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Complete Dissertation VU Research Portal Understanding and Treating Suicidal Ideation among Turkish Migrants Eylem, O. 2020 document version Publisher's PDF, also known as Version of record Link to publication in VU Research Portal citation for published version (APA) Eylem, O. (2020). Understanding and Treating Suicidal Ideation among Turkish Migrants: Challenges and Innovations. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. E-mail address: [email protected] Download date: 07. Oct. 2021 Özlem Eylem UNDERSTANDING AND TREATING SUICIDAL IDEATION AMONG TURKISH MIGRANTS Challenges and Innovations UNDERSTANDING AND TREATING SUICIDAL IDEATION AMONG TURKISH MIGRANTS Challenges and Innovations Özlem Eylem Colofon UNDERSTANDING AND TREATING SUICIDAL IDEATION AMONG TURKISH MIGRANTS - Challenges and Innovations by Özlem Eylem ISBN/EAN: 978-94-028-2118-5 Copyright © 2020 Özlem Eylem All rights reserved. No part of this thesis may be reproduced, stored or transmitted in any way or by any means without the prior permission of the author, or when applicable, of the publishers of the scientific papers. Cover design by Larisa Wiegant Layout and design by Birgit Vredenburg, persoonlijkproefschrift.nl Printed by Ipskamp Printing | proefschriften.net promotoren: prof.dr. A.J.F.M. Kerkhof prof.dr. A. van Straten prof.dr. K.S. Bhui copromotor: dr. L.M. de Wit Leescommissie: prof.dr. Marcus Huibers prof.dr. Marrie Bekker prof.dr. Joop de Jong prof.dr. Karien Stronks dr. Derek de Beurs dr. Fatima El Fakiri TABLE OF CONTENTS Chapter 1 General Introduction 11 Chapter 2 Stigma for Common Mental Disorders Between Racial Minorities 27 and Majorities: A Systematic Review and Meta-analysis Chapter 3 Acculturation and Suicidal Ideation Among Turkish Migrants in 63 the Netherlands Chapter 4 Canına Kıymak “Crushing Life Energy”: A Qualitative Study 87 on Lay and Professional Understandings of Suicide and Help- seeking for Suicide among Turkish Migrants in the UK and in the Netherlands Chapter 5 Attempted Suicide and Suicide of Young Turkish Women in Turkey 115 and in Europe. A systematic Literature Review of Characteristics and Precipitating Factors Chapter 6 Protocol: Reducing Suicidal Ideation Among Turksih Migrants 175 in the Netherlands and in the UK: Effectiveness of an Online Intervention Chapter 7 Reducing Suicidal Ideation among Turkish Migrants in the 197 Netherlands and in the UK:A Feasibility and Pilot RCT of an Online Intervention Chapter 8 General Discussion 235 Chapter 9 Summary 253 Samenvatting (Summary in Dutch) 259 Özet (Summary in Turkish) 265 About the author 271 Publications 275 Acknowledgements 279 References 287 Appendices 313 ¶”I had melancholy thoughts….. A strangeness in my mind, A feeling that I was not for that hour, Not for that place.” William Wordsworth, The Prelude 1 GENERAL INTRODUCTION 12 ― Chapter 1 RATIONALE AND AIMS uicide is a global public health problem with serious consequences at individual and societal levels (Bertolote & Fleischmann, 2005). The international lifetime prevalence of suicidal ideation, plans and attempts in the general population in both high income and low income countries is S9.2%, 3.1% and 2.7%, respectively (Nock et al., 2008). One of the long-standing patterns in suicide epidemiology is the ethnic variation in rates and characteristics of suicidal behaviours (Haigh, Kapur & Cooper, 2015; Bhui, McKenzie & Rasul, 2007). There is also evidence for further variation particularly when stratified by region (whether urban or rural area), age and gender (Cooper et al., 2010). Suicide risks in ethnic minorities are elevated 2-4 fold when compared to their White counterparts in the UK (Bhui, Halvorsrud & Nazroo, 2018). In Europe, there is an increased risk for suicidal behaviours among Turkish migrant populations compared with the majority populations of the host countries (Razum & Zeeb, 2004; Garssen et al., 2006; van Bergen et al., 2019). The suicide attempt risk is increased 2-5 fold among a sub-group of Turkish migrant women aged between 14 and 25 when compared with the same aged women from the majority populations of the Netherlands (Burger et al., 2006), Germany (Lizardi et al., 2006) and Switzerland (Brückner et al., 2011) respectively. These differences in suicide epidemiology point to the patterns and circumstances leading to suicidal behaviours amongst some ethnic groups which might be different to the better known circumstances and factors identified for majority populations such as history of suicide attempts (Heredia-Montesinos, 2015). It is a well-documented phenomenon that suicidal people do not receive adequate psychological treatment. A worldwide survey on the treatment of suicidal people estimated that 56% of people living in high income countries receive help compared with only 17% in low income countries. (Bruaffers et al., 2011). These findings are comparable to data on accessibility for depression treatment (44% in high income; 7% in low income countries; Thornicroft et al., 2017). Ethnic inequalities in access to mental health care General introduction ― 13 exist worldwide and continue to be a cause for concern (Bhui et al., 2018). For instance in the UK, Black (21%) and South Asian (18%) ethnic groups presenting with self-harm are less likely to receive treatment compared to White populations (33%; Cooper et al., 2010). Similarly, in the Netherlands, Turkish migrants` mental health needs are less likely to be met compared to their Dutch counterparts (Turkish: 24.6%; Dutch:9.3%) during the help seeking stage (Fassaert et al., 2009b) and this is highlighted as one of 1 the key reasons for dropping out of mental health services among Turkish migrants (Hilderink et al., 2009; O`Brien, Fahmi & Singh, 2009). Although the research from the Netherlands represent the use of psychological services in general, it is known that the underutilisation of mental health care for suicidal behaviours mirror the general trends of ethnic disparity (Sheehan et al., 2018). Thus, ethnic minorities have been identified as representing vulnerable groups and have recently been prioritised in national suicide prevention strategies in many countries (e.g. Department of Health, 2012; Han et al., 2014). A number of specific barriers in the low uptake of services have been identified such as unemployment, or transportation problems. There are also cultural barriers such as the stigma attached to seeking help, mistrust in the health care system of the host country and the cultural mismatch between the service-user and the provider (Goldston et al., 2008; Fassaert et al., 2010; Snowden & Yamada, 2005). In recent years, e-mental health has been introduced to treatment provision, as an addition, or alternative to the conventional format of face to face service delivery. Offering treatments online is less costly and also removes the transportation barrier from the help-seeking process (Arshad et al., 2019). It is relatively easy to offer treatments through personal computers, mobile phones or tablets depending on the users’ language preferences and cultural values (Eylem et al., 2015). There are several randomised controlled trials (RCTs) demonstrating the effectiveness of e-mental health in treating suicidal ideation amongst general populations (e.g. van Spijker et al., 2014; De Jaegere et al., 2019; Arshad et al., 2019). However, evidence for the effectiveness of e-mental health among ethnic minorities with suicidal behaviours is currently lacking (Mishara & Kerkhof, 2013; Caplan et al., 2018). Given the assumed 14 ― Chapter 1 advantages such as flexibility and cultural relevance, e-mental health is promising for engaging with ethnic minorities and facilitating greater access to appropriate mental health care (Eylem et al., 2015). Overall, this thesis aims to improve the availability and provision of psychological interventions in the treatment of suicidal ideation. The thesis mainly focuses on the Turkish migrant populations in Europe given the widely reported disparity between the elevated risk for suicidal behaviours and their engagement with the available services (Fassaert et al., 2009b; Ünlü İnce et al., 2014a). Further, this thesis uses an e-mental health intervention for suicidal ideation, which was developed and tested by van Spijker and colleagues for the general population in the Netherlands (van Spijker et al., 2010). Specifically, this research seeks to understand the feasibility and clinical usefulness of the culturally adapted version of this intervention in improving engagement with Turkish migrants presenting with suicidal ideation. In the current introductory chapter, definitions of the constructs used in this thesis will be clarified, background research will be outlined and the remaining chapters are presented. DEFINITIONS Historically, there has been much debate regarding
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