Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method: A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services

Social Skills Training as a Classroom Program among a Group of Female Students of a Primary School

"n Objective: "n "nThe main objective of this study is to compare the efficacy of social skill training as a classroom program in schoolgirl students of a primary school with a control group. "nMethod: The 4th grade school girls of two classes in a primary school and at least one of their parents or caregivers participated in this study and they were allocated in the case and control groups. The student's age range was 9-11 years. The social skill education program was designed for primary school children by child and adolescent psychiatry department of Shahid Beheshti University of Medical Sciences .Demographic characteristics were recorded in a designed questionnaire , and included name, age, prior history of psychiatric and medical condition, and prior history of participation in a social skill education program . Achenbach Child Behavior Check List parent's report form (CBCL) was used before and after the study in the case group to evaluate the efficacy of the program interventions and, it was also used for the controls at the same times . The change of mean scores, inter and intra groups, and the categorical shifts were compared using repeated measure ANOVA and Chi square statistical methods of analysis by the SPSS-15 statistical software. "nResults: "nThe total number of 66 students with the mean age of 9.80±0.49 years participated in the study: 39 students were assigned to the experimental group and 27 students to the control group. The comparison of the mean age revealed no statistically significant differences between the two groups. The results showed an increment in internalizing problems and total competence and also in affective, anxiety, oppositionality and conduct problem scores which are statistically significant. The percentage of change in behavioral problems was compared between the cases and controls after the interventions. Based on the results, 25.6% of the intervention group got worse in internalizing problems after the intervention compared to the 3.7% in the control group which is statistically significant. "nConclusion: Social skill training in classroom settings may worsen some behavioral problems in girls; therefore, this type of training needs standard settings

The Effect of Social Skills Training Program on the Emotional and Behavioral Problems of Adolescent Girls in a High School

"n  "n  "nObjective: "nSchool-based interventions (such as life skills training) have become the mainstay for prevention of some behavioral problems. This study was conducted to evaluate the efficacy of a social skills training program on a group of students who were in the first grade of high school in an urban area of Tehran, Iran "n  "n  "nMethod: "nIn a before-after study, a kind of social skill education program named Right Choices" was used for high school female students. The entire students of a class in a high school participated in the study. The students' age  ranged from 14-16 years. All of the participants lived in an urban area. Demographic characteristics were recorded in a designed questionnaire and included the name, age, educational level of the students and their parents, and prior history of psychiatric and medical condition. The total problem score and each of the subscale scores of the students before and after the study were calculated and compared. "n  "n  "nResults: "nThe mean age of the 33 participants in the study whose SDQ answer sheets were completed was equal to 15.15±6.2 years (14 to 17 years). The mean total problem score of the participants in the beginning of the program was equal to 14.3±5. After the program, the students' total problem score and all of the subscale scores improved, however, the differences between pre- and post intervention scores were not statistically significant. "n  "n  "nConclusion: "nSocial skills training program may impact the problem behaviors of the adolescent girls

Efficacy of the Positive Parenting Program (Triple-P) for a Group of Parents of Children with Attention Deficit Hyperactivity Disorder (ADHD)

"nObjective: To evaluate the efficacy of the Positive Parenting Program (Triple-P) for parents of children with attention deficit hyperactivity disorder (ADHD). "nMethod:  Sixty families who had at least one child with clinically diagnosed ADHD aged between 6 to12 were recruited from the consecutive referrals to a child and adolescent psychiatric clinic. Families were randomly assigned to the intervention group (who participated in an 8- week- group Triple-P, N=30) and a control group (N=30). Parents completed the battery of self-report questionnaires of triple-P at the beginning and after the 8th session. "nResults: There were no significant differences in pre intervention measures between the two groups. Comparing the pre and post intervention data, the Triple- P group was associated with significantly lower levels of parent reported child behavior problems (P=0.001), lower levels of dysfunctional parenting (P=0.001) and greater parental competence (P=0.001) than the control group. The parents the in triple-P group had significant improvement on measures of depression, anxiety and stress, in comparison with the control group (P=0.001). This study did not follow the long term effect which marks its limitation. "nConclusion: The Triple-P program can be recommended for parents of children with ADHD to reduce the problem behavior of their children and to improve their abilities

The Effects of a Short-term Cognitive Behavioral Group Intervention on Bam Earthquake Related PTSD Symptoms in Adolescents

"n "n "nObjective :Post traumatic stress disorder (PTSD) may be the first reaction after disasters. Many studies have shown the efficacy of cognitive- behavioral therapy in treatment of post traumatic stress disorder. The main objective of this study is to evaluate the effect of group CBT in adolescent survivors of a large scale disaster (Bam earthquake). "n "nMethods: In a controlled trial, we evaluated the efficacy of a short term method of group cognitive-behavioral therapy in adolescent survivors of Bam earthquake who had PTSD symptoms and compared it with a control group. The adolescents who had severe PTSD or other psychiatric disorders that needed pharmacological interventions were excluded. We evaluated PTSD symptoms using Post traumatic Stress Scale (PSS) pre and post intervention and compared them with a control group. "n "nResults: 100 adolescents were included in the study and 15 were excluded during the intervention. The mean age of the participants was 14.6±2.1 years. The mean score of total PTSD symptoms and the symptoms of avoidance was reduced after interventions, and was statistically significant. The mean change of re-experience and hyper arousal symptoms of PTSD were not significant. "n "nConclusion: Psychological debriefing and group cognitive behavioral therapy may be effective in reducing some of the PTSD symptoms

Frequency of Psychological Disorders amongst Children in Urban Areas of Tehran

Objective: To evaluate the frequency of different psychiatric disorders among 7 to 12 years old children in urban areas of Tehran. "nMethod: A sample of 799 children (6 to 11 years old) were selected from 250 clusters of the entire 22 municipality areas of Tehran using a multistage sampling method from 250 clusters from the entire 22 municipality areas of Tehran. . After responding to a Persian version of the Strengths and Difficulties Questionnaire (SDQ) parent-report form, the Persian version of Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime (K-SADS-PL) was administered to 241 children and their families. The frequency of child psychological disorders was determined using the results of K-SADS-PL. "n Results:The overall frequency of any psychological disorders in the sample of children was 17.9 percent. Among the interviewed children childrenwho were interviewed, the most prevalent diagnoses were Attention-Deficit/ Hyperactivity Disorder (ADHD) (8.6 percent)8.6%, Oppositional Defiant Disorder (ODD) (7.3 percent)7.3%, and separation anxiety disorder (SAD) (5.9 percent)5.9%. There were not any statistically significant differences between sexes in the frequency of psychological disorders except enuresis that was more frequent in the boys and anorexia nervosa that was observed more frequently in the girls . "nConclusion:Higher frequency of ADHD and ODD and SAD among the studied children warrantswarrants more specific evaluation of frequency and possible causes of these high frequency rates. The frequency of psychological disorders in the studied children was comparable to the that of other studies

Validity and Reliability of Preschool, First and Second Grade Versions of Berkeley Parenting Self-Efficacy Scale

"nObjective: The purpose of this study is to examine the factor structure, internal consistency, and construct validity of preschool, first and second grade versions of Berkeley Parenting self-efficacy scale. "nMethod:  The subjects were 317 mothers: (102 mothers of preschool children, 111 mothers of first grade children and 104 mothers of second grade children) who were randomly selected from schools in Tehran. They completed Berkeley parenting self-efficacy and Rotter `s locus of control scales. Factor analysis using the principle component method was used to identify the factor structure of parenting self-efficacy scale. Cronbach`s alpha coefficient was used to identify the reliability of parenting self efficacy scale. "nResults: Results of this study indicated that the cronbach`s alpha coefficient was 0.84, 0.87, 0.64 for preschool, first grade and second grade versions respectively. Based on the scree test ,,factor analysis produced two factors of maternal strategy and child outcome, and it also produced the highest level of total variance explained by these 2 factors. The Parenting self-efficacy scale was negatively associated with measure of locus of control(r=-0.54 for the preschool version, -0.64 for the first grade version and -0.54 for the second grade version). "nConclusion: Due to relatively high reliability and validity of preschool, first and second grade versions of Berkeley Parenting Self-Efficacy scale, this scale could be used as a reliable and valid scale in other research area

Attention-Deficit Hyperactivity Disorder in Adults Using Methamphetamine: Does It Affect Comorbidity, Quality of Life, and Global Functioning?

Objective: Attention-deficit hyperactivity disorder (ADHD) is common in adulthood, and it is associated with different high- risk behaviors, particularly substance use. Evidence suggests a high prevalence of ADHD in adults who take methamphetamine (METH). This study aimed at comparing functional level, quality of life, and psychiatric comorbidities in METH users with and without adult ADHD (A-ADHD). Method: In this cross-sectional study, 134 patients who had a history of METH use (at least once in lifetime) were selected from among inpatient and outpatient referrals to a psychiatric hospital. DIVA was performed for those who were positive on the Conners' Adult ADHD Rating Scales–Self-Report-Screening Version (CAARS-SR-SV). The Global Assessment of Functioning (GAF) and World Health Organization Quality of Life Scale-Brief (WHOQoL-BREF) were used to assess the participants’ level of functioning and quality of life, respectively. Psychiatric comorbidities including substance use disorders were evaluated using the Structured Clinical Interview for DSM-IV-Axis I (SCID-I). Results: Among the METH users, 10.4% were diagnosed as having A-ADHD. A-ADHD was more prevalent among female METH users than males. The hyperactive-impulsive and combined types were more common than the inattentive type. Opiates and cannabis were the most commonly abused drugs by the 2 groups, while sedative-hypnotic use was significantly higher in the individuals with A-ADHD. Substance-induced mood disorder was the most prevalent comorbidity in the 2 groups and was higher in those with A-ADHD. quality of life and the GAF scores were significantly lower in those with A-ADHD and duration of METH use was higher Compared to the METH users without A-ADHD, (p>0.05). Conclusion: This study provided some preliminary findings supporting the prevalence of Adult ADHD among METH users and its negative impacts on their global functioning and quality of life. To provide more effective intervention for METH users, detection and treatment of those with A-ADHD can be of clinical value

The Effect of Parental Presence on the 5 year-Old Children's Anxiety and Cooperative Behavior in the First and Second Dental Visit

Objective: One of the most significant problems in pediatric dentistry is behavioral resistance of preschool children in the first visit. There is a debate on parental presence in operation room. The purpose of this study was to evaluate the Iranian 5-year-old children's behavior including anxiety and cooperation relative to parental presence in the first and second dental appointments. Methods: The study was conducted on sixty seven 5-year-old children selected according to inclusion criteria and randomly divided into two subgroups. Children in group I were visited in parent's presence and in group II in parent's absence. Before the child's first dental visit, parents were interviewed. Forty eight of the children receiving the initial examination were recalled for a second visit. The children's responses during the Holst procedure of the first visit and restorative second visit were assessed using a combination of two measures including heart rate and clinical behavior. The dentist-patient interactions were regulated by standardized scripts and recorded on videotape. Then, the behavior of the child on the recording during each visit was quantified by two pediatric dentists independently according to Venham 6-point rating scale and Frankle 4-point rating scale. Findings: There were no significant differences between the heart rate measures of children in group I and II in the first and second visit (0.67, 0.8 respectively). There were also no significant differences between the clinical anxiety scores of children in the two groups in the first and second visit (0.98, 0.42 respectively). Moreover, there were no significant differences between the clinical cooperation scores of children in group I and group II in the first and second visit (0.88, 0.40 respectively), neither were there any significant differences between response measures of each child between two visits (P>0.05). In addition, there were no significant differences related to sex, parental education and dental experiences (P>0.05). Conclusion: Parental presence or absence doesn't affect an Iranian 5-year-old child's anxiety on the first and second dental visit, as well as an Iranian 5-year-old child's cooperation on the first and second dental visit

Effect of Preoperative Play Interventions on Post Surgery Anxiety

"n "nObjective: Many studies have shown that the level of postoperative distress and anxiety in children is associated with the amount of anxiety during the pre operative period. In this study, we compared the effect of pre-operational attending in a playroom and using play activities on the level of anxiety increment after surgery in an intervention and a control group of Iranian children. "n "nMethod: In a clinical trial, 75 children aged 5 to 12 enrolled in the intervention and the control group. The anxiety symptoms were assessed using State-Trait Anxiety Inventory for Children, Revised Children's Manifest Anxiety Scale, and Yale modified Pre operative Anxiety Scale. The mean differences of pre and post operative anxiety scores were calculated and compared using the ANCOVA statistical method. "n "nResults: The two groups had similar demographic characteristics except for age which was higher in the control group. The baseline anxiety score was lower in the intervention compare to the control group and was statistically significant. There was a significant reduction in the trend of anxiety increment after surgery in the intervention group in comparison to the control group. "n "nConclusion: Attending in playrooms and using play activities may reduce the trend of increment in the anxiety level induced by surgical procedures