Turkish Adult Children as Caregivers of Parents with Alzheimer's Disease: Perceptions and Caregiving Experiences

There is substantial evidence suggesting that Western and non-Western caregivers of patients with Alzheimer's disease have different caregiving experiences depending on the cultural values they adopt. Although family-centered constructs such as familism and filial piety have taken some attention, there is still a paucity of research on how cultural values and norms shape caregiving appraisals, coping strategies, and formal service use specifically in Eastern-oriented contexts. The aim of this study was to investigate Turkish adult children caregivers' perceptions of Alzheimer's disease and caregiving experience. Researchers conducted in-depth interviews with 20 primary caregivers and analyzed data with interpretative phenomenological analysis. First, most caregivers viewed family disharmony as the main cause of the disease. Second, although burden is evident in their accounts, caregivers reported positive changes during their caregiving experiences, as well. Third, caregivers employ religious/fatalistic coping and they benefit from social support during their caregiving experiences. Forth, most caregivers opposed to nursing home placement because they view it as a morally improper act; they are afraid of neighborhood pressure; they perceive caregiving as a child's responsibility; they do not want their children to do so; and they do not trust conditions of care facilities in Turkey. Findings indicated that Eastern norms and values might have differential impacts on Alzheimer's disease caregiving outcomes. Hence, we invite mental health professionals to integrate culturally sensitive aspects into the possible intervention programs targeting Alzheimer's disease caregivers from non-Western contexts.

What Determines Posttraumatic Stress and Growth Following Various Traumatic Events? A Study in a Turkish Community Sample

This study aimed to examine the roles of personality traits, traumatic event types, coping, rumination, and social support in explaining posttraumatic stress symptoms (PTS) and posttraumatic growth (PTG) in a representative community sample of 498 Turkish adults. The results of 2 multiple regression analyses showed that PTS was associated with neuroticism, experiencing events involving intentional/assaultive violence, intrusive and deliberate rumination, and fatalistic coping. In contrast, PTG was related to conscientiousness, openness to experience, injury/shocking and sudden-death type of events, deliberate rumination, problem-solving coping, and perceived social support. When all variables were entered into the equation, almost two thirds of the variability (R² = .64) in the severity of PTS and more than one third of the variability (R² = .40) in PTG was explained. The findings can aid in the development of psychosocial support programs for individuals experiencing traumatic events.

Adaptation study of the Turkish version of the Gambling-Related Cognitions Scale (GRCS-T)

This study aimed to adapt and to test the validity and the reliability of the Turkish version of the Gambling-Related Cognitions Scale (GRCS-T) that was developed by Raylu and Oei (Addiction 99(6):757-769, 2004a). The significance of erroneous cognitions in the development and the maintenance of gambling problems, the importance of promoting gambling research in different cultures, and the limited information about the gambling individuals in Turkey due to limited gambling research interest inspired the present study. The sample consisted of 354 voluntary male participants who were above age 17 and betting on sports and horse races selected through convenience sampling in betting terminals. The results of the confirmatory factor analysis following the original scale's five factor structure indicated a good fit for the data. The analyses were carried out with 21 items due to relatively inadequate psychometric properties of two GRCS-T items. Correlational analyses and group comparison tests supported the concurrent and the criterion validity of the GRCS-T. Cronbach's alpha coefficient for the whole scale was 0.84 whereas the coefficients ranged between 0.52 and 0.78 for the subscales of GRCS-T. The findings suggesting that GRCS-T is a valid and reliable instrument to identify gambling cognitions in Turkish samples are discussed considering the possible influence of the sample make-up and cultural texture within the limitations of the present study and in the light of the relevant literature.

The reliability and validity study of the Turkish version of Two Track Model of Bereavement Questionnaire

OBJECTIVE

The aim of this study was to determine the reliability and validity of the Turkish version of the Two Track Model of Bereavement Questionnaire (TTBQ-T) (Rubin et al. 2009), a-70 items questionnaire for comprehensively evaluating the process of bereavement.

MATERIALS AND METHODS

The questionnaire was initially translated from English into Turkish, and then back translated. Subsequently, it was administered to 205 bereaved individuals that lost a significant other within the last 5 years. In order to assess the questionnaire's validity, the Beck Depression Inventory (BDI) and the Impact of Event Scale-Revised (IES-R) were also administered to the participants. The factor structure, total reliability, and test-retest reliability of the TTBQ-T were evaluated.

RESULTS

Factor analysis yielded results that were, for the most part, similar with those yielded by the original study; however, there were some cross loading items that yielded a 5-factor solution (Relational active grieving, Close and positive Relationship with the Deceased, Traumatic perception of the loss, Conflictual relationship with the deceased and Social Dysfunction). Cronbach's Alpha coefficients for these 5 factors were 0,91, 0,88, 0,82, 0,78 and 0,65 respectively. In order to determine if the responses were loaded under 2 tracks, a higher order factor analysis was conducted. The relationships between BDI and IES-R, and TTBQ-T total scores were examined in order to determine the construct validity of the TTBQ-T. The present findings indicate that TTBQ-T has construct validity.

CONCLUSIONS

The findings indicate that TTBQ-T is a reliable and valid the questionnaire for use in Turkey. The findings are discussed in the light of the literature.

Why are religious individuals more obsessional? The role of mental control beliefs and guilt in Muslims and Christians

BACKGROUND AND OBJECTIVES

The cognitive-behavioural perspective on obsessions recognizes that certain cultural experiences such as adherence to religious beliefs about the importance of maintaining strict mental control might increase the propensity for obsessional symptoms via the adoption of faulty appraisals and beliefs about the unacceptability and control of unwanted intrusive thoughts. Few studies have directly investigated this proposition, especially in a non-Western Muslim sample.

METHOD

In the present study high religious, low religious and religious school Canadian Christian and Turkish Muslim students were compared on measures of OCD symptoms, obsessive beliefs, guilt, religiosity, and negative affect.

RESULTS

Analysis revealed that religiosity had a specific relationship with obsessional but not anxious or depressive symptoms in both samples, although the highly religious Muslim students reported more compulsive symptoms than highly religious Christians. In both samples the relationship between religiosity and obsessionality was mediated by importance/control of thoughts and responsibility/threat beliefs as well as generalized guilt.

LIMITATIONS

The sample composition was limited to non-clinical undergraduates and only two major religions were considered without recognition of denominational differences.

CONCLUSIONS

These findings indicate that the tendency for highly religious Christians and Muslims to experience greater obsessionality is related to their heightened sense of personal guilt and beliefs that they are responsible for controlling unwanted, threatening intrusive thoughts.

Scrupulosity in Islam: a comparison of highly religious Turkish and Canadian samples

Scrupulosity is a form of obsessive-compulsive disorder (OCD) characterized by a tendency to have persistent doubts about God, sin, and the adequacy of one's religious behaviors and devotion. To date, no published studies have compared scrupulosity in high- and low-religious Muslim and Christian samples. In the present study religious school students as well as high- and low-religious university students in Turkey and Canada were compared on the Penn Inventory of Scrupulosity (PIOS), Obsessive Beliefs Questionnaire (OBQ-44), and symptom measures of obssesionality and negative affect. Between-group comparisons revealed that the highly religious Turkish sample scored significantly higher than the highly religious Canadian students on the PIOS Fear of God but not the Fear of Sin subscale. Separate multiple regression analyses revealed that the Clark-Beck Obsessive Compulsive Inventory (CBOCI) Obsessions subscale, OBQ-44 Importance and Control of Thoughts subscale, and guilt were significant unique predictors of PIOS scrupulosity. These findings suggest that subtle differences exist in how scrupulosity is manifested in Islamic and Christian believers.

EFPA and Work on Disaster, Crisis, and Trauma Psychology

In response to increasing concern about the effects of crises, disaster, trauma and, more recently, terrorism, EFPA established first a working party and then a Standing Committee to advise on the part psychology can play in preparing for emergencies and responding to them. The Committee has drawn together evidence and views from across Europe and the wider international scene. It has worked closely with the European Commission and has embarked on further training for members from recently acceded countries. It has recommended better ways of liaising across countries so that in the event of cross-border incidents, more efficient and effective responses can be assured. In turn this has implications for the training of psychologists and other professionals involved in emergency planning and response. Currently, there is a move to develop quality standards for such training.

How does locus of control and inflated sense of responsibility relate to obsessive-compulsive symptoms in Turkish adolescents?

This study aimed to examine the effects of responsibility attitudes, locus of control and their interactions on the general obsessive-compulsive (OC) symptomatology and the dimensions of OC symptoms in a sample of Turkish adolescents (n=385), their ages varied from 16 to 20 with a mean of 17.23 (S.D.=.68). The results of the present study revealed a significantly positive relationship between responsibility attitudes and general OC symptomatology. However, locus of control did not appear as a significant predictor of general OC symptomatology. Furthermore, results revealed that there was a significant interaction effect of responsibility attitudes with locus of control on OC symptomatology. That is, an inflated sense of responsibility and the presence of an external locus of control produced the highest level of OC symptoms. Related to the dimensions of OC symptoms, responsibility was a weak predictor of obsessive thinking symptoms, and a moderate predictor of cleanliness and checking symptoms. Locus of control and its interaction with responsibility attitudes only significantly predicted obsessional thinking symptoms.

What are the differences in decisional balance and self-efficacy between Turkish smokers in different stages of change?

This paper reports the results of an examination of decisional balance (pros and cons of smoking), and self-efficacy constructs, sociodemographic and smoking-related variables among smokers from different stages of change as proposed by the transtheoretical model. A convenience sample of 398 smokers completed the research instrument. Almost 60% of the sample were in the precontemplation stage. The results indicated that pros of smoking dropped significantly from precontemplation to contemplation and preparation but then increased again for the action stage smokers. Cons of smoking increased almost linearly from precontemplation to preparation stages and they were the highest for the action stage. Self-efficacy also increased in a linear fashion and preparation and action stages were significantly higher than the precontemplation and contemplation stages. There were also significant differences among stages of change of groups on age, years of education, and smoking duration and number of quit attempts. Results underlined the importance of finding alternatives that may substitute for the pros of smoking and interventions for changing the cognitive evaluations related to cons of smoking. Additionally, smokers may gain from approaches that focus on encouraging and reinforcing self-efficacy during the action and maintenance stages to ensure a long-term positive outcome.

[Reliability and validity studies of Turkish translation of Eysenck Personality Questionnaire Revised-Abbreviated]

OBJECTIVE

The aim of the present study was to examine the reliability and the validity of the Turkish translation of the Eysneck Personality Questionnaire Revised-abbreviated Form (EPQR-A) (Francis et al., 1992), which consists of 24 items that assess neuroticism, extraversion, psychoticism, and lying.

METHOD

The questionnaire was first translated into Turkish and then back translated. Subsequently, it was administered to 756 students from 4 different universities. The Fear Survey Inventory-III (FSI-III), Rosenberg Self-Esteem Scales (RSES), and Egna Minnen Betraffande Uppfostran (EMBU-C) were also administered in order to assess the questionnaire's validity. The internal consistency, test-retest reliability, and validity were subsequently evaluated.

RESULTS

Factor analysis, similar to the original scale, yielded 4 factors; the neuroticism, extraversion, psychoticism, and lie scales. Kuder-Richardson alpha coefficients for the extraversion, neuroticism, psychoticism, and lie scales were 0.78, 0.65, 0.42, and 0.64, respectively, and the test-retest reliability of the scales was 0.84, 0.82, 0.69, and 0.69, respectively. The relationships between EPQR-A-48, FSI-III, EMBU-C, and RSES were examined in order to evaluate the construct validity of the scale. Our findings support the construct validity of the questionnaire. To investigate gender differences in scores on the subscales, MANOVA was conducted. The results indicated that there was a gender difference only in the lie scale scores.

CONCLUSIONS

Our findings largely supported the reliability and validity of the questionnaire in a Turkish student sample. The psychometric characteristics of the Turkish version of the EPQR-A were discussed in light of the relevant literature.

What are the roles of perfectionism and responsibility in checking and cleaning compulsions?

Empirical findings revealed that an inflated sense of responsibility has a major impact on obsessive-compulsive symptomatology (OCS). Another cognitive variable, perfectionism, is also theoretically linked to OCS. The assumption about the insufficient but necessary role of perfectionism for OCS and the view of perfectionism as a manifestation of avoidance of serious consequences led us to explore the role of an important cognitive mediator (responsibility) in this relationship. The present study aimed to explore the mediational role of responsibility for the effects of perfectionism on checking and cleaning symptom profiles of OCS in a nonclinical population in Turkey. Findings of the present study suggested that responsibility appraisals mediate effects of self-oriented and socially prescribed perfectionism on checking and the effect of socially prescribed perfectionism on cleaning. There was a partial mediation for self-oriented perfectionism on cleaning. The findings are discussed within the scope of current literature and implications for clinical applications are suggested.

Personal resources, coping self-efficacy, and quake exposure as predictors of psychological distress following the 1999 earthquake in Turkey

This study examined the predictive power of personal resources (i.e., self-esteem, optimism, and perceived control), severity of earthquake experience (i.e., material and human loss and perceived threat), and coping self-efficacy (CSE) on general distress, intrusion, and avoidance symptoms among the survivors of the 1999 Marmara earthquake in Turkey. Specifically, we expected that CSE would mediate the links between personal resources, severity of earthquake experience, and distress. Survivors (N = 336) filled out various measures of earthquake exposure, personal resources, CSE, and distress. Results of the path analyses indicated that personal resources, earthquake experiences, CSE, and gender have direct effects on intrusion and general distress. Personal resources had also an indirect effect on general distress mediated by CSE. Findings were discussed considering the implications for conservation of resources model and social cognitive theory as well as for interventions following natural disasters.

Predictors of pre- and postoperative anxiety in emergency surgery patients

OBJECTIVE

Emergency surgery is a highly stressful life event. Patients experience distressing anxiety both before and after surgery and this anxiety affects their recovery process. The aim of the present study is to examine variables related to pre- and postoperative anxiety in emergency surgery patients.

METHODS

The sample consisted of 146 emergency surgery patients who had abdominal surgery in an emergency surgery clinic. The research instruments were administered before and after the surgery. State Anxiety Inventory (STAI-A State), Anxiety Specific to Surgery Questionnaire (ASSQ), a scale tapping fears and worries specific to surgery developed for the present study, Ways of Coping Inventory (WCI), and the Multidimensional Scale of Perceived Social Support (MSPSS) were administered.

DATA ANALYSIS

Data were analyzed by using the appropriate programs of the Statistical Package for the Social Sciences (SPSS).

RESULTS

There was a significant drop in anxiety from the pre- to the postoperative period. Female patients had higher preoperation anxiety than males. Females and males did not differ in anxiety at the postoperation period. Being female, waiting for primary suture for peptic ulcer perforation operation, and helplessness and self-blaming coping appeared as significant predictors of anxiety specific to surgery. Being female and awaiting for primary suture for peptic ulcer perforation were significant predictors of preoperative state anxiety. Finally, years of education were negatively and use of active coping was positively related to postoperative state anxiety.

CONCLUSION

Patient sociodemographic and psychological characteristics and type of surgery need to be considered for identifying patients at risk of experiencing anxiety both before and after surgery and psychological support and clinical management needs to be tailored to the needs of the patients to alleviate their anxiety.

Predictors of components of expressed emotion in major caregivers of Turkish patients with schizophrenia

BACKGROUND

Expressed emotion (EE) is a concept reflecting the emotional atmosphere of the home environment. Specific components of EE, namely criticism, hostility and emotional over-involvement, have been found to be important predictors of relapse for schizophrenic patients. The main aim of this study was to examine the predictive power of patient and caregiver characteristics and caregivers' perceptions of frequency, coping, distress/discomfort, control of symptom behaviours by the patient, and attributions on locus of causality for the development of the illness on two components of EE (criticism/hostility and emotional over-involvement) in a sample of major caregivers of Turkish schizophrenic patients.

METHODS

Seventy-two caregivers of schizophrenic patients were administered a set of questionnaires tapping socio-demographic and illness-related variables, the family questionnaire tapping perceived frequency, distress/discomfort, coping and control of symptom behaviours, causal attributions for illness and, finally, the Expressed Emotion Scale in the hospital setting.

RESULTS

The results showed that caregivers' perceptions of coping with specific symptom behaviours decreased criticism/hostility (C/H), whereas perceptions of higher frequency of symptom behaviours increased C/H. For emotional over-involvement (EOI), the number of individuals living in the household, being the mother, father or the spouse, perceptions of coping with symptom behaviours and reported distress/discomfort about symptom behaviours were significant predictors.

CONCLUSIONS

Caregivers' perceptions of their ability to cope with symptom behaviours and their reported distress due to these behaviours are important variables related to components of EE and need to be targets in intervention studies. The cultural and clinical implications of the results for the management of schizophrenia and for support for the caregivers are discussed.

Caregivers of Turkish schizophrenic patients: causal attributions, burdens and attitudes to help from the health professionals

The purpose of this study was to examine the causal attributions, difficulties, perceived and expected help behaviour of health care professionals, and hope for the future well-being of the caregivers of Turkish schizophrenic patients in order to form guidelines for forming a collaboration with the families of schizophrenic patients. Sixty caregivers were interviewed by using a semi-structured interview schedule. The responses of the caregivers were categorized within the guidelines of the literature in this area. The caregivers attributed schizophrenia mainly to psychosocial causes, namely stressful events (50%), family conflicts (40%) and patients' characteristics (28%). The most frequently reported difficulties were family conflicts and disruptions of family life, subjective burden (48%), and financial costs due to the patient (27%). The number of difficulties reported by caregivers was related to the duration of the patient's illness. Caregivers perceived pharmacological treatment (42%), interest and support given to the caregiver (28%), and the hospitalization of the patient (20%) as helpful. THeir expectations of help were in similar areas. About half of the caregivers were optimistic about the future well-being of their relatives. Optimistic and pessimistic caregivers differed in the educational level of the caregiver and the duration of the patient's illness. The results suggested that the families of schizophrenics need support of professionals and the establishment of networks focusing on the caregivers and their relationships with their ill relatives and with health care institutions.

Psychological consequences of the 1992 Erzincan (Turkey) earthquake

The long-term psychological after-effects of the 1992 Erzincan earthquake are examined. 461 subjects from Erzincan were administered a semi-structured interview. Emotional distress was measured by a symptom checklist containing 40 items. 129 subjects from Ankara, the capital of Turkey, were also used as a comparison sample. The factor analysis revealed that distress symptoms can be grouped into phobic anxiety, somatization, depression and hostility. The comparison of the Erzincan and Ankara samples showed that the Erzincan sample had higher phobic anxiety scores, the females from Erzincan had higher distress as compared to the males from Erzincan and to both males and females from Ankara. Regression analyses showed that being female and evaluating one's home as insecure against future earthquakes were related to elevated levels of distress. Results showed that, even after sixteen months, Erzincan residents had higher phobic anxiety and that females seemed to be especially vulnerable to distress. Implications of the results for psychosocial intervention are discussed.

Causal attributions for illness among Turkish psychiatric out-patients and differences between diagnostic groups

Causal attributions of 152 Turkish non-psychotic psychiatric out-patients for the development of their psychological problems were examined by using a 31-item attributions for psychological problems questionnaire (APP). The factor analysis of the responses to the APP yielded seven factors, which were: attributions to conflicts within the family of origin and with the present family, attributions to personal-characterological and behavioural attributes, work problems, interpersonal conflicts and bad luck. Examination of the causal attributions of patients from three DSM-III-R diagnostic groups revealed no significant differences between diagnostic groups. The highest attributional scores were for conflicts with the present family and personal-characterological attributes.