The role of refugee and migrant migration status on medication adherence: mediation through illness perceptions. PLoS One, 15:e0227326.
  • Sandahl H, Lindberg LG, Mortensen EL, Carlsson J (2024) Factors affecting adherence to psychotropics in trauma-affected refugees: data from a randomized controlled trial. J Psychiatr Res, 169:272-278.
  • Şen ET, Berk OS, Sindel D (2019) İlaç Uyumunu Bildirim Ölçeğinin Türkçe uyarlamasının geçerlik ve güvenirlik çalışması. İstanbul Tıp Fakültesi Dergisi, 82:52-61.
  • Tahir R, Due C, Ward P, Ziersch A (2022) Understanding mental health from the perception of Middle Eastern refugee women. SSM Ment Health, 2:100130.
  • Taipale H, Niederkrotenthaler T, Tanskanen A, Cullen AE, Helgesson M, Berg L et al. (2021) Persistence of antidepressant use among refugee youth with common mental disorder. J Affect Disord, 294:831-837.
  • UNHCR (2024) Global Trends Reports 2023. Copenhagen, United Nations High Commissioner for Refugees.
  • WHO (2003) Adherence to Long-Term Therapies. Geneva, World Health Organization .
  • Xin H (2020) Addressing mental health stigmas among refugees: a narrative review from a socio-ecological perspective. Univers J Public Health, 8:57-64.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Psikiyatri
Bölüm Araştırma Makalesi
Yazarlar

Gül Dikeç 0000-0002-7593-4014

Emine Tekin 0009-0004-7555-9252

Hanieh Barkalinezdeh 0009-0004-4551-896X

Gönderilme Tarihi 27 Mart 2025
Kabul Tarihi 8 Ağustos 2025
Erken Görünüm Tarihi 10 Ağustos 2025
Yayımlanma Tarihi 16 Aralık 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 17 Sayı: Supplement 1

Kaynak Göster

JAMA Dikeç G, Tekin E, Barkalinezdeh H. Relationship between Internalized Stigmatization and Treatment Adherence among Syrian Refugees with Mental Disorders. Psikiyatride Güncel Yaklaşımlar. 2025;17:201–208.

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