Prioritization of Iranian Male Mental Disorders Based on latest Prevalence, Burden, Male/Female Ratio and Expert Pane; a Systematic Review

Introduction: Mental disorders are the most prevalent health problems in the world. 23.6\% of Iranians have at least one psychological disorder. Men usually neglect their mental health issues, and their top priority mental health disorders should be determined for health planning. Methods: International databases including MedLine, Scopus, Web of Science, ProQuest, and SID national database were searched from 2015 to October 2020. The latest reported prevalence and percent of total DALY (Disability-adjusted life year), their difference between sexes as well as the expert panel’s opinion about mental disorders were gathered in a matrix based on the Three-Dimensional Combined Approach Matrix (3D-CAM). Each item got a rank and prioritization was made base on mean rank. Results: Eight studies were included. The most prevalent mental disorders among the Iranian male population were Major Anxiety Disorders (MADs, 12\%) and the highest burden belonged to Major depressive disorder (MDD) comprising 2.88\% of the total DALY. Considering all parameters, the highest priority was the Drug Use Disorders (DUD) followed by Alcohol Use disorders (AUDs), Conduct disorder, MADs, Bipolar disorder, MDD, and Schizophrenia, respectively. Conclusion: Men are extremely affected by drug and alcohol use disorders in Iran and also there is a lack of practical screening and effective interventional programs for these disorders in the primary health care system. More intensive harm reduction programs are needed for decreasing devastating consequences of any substance use disorders as well as improving mental health literacy and raising awareness toward risk perception for preventive and controlling purposes

Measuring self-rated social health of Iranians: a population based survey in three cities

Abstract:Background and objectives: Social health as third dimension of health, along with physical and mental health, has drawn more attention in recent years among policy makers and health system managers. No other study, to our knowledge, has documented measuring individual-level social health in Iran. In response to this need, our study tends to assess Iranians self-rated social health through conducting a survey in 3 cities of Iran. Methods: We conducted a survey using cross sectional method in three cities of Iran included people more than 18 years old. We use a random sample size of 800 people. The scale provides a total score of social health and three sub-scores. Total score was calculated by summing all 33 items, so the range was between 33 to 165, considering that higher score indicating better social health. Psychometric parameters of scale were acceptable. To interpret scores, respondents were categorized into five ordered groups as quintiles for amount of social health. To compare social health scores in different demographic groups multiple linear regression was employed to interpret association between demographic variables and social health score. Results: From a pool of 800 persons, 794 (99%) agreed to participate and filled out the questionnaire completely.  The mean of self-rated social health score was 105.0 (95% confidence interval, 103.8 to 106.2). 50% of participants had medium level of social health. social health score was higher for those who live in Urmia as a small city in comparison with big cities- Tehran and Isfahan (P V< 0.001) and was lower for unemployed people (PV= 0.029). There was no association between social health score and other factors such as sex, age and educational level (PV>0.05) Conclusion:This study may be considered as the first step in evidence-based policy-making in the field of social health in Iran. Certainly, it is necessary to conduct more studies to measure social health and its determinants in a nation-wide approach

Measuring Self-perceived Social Health of Iranians; Finding from Iran Social Health Survey

Background: The novelty of the study is to measure self-perceived social health of Iranians as one of the main dimensions of health.Materials and Methods: This cross-sectional study was conducted in all provinces of Iran in September 2014 with 10500 participants to measure self-perceived social health on a scale from 33 to 165 arranged in three areas; family, friends and relatives, and community. Area of "family" was measure in a range from 6 to 30; area of "friends and relatives" was from 9 to 45; and area of "community" was from 19 to 95. The psychometrics of scale was examined in separate previous study.Results: From a total of 10500 participants, 10244 fulfilled questionnaire (Response rate= 97.6%). 49.2% of participants were male. Mean of the total social health score was 99.91; area of "family" was 22; area of "friends and relatives" was 27.6; and area of "community" was 51.2. The main factors negatively influences on social health were low house size, unemployment, being divorced or widow and being at the age of 18-30. There was no significant relationship between social health score and educational level.Conclusion: It is magnificently attained that standardized social health rate in the present study was 3.9% lower than the rate has been estimated in comparison to similar previously conducted study in three big cities of Iran, two years earlier. Area of "community" is also the main accountant for this drop. To continue monitoring the social health of Iranians, we recommend conducting the next rounds every 3-5 years

Randomized controlled trial for the efficacy of three versus five sessions of grief counseling on the psychological aspects following COVID-19 bereavement: A study protocol

BackgroundDuring the COVID-19 pandemic, many people have experienced traumatic losses and therefore are at risk of developing complicated grief regarding the restrictions on the performance of routine mourning rituals. This study is a randomized controlled trial for assessing the efficacy of three versus five sessions of grief counseling on grief intensity, psychological distress, and quality of life of grief among bereaved people due to COVID-19.MethodsA total of 120 bereaved people, due to COVID-19, will be enrolled in this multi-center randomized controlled trial after assessment for inclusion and exclusion criteria. Following the informed consent procedure, participants will be allocated into two groups equally by the Stratified Balanced Block Randomization, one of them delivering a three-session grief counseling intervention and the other delivering a five-session grief counseling intervention. The intervention will be delivered by trained psychologists via in-person individual sessions. The primary outcome is grief intensity, and the secondary outcomes are psychological distress, quality of life, and satisfaction of the participants. These outcomes will be measured by the Grief Intensity Scale (GIS), the General Health Questionnaire-28 (GHQ-28), the Short Form Health Survey-12 (SF-12), and the Client Satisfaction Questionnaire (CSQ-8), respectively. The assessments will be done at three time points, one before the intervention and the others 1 month and 3 months after the intervention. The data will be analyzed using the SPSS V.18 and Stata V.11 software. The analysis approach will be “intention to treat.”DiscussionResults of this study can be applied for selecting the most suitable intervention leading to the prevention of complicated grief and the maintenance and promotion of the mental health of bereaved people due to COVID-19.Clinical trial registration[irct.ir], identifier [IRCT20200505047305N1]

Cross-country Comparison of Treatment Policies Facing the Drug Abuse in Five Selected Countries

Background: Drug abuse is one of the main problems of human's life; thus communities have been thinkingabout the solution of this problem. The present study aimed to compare the general features of drug abusetreatment policies, war on drugs (WOD), and harm reduction (HR), in the selected countries.Methods: The present study was a comparative and desk research that sought to compare context,stewardship, financing, type of substance abuse treatment services, reasons of paradigm shift, and executivechallenges of treatment policies in the selected countries (China, Malaysia, Germany, Netherland, and Iran).The necessary data for comparison of the countries were collected through valid databases, review ofdocuments, and reports of international organizations.Findings: Context conditions were better in the HR countries. In most countries, the central governmentplayed a key role in the stewardship, financing, and service providing. In WOD countries, the presence ofjudicial structure was higher in the treatment of drug abuse. The policy-making approach was ideological inWOD countries, but evidence-based in HR countries.Conclusion: It seems that performance of HR countries is better than WOD countries

Stigma barriers of mental health in Iran: A qualitative study by stakeholders of mental health.

Background: Many people who accesses mental health services usually do not seek treatment to avoid the consequences of stigma and label of mental illness. Determining each of these aspects related to stigma reduction barriers seems necessarily. Objective: A qualitative study was undertaken to investigate stigma reduction barriers toward mental disorders in Iran. Methodology: The present study used content analysis and was carried out from 2013 to 2015. All stakeholders have been chosen by purposive sampling technique. All data obtained through 16 individual interviews, 2 focus groups and 6 written narratives. The data were collected, coded and analyzed accordingly.  Results: The major themes were: The universality of stigma, Beliefs, Attitudes and lack of awareness, Mental health providers and other specialists, Cultural barriers, Structures and policy makers, Insufficient financial resources.   Conclusion: It is necessarily to identify the barriers of stigma reduction programs in Iran to increase the quality of life of mental patients. In the present study due to the presence of mental health stakeholders the main barriers have been obtained

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

The impact of the COVID-19 pandemic on the well-being, work conditions, and education of early career psychiatrists in the WHO Eastern Mediterranean Region: study protocol

BackgroundThe COVID-19 pandemic placed great strain on healthcare professionals, leading to a substantial impact and a redistribution of the workforce. Despite the active involvement of the Eastern Mediterranean Region Office (EMRO) and the World Health Organization in managing mental health crises, there is a knowledge gap concerning the working conditions and training opportunities available for early career psychiatrists (ECPs) during the pandemic period.ObjectivesThis study aims to investigate the impact of the COVID-19 pandemic on ECPs and how it affected their well-being, employment, and educational opportunities.MethodsA mixed methods study has been conducted in Iran, Egypt, and Tunisia, three EMRO member countries. It includes a cross-sectional survey with self-reported questions, and a qualitative study with individual in-depth interviews.DiscussionThe findings of this study will raise awareness to the working conditions of ECPs within the EMRO region and its member societies, both during the COVID-19 pandemic and beyond. The results will serve as a basis for encouraging supervisors and policymakers to mitigate the pandemic’s impact on psychiatric training, strengthen healthcare systems’ preparedness, and equip early career psychiatrists with the necessary skills to deal with the mental health consequences of the COVID-19 pandemic

Developing an Educational Parenting Skills Package to Parents Undergoing Substance Abuse Treatment for Preventing Addiction among Adolescents: A Study Protocol Based on Social Marketing Approach

Background: Developing an educational parenting skills package for parents with substance abuse may be effective in preventing the same problem in their adolescents. Social marketing is one of the approaches facilitating the preparation of educational content for this purpose. Social marketing is a regular and planned process focusing on customers and their needs for encouraging a target group to exhibit a particular behavior or adopt a specific idea. This study protocol aims to use the social marketing approach to prepare an educational parenting skills package for the parents undergoing substance abuse treatment to prevent addiction in their adolescents. Methods: An educational parenting skills package will be designed and validated by a combination of qualitative research (descriptive phenomenology), scoping review, and Delphi study based on social marketing approach (4 Ps = product, price, place, promotion). The package will be prepared in four phases including educational need assessment, ranking the identified educational needs, determining the suitable health education constructs, and modeling and developing the educational content based on the identified constructs. The designed educational package will be validated from the perspective of the target group (parents undergoing substance abuse treatment) and experts. Conclusion: Developing educational packages based on a scientific health education approach and mainly the Social Marketing Assessment and Response Tool (SMART) model with an emphasis on market analysis or marketing mix (4 Ps = product, price, place, promotion) can prove effective in attracting the audience and promoting the target activitie

Province-level Prevalence of Psychiatric Disorders: Application of Small-Area Methodology to the Iranian Mental Health Survey (IranMHS)

Objective: National surveys revealed a high prevalence of psychiatric disorders in Iran. Province-level estimates are needed to manage the resources and focus on preventive efforts more efficiently. The objective of this study was to provide province-level estimates of psychiatric disorders. Method: In this study, Iranian Mental Health Survey (IranMHS) data (n = 7886) was used to produce province-level prevalence estimates of any psychiatric disorders among 15-64 year old males and females. Psychiatric disorders were diagnosed based on structured diagnostic interview of the Persian version of Composite International Diagnostic Interview (CIDI, version, 2.1). The Hierarchical Bayesian (HB) random effect model was used to calculate the estimates. The mental health status of half of the participants was also measured using a 28-item general health questionnaire (GHQ). Results: A wide variation in the prevalence of psychiatric disorders was found among 31 provinces of Iran. The direct estimates ranged from 3.6% to 62.6%, while the HB estimates ranged from 12.6% to 36.5%. The provincial prevalence among men ranged from 11.9% to 34.5%, while it ranged from 18.4% to 38.8% among women. The Pearson correlation coefficient between HB estimates and GHQ scores was 0.73. Conclusion: The Bayesian small area estimation provides estimation with improved precision at local levels. Detecting high-priority communities with small-area approach could lead to a better distribution of limited facilities and more effective mental health interventions