Effects of Occupational Therapy Workshops on Functionality and Psychiatric Symptoms in Syrian Patients Receiving Community Mental Health Services

Effects of Occupational Therapy Workshops on Functionality and Psychiatric Symptoms in Syrian Patients Receiving Community Mental Health Services | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of Occupational Therapy Workshops on Functionality and Psychiatric Symptoms in Syrian Patients Receiving Community Mental Health Services Hatice Şahin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8508332/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Impairments in functionality and social participation are common among individuals with severe mental disorders, particularly within refugee populations. Community-based psychosocial interventions may play a crucial role in improving both psychiatric symptoms and daily functioning. Methods : This controlled, prospective study was conducted at a Community Mental Health Center in Turkey. Syrian patients under temporary protection who participated in occupational therapy workshops (experimental group) were compared with a control group receiving routine care only. Functionality (Brief Functionality Assessment Scale – BFAS), depression (Beck Depression Inventory – BDI), anxiety (Beck Anxiety Inventory – BAI), and psychotic symptom severity (Positive and Negative Syndrome Scale – PANSS) were assessed at baseline and at 6-month follow-up. Results : At baseline, no significant differences were observed between the groups. In the experimental group, significant improvements were observed in functionality, depression, anxiety, and psychotic symptoms at 6 months (p < 0.001 for BFAS, BDI, and BAI; p = 0.018 for PANSS), whereas no significant changes were observed in the control group. At the 6-month assessment, the experimental group demonstrated significantly better outcomes compared to the control group. Conclusions : Occupational therapy workshops integrated into community mental health services are associated with significant improvements in functionality and psychiatric symptoms among Syrian patients, highlighting the importance of structured psychosocial interventions for vulnerable populations. INTRODUCTION In individuals with mental disorders, not only clinical symptoms but also the impact of these symptoms on daily life and social roles constitute fundamental determinants of disease course. Loss of social functioning, inadequacies in self-care skills, and social isolation are common problems, particularly in chronic mental disorders (1,2). Unemployment and social exclusion may further deepen this functional impairment, leading to exacerbation of psychiatric symptoms and reduced adherence to treatment (3). Occupational therapy is a holistic psychosocial intervention approach aimed at enabling individuals to regain daily living skills through meaningful and structured activities. The literature has demonstrated that occupational therapy has positive effects on social skills, executive functions, vocational performance, and quality of life (4–6). Importantly, these interventions have been shown to improve functional outcomes independently of reductions in symptom severity (2,5). In Turkey, Community Mental Health Centers were established within the scope of the European Union–funded SIHHAT Project to strengthen community-based mental health services. These centers aim to reduce functional impairment and enhance social integration, particularly among refugees and individuals under temporary protection, in addition to alleviating psychiatric symptoms (12–14). Bursa Hürriyet Community Mental Health Center has been providing community-based mental health services to Syrian refugee patients since 2018. The present study aims to evaluate changes in psychiatric symptoms and functionality among patients under temporary protection who participated in occupational therapy workshops conducted at Bursa Hürriyet Community Mental Health Center. Accordingly, baseline and six-month follow-up assessments of patients participating in occupational therapy (experimental group) were compared with those of a control group not participating in these workshops, in order to statistically determine changes in depression, anxiety, psychotic symptom severity, and overall functionality. METHODS Study Design and Setting This study is a quasi-experimental, controlled, prospective follow-up study conducted at the Bursa Hürriyet Community Mental Health Center (CMHC). The study is based on comparing baseline (month 0) and 6-month measurements of patients who participated in occupational therapy workshops with those who did not participate. The research aims to evaluate the effects of psychosocial interventions provided within community-based mental health services on psychiatric symptoms and functionality. The sample size was determined based on the available population during the study period. Participants Patients followed at Bursa Hürriyet CMHC who were under temporary protection and diagnosed with a mental disorder were included in the study. Inclusion criteria were defined as follows: Age between 18 and 65 years, Being under follow-up at the CMHC with a diagnosis of at least one chronic mental disorder, Completion of baseline assessments, Ability to participate in the 6-month follow-up period. Exclusion criteria included acute psychotic exacerbation, severe cognitive impairment, or clinical conditions that prevented completion of the assessment scales. Participants were divided into two groups: those who regularly attended occupational therapy workshops (experimental group) and those who did not attend (control group). Both groups continued to receive routine psychiatric follow-up and pharmacological treatment throughout the study period. Intervention: Occupational Therapy Workshops Patients in the experimental group participated in structured occupational therapy workshops conducted within the CMHC over a six-month period. The workshops included: Activities aimed at supporting activities of daily living, Group activities focused on social skills and communication, Handcrafts, productive occupations, and structured group work. These interventions were designed to enhance patients’ social functioning, self-care skills, and level of community participation. Patients in the control group did not participate in occupational therapy workshops during this period and were followed under routine clinical care only. Measures All participants in both the experimental and control groups were assessed at baseline (month 0) and at 6 months using the following instruments: Brief Functionality Assessment Scale (BFAS): used to evaluate overall functioning, Beck Depression Inventory (BDI): applied to assess the severity of depressive symptoms, Beck Anxiety Inventory (BAI): used to measure the severity of anxiety symptoms, Positive and Negative Syndrome Scale (PANSS): used to assess the severity of psychotic symptoms. These scales enabled quantitative evaluation of changes in psychiatric symptoms as well as overall functionality. Statistical Analysis Statistical analyses were performed using SPSS software. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. All tests were two-tailed, and the level of statistical significance was set at p < 0.05. Differences in baseline (month 0) sociodemographic and clinical characteristics, as well as scale scores between the experimental and control groups, were analyzed using independent samples t-tests to assess baseline comparability (Table 1). To evaluate within-group changes over time, baseline (month 0) and 6-month measurements were analyzed separately for the experimental and control groups using paired samples t-tests. These analyses were conducted to determine the effect of participation in occupational therapy workshops in the experimental group and the natural course of outcomes in the control group (Tables 2 and 3). To assess the effect of the intervention, scale scores of the experimental and control groups at 6 months were compared using independent samples t-tests. This analysis aimed to statistically evaluate the effects of workshop-based occupational therapy on depression, anxiety, psychotic symptom severity, and functionality in comparison with the control group (Table 4). ANCOVA was not performed due to the absence of significant baseline differences. Ethical Considerations The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants, and data were evaluated in accordance with confidentiality principles. RESULTS At baseline (month 0), no statistically significant differences were observed between the experimental and control groups with regard to age, gender, educational level, or antipsychotic medication use. Similarly, there were no significant differences between the groups in terms of BFAS, BDI, BAI, or PANSS scores, indicating that the groups were comparable at baseline (Table 1). Table 1 here In the experimental group, a marked and statistically significant improvement was observed in BFAS scores, reflecting overall functionality, following regular participation in occupational therapy workshops over a six-month period (p < 0.001). During the same period, significant reductions were also observed in BDI scores assessing depressive symptoms and BAI scores measuring anxiety symptoms (both p < 0.001). In addition, a statistically significant decrease was detected in PANSS total scores, indicating reduced psychotic symptom severity (p = 0.018) (Table 2). Table 2 here In the control group, no statistically significant changes were observed in BFAS, BDI, BAI, or PANSS scores when baseline and 6-month measurements were compared (Table 3). This finding indicates the absence of a notable natural improvement in psychiatric symptoms or functionality in the control group. Table 3 here In the between-group comparison conducted at the 6-month follow-up, BFAS, BDI, and BAI scores were found to be significantly lower in the experimental group compared with the control group (all p < 0.001). PANSS total scores were also significantly lower in the experimental group than in the control group (p = 0.008) (Table 4). These results demonstrate that participation in occupational therapy workshops had a positive effect on both psychiatric symptom severity and overall functionality. Table 4 here DISCUSSION In this study, the effects of occupational therapy workshops conducted within a Community Mental Health Center (CMHC) on both psychiatric symptoms and functionality were evaluated among individuals under temporary protection with mental disorders. The findings indicate that patients who participated in occupational therapy experienced significant reductions in depressive and anxiety symptoms, accompanied by a meaningful improvement in overall functionality. The significant decrease observed in BFAS scores is consistent with the literature emphasizing that functionality should be considered a core outcome measure beyond symptom severity in the assessment of mental disorders (1,2). Previous studies have reported that even when partial symptom improvement is achieved, clinical recovery remains limited in the absence of functional gains (2,3). The significant reductions observed in BDI and BAI scores in the experimental group suggest that participation in structured and meaningful occupations exerts a regulatory effect on mood and anxiety symptoms. Social interaction, establishment of daily routines, and the sense of productivity facilitated through occupational therapy have been shown to reduce depressive withdrawal and anxiety-related avoidance behaviors in previous studies (4–6). The more modest yet statistically significant improvement observed in PANSS total scores suggests that occupational therapy plays a supportive and complementary role in the management of psychotic symptoms rather than exerting a direct therapeutic effect. This finding is consistent with previous research highlighting the adjunctive nature of psychosocial interventions alongside pharmacological treatment within community-based mental health services (14,15). The absence of significant changes across all measures in the control group supports the interpretation that the improvements observed in the experimental group were associated with the occupational therapy intervention rather than the natural course of illness. These results align with the literature emphasizing that community-based, functionality-oriented interventions should constitute a fundamental component of mental health services, particularly in refugee populations (11–13). Overall, this study demonstrates that occupational therapy workshops conducted within CMHCs not only reduce depressive, anxiety, and psychotic symptom severity among individuals under temporary protection but also lead to significant improvements in functional outcomes (1,2). The findings support the notion that structured psychosocial interventions should be considered an indispensable component of community-based mental health services, especially for vulnerable and disadvantaged populations (12–14). These findings have direct implications for routine community mental health practice, particularly in services addressing refugee populations. Limitations This study has several limitations. First, the relatively small sample size may limit the generalizability of the findings. In addition, the single-center design restricts the applicability of the results to patients followed at Bursa Hürriyet CMHC under temporary protection, necessitating caution when generalizing to CMHC populations with different sociocultural characteristics. Second, the study employed a quasi-experimental design without randomization. Although no significant baseline differences were observed between the experimental and control groups, the influence of unmeasured confounding variables—such as levels of social support, individual motivation, or intensity of workshop participation—cannot be entirely excluded. Furthermore, although functionality was assessed using the BFAS, additional instruments evaluating different dimensions of functionality—such as occupational functioning, social role performance, and independent living skills—were not included. Similarly, reliance on self-report scales and the absence of observer-rated functional assessments constitute additional limitations. Finally, the follow-up period was limited to six months, restricting the ability to draw conclusions regarding the long-term effects of occupational therapy. Longer follow-up studies are needed to evaluate the sustainability of the observed improvements. Clinical Implications The findings of this study indicate that occupational therapy workshops implemented within CMHCs not only reduce symptom severity in individuals with mental disorders but also produce clinically meaningful improvements in functionality. The marked reduction in BFAS scores suggests that workshop-based interventions have substantial effects on patients’ daily living skills, self-care capacity, and level of community participation. The significant improvements observed in BDI and BAI scores demonstrate the supportive role of occupational therapy in alleviating depressive and anxiety symptoms. This underscores the complementary nature of psychosocial interventions to pharmacological treatments and highlights the importance of holistic treatment approaches within CMHCs. The more limited yet significant improvement in PANSS scores suggests that occupational therapy provides an indirect and supportive benefit in the management of psychotic symptoms. When considered alongside concurrent improvements in mood and functionality, this reduction in psychotic symptom severity may be regarded as clinically meaningful. In light of these findings, and considering the high prevalence of social isolation and functional impairment among refugee populations, it may be recommended that occupational therapy workshops be incorporated as a standard component of CMHC services. Structured and sustainable psychosocial interventions have the potential to enhance social integration and may reduce long-term healthcare utilization by improving overall functional outcomes. Declarations Ethics statement: This study was reviewed by the SBU Dr. Abdurrahman Yurtaslan Ankara Oncology SUAM Non-Interventional Clinical Research Ethics Committee. As the study was a retrospective analysis of anonymized data obtained during routine clinical service delivery, the ethics committee determined that formal ethical approval was not required. The requirement for written informed consent from participants was also waived by the ethics committee due to the retrospective nature of the study and the absence of identifiable personal data. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethics committee meeting date: 30 November 2023 File number: 2023-11/119 Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Clinical Trial Registration Clinical trial number: not applicable. References World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva: WHO; 2001. Harvey PD, Bellack AS.Toward a terminology for functional recovery in schizophrenia: Is functional remission a viable concept? Schizophrenia Bulletin. 2009;35(2):300–306. Burns T, Patrick D.Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatrica Scandinavica. 2007;116(6):403–418. Lloyd C, Williams PL.Occupational therapy in mental health: Considering occupational justice. British Journal of Occupational Therapy. 2010;73(6):251–259. Eklund M, Argentzell E.Perception of occupational balance and life satisfaction in mental health service users. Scandinavian Journal of Occupational Therapy. 2016;23(5):348–356. Arbesman M, Logsdon DW.Occupational therapy interventions for employment and education for adults with serious mental illness. American Journal of Occupational Therapy. 2011;65(3):238–246. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996. Beck AT, Epstein N, Brown G, Steer RA.An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology. 1988;56(6):893–897. Kay SR, Fiszbein A, Opler LA.The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin. 1987;13(2):261–276. Üstün TB, Kostanjsek N, Chatterji S, Rehm J (eds.). Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0). Geneva: WHO; 2010. Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement. JAMA. 2009;302(5):537–549. Silove D, Ventevogel P, Rees S.The contemporary refugee crisis: An overview of mental health challenges. World Psychiatry. 2017;16(2):130–139. Priebe S, Giacco D, El-Nagib R. Public health aspects of mental health among migrants and refugees. Copenhagen: WHO Europe; 2016. Thornicroft G, Tansella M.The balanced care model for global mental health. Psychological Medicine. 2013;43(4):849–863. Drake RE, Whitley R.Recovery and severe mental illness: Description and analysis. Canadian Journal of Psychiatry. 2014;59(5):236–242. Tables Table 1. Baseline (0. Ay) Sociodemographic and Clinical Characteristics of the Study Groups Değişken Deney Grubu (n = 30) Kontrol Grubu (n = 30) p Yaş (yıl), Ort ± SS 28.9 ± 3.4 29.1 ± 3.6 >0.05ᵃ Cinsiyet (E / K), n 17 / 13 16 / 14 >0.05ᵇ Eğitim düzeyi (≥ lise), n (%) 22 (73%) 21 (70%) >0.05ᵇ Antipsikotik kullanımı, n (%) ᵇ └ Atipik 20 (67%) 19 (63%) >0.05 └ Tipik 10 (33%) 11 (37%) >0.05 KİDÖ , Ort ± SS 53.5 ± 6.8 52.8 ± 6.6 0.674ᵃ BDÖ , Ort ± SS 46.9 ± 5.9 46.3 ± 5.8 0.706ᵃ BAÖ , Ort ± SS 43.4 ± 6.2 43.1 ± 6.1 0.832ᵃ PANSS (Toplam) , Ort ± SS 101.2 ± 8.4 100.7 ± 8.3 0.819ᵃ ᵃ Independent samples t-test ᵇ Chi-square test All statistical tests were two-tailed. Table 2. Experimental Group: Comparison of Scale Scores Between Baseline and 6 Months (Paired samples t-test) Ölçek 0. Ay (Ort ± SS) 6. Ay (Ort ± SS) p KİDÖ 53.5 ± 6.8 36.4 ± 5.1 <0.001 BDÖ 46.9 ± 5.9 30.2 ± 4.8 <0.001 BAÖ 43.4 ± 6.2 29.7 ± 4.9 <0.001 PANSS (Toplam) 101.2 ± 8.4 94.6 ± 7.9 0.018 Paired samples t-test, two-tailed. Table 3. Control Group: Comparison of Scale Scores Between Baseline and 6 Months (Paired samples t-test) Ölçek 0. Ay (Ort ± SS) 6. Ay (Ort ± SS) p KİDÖ 52.8 ± 6.6 51.9 ± 6.5 0.356 BDÖ 46.3 ± 5.8 45.8 ± 5.7 0.482 BAÖ 43.1 ± 6.1 42.7 ± 6.0 0.561 PANSS (Toplam) 100.7 ± 8.3 100.1 ± 8.1 0.412 Paired samples t-test, two-tailed. Table 4. Comparison of Experimental and Control Groups at 6 Months (Independent samples t-test) Ölçek Deney Grubu (Ort ± SS) Kontrol Grubu (Ort ± SS) p KİDÖ 36.4 ± 5.1 51.9 ± 6.5 <0.001 BDÖ 30.2 ± 4.8 45.8 ± 5.7 <0.001 BAÖ 29.7 ± 4.9 42.7 ± 6.0 <0.001 PANSS (Toplam) 94.6 ± 7.9 100.1 ± 8.1 0.008 Independent samples t-test, two-tailed. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Loss of social functioning, inadequacies in self-care skills, and social isolation are common problems, particularly in chronic mental disorders (1,2). Unemployment and social exclusion may further deepen this functional impairment, leading to exacerbation of psychiatric symptoms and reduced adherence to treatment (3).\u003c/p\u003e\n\u003cp\u003eOccupational therapy is a holistic psychosocial intervention approach aimed at enabling individuals to regain daily living skills through meaningful and structured activities. The literature has demonstrated that occupational therapy has positive effects on social skills, executive functions, vocational performance, and quality of life (4\u0026ndash;6). Importantly, these interventions have been shown to improve functional outcomes independently of reductions in symptom severity (2,5).\u003c/p\u003e\n\u003cp\u003eIn Turkey, Community Mental Health Centers were established within the scope of the European Union\u0026ndash;funded SIHHAT Project to strengthen community-based mental health services. These centers aim to reduce functional impairment and enhance social integration, particularly among refugees and individuals under temporary protection, in addition to alleviating psychiatric symptoms (12\u0026ndash;14). Bursa H\u0026uuml;rriyet Community Mental Health Center has been providing community-based mental health services to Syrian refugee patients since 2018.\u003c/p\u003e\n\u003cp\u003eThe present study aims to evaluate changes in psychiatric symptoms and functionality among patients under temporary protection who participated in occupational therapy workshops conducted at Bursa H\u0026uuml;rriyet Community Mental Health Center. Accordingly, baseline and six-month follow-up assessments of patients participating in occupational therapy (experimental group) were compared with those of a control group not participating in these workshops, in order to statistically determine changes in depression, anxiety, psychotic symptom severity, and overall functionality.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eStudy Design and Setting\u003c/p\u003e\n\u003cp\u003eThis study is a quasi-experimental, controlled, prospective follow-up study conducted at the Bursa H\u0026uuml;rriyet Community Mental Health Center (CMHC). The study is based on comparing baseline (month 0) and 6-month measurements of patients who participated in occupational therapy workshops with those who did not participate. The research aims to evaluate the effects of psychosocial interventions provided within community-based mental health services on psychiatric symptoms and functionality. The sample size was determined based on the available population during the study period.\u003c/p\u003e\n\u003cp\u003eParticipants\u003c/p\u003e\n\u003cp\u003ePatients followed at Bursa H\u0026uuml;rriyet CMHC who were under temporary protection and diagnosed with a mental disorder were included in the study. Inclusion criteria were defined as follows:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eAge between 18 and 65 years,\u003c/li\u003e\n \u003cli\u003eBeing under follow-up at the CMHC with a diagnosis of at least one chronic mental disorder,\u003c/li\u003e\n \u003cli\u003eCompletion of baseline assessments,\u003c/li\u003e\n \u003cli\u003eAbility to participate in the 6-month follow-up period.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eExclusion criteria included acute psychotic exacerbation, severe cognitive impairment, or clinical conditions that prevented completion of the assessment scales.\u003c/p\u003e\n\u003cp\u003eParticipants were divided into two groups: those who regularly attended occupational therapy workshops (experimental group) and those who did not attend (control group). Both groups continued to receive routine psychiatric follow-up and pharmacological treatment throughout the study period.\u003c/p\u003e\n\u003cp\u003eIntervention: Occupational Therapy Workshops\u003c/p\u003e\n\u003cp\u003ePatients in the experimental group participated in structured occupational therapy workshops conducted within the CMHC over a six-month period. The workshops included:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eActivities aimed at supporting activities of daily living,\u003c/li\u003e\n \u003cli\u003eGroup activities focused on social skills and communication,\u003c/li\u003e\n \u003cli\u003eHandcrafts, productive occupations, and structured group work.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThese interventions were designed to enhance patients\u0026rsquo; social functioning, self-care skills, and level of community participation. Patients in the control group did not participate in occupational therapy workshops during this period and were followed under routine clinical care only.\u003c/p\u003e\n\u003cp\u003eMeasures\u003c/p\u003e\n\u003cp\u003eAll participants in both the experimental and control groups were assessed at baseline (month 0) and at 6 months using the following instruments:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eBrief Functionality Assessment Scale (BFAS): used to evaluate overall functioning,\u003c/li\u003e\n \u003cli\u003eBeck Depression Inventory (BDI): applied to assess the severity of depressive symptoms,\u003c/li\u003e\n \u003cli\u003eBeck Anxiety Inventory (BAI): used to measure the severity of anxiety symptoms,\u003c/li\u003e\n \u003cli\u003ePositive and Negative Syndrome Scale (PANSS): used to assess the severity of psychotic symptoms.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThese scales enabled quantitative evaluation of changes in psychiatric symptoms as well as overall functionality.\u003c/p\u003e\n\u003cp\u003eStatistical Analysis\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using SPSS software. Continuous variables were expressed as mean \u0026plusmn; standard deviation, while categorical variables were presented as frequencies and percentages. All tests were two-tailed, and the level of statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003eDifferences in baseline (month 0) sociodemographic and clinical characteristics, as well as scale scores between the experimental and control groups, were analyzed using independent samples t-tests to assess baseline comparability (Table 1).\u003c/p\u003e\n\u003cp\u003eTo evaluate within-group changes over time, baseline (month 0) and 6-month measurements were analyzed separately for the experimental and control groups using paired samples t-tests. These analyses were conducted to determine the effect of participation in occupational therapy workshops in the experimental group and the natural course of outcomes in the control group (Tables 2 and 3).\u003c/p\u003e\n\u003cp\u003eTo assess the effect of the intervention, scale scores of the experimental and control groups at 6 months were compared using independent samples t-tests. This analysis aimed to statistically evaluate the effects of workshop-based occupational therapy on depression, anxiety, psychotic symptom severity, and functionality in comparison with the control group (Table 4).\u003c/p\u003e\n\u003cp\u003eANCOVA was not performed due to the absence of significant baseline differences.\u003c/p\u003e\n\u003cp\u003eEthical Considerations\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants, and data were evaluated in accordance with confidentiality principles.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAt baseline (month 0), no statistically significant differences were observed between the experimental and control groups with regard to age, gender, educational level, or antipsychotic medication use. Similarly, there were no significant differences between the groups in terms of BFAS, BDI, BAI, or PANSS scores, indicating that the groups were comparable at baseline (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1 here\u003c/p\u003e\n\u003cp\u003eIn the experimental group, a marked and statistically significant improvement was observed in BFAS scores, reflecting overall functionality, following regular participation in occupational therapy workshops over a six-month period (p \u0026lt; 0.001). During the same period, significant reductions were also observed in BDI scores assessing depressive symptoms and BAI scores measuring anxiety symptoms (both p \u0026lt; 0.001). In addition, a statistically significant decrease was detected in PANSS total scores, indicating reduced psychotic symptom severity (p = 0.018) (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2 here\u003c/p\u003e\n\u003cp\u003eIn the control group, no statistically significant changes were observed in BFAS, BDI, BAI, or PANSS scores when baseline and 6-month measurements were compared (Table 3). This finding indicates the absence of a notable natural improvement in psychiatric symptoms or functionality in the control group.\u003c/p\u003e\n\u003cp\u003eTable 3 here\u003c/p\u003e\n\u003cp\u003eIn the between-group comparison conducted at the 6-month follow-up, BFAS, BDI, and BAI scores were found to be significantly lower in the experimental group compared with the control group (all p \u0026lt; 0.001). PANSS total scores were also significantly lower in the experimental group than in the control group (p = 0.008) (Table 4). These results demonstrate that participation in occupational therapy workshops had a positive effect on both psychiatric symptom severity and overall functionality.\u003c/p\u003e\n\u003cp\u003eTable 4 here\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, the effects of occupational therapy workshops conducted within a Community Mental Health Center (CMHC) on both psychiatric symptoms and functionality were evaluated among individuals under temporary protection with mental disorders. The findings indicate that patients who participated in occupational therapy experienced significant reductions in depressive and anxiety symptoms, accompanied by a meaningful improvement in overall functionality.\u003c/p\u003e\n\u003cp\u003eThe significant decrease observed in BFAS scores is consistent with the literature emphasizing that functionality should be considered a core outcome measure beyond symptom severity in the assessment of mental disorders (1,2). Previous studies have reported that even when partial symptom improvement is achieved, clinical recovery remains limited in the absence of functional gains (2,3).\u003c/p\u003e\n\u003cp\u003eThe significant reductions observed in BDI and BAI scores in the experimental group suggest that participation in structured and meaningful occupations exerts a regulatory effect on mood and anxiety symptoms. Social interaction, establishment of daily routines, and the sense of productivity facilitated through occupational therapy have been shown to reduce depressive withdrawal and anxiety-related avoidance behaviors in previous studies (4\u0026ndash;6).\u003c/p\u003e\n\u003cp\u003eThe more modest yet statistically significant improvement observed in PANSS total scores suggests that occupational therapy plays a supportive and complementary role in the management of psychotic symptoms rather than exerting a direct therapeutic effect. This finding is consistent with previous research highlighting the adjunctive nature of psychosocial interventions alongside pharmacological treatment within community-based mental health services (14,15).\u003c/p\u003e\n\u003cp\u003eThe absence of significant changes across all measures in the control group supports the interpretation that the improvements observed in the experimental group were associated with the occupational therapy intervention rather than the natural course of illness. These results align with the literature emphasizing that community-based, functionality-oriented interventions should constitute a fundamental component of mental health services, particularly in refugee populations (11\u0026ndash;13).\u003c/p\u003e\n\u003cp\u003eOverall, this study demonstrates that occupational therapy workshops conducted within CMHCs not only reduce depressive, anxiety, and psychotic symptom severity among individuals under temporary protection but also lead to significant improvements in functional outcomes (1,2). The findings support the notion that structured psychosocial interventions should be considered an indispensable component of community-based mental health services, especially for vulnerable and disadvantaged populations (12\u0026ndash;14).\u003c/p\u003e\n\u003cp\u003eThese findings have direct implications for routine community mental health practice, particularly in services addressing refugee populations.\u003c/p\u003e\n\u003cp\u003eLimitations\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, the relatively small sample size may limit the generalizability of the findings. In addition, the single-center design restricts the applicability of the results to patients followed at Bursa H\u0026uuml;rriyet CMHC under temporary protection, necessitating caution when generalizing to CMHC populations with different sociocultural characteristics.\u003c/p\u003e\n\u003cp\u003eSecond, the study employed a quasi-experimental design without randomization. Although no significant baseline differences were observed between the experimental and control groups, the influence of unmeasured confounding variables\u0026mdash;such as levels of social support, individual motivation, or intensity of workshop participation\u0026mdash;cannot be entirely excluded.\u003c/p\u003e\n\u003cp\u003eFurthermore, although functionality was assessed using the BFAS, additional instruments evaluating different dimensions of functionality\u0026mdash;such as occupational functioning, social role performance, and independent living skills\u0026mdash;were not included. Similarly, reliance on self-report scales and the absence of observer-rated functional assessments constitute additional limitations.\u003c/p\u003e\n\u003cp\u003eFinally, the follow-up period was limited to six months, restricting the ability to draw conclusions regarding the long-term effects of occupational therapy. Longer follow-up studies are needed to evaluate the sustainability of the observed improvements.\u003c/p\u003e\n\u003cp\u003eClinical Implications\u003c/p\u003e\n\u003cp\u003eThe findings of this study indicate that occupational therapy workshops implemented within CMHCs not only reduce symptom severity in individuals with mental disorders but also produce clinically meaningful improvements in functionality. The marked reduction in BFAS scores suggests that workshop-based interventions have substantial effects on patients\u0026rsquo; daily living skills, self-care capacity, and level of community participation.\u003c/p\u003e\n\u003cp\u003eThe significant improvements observed in BDI and BAI scores demonstrate the supportive role of occupational therapy in alleviating depressive and anxiety symptoms. This underscores the complementary nature of psychosocial interventions to pharmacological treatments and highlights the importance of holistic treatment approaches within CMHCs.\u003c/p\u003e\n\u003cp\u003eThe more limited yet significant improvement in PANSS scores suggests that occupational therapy provides an indirect and supportive benefit in the management of psychotic symptoms. When considered alongside concurrent improvements in mood and functionality, this reduction in psychotic symptom severity may be regarded as clinically meaningful.\u003c/p\u003e\n\u003cp\u003eIn light of these findings, and considering the high prevalence of social isolation and functional impairment among refugee populations, it may be recommended that occupational therapy workshops be incorporated as a standard component of CMHC services. Structured and sustainable psychosocial interventions have the potential to enhance social integration and may reduce long-term healthcare utilization by improving overall functional outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003e\u003cstrong\u003eEthics statement:\u003c/strong\u003e This study was reviewed by the SBU Dr. Abdurrahman Yurtaslan Ankara Oncology SUAM Non-Interventional Clinical Research Ethics Committee. As the study was a retrospective analysis of anonymized data obtained during routine clinical service delivery, the ethics committee determined that formal ethical approval was not required. The requirement for written informed consent from participants was also waived by the ethics committee due to the retrospective nature of the study and the absence of identifiable personal data. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethics committee meeting date: 30 November 2023 File number: 2023-11/119\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eWorld Health Organization.\u003cem\u003eInternational Classification of Functioning, Disability and Health (ICF).\u003c/em\u003e Geneva: WHO; 2001.\u003c/li\u003e\n \u003cli\u003eHarvey PD, Bellack AS.Toward a terminology for functional recovery in schizophrenia: Is functional remission a viable concept?\u003cem\u003eSchizophrenia Bulletin.\u003c/em\u003e 2009;35(2):300\u0026ndash;306.\u003c/li\u003e\n \u003cli\u003eBurns T, Patrick D.Social functioning as an outcome measure in schizophrenia studies.\u003cbr\u003e\u003cem\u003eActa Psychiatrica Scandinavica.\u003c/em\u003e 2007;116(6):403\u0026ndash;418.\u003c/li\u003e\n \u003cli\u003eLloyd C, Williams PL.Occupational therapy in mental health: Considering occupational justice.\u003cem\u003eBritish Journal of Occupational Therapy.\u003c/em\u003e 2010;73(6):251\u0026ndash;259.\u003c/li\u003e\n \u003cli\u003eEklund M, Argentzell E.Perception of occupational balance and life satisfaction in mental health service users.\u003cem\u003eScandinavian Journal of Occupational Therapy.\u003c/em\u003e 2016;23(5):348\u0026ndash;356.\u003c/li\u003e\n \u003cli\u003eArbesman M, Logsdon DW.Occupational therapy interventions for employment and education for adults with serious mental illness.\u003cem\u003eAmerican Journal of Occupational Therapy.\u003c/em\u003e 2011;65(3):238\u0026ndash;246.\u003c/li\u003e\n \u003cli\u003eBeck AT, Steer RA, Brown GK.\u003cem\u003eManual for the Beck Depression Inventory-II.\u003c/em\u003e San Antonio, TX: Psychological Corporation; 1996.\u003c/li\u003e\n \u003cli\u003eBeck AT, Epstein N, Brown G, Steer RA.An inventory for measuring clinical anxiety: Psychometric properties.\u003cem\u003eJournal of Consulting and Clinical Psychology.\u003c/em\u003e 1988;56(6):893\u0026ndash;897.\u003c/li\u003e\n \u003cli\u003eKay SR, Fiszbein A, Opler LA.The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.\u003cem\u003eSchizophrenia Bulletin.\u003c/em\u003e 1987;13(2):261\u0026ndash;276.\u003c/li\u003e\n \u003cli\u003e\u0026Uuml;st\u0026uuml;n TB, Kostanjsek N, Chatterji S, Rehm J (eds.).\u003cem\u003eMeasuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0).\u003c/em\u003e Geneva: WHO; 2010.\u003c/li\u003e\n \u003cli\u003eSteel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M.\u003cbr\u003e\u0026nbsp;Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement.\u003cbr\u003e\u003cem\u003eJAMA.\u003c/em\u003e 2009;302(5):537\u0026ndash;549.\u003c/li\u003e\n \u003cli\u003eSilove D, Ventevogel P, Rees S.The contemporary refugee crisis: An overview of mental health challenges.\u003cem\u003eWorld Psychiatry.\u003c/em\u003e 2017;16(2):130\u0026ndash;139.\u003c/li\u003e\n \u003cli\u003ePriebe S, Giacco D, El-Nagib R.\u003cem\u003ePublic health aspects of mental health among migrants and refugees.\u003c/em\u003e Copenhagen: WHO Europe; 2016.\u003c/li\u003e\n \u003cli\u003eThornicroft G, Tansella M.The balanced care model for global mental health.\u003cbr\u003e\u003cem\u003ePsychological Medicine.\u003c/em\u003e 2013;43(4):849\u0026ndash;863.\u003c/li\u003e\n \u003cli\u003eDrake RE, Whitley R.Recovery and severe mental illness: Description and analysis.\u003cbr\u003e\u003cem\u003eCanadian Journal of Psychiatry.\u003c/em\u003e 2014;59(5):236\u0026ndash;242.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline (0. Ay) Sociodemographic and Clinical Characteristics of the Study Groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeğişken\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeney Grubu (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKontrol Grubu (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYaş (yıl), Ort \u0026plusmn; SS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28.9 \u0026plusmn; 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.1 \u0026plusmn; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.05ᵃ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCinsiyet (E / K), n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17 / 13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16 / 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.05ᵇ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEğitim d\u0026uuml;zeyi (\u0026ge; lise), n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22 (73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.05ᵇ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntipsikotik kullanımı, n (%)\u003c/strong\u003e\u003cstrong\u003eᵇ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e└ Atipik\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19 (63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e└ Tipik\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKİD\u0026Ouml;\u003c/strong\u003e, Ort \u0026plusmn; SS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.5 \u0026plusmn; 6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.8 \u0026plusmn; 6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.674ᵃ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBD\u0026Ouml;\u003c/strong\u003e, Ort \u0026plusmn; SS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.9 \u0026plusmn; 5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.3 \u0026plusmn; 5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.706ᵃ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBA\u0026Ouml;\u003c/strong\u003e, Ort \u0026plusmn; SS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.4 \u0026plusmn; 6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.1 \u0026plusmn; 6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.832ᵃ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePANSS (Toplam)\u003c/strong\u003e, Ort \u0026plusmn; SS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e101.2 \u0026plusmn; 8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.7 \u0026plusmn; 8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.819ᵃ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eᵃ \u003cem\u003eIndependent samples t-test\u003c/em\u003e\u003cbr\u003e ᵇ \u003cem\u003eChi-square test\u003c/em\u003e\u003cbr\u003e\u003cem\u003eAll statistical tests were two-tailed.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Experimental Group: Comparison of Scale Scores Between Baseline and 6 Months (Paired samples t-test)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Ouml;l\u0026ccedil;ek\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0. Ay (Ort \u0026plusmn; SS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6. Ay (Ort \u0026plusmn; SS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKİD\u0026Ouml;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.5 \u0026plusmn; 6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.4 \u0026plusmn; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBD\u0026Ouml;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.9 \u0026plusmn; 5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.2 \u0026plusmn; 4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBA\u0026Ouml;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.4 \u0026plusmn; 6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.7 \u0026plusmn; 4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePANSS (Toplam)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e101.2 \u0026plusmn; 8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e94.6 \u0026plusmn; 7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003ePaired samples t-test, two-tailed.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Control Group: Comparison of Scale Scores Between Baseline and 6 Months (Paired samples t-test)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Ouml;l\u0026ccedil;ek\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0. Ay (Ort \u0026plusmn; SS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6. Ay (Ort \u0026plusmn; SS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKİD\u0026Ouml;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.8 \u0026plusmn; 6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.9 \u0026plusmn; 6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBD\u0026Ouml;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46.3 \u0026plusmn; 5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.8 \u0026plusmn; 5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.482\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBA\u0026Ouml;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.1 \u0026plusmn; 6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.7 \u0026plusmn; 6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.561\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePANSS (Toplam)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.7 \u0026plusmn; 8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.1 \u0026plusmn; 8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003ePaired samples t-test, two-tailed.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Comparison of Experimental and Control Groups at 6 Months (Independent samples t-test)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Ouml;l\u0026ccedil;ek\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeney Grubu (Ort \u0026plusmn; SS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKontrol Grubu (Ort \u0026plusmn; SS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKİD\u0026Ouml;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.4 \u0026plusmn; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.9 \u0026plusmn; 6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBD\u0026Ouml;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.2 \u0026plusmn; 4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.8 \u0026plusmn; 5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBA\u0026Ouml;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.7 \u0026plusmn; 4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.7 \u0026plusmn; 6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePANSS (Toplam)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e94.6 \u0026plusmn; 7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.1 \u0026plusmn; 8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eIndependent samples t-test, two-tailed.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8508332/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8508332/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e:\u003cbr\u003e\nImpairments in functionality and social participation are common among individuals with severe mental disorders, particularly within refugee populations. Community-based psychosocial interventions may play a crucial role in improving both psychiatric symptoms and daily functioning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e:\u003cbr\u003e\nThis controlled, prospective study was conducted at a Community Mental Health Center in Turkey. Syrian patients under temporary protection who participated in occupational therapy workshops (experimental group) were compared with a control group receiving routine care only. Functionality (Brief Functionality Assessment Scale – BFAS), depression (Beck Depression Inventory – BDI), anxiety (Beck Anxiety Inventory – BAI), and psychotic symptom severity (Positive and Negative Syndrome Scale – PANSS) were assessed at baseline and at 6-month follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e:\u003cbr\u003e\nAt baseline, no significant differences were observed between the groups. In the experimental group, significant improvements were observed in functionality, depression, anxiety, and psychotic symptoms at 6 months (p \u0026lt; 0.001 for BFAS, BDI, and BAI; p = 0.018 for PANSS), whereas no significant changes were observed in the control group. At the 6-month assessment, the experimental group demonstrated significantly better outcomes compared to the control group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e:\u003cbr\u003e\nOccupational therapy workshops integrated into community mental health services are associated with significant improvements in functionality and psychiatric symptoms among Syrian patients, highlighting the importance of structured psychosocial interventions for vulnerable populations.\u003c/p\u003e","manuscriptTitle":"Effects of Occupational Therapy Workshops on Functionality and Psychiatric Symptoms in Syrian Patients Receiving Community Mental Health Services","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-08 07:42:17","doi":"10.21203/rs.3.rs-8508332/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"95363588-be5c-4c10-b326-ad076e8e5fe5","owner":[],"postedDate":"January 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-27T08:12:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-08 07:42:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8508332","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8508332","identity":"rs-8508332","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}