Risk Factors of Suicide Death Based on Psychological Autopsy Method; a Case-Control Study

Introduction: Investigation in each community can contribute to understanding the key factors involved in suicide death and its prevention. The present study aimed to investigate suicide death risk factors based on psychological autopsy method. Methods: The present case-control study was conducted from April to September 2017, in Tehran, Iran, to compare two groups of people; those who died by suicide and controls (over the age of 18 years). Data were collected by one interviewer via Structured Clinical Interviews (SCID-I), questionnaires used in the SUPREMISS study, and the Dickman impulsivity scale. Results: Each group consisted of 40 individuals. There was no significant difference between the case and control groups in terms of all demographic variables except for the level of education (p = 0.06)  and occupational status (p = 0.009). The frequency of previous history of suicide attempt (p = 0.001), family history of suicide (p = 0.003), DSM IV Axis I disorders (p = 0.006), and substance and alcohol consumption (p = 0.01) were significantly higher in the case group. The most commonly diagnosed disorders included MDD (45%) and substance use disorders (30%), respectively. The most common methods used in suicide included hanging (32.5%), and Aluminum phosphide poisoning (32.5%) known as rice tablet. The strongest predictor of suicide death was the deceased person's Previous history of suicide attempt (OR= 9.3; p = 0.04), smoking (OR= 6.4; p = 0.006), unemployment (OR= 5; p = 0.02), and DSM IV axis I disorders (OR= 3.8; p = 0.04). Conclusion: Previous suicide attempt, smoking, unemployment, and suffering from at least one mental disorder were the significant predictors of suicide death. Among mental disorders, major depressive disorder and substance use disorder were the most prevalent mental health problems

A multicenter randomized controlled trial of aftercare services for severe mental illness: study protocol

BACKGROUND: Severe mental illness is responsible for a significant proportion of burden of diseases in Iranian population. People with severe mental illnesses are more likely to have high rates of non-attendance at follow-up visits, and lack of an active follow-up system, particularly in the country’s urban areas that has resulted in the revolving door phenomenon of rehospitalizations. Therefore, there is an increasing need for implementation of effective and cost-effective aftercare services. METHOD/DESIGN: This is a randomized control trial with the primary hypothesis that aftercare services delivered to patients with severe mental illnesses in outpatient department and patient's home by a community care team would be more effective when compared to treatment as usual (TAU) in reducing length of hospital stay and any psychiatric hospitalization. Patients were recruited from three psychiatric hospitals in Iran. After obtaining informed written consent, they were randomly allocated into aftercare intervention and control (TAU) groups. Aftercare services included treatment follow-up (through either home care or telephone follow-up prompts for outpatient attendance), family psychoeducation, and patient social skills training that were provided by community mental health teams. Patients were followed for 12 months after discharge. The primary outcome measures were length of hospital stay and any hospitalization in the 12 month follow-up. Secondary outcome measures included patients' clinical global impression, global functioning, quality of life, and patient's satisfaction. The trial also allowed an assessment of direct cost-effectiveness of the aftercare services. DISCUSSION: This paper presents a protocol for an RCT of aftercare services delivered to patients with severe mental illnesses within patients' home or outpatient department. The findings of this study can influence policy and program planning for people with severe mental illnesses in Iran. TRIAL REGISTRATION: IRCT201009052557N

Daytime sleepiness: a factor correlated with mental health of older people (Text in Persian)

Objectives: Increased Population Of Older People In Recent Decades Has Brought Their Health Issues At Forefront. Mental Health And Sleep Problems Are Common In Elderly. This Study Intended To Investigate On The Relations Between These Two. Methods & Materials: The Present Study Is A Cross-Sectional, Descriptive- Analytic One Which Has Been Implemented On Retired Elderly, Presenting At The Retirement Organization(RO) And Its Agents In Tehran. Three Hundred-Ninety(390) Elderly Entered The Study Through Easy Sampling And Responded To A Three Part Questionnaire Including A Demographic Check List, General Health Questionnaire-15. And Epworth Sleepiness Scale. Gathered Data Analyzed By T-Test, K Square, And ANOVA. Results: Of The Participants 51% Were Male, 66.8% Were Married, And 49% Were In The Age Range Of 60-64. 29% Suffered From Mild To Severe Daytime Sleepiness And 46% Had Mental Health Problems. Mental Health, As An Independent Factor, Had A Significant Statistical Relation With Sleepiness (P<0.05). Conclusion: Given To The Study Finding, Further Researches With The Aim Of Determining The Predictive Values Of Each Factor Are Recommended

Daytime Sleepiness: A Factor Correlated With Mental Health Of Older People

Objectives: Increased Population Of Older People In Recent Decades Has Brought Their Health Issues At Forefront. Mental Health And Sleep Problems Are Common In Elderly. This Study Intended To Investigate On The Relations Between These Two. Methods & Materials: The Present Study Is A Cross-Sectional, Descriptive- Analytic One Which Has Been Implemented On Retired Elderly, Presenting At The Retirement Organization(RO) And Its Agents In Tehran. Three Hundred-Ninety(390) Elderly Entered The Study Through Easy Sampling And Responded To A Three Part Questionnaire Including A Demographic Check List, General Health Questionnaire-15. And Epworth Sleepiness Scale. Gathered Data Analyzed By T-Test, K Square, And ANOVA. Results: Of The Participants 51% Were Male, 66.8% Were Married, And 49% Were In The Age Range Of 60-64. 29% Suffered From Mild To Severe Daytime Sleepiness And 46% Had Mental Health Problems. Mental Health, As An Independent Factor, Had A Significant Statistical Relation With Sleepiness (P<0.05). Conclusion: Given To The Study Finding, Further Researches With The Aim Of Determining The Predictive Values Of Each Factor Are Recommended

Knowledge Translation Improvement Strategies in Universities of Medical Sciences in Iran: A Qualitative Study

BACKGROUND፡ Recently, one of the challenges in the health system of the country is the need for research contributing to policy-making. Therefore, it is crucial to develop activities in the field of knowledge Translation (KT). This study aimed to propose KT improvement strategies in universities of medical sciences in Iran.METHODS: In this qualitative study, 18 semi-structured interviews were conducted with key informants from the medical universities in Iran during January-July 2018. The transcribed documents were analyzed using the Gale framework analysis approach. Data organization was carried out using MAXQDA version 10 software.RESULTS: According to framework analysis, six KT improvement strategies were identified including improving the abilities and skills of researchers, improving the processes and quality of knowledge production, revising policies and laws, mproving the prerequisites, culture-building, and promoting the, use of evidence.CONCLUSION: Given the challenges and strategies outlined in this study, it seems that the mechanism of KT and its effects on improving health plans for policymakers and researchers has not been elucidated yet. Therefore, considerable changes in prerequisites, knowledge production processes, academic procedures, policies and laws are necessary for implementing KT in universities of medical sciences in Iran.&nbsp

Effectiveness and cost-effectiveness of community-based mental health services for individuals with severe mental illness in Iran: a systematic review and meta-analysis

Abstract Background Severe mental illness (SMI) imposes a substantial worldwide burden of disability, highlighting the need for comprehensive and adaptable mental health services. This study aims to assess the efficacy and cost-effectiveness of community-based mental health services (CBMHS) in reducing relapse and rehospitalization rates among individuals with SMI in Iran. Method A systematic review and meta-analysis were conducted. Medline, EMBASE, ISI, SCOPUS, and ProQuest were searched until December 2022. We focused on randomized controlled trials, quasi-experimental studies, or economic studies related to individuals with SMI. Out of 127 articles, 17 were selected for a full-text review. The primary outcomes were the severity of psychopathology, rehospitalization rates, and the mental health of caregivers. We also examined community-based interventions and their impact on various outcomes. Data extraction and risk of bias assessment were performed, and critical appraisal was conducted using JBI checklists. Meta-analysis was carried out using STATA software. (PROSPERO registration. CRD42022332660). Result Rehospitalization rates among patients who received CBMHS were significantly lower, with an odds ratio of 2.14 (95% CI: 1.44 to 3.19), indicating a 2.14 times lower likelihood than those who received treatment as usual. A reduction in psychopathology accompanied this, SMD: -0.31, 95% CI: -0.49 to -0.13, I2 = 40.23%). Moreover, there was a notable improvement in social skills (SMD: -0.7, 95% CI: -0.98 to -0.44, I2 = 0.00%). The burden on caregivers also decreased (SMD: -0.55, 95% CI: -0.99 to -0.1, I2 = 63.2). The Incremental Cost-Effectiveness Ratio (ICER) for QUALY was acceptable, albeit with a wide range of 613 to 8400 Dollars. Conclusion CBMHS has demonstrated effectiveness and efficiency in Iran as a developing country. Additionally, it shows promise in mitigating the shortage of acute psychiatry beds. Using multiple data collection tools poses a limitation regarding data consolidation and conducting a meta-analysis

Structural Factors Contributing to Suicidal Ideation in Iranian Older Adults: A Grounded Theory Approach

Introduction: The high rate of complete suicide in older adults on the one hand and the low report of suicidal thoughts by them compared to other groups on the other hand, indicate the importance of suicide in this group. The objective of this study was to explore the structural factors contributing to suicidal ideation in Iranian older adults. Methods: This was a qualitative study using grounded theory approach. The sample included a total of 13 community-dwelling (visiting day-care centers and psychiatric clinics) and institutionalized older adults aged 60 years or above selected using purposive and theoretical sampling methods. The data were collected using in-depth  semi-structured interviews. The data were analyzed using constant comparative method, constant review of the written text of the interviews, field notes, and memo writing via Strauss and Corbin’s method. Results: The results indicated 2 main categories including perceived adversities and negative self-concept that were represented in the form of 10 subcategories including having a difficult life, financial strain, retirement, disempowerment, disrupted family, being lonely, being a trouble to others, self-perceived uselessness, lack of control over life, and losing reputation. Conclusion: Suicidal ideation among Iranian older adults occurs in the context of negative life events that can cause significant pain and suffering. The concepts related to family, health, and performance of older adults are especially important in the development of suicidal thoughts due to their cultural significance. Therefore, professionals and policymakers can reduce suicidal ideation in older adults by enriching social interactions, increasing welfare activities, paying more attention to spiritual capacities, and generally reducing the structural challenges in day-care centers and nursing homes