Independent and social living skills training for people with Schizophrenia in Iran: A randomized controlled trial

Objectives: Schizophrenia is responsible for a significant proportion of burden of mental diseases in Iran. Lack of a follow-up system has resulted in the repeated hospitalizations. In this study it is hypothesized that standardized living skills training delivered to participants with schizophrenia in outpatient and inpatient centers can be effective compared to a control group (with occupational therapy) in reducing psychopathology severity and increasing quality of life. Methods: This is a multi-centered parallel group randomized controlled trial in Iran and it is singleblinded. Eligible participants are randomly allocated into two groups in a 1:1 ratio. Participants are assigned by stratified balanced block randomization method. The trial is conducted in the cities of Tehran and Mashhad. Its aim is to recruit 160 clients with schizophrenia. The intervention for the experimental group is social living skills training. The intervention for the control group is occupational therapy. The intervention for both groups is conducted in 90 to 120-minute group sessions. The primary outcome of the study would be a decrease in psychopathology severity, an improvement in participants' quality of life, and reduction in family burden will be followed for 6 months. Discussion: This paper presents a protocol for a randomized controlled trial of independent and social living skills training intervention delivered to participants with schizophrenia. If this intervention is effective, it could be scaled up to be developing for policymaking and improving outcomes for schizophrenic participants and their families in Iran

Efficacy of aftercare services for people with severe mental disorders in Iran: A randomized controlled trial

Objectives: This study aimed to determine whether after-care services reduced the number of rehospitalizations and length of hospital stay among patients with severe mental disorders. Methods: A total of 120 patients with schizophrenia and schizoaffective or bipolar disorder between the ages of 15 and 65 were recruited from 2010 to 2012 for a randomized controlled trial. The participants were followed up for 20 months after discharge from a university-affiliated hospital in Tehran, Iran. The selection procedure was random sampling. Sixty patients received aftercare services, which included treatment follow-up, family psychoeducation, and patient social skills training, and 60 patients received treatment as usual. Number of hospitalizations and length of hospital stay were primary outcome measures, and severity of psychopathology and severity of illness were secondary outcome measures. The quantitative primary and secondary outcomes measures were compared by using repeated-measures analysis. Results: Three members of the control group did not complete the study. The cumulative number of hospitalizations during the follow-up period was 55 for the control group and 26 for the intervention group. Length of stay was significantly greater in the control group compared with the intervention group (rate ratio=2.38, 95 confidence interval=2.17-2.62). Psychopathology was less severe in the intervention group compared with the control group (p<.001). Conclusions: Aftercare services are efficacious for reducing both the need for rehospitalization and the severity of psychopathology. © 2015, American Psychiatric Association. All rights reserved

Trend of suicide in Iran during 2009 to 2012: Epidemiological evidences from national suicide registration

Background: Suicide behaviors cause a large portion of Disability adjusted life years worldwide. Objectives: The aim of this research was to study the trend, correlations and discrepancy of registered suicide incidents in Iran from 2009 to 2012 using data from the Iranian suicide registry. Materials and Methods: Suicide registry entries throughout the country between 2009 and 2012, including suicidal attempts and suicides, were collected. Data on age, gender, occupational, marital and residential status along with suicide method, history of previous attempt and history of medical or mental disorders were registered by health service provision staff at the service centers. Geographic mapping and statistical analysis were performed. Results: Amongst the 252911 attempted suicides during the period, we found suicide attempt and suicide rate of 30.5 - 44.8 and 1.76 - 2.23 per 100000 individuals, respectively, denoting overall suicide fatality rate of 2.63. The rate of suicide attempt in different provinces ranged between 0.7 and 271.1 and the rate of suicide between 0.17 and 17.7 per 100000 individuals. Attempted suicides showed more fatality in males, elderly, widow/widowers, divorced and unemployed subjects as well as in residents of rural areas. The most common attempt methods were medication overdose (84), and the mostcommonsuicide methods were hanging (30.3), medications overdose (28.1) and self-burning (17.9); these methods are found at different rates in various parts of the world. Conclusions: While the registry could provide us the most valid data on suicide, the wide range of suicide and suicide attempt rates in different provinces not only could question this statement but also could highlight the importance of studying the ethnic/geographic variations in suicide epidemiology with improved suicide registry and surveillance systems. � 2016, Mazandaran University of Medical Sciences

Interventions for decreasing drug abuse and social problem in Iran's mental and social health services model (SERAJ program)

Objective: Social problems and drug abuse, especially addiction, divorce, poverty, crime, violence, alcohol consumption, and substance abuse, have increased in Iran over the past two decades. The present study aims to determine an approach to decrease drug abuse and social problems in the Islamic Republic of Iran. Method: A national program on providing comprehensive social and mental health services, entitled "SERAJ", was developed and piloted in three districts of Iran. To compile this study, three types of data collection have been used: (1) review of the literature, (2) an in-depth interview with experts and stakeholders, (3) focused group discussions. Results: In our proposed model for decreasing drug abuse and social problems, comprehensive mental and social health service are provided. Social care is integrated into the primary health care and six types of services, including social health education, screening for risk factors of social problems, and drug abuse, identifying underlying psychiatric, psychological, or social causes, short consultations, referral to social workers, and follow-up. Conclusion: Theoretically, if mental disorders are reduced, social harm and addiction will also be reduced because it is one of the important risk factors for divorce, violence, crime, drug abuse, and alcohol consumption. SERAJ reduces mental disorders; therefore, it can reduce social problems and addiction. Copyright © 2021 Tehran University of Medical Sciences

The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran

Background: Needle and syringe programs (NSPs) are widely used to reduce harms associated with drug injecting. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach models of NSP on injection risk behaviours. Methods: Self-reported data from 455 people who injected drugs (PWID) during 2014 in Kermanshah, Iran, were examined to measure demographic characteristics and risk behaviors. Self-reported and program data were also assessed to identify their main source of injection equipment. Participants were divided into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Coarsened exact matching was used to make the three groups statistically equivalent based on age, place of residence, education and income, and groups were compared regarding the proportion of borrowing or lending of syringes/cookers, reusing syringes and recent HIV testing. Results: Overall, 76% of participants reported any NSP service use during the two months prior to interview. Only 23% (95%CI: 17-27) reported outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI: 0.10-0.70), recent syringe reuse (OR: 0.38, 95%CI: 0.23-0.68) and increased recent HIV testing (OR: 2.60, 95%CI: 1.48-4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI: 0.15-0.60), compared to facility-based NSP (OR: 1.25, 95%CI: 0.74-2.17). Conclusion: These findings suggest that the outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and increasing the rate of HIV testing. Outreach NSP was even more effective than facility-based in reducing the lending of syringes to others. Scaling up outreach NSP is an effective intervention to further reduce transmission of HIV via needle sharing

Client-Level Coverage of Needle and Syringe Program and High-Risk Injection Behaviors: A Case Study of People Who Inject Drugs in Kermanshah, Iran

Background: Needle-syringe programs (NSP) have been running in Iran since 2002. However, the coverage of such program among the NSP clients at the individual level was not studies yet. This study aimed to determine the client coverage of NSP and its correlation with high injection-related risk behaviors. Methods: A cross-sectional survey was conducted in Kermanshah province, Iran, in 2014. 230 people who inject drugs (PWID) recruited from two drop-in centers (DICs) from April to September 2014, participated in a face-to-face interview to provide information related individual coverage of NSP, demographic characteristics, and injecting behaviors 30 days prior to the interview. Findings: Overall, the average of syringe coverage was 158% [95% confidence interval (CI) = 65.7-205.5], while 56% (95% CI = 40-97) have individual converge less than 100%. Needle/syringe sharing was significantly higher among individual with low NSP coverage [adjusted odds ratio (AOR) = 2.6, 95% CI = 1.3-6.2]. About 85% participants with coverage of less than 100% reported reuse of syringe within the last 30 days (AOR = 3.2, 95% CI = 1.4-7.7). Conclusion: PWID are different regarding their NSP individual-level converges. There are certain clusters of PWID, who do not receive sufficient number of syringes. Given that insufficient individual syringe coverage level is highly associated with injection risk behaviors, reasons for such low converge need to be assessed and addressed carefully

The effectiveness of the pilot implementation of iran's comprehensive mental and social health services (the SERAJ Program): A controlled community trial

Objective: A national program on providing comprehensive social and mental health services, entitled "SERAJ"was developed and piloted in three districts of Iran. The present study aimed to evaluate the effectiveness of SERAJ by conducting assessments before and after the implementation in the intervention and the control areas. Method: This was a controlled community trial that was assessed by conducting repeated surveys in the intervention and the control areas. In total, 2952 and 2874 individuals were assessed in the intervention and the control areas, respectively. The change in prevalence of mental disorders (using the Composite International Diagnostic Interview; CIDI), service utilization, mental health literacy, happiness, and perceived social support were measured over 18 months in three districts of Osko, Bardsir, and Quchan as the intervention areas, which were compared with three matched districts as the control areas. Results: No significant difference was found in the mean score of happiness between the intervention and the control areas throughout the study period. Most aspects of mental health literacy were improved in the intervention areas after implementing the intervention. The mean score of social support decreased after implementing the intervention in all areas. The prevalence of mental disorders in the intervention districts was significantly reduced after 18 months. The rate of using any mental health services after the intervention was not statistically different between the intervention and the control areas. Conclusion: There was no significant change in some indicators in the intervention compared with the control areas. We suggest evaluating SERAJ's achievements and challenges in the three intervention districts before expanding the implementation of this pilot experience into other districts. Copyright © 2021 Tehran University of Medical Sciences

How much should we pay to deliver comprehensive mental and social health services? Experiences from Iran

Objective: Comprehensive mental and social health services is the new benefit package which had been aimed to provide mental health services to people who suffer from mental disorders. The aim of this study was to estimate the cost of plan and its drivers to provide evidence for decision-making by national policymakers. Method: We used the bottom-up costing approach to estimate the cost of plan. We identified the cost centers, services delivery process, and facilities. Data were collected via different sources and tools such as the new financial system, registration forms, and performance reporting forms. We categorized the cost into 4 groups and selected appropriate measures to estimate the cost. We estimate the total and unit cost for 3 levels in 2 scenarios by considering the 2017 prices. Results: Screening resulted in 8.9 new detection with a different incidence in urban and rural areas (urban: 16.5; rural: 2.7). Also, 61 842 million IRR was spent for the screening, diagnose, treatment, and rehabilitation of detected people in 2017. Personal cost is responsible for 90.6 and primary screening for 66.4 of the total cost. Conclusion: For the development of the program (from screening to rehabilitation) 530 513 IRR should be spent per capita. The cost of detection per client can vary due to differences in disease prevalence, especially treatment and rehabilitation costs. It is suggested to consider the variation of the prevalence in expanding the plan to the whole country. Integrating the services in primary health care lead to huge cost saving. Copyright © 2021 Tehran University of Medical Sciences

Inpatient buprenorphine-assisted withdrawal for treatment of vulnerable adolescents with opioids use disorder in Zahedan, Iran: An observational study

Background: There are limited data supporting the effectiveness of buprenorphine treatment for opioid use disorder among adolescents. Objectives: The aim of this study was to investigate the outcomes of using buprenorphine for inpatient medically assisted withdrawal of vulnerable adolescents with opioid use disorder. Methods: Twelve consecutive vulnerable adolescents due to working or living in streets were admitted to the Child and Adolescent PsychiatricWard of Ali Ibn-e-Abi Talib Hospital for treatment of opioid use disorder using buprenorphine-assisted withdrawal. The clinical chart abstraction of patients' files was made to provide the baseline situation of the patients, as well as treatment progress at discharge and one and three months post-discharge. Results: All the complaints of pain and other withdrawal signs and symptoms decreased dramatically within the first four days of treatment. At one-month follow-up, all study participants were still in the foster care and the urine tests for morphine and methamphetaminewerenegative. At the three-month follow-up, the older sister of the onlyone15-year-old adolescent took the responsibility of his guardianship. The urine tests of all study participants were negative in month 3. Conclusions: Medically managed opioid withdrawal must be considered only as a part of a comprehensive psychosocial program providing a stable living environment, adolescent welfare, and custody services. The treatment program also proved its safety and effectiveness for the management of pain and other opioid withdrawal signs and symptoms among adolescents. © 2019, Author(s)

Emotional and behavioral problems of single parent vs. Two parent children: Imam Khomeini charity

Background: The aim of this survey is to compare the emotional and behavioral problems of children with only one parent versus those from two-parent families. We analyzed behavioral problems such as aggression, delinquency and socialization issues, as well as emotional problems such as depression, anxiety, and somatic complaints. Methods: Using a multi-stage cluster sampling, 10 of the 20 geographic regions covered by Imam Khomeini Charity were selected. Using systematic random sampling, 460 families with children aged 4-18 years were selected. All children were evaluated using the Child Behavior Check List (CBCL) to determine behavioral and emotional problems. Logistic regression tests were conducted to measure the effects variables, including age, gender, number of parents in the family, psychiatric history of each child and history of parental psychiatric treatment, on the internalizing, externalizing and total CBCL scores. A cut-off score of 64 was used to convert raw scores. Results: No differences were observed in CBCL subscales between single-parent children vs. children of two-parent families. Conclusion: Regarding the two-parent families among the study population, the results could not be generalized. As these families have qualified for assistance, the father cannot manage the family because of his disability, such as physical or mental problems. This minimizes the effect of having a father in a two-parent family, rendering them similar to single-parent families. Thus, differences were not observed between the two types of families. Further studies are necessary to compare single-parent families with two-parent families among the community. © 2008, Tehran University of Medical Sciences. All rights reserved