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Childhood Psychological Resilience Factors in Young Adults with Adverse Childhood Experiences: A Qualitative Preliminary Study

Yıl 2023, Cilt: 15 Sayı: Supplement 1, 213 - 224, 29.12.2023

Öznur Bayar Türkan Doğan

https://doi.org/10.18863/pgy.1292636

Öz

Over the past decades, numerous studies have repeatedly demonstrated the risk factors and long-term negative outcomes associated with adverse childhood experiences. However, the factors that contribute to positive development and psychological resilience after adverse childhood experiences are less well known. The aim of this study was to understand the childhood resilience factors of young adults who experienced adverse childhood experiences. Focus Group Interview was used in this qualitative study. Participants were young adults (n= 6) who were university students between the ages of 21 and 26 (mean age = 23.17, SD= 2.14). The data were analyzed using thematic analysis. The results showed that individual, relational and societal factors played a protective role in the participants' childhood. At the same time, participants emphasized that relational and societal protective factors had some shortcomings or potentially damaging consequences. This preliminary study uncovered multiple layers of childhood protective factors (individual, relational and societal) and emphasized the importance of assessing the multifaceted nature of protective factors.

Anahtar Kelimeler

child abuse and neglect protective factors resiliency emerging adulthood focus group interview

Kaynakça

  • Afifi TO, MacMillan H (2011) Resilience following child maltreatment: A review of protective factors. Can. J. Psychiatry, 56:266–272.
  • Bellis MA, Hardcastle K, Ford K, Hughes K, Ashton K, Quigg Z et al (2017) Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences- A retrospective study on adult health-harming behaviours and mental well-being. BMC Psychiatry, 17:1–12.
  • Braun V, Clarke V (2021) To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport Exerc Health, 13:201–216.
  • Browne A, Finkelhor D (1986) Impact of child sexual abuse: A review of the research. Psychol Bull, 99:66–77.
  • Chang Y, Yoon, S, Maguire-Jack K, Lee J (2022) Family-, school-, and neighborhood-level predictors of resilience for adolescents with a history of maltreatment. Children (Basel), 10:1.
  • Cicchetti D, Garmezy N (1993) Milestones in the development of resilience. Dev Psychopathol, 5:497–774.
  • Cicchetti D, Toth, SL (2005) Child maltreatment. Annu Rev Clin Psychol, 1:409–438.
  • Currie J, Spatz Widom C (2010) Long-term consequences of child abuse and neglect on adult economic well-being. Child Malt, 15:111–120.
  • Crandall A, Miller JR, Cheung A, Novilla LK, Glade R, Novilla MLB et al (2019) ACEs and counter-ACEs: How positive and negative childhood experiences influence adult health. Child Abuse Negl, 96: 104089.
  • Dong C, Xu R, Xu L (2021) Relationship of childhood trauma, psychological resilience, andfamily resilience among undergraduate nursing students: A cross-sectional study. Perspect Psychiatr Care, 57:852–859.
  • Folger SF, Wright MOD (2013) Altering risk following child maltreatment: Family and friend support as protective factors. J Fam Violence, 28:325–337.
  • Guest G, Bunce A, Johnson L (2006) How many interviews are enough? An experiment with data saturation and variability. Field Methods,18:59–82.
  • Hamby S, Grych J, Banyard V (2018) Resilience portfolios and poly-strengths: Identifying protective factors associated with thriving after adversity. Psychol Violence, 8:172–183.
  • Haskan-Avcı Ö, Bayar Ö, Koç M (2016) PDR öğrencilerinde boyun eğici davranışlar ve toplumsal cinsiyet. Hedefe Doğru İnsan: Psikolojik Danışma ve Rehberlik Sempozyumu I, Mayıs 2016 Samsun Türkiye. Kongre Kitapçığı Sayfa: 494.
  • Hildyard KL, Wolfe DA (2002) Child neglect: Developmental issues and outcomes. Child Abuse Negl, 26:679–695.
  • Kağıtçıbaşı Ç (2005) Autonomy and relatedness in cultural context: Implications for self and family. J Cross Cult Psychol, 36:403–422.
  • Kağıtçıbaşı Ç (2007) Family, Self, and Human Development Across Cultures: Theory and Applications. New Jersey, Lawrence Erlbaum.
  • Kitzinger J (1995) Qualitative research: Introducing focus groups. BMJ, 311:299–302.
  • Koçtürk N, Ulaş Ö, Bilginer Ç (2019) Career development and educational status of the sexual abuse victims: The first data from Turkey. Sch Ment Health, 11:179–190.
  • Koç M, Bayar Ö, Haskan Avcı Ö (2017) Kadın Toplumsal Cinsiyet Rolü Stresi Ölçeği’nin (KTCRSÖ) geliştirilmesi: Geçerlik ve güvenirlik çalışması. Mehmet Akif Ersoy Üniversitesi Eğitim Fakültesi Dergisi, 1:284–297.
  • Krueger RA, Casey MA (2014) Focus Groups: A Practical Guide for Applied Research. Sage publications, Inc.
  • Kırbaç E (2017) Çocuk istismarı ve ihmalinin bazı değişkenler açısından incelenmesi. (Yükseklisans tezi), Malatya, İnönü Üniversitesi.
  • Maguire-Jack K, Showalter K (2016) The protective effect of neighborhood social cohesion in child abuse and neglect. Child Abuse Negl, 52:29–37.
  • Maguire-Jack K, Font S, Dillard R, Dvalishvili D, Barnhart S (2021) Neighborhood poverty and adverse childhood experiences over the first 15 years of life. Int J Child Maltreat, 4:93–114.
  • Maguire-Jack K, Yoon S, Hong S (2022) Social cohesion and informal social control as mediators between neighborhood poverty and child maltreatment. Child Malt, 27:334–343.
  • Malinosky-Rummell R, Hansen DJ (1993) Long-term consequences of childhood physical abuse. Psychol Bull, 114:68–79.
  • Masten AS (2001) Ordinary magic: Resilience processes in development. Am Psychol, 56:227–238.
  • Masten AS (2014) Ordinary Magic: Resilience in Development. New York, Guilford Press.
  • Masten AS, Barnes AJ (2018) Resilience in children: Developmental perspectives. Children, 5:98.
  • Meng X, Fleury MJ, Xiang YT, Li M, D’arcy C (2018) Resilience and protective factors among people with a history of child maltreatment: A systematic review. Soc Psychiatry Psychiatr Epidemiol, 53:453–475.
  • Moses JO, Villodas MT (2017) The potential protective role of peer relationships on school engagement in at-risk adolescents. J Youth Adolesc, 46:2255–2272.
  • Narayan AJ, Rivera LM, Bernstein RE, Harris WW, Lieberman AF (2018) Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale. Child Abuse Negl, 78:19-30.
  • Özsoy G, Çelikkaleli Ö (2021) Çocukluk dönemi ihmal ve istismar yaşantısının psikolojik sağlamlık üzerindeki etkisinde ebeveyn duygusal erişilebilirliğinin aracılık rolü. Mehmet Akif Ersoy Üniversitesi Eğitim Fakültesi Dergisi, 58:312–333.
  • Ozer EJ, Lavi I, Douglas L, Wolf JP (2017) Protective factors for youth exposed to violence in their communities: A review of family, school, and community moderators. J ClinChild Adolesc Psychol, 46:353–378.
  • Runyan D, Wattam C, Ikeda R, Hassan F, Ramiro L (2002) Child abuse and neglect by parents and caregivers. In Wolrd Report on Violence and Health (Eds EG Krug, JA Dahlberg, AB Mercy, Z Lozano, R Lozano):59–86. Geneva, World Health Organization.
  • Schaefer LM, Howell KH, Schwartz LE, Bottomley JS, Crossnine CB (2018) A concurrent examination of protective factors associated with resilience and posttraumatic growth following childhood victimization. Child Abuse Negl, 85:17–27.
  • Sümer N, Gündoğdu Aktürk E, Helvacı E (2010) Anne-baba tutum ve davranışlarının psikolojik etkileri: Türkiye’de yapılan çalışmalara toplu bakış. Türk Psikoloji Yazıları, 13:42–59.
  • Şar V, Necef I, Mutluer T, Fatih P, Türk-Kurtça T (2021) A revised and expanded version of the Turkish Childhood Trauma Questionnaire (CTQ-33): Overprotection-overcontrol as additional factor. J Trauma Dissociation, 22:35–51.
  • Topitzes J, Mersky JP, Dezen KA, Reynolds AJ (2013) Adult resilience among maltreated children: A prospective investigation of main effect and mediating models. Child Youth Serv Rev, 35:937–949.
  • Uluç S, Köyden D (2022) Cinsiyete göre ebeveynleşmenin farklı boyutları arasındaki ilişkiler ve ebeveynleştirme boyutlarının psikolojik belirtileri yordama düzeyi. Klinik Psikoloji Dergisi, 6:317–330.
  • Ulukol B, Kahiloğulları AK, Sethi D (2013) Adverse childhood experiences survey among university students in Turkey: Study Report-2013. Geneva, World Health Organization.
  • Walsh WA, Dawson J, Mattingly MJ (2010) How are we measuring resilience following childhood maltreatment? Is the research adequate and consistent? What is the impact on research, practice, and policy? Trauma Violence Abuse, 11:27–41.
  • Wekerle C (2013) Resilience in the context of child maltreatment: Connections to the practice of mandatory reporting. Child Abuse Negl, 37:93–101.
  • Yıldırım A, Şimşek H (2013) Sosyal Bilimlerde Nitel Araştırma Yöntemleri (9. baskı). Ankara, Seçkin Yayıncılık.
  • Yılmaz Aslantürk A, Aslantürk O (2023) Mahalle baskısının sosyolojik tahayyülünde kentsel güvenlik. Gümüşhane Üniversitesi Sosyal Bilimler Dergisi, 14:197–209.
  • Yoon S, Bellamy JL, Kim W, Yoon D (2018) Father involvement and behavior problems among preadolescents at risk of maltreatment. J Child Fam Stud, 27:494–504.
  • Yoon S, Dillard R, Pei F, McCarthy KS, Beaujolais B, Wang X et al (2020) Defining resilience in maltreated children from the practitioners’ perspectives: A qualitative study. Child Abuse Negl, 106:104516.
  • Yoon S, Howell K, Dillard R, Shockley McCarthy K, Rae Napier T et al (2021) Resilience following child maltreatment: Definitional considerations and developmental variations. Trauma Violence Abuse, 22:541–559.
  • Yoon S, Maguire-Jack K, Knox J, Ploss A (2021) Socio-ecological predictors of resilience development over time among youth with a history of maltreatment. Child Malt, 26:162–171.
  • Yule K, Houston J, Grych J (2019) Resilience in children exposed to violence: A meta- analysis of protective factors across ecological contexts. Clin Child Fam Psychol Rev, 22:406–431.
  • Vaismoradi M, Turunen H, Bondas T (2013) Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci, 15:398–405.
  • Von Cheong E, Sinnott C, Dahly D, Kearney, PM (2017) Adverse childhood experiences (ACEs) and later-life depression: Perceived social support as a potential protective factor. BMJ Open, 7:e013228.
  • Zencir T, Haskan-Avcı Ö (2019) Development of the Parentified Child Scale-Adult Version: A reliability and validity study. Cukurova University Faculty of Education Journal, 48:531–553.

Olumsuz Çocukluk Yaşantıları Olan Genç Yetişkinlerde Çocukluk Dönemi Psikolojik Sağlamlılık Faktörleri: Nitel Bir Ön Çalışma

Yıl 2023, Cilt: 15 Sayı: Supplement 1, 213 - 224, 29.12.2023

Öznur Bayar Türkan Doğan

https://doi.org/10.18863/pgy.1292636

Öz

Geçtiğimiz on yıllarda çok sayıda araştırma çocukluk dönemi olumsuz yaşantılarına ilişkin risk faktörlerini ve uzun süreli olumsuz sonuçları tekrar tekrar ortaya koymuştur. Ancak, çocukluk dönemi olumsuz yaşantıları sonrası olumlu gelişime ve psikolojik sağlamlığa katkı sağlayan faktörler daha az bilinmektedir. Bu çalışmanın amacı çocukluk döneminde olumsuz yaşantılar deneyimleyen genç yetişkinlerin çocukluk dönemi psikolojik sağlamlık faktörlerini anlamaktır. Bu nitel çalışmada Odak Grup Görüşmesi kullanılmıştır. Katılımcılar 21–26 yaş arası (Yaş Ort.= 23.17, SS= 2.14) üniversite öğrencisi olan genç yetişkinlerden oluşmaktadır (n= 6). Veriler tematik analiz ile incelenmiştir. Sonuçlar bireysel, ilişkisel ve toplumsal düzeydeki faktörlerin katılımcıların çocukluğunda koruyucu rol oynadığını göstermiştir. Aynı zamanda katılımcılar ilişkisel ve toplumsal koruyucu faktörlerin kimi eksiklikleri veya potansiyel olarak zarar veren sonuçları olduğunu vurgulamıştır. Başlangıç niteliğindeki bu çalışma, çok katmanlı çocukluk dönemi koruyucu faktörlerini ortaya çıkarmıştır (bireysel, ilişkisel ve toplumsal) ve koruyucu faktörlerin çok yönlü doğasını değerlendirmenin önemini vurgulamıştır.

Anahtar Kelimeler

çocuk istismarı ve ihmali koruyucu faktörler psikolojik sağlamlık beliren yetişkinlik odak grup görüşmesi

Kaynakça

  • Afifi TO, MacMillan H (2011) Resilience following child maltreatment: A review of protective factors. Can. J. Psychiatry, 56:266–272.
  • Bellis MA, Hardcastle K, Ford K, Hughes K, Ashton K, Quigg Z et al (2017) Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences- A retrospective study on adult health-harming behaviours and mental well-being. BMC Psychiatry, 17:1–12.
  • Braun V, Clarke V (2021) To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport Exerc Health, 13:201–216.
  • Browne A, Finkelhor D (1986) Impact of child sexual abuse: A review of the research. Psychol Bull, 99:66–77.
  • Chang Y, Yoon, S, Maguire-Jack K, Lee J (2022) Family-, school-, and neighborhood-level predictors of resilience for adolescents with a history of maltreatment. Children (Basel), 10:1.
  • Cicchetti D, Garmezy N (1993) Milestones in the development of resilience. Dev Psychopathol, 5:497–774.
  • Cicchetti D, Toth, SL (2005) Child maltreatment. Annu Rev Clin Psychol, 1:409–438.
  • Currie J, Spatz Widom C (2010) Long-term consequences of child abuse and neglect on adult economic well-being. Child Malt, 15:111–120.
  • Crandall A, Miller JR, Cheung A, Novilla LK, Glade R, Novilla MLB et al (2019) ACEs and counter-ACEs: How positive and negative childhood experiences influence adult health. Child Abuse Negl, 96: 104089.
  • Dong C, Xu R, Xu L (2021) Relationship of childhood trauma, psychological resilience, andfamily resilience among undergraduate nursing students: A cross-sectional study. Perspect Psychiatr Care, 57:852–859.
  • Folger SF, Wright MOD (2013) Altering risk following child maltreatment: Family and friend support as protective factors. J Fam Violence, 28:325–337.
  • Guest G, Bunce A, Johnson L (2006) How many interviews are enough? An experiment with data saturation and variability. Field Methods,18:59–82.
  • Hamby S, Grych J, Banyard V (2018) Resilience portfolios and poly-strengths: Identifying protective factors associated with thriving after adversity. Psychol Violence, 8:172–183.
  • Haskan-Avcı Ö, Bayar Ö, Koç M (2016) PDR öğrencilerinde boyun eğici davranışlar ve toplumsal cinsiyet. Hedefe Doğru İnsan: Psikolojik Danışma ve Rehberlik Sempozyumu I, Mayıs 2016 Samsun Türkiye. Kongre Kitapçığı Sayfa: 494.
  • Hildyard KL, Wolfe DA (2002) Child neglect: Developmental issues and outcomes. Child Abuse Negl, 26:679–695.
  • Kağıtçıbaşı Ç (2005) Autonomy and relatedness in cultural context: Implications for self and family. J Cross Cult Psychol, 36:403–422.
  • Kağıtçıbaşı Ç (2007) Family, Self, and Human Development Across Cultures: Theory and Applications. New Jersey, Lawrence Erlbaum.
  • Kitzinger J (1995) Qualitative research: Introducing focus groups. BMJ, 311:299–302.
  • Koçtürk N, Ulaş Ö, Bilginer Ç (2019) Career development and educational status of the sexual abuse victims: The first data from Turkey. Sch Ment Health, 11:179–190.
  • Koç M, Bayar Ö, Haskan Avcı Ö (2017) Kadın Toplumsal Cinsiyet Rolü Stresi Ölçeği’nin (KTCRSÖ) geliştirilmesi: Geçerlik ve güvenirlik çalışması. Mehmet Akif Ersoy Üniversitesi Eğitim Fakültesi Dergisi, 1:284–297.
  • Krueger RA, Casey MA (2014) Focus Groups: A Practical Guide for Applied Research. Sage publications, Inc.
  • Kırbaç E (2017) Çocuk istismarı ve ihmalinin bazı değişkenler açısından incelenmesi. (Yükseklisans tezi), Malatya, İnönü Üniversitesi.
  • Maguire-Jack K, Showalter K (2016) The protective effect of neighborhood social cohesion in child abuse and neglect. Child Abuse Negl, 52:29–37.
  • Maguire-Jack K, Font S, Dillard R, Dvalishvili D, Barnhart S (2021) Neighborhood poverty and adverse childhood experiences over the first 15 years of life. Int J Child Maltreat, 4:93–114.
  • Maguire-Jack K, Yoon S, Hong S (2022) Social cohesion and informal social control as mediators between neighborhood poverty and child maltreatment. Child Malt, 27:334–343.
  • Malinosky-Rummell R, Hansen DJ (1993) Long-term consequences of childhood physical abuse. Psychol Bull, 114:68–79.
  • Masten AS (2001) Ordinary magic: Resilience processes in development. Am Psychol, 56:227–238.
  • Masten AS (2014) Ordinary Magic: Resilience in Development. New York, Guilford Press.
  • Masten AS, Barnes AJ (2018) Resilience in children: Developmental perspectives. Children, 5:98.
  • Meng X, Fleury MJ, Xiang YT, Li M, D’arcy C (2018) Resilience and protective factors among people with a history of child maltreatment: A systematic review. Soc Psychiatry Psychiatr Epidemiol, 53:453–475.
  • Moses JO, Villodas MT (2017) The potential protective role of peer relationships on school engagement in at-risk adolescents. J Youth Adolesc, 46:2255–2272.
  • Narayan AJ, Rivera LM, Bernstein RE, Harris WW, Lieberman AF (2018) Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale. Child Abuse Negl, 78:19-30.
  • Özsoy G, Çelikkaleli Ö (2021) Çocukluk dönemi ihmal ve istismar yaşantısının psikolojik sağlamlık üzerindeki etkisinde ebeveyn duygusal erişilebilirliğinin aracılık rolü. Mehmet Akif Ersoy Üniversitesi Eğitim Fakültesi Dergisi, 58:312–333.
  • Ozer EJ, Lavi I, Douglas L, Wolf JP (2017) Protective factors for youth exposed to violence in their communities: A review of family, school, and community moderators. J ClinChild Adolesc Psychol, 46:353–378.
  • Runyan D, Wattam C, Ikeda R, Hassan F, Ramiro L (2002) Child abuse and neglect by parents and caregivers. In Wolrd Report on Violence and Health (Eds EG Krug, JA Dahlberg, AB Mercy, Z Lozano, R Lozano):59–86. Geneva, World Health Organization.
  • Schaefer LM, Howell KH, Schwartz LE, Bottomley JS, Crossnine CB (2018) A concurrent examination of protective factors associated with resilience and posttraumatic growth following childhood victimization. Child Abuse Negl, 85:17–27.
  • Sümer N, Gündoğdu Aktürk E, Helvacı E (2010) Anne-baba tutum ve davranışlarının psikolojik etkileri: Türkiye’de yapılan çalışmalara toplu bakış. Türk Psikoloji Yazıları, 13:42–59.
  • Şar V, Necef I, Mutluer T, Fatih P, Türk-Kurtça T (2021) A revised and expanded version of the Turkish Childhood Trauma Questionnaire (CTQ-33): Overprotection-overcontrol as additional factor. J Trauma Dissociation, 22:35–51.
  • Topitzes J, Mersky JP, Dezen KA, Reynolds AJ (2013) Adult resilience among maltreated children: A prospective investigation of main effect and mediating models. Child Youth Serv Rev, 35:937–949.
  • Uluç S, Köyden D (2022) Cinsiyete göre ebeveynleşmenin farklı boyutları arasındaki ilişkiler ve ebeveynleştirme boyutlarının psikolojik belirtileri yordama düzeyi. Klinik Psikoloji Dergisi, 6:317–330.
  • Ulukol B, Kahiloğulları AK, Sethi D (2013) Adverse childhood experiences survey among university students in Turkey: Study Report-2013. Geneva, World Health Organization.
  • Walsh WA, Dawson J, Mattingly MJ (2010) How are we measuring resilience following childhood maltreatment? Is the research adequate and consistent? What is the impact on research, practice, and policy? Trauma Violence Abuse, 11:27–41.
  • Wekerle C (2013) Resilience in the context of child maltreatment: Connections to the practice of mandatory reporting. Child Abuse Negl, 37:93–101.
  • Yıldırım A, Şimşek H (2013) Sosyal Bilimlerde Nitel Araştırma Yöntemleri (9. baskı). Ankara, Seçkin Yayıncılık.
  • Yılmaz Aslantürk A, Aslantürk O (2023) Mahalle baskısının sosyolojik tahayyülünde kentsel güvenlik. Gümüşhane Üniversitesi Sosyal Bilimler Dergisi, 14:197–209.
  • Yoon S, Bellamy JL, Kim W, Yoon D (2018) Father involvement and behavior problems among preadolescents at risk of maltreatment. J Child Fam Stud, 27:494–504.
  • Yoon S, Dillard R, Pei F, McCarthy KS, Beaujolais B, Wang X et al (2020) Defining resilience in maltreated children from the practitioners’ perspectives: A qualitative study. Child Abuse Negl, 106:104516.
  • Yoon S, Howell K, Dillard R, Shockley McCarthy K, Rae Napier T et al (2021) Resilience following child maltreatment: Definitional considerations and developmental variations. Trauma Violence Abuse, 22:541–559.
  • Yoon S, Maguire-Jack K, Knox J, Ploss A (2021) Socio-ecological predictors of resilience development over time among youth with a history of maltreatment. Child Malt, 26:162–171.
  • Yule K, Houston J, Grych J (2019) Resilience in children exposed to violence: A meta- analysis of protective factors across ecological contexts. Clin Child Fam Psychol Rev, 22:406–431.
  • Vaismoradi M, Turunen H, Bondas T (2013) Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci, 15:398–405.
  • Von Cheong E, Sinnott C, Dahly D, Kearney, PM (2017) Adverse childhood experiences (ACEs) and later-life depression: Perceived social support as a potential protective factor. BMJ Open, 7:e013228.
  • Zencir T, Haskan-Avcı Ö (2019) Development of the Parentified Child Scale-Adult Version: A reliability and validity study. Cukurova University Faculty of Education Journal, 48:531–553.
Toplam 53 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Gen-Çevre Etkileşimi, Bilişsel Gelişim
Bölüm Araştırma
Yazarlar

Öznur Bayar 0000-0002-9385-8641

Türkan Doğan 0000-0002-5976-7666

Erken Görünüm Tarihi 1 Ekim 2023
Yayımlanma Tarihi 29 Aralık 2023
Kabul Tarihi 20 Eylül 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 15 Sayı: Supplement 1

Kaynak Göster

AMA Bayar Ö, Doğan T. Childhood Psychological Resilience Factors in Young Adults with Adverse Childhood Experiences: A Qualitative Preliminary Study. Psikiyatride Güncel Yaklaşımlar. Aralık 2023;15(Supplement 1):213-224. doi:10.18863/pgy.1292636

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