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Purpose The association of major depressive disorder (MDD) with higher risk of susceptibility to COVID-19 infection and hospitalization remained inconclusive. The aim of this study was to assess the both hypotheses in the Employees’ Health Cohort Study of Iran (EHCSIR). Methods Among 4886 EHCSIR participants, 3355 subjects who had a complete data on major depressive disorder and two annual telephone follow-ups from January 2020 to March 2022 were recruited in this study. Trained psychologists applied the Persian version of the Composite International Diagnostic Interview (CIDI-2.1) to recognize major depressive disorders at baseline assessment. Log binomial regression models were separately applied to investigate the association between MDD and risk of susceptibility to COVID-19 infection and hospitalization, adjusting for sociodemographic factors and background health conditions. Results The lifetime and twelve-month prevalence of MDD at the baseline of the cohort study were 11.4% and 7.3%, respectively. During the pandemic, 876 (26.1%) of the participants were infected with COVID-19 and 126 of these patients (14.4%) were hospitalized. The risk of susceptibility to COVID-19 infection among study participants who had lifetime MDD was significantly higher than unexposed participants (ARR = 1.24, 95% CI: 1.06–1.47). Among the COVID-19 cases, neither lifetime MDD (ARR = 1.26, 95% CI: 0.71–2.24) nor twelve-month MDD (ARR = 1.02, 95% CI: 0.48–2.15) was independently associated with hospitalization. Conclusion Preexisting major depressive disorder may cause a higher risk of susceptibility to COVID-19 infection, but it is not associated with higher risk of COVID-19 hospitalization.

ImportanceIntegrated care for children is rarely studied, especially in low- and middle-income countries, where generalists often provide mental health care.ObjectivesTo explore the effect of adding a child and youth component to an existing adult collaborative care program on mental health outcomes and receipt of care.Design, Setting, and ParticipantsThis cluster randomized trial was conducted within an adult collaborative care program in Tehran, Iran. General practitioners (GPs), their 5- to 15-year-old patients, and patients’ parents were included. Children and youths coming for routine medical visits who scored greater than the cutoff on the Strengths and Difficulties Questionnaire (SDQ) were followed up for 6 months. The study was conducted from May 2018 to October 2019, and analysis was conducted from March 2020 to August 2021.InterventionsGPs were randomized to either a 2.5-day training on managing common child mental health problems (intervention) or refresher training on identification and referral (control).Main Outcomes and MeasuresPrimary outcome was change in SDQ total problems score; secondary outcomes included discussion of psychosocial issues by the GPs and receipt of mental health care during the follow-up period.ResultsOverall, 49 GPs cared for 389 children who scored greater than the cutoff on the SDQ (216 children in intervention group, 173 in control group). Patients’ mean (SD) age was 8.9 (2.9) years (range, 5 to 15 years), and 182 (47%) were female patients. At 6 months, children in the intervention group had greater odds of receiving mental health care during the study (odds ratio [OR], 3.0; 95% CI, 1.1 to 7.7), parents were more likely to report that intervention GPs had discussed parent (OR, 2.1; 95% Cl, 1.1 to 3.8) and child (OR, 2.0; 95% Cl, 0.9 to 4.8) psychosocial issues, and intervention GPs were more likely to say they had provided counseling (OR, 1.8; 95% Cl, 1.02 to 3.3). However, there was no greater improvement in SDQ scores among children seen by intervention vs control GPs. Adjusted for clustering within GP, the variables used for balanced allocation (practice size, practice ownership, and study wave), and the other variables associated with change in SDQ scores over time, there was not a significant time-treatment interaction at either the 3- or 6-month follow-up points (linear combination of coefficients for intervention, 0.57 [95% CI, –1.07 to 2.22] and –0.08 [95%CI, –1.76 to 1.56], respectively). In a subgroup of GPs with practices composed of 50% or more children, children seen by intervention GPs improved to a significantly greater extent (–3.6 points; 95% CI, –6.7 to –0.46 points; effect size d = 0.66; 95% CI, 0.30 to 1.01) compared with those seen by control GPs.Conclusions and RelevanceIn this cluster randomized trial, GP training on managing common child mental health problems did not demonstrate greater improvement in child SDQ scores. Child mental health training for GPs in collaborative care can improve children’s access to mental health care, but prior experience working with children and their families may be required for GPs to use a brief training in a way that improves child outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT03144739

Background: This study aimed to evaluate the prevalence of domestic and non-domestic violence (outside home) in Iran during 2015. Methods: This descriptive cross-sectional study was conducted on individuals aged 15 and older living in urban and rural areas of Iran. A total of 36,600 people from 31 provinces of Iran were selected by systematic and cluster random sampling using the postal code available in the country’s post office software. A researcher-made survey questionnaire was used for evaluating violence. The data were analyzed using SPSS software version 20. Results: A total of 23.1% of individuals have admitted domestic violence towards their families in the last 12 months, and 8.1% have admitted non-domestic violence in the past 30 days. The prevalence of domestic and non-domestic violence was higher among males than females and in urban areas than rural places. In addition, the highest prevalence rate of domestic violence in the last 12 months was related to Lorestan province. Tehran province had the highest prevalence rate of non-domestic violence during the last 30 days. However, the lowest prevalence rate of domestic and non-domestic violence was related to Qom province. Conclusions: Based on the results, the prevalence rate of 23.1% of domestic violence and 8.1% of non-domestic violence necessitates preventing and treating this social problem. Therefore, health authorities need to take necessary action to raise awareness and reduce the risk-taking behaviors of the population in Iran.

Background The integration of core packages of mental health care into routine primary health care has been introduced as an effective way to achieve universal health coverage in mental health care. Based on the transition of mental health care in Iran, from introducing basic mental health care in PHC to the experience of community-based mental health centers for urban areas, a new socio-mental health service model has been so far proposed. This study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs. Methods This study was a cost-consequence analysis following One Health Tool methodology. The data required for the study were collected in the first quarter of the year 2020 with a time horizon from 2020 to 2030. The selected metric for summarizing health effects is healthy life years gained. Resources used in terms of drug and supply, staff salaries and outpatient visits were documented and associated costs were subsequently estimated in order to estimate the average cost of each intervention per case. Results The health impacts are calculated in terms of healthy life years gained for 2020–2030, after adjusting the prevalence and incidence rates for each disorder. In total, 1,702,755 healthy life years were expected to be gained. Considering total 1,363,581,654 US dollars cost in base case scenario, each healthy life years gained will cost around 801 US dollars. Based on the WHO criteria for cost-effectiveness threshold, all of the values ranged from 724 to 1119 US dollars obtained through eight different scenarios were considered as cost-effective given the GDP per capita of 5550 US dollars for Iran in 2018. Conclusions Mental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar per capita for scaling up this comprehensive mental health service model can convince high-level policy-makers to increase the share of mental health budget accordingly. The present study demonstrated that the cost in this new socio-mental services model is not substantial compared with GDP per capita of Iran.

Background: Due to the need to identify problems related to mental health among students and their proper management by offering specialized medical services to them, recently a relevant research project has been fully implemented in schools of all grades in Iran. Since the only way to measure the effectiveness and find the strengths and weakness of a program is to evaluate it, the present study aims to monitor and evaluate the mentioned project in order to improve the quality of project implementation, identify defects and shortcomings and upgrade the existing system. Methods: The present study was a qualitative study using conventional content analysis that used a semi-structured in-depth interview to obtain information from group of stakeholders. Selected instructors, teachers, principals and designers of the School Mental Health Promotion Program were the target of the study. Results: The findings of the present study were presented in four categories of program strengths, program weaknesses, factors preventing achievement of program objectives and recommendations for program improvement. It is to be noted that 14 subcategories were also devised, and finally, 50 codes were extracted. The overall results of the evaluation of the School Mental Health Program showed its effectiveness. Conclusions: The new and practical model of School Mental Health Program has opened a new perspective to school-based interventions. However, the expectation of full implementation and continuation of this program in the short term and with limited resources does not seem very realistic because making change is often challenging and fraught with problems and obstacles.

Posttraumatic stress disorder (PTSD) is a common mental disorder following traumatic events. The present study was conducted to understand the prevalence of PTSD after the earthquake in Iran and Pakistan. The review includes all articles published from inception to March 2019. The pooled prevalence for overall PTSD was 55.6% (95% CI: 49.9–61.3). It was 60.2% (95% CI: 54.1–66.3) and 49.2% (95% CI: 39.4–59) for Iranian and Pakistani survivors, respectively. Women experienced higher incidence of PTSD than men. The variation of PTSD based on the clinical interview was lower than the self-report approach. The interval time between the earthquakes and the assessment showed that the prevalence of PTSD decreased over time. The prevalence of PTSD in Iran and Pakistan was higher than the global average, and the rate of the disorder in Iran was higher than in Pakistan. Sex, method of assessment, and time lag between the occurrence of disaster and assessment of PTSD affect the prevalence.

Spirituality has a significant role in the individuals' physical and mental health, nevertheless health care professionals neglect these needs. This study was aimed at developing a package for the p...

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.

Objective: The Iranian Mental Health Survey (IranMHS) in 2011 has demonstrated that almost 1 out of 4 adult individuals suffer from psychiatric disorders; however, more than two-thirds are left unrecognized and untreated and many of the services have poor quality of care. In this paper we present our experience in developing and employing community-based mental health services through community mental health centers (CMHCs), which has been incorporated in Iran's comprehensive mental and social health services (the Seraj program). Method : The service model of the CMHCs was developed though an evidence-based service planning approach and was then incorporated as the specialized outpatient services model into the Seraj program in 2015. Results: The CMHCs in the Seraj program provide mental health care to patients with common mental and severe mental disorders in a defined catchment area. The services include the collaborative care, the aftercare, and day rehabilitation. The collaborative care model works with primary care providers in the health centers to provide detection and treatment of common mental illnesses. In the aftercare, services are offered to patients with severe mental disorders following discharge from the hospital and include telephone follow-ups and home visits. Day rehabilitation is mostly focused on providing psychoeducation and skill trainings. During the first 4 years of implementation in 2 pilot areas, more than 6200 patients (10% having severe mental disorders) received care at CMHCs. Conclusion: The main challenge of the implementation of the CMHC component in the Seraj program is to secure funds and employ skilled personnel. We need to incorporate Seraj in the existing national health system, and if successful, it can fill the treatment gap that has been so huge in the country.

Background: In this study, the basic criteria, models, and indicators of intersectoral collaboration in health promotion were investigated to facilitate the implementation of collaboration. Methods: This scoping review was conducted using datasets of Embase, Web of Science, Scopus, and PubMed, and search engines of Google, Google Scholar, and ProQuest. Results: 52 studies were included, and 32 codes in Micro, Meso, and Macro level, were obtained. Micro-level criteria had the highest frequency. Among the models used in the reviewed studies, social network analysis, Diagnosis of Sustainable Collaboration, Bergen, and logic models had the highest frequency. Among the indicators studied, the number of participants and the level of collaboration as well as its sustainability were the most frequent indicators. Conclusion: The findings identified the most important and widely used criteria, models, and indicators of intersectoral collaboration in health promotion which can be useful for decision-makers and planners in the domain of health promotion, in designing, implementing, and evaluating collaborative programs.

Objective: The social component of health plays a significant role in improving the mental health of the people of a district. 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 aims to determine its model for improving the indicators of the social component of mental health. Method: This study is a system design for which a literature review, interviews with experts, and focused group discussions with stakeholders were used. Results: Community action in promoting the mental health of the districts has three main components: strengthening intersectoral collaboration through the memorandum of understandings (MoU), increasing people's participation by establishing People’s Participation House (PPH) with the presence of the representative of current People’s network, and social protection of people suffering from mental disorders by establishing the Social Support Unit (SSU) for self-reliance activity. All three components are controlled by the governor and with supervision and technical consult of the health network of the district and stakeholder participation Conclusion: The model uses the inner capacities of the city instead of creating new structures. The prerequisites for the effective function of the main three components are educating departments, educating members of the PPH, and hiring a social worker at the SSU. The effective measures taken by the departments to reduce the risk factors for mental disorders are dependent on the technical and financial support of relevant organizations at the provincial and national levels.

One in eight adults in Iran is estimated to have major depressive disorder (MDD) – a leading cause of disability in the country. Many remain undiagnosed, and some receive only partial treatment. An estimated 60% of those with MDD were reported to have received no treatment during the past year. In this paper, we have critically reviewed the current health-care structure in the country along with prevailing patterns of health-care service utilization. We have addressed the role of psychiatrists, general practitioners (GPs), psychologists, and other health-care personnel in the treatment and care of patients with MDD, with an emphasis on the quality of service provision. In addition, the strengths and weaknesses of primary healthcare (PHC), the health insurance system, and inpatient care have been discussed. We have paid attention to the contextual issues such as mental health literacy, stigma, and healthcare inequity where relevant. Finally, practical recommendations have been provided to improve the quality of care for patients with MDD in Iran.

Backgrounds and aims Iran has 2.1 and 1.8% of its 15-64-year-old population living with illicit substance and opioid use disorders, respectively. To address these problems, Iran has been developing a large and multi-modality addiction treatment system, spanning the time before and after the Islamic Revolution. Methods Iran's current drug treatment scene is a combination of services, ranging from medical/harm reduction services to punitive/criminal justice programs. Included in this array of services are drop-in centers providing low-threshold harm reduction services, such as distribution of sterile needles and syringes; opioid maintenance treatment clinics providing methadone, buprenorphine and opium tincture; and abstinence-based residential centers. We will review the evolution of this system in four phases. Results In 1980, Iran's revolutionary government shut down all voluntary treatment programs and replaced them with residential correctional programs. The first shift in the addiction treatment policies came 15 years later after facing the negative consequences. Addiction is viewed as a disease, and new voluntary treatment centers offering non-agonist medications and psychosocial services were established. With an increased number of people who inject drugs and HIV/AIDS epidemics, in the second shift an extensive move towards harm reduction strategies and opioid-maintenance programs has been implemented to reduce HIV-related high-risk behavior. The emergence of a methamphetamine use crisis creating an increased number of socially marginalized addicted people resulted in public and political demands for stricter policies and ended in the third shift starting in 2010, with extended compulsory court-based residential programs. Currently, there is a new shift towards reducing the severity of criminal penalties for drug use/sales and promoting proposals for opium legalization. Conclusion Iran's evolutionary experience in developing a large addiction treatment program in a complex combination of medical/harm reduction and punitive/criminal justice addiction treatment can be examined in its political, clinical and pragmatic context.

Background: Sharing of injecting paraphernalia is known to contribute to hepatitis C virus (HCV) transmission amongst people who inject drugs.Objectives: In this paper, we identify the variables co...

Background: Estimating the number of people using illicit drugs and alcohol is necessary for informing health policy and programming. However, it is often challenging to reliably estimate the size of these marginalized populations through direct methods. In this study, we estimated the population size of these groups using the indirect Network Scale-Up (NSU) method in Iran from 2015 to 2016. Methods: Using a self-administered questionnaire, we asked 15 124 individuals (54% men) about the number of people they know who used different types of drugs at least once in the past 12 months. Prevalence estimates were reported per 100 000 population. The uncertainty level (UL) was calculated using the bootstrap method. Results: The average age of the respondents was 33 years old, and 35.1% of them were unmarried. The most common drugs and their prevalence were as follows: opium (2534 [95% UL: 2467-2598]), hashish (849 [95% UL: 811-886]), stimulants (methamphetamine, ecstasy pills, cocaine, and Ritalin) (842 [95% UL: 802-879]), heroin/crack (578 [95% UL: 550-607]), and drug injection (459 [95% UL: 438-484]). Additionally, we estimated the prevalence of alcohol use as 2797 (95% UL: 2731-2861). On average, substance use was 5.23 times more prevalent among men than women. Opium use was more prevalent among individuals aged >50 years old. Moreover, alcohol use was more prevalent among participants between 18 and 30 years old (5164 per 100 000 population). Conclusion: Although opium continues to be the most prevalent illicit drug in Iran, the patterns of illicit drug use are heterogeneous among different age groups, genders, and provinces. Age-gender specific and culturally appropriate interventions are warranted to meet the needs of people in different subgroups.

BACKGROUND: Iran has well-established networks for primary care staffed by general practitioners who provide services to patients across the lifespan. Iran recently established collaborative care networks to build general practitioners’ capacity to provide adult mental health services. In an NIH-funded study, we are designing and evaluating a training program for general practitioners (GPs) to extend this collaboration to include services for children and adolescents. In the formative phase of this project, we conducted a qualitative study to obtain information relevant to the design of the training program. METHODS: We conducted semi-structured individual interviews with 28 stakeholders; including 15 GPs working in a collaborative care network, 6 parents and 4 adolescents who had received child mental health care from a GP, and 3 policymakers. We also held a focus group discussion with 8 school teachers and counselors. All interviews were transcribed during the interviews’ sessions and then were thematically analyzed. RESULTS: GPs reported seeing a range of child emotional and behavioral problems but felt the need for additional training in diagnosis and management, especially in skills for interviewing and communicating with children. GPs also expressed the need to understand legal issues involved in treating children, including cases of possible child abuse. School staff agreed that GPs could help with children’s educational and emotional problems but also believed GPs would need extra training. Parents indicated a preference for GPs over psychiatrists (as did adolescents) as a source of mental health care, and for psychological over pharmacological interventions. Adolescents expressed a preference not to speak about private issues in the presence of their parents, and expressed concern that the GPs did not respect their preference. They also desired a more active role during visits. CONCLUSIONS: Before expanding the scope of practice of Iranian GPs to provide management of common emotional and behavioral problems in children and adolescents, the concerns and specific needs of these practitioners need to be addressed. Parents and youth in the study expressed a preference for mental health care from a GP rather than a specialist. However, they also commented on the need for restructuring the current GP visits to facilitate youth participation. These findings provide directions for expanding the scope of practice of adult collaborative care networks to meet the mental health care needs of children and adolescents more expeditiously and effectively.

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 activities.

Background: Cigarette smoking is known as a gateway drug for illicit drug use in youth. The objective of this study is to assess the prevalence of cigarette smoking in the college students in Iran. Methods: We searched electronic databases including Scopus, Medline/PubMed, Google Scholar and Web of Science, and national databases such as Magiran, Scientific Information Database, Iranmedex, Medlib, Irandoc, and IranPsych from 1946 to 21st July 2018 without any language restriction using a proper search strategy. We used a random effect model to calculate the pooled prevalence of cigarette smoking in college students in Iran. Chi-square test and I2 index were used to evaluate the heterogeneity between the studies. We used the meta-regression and subgroup analysis to assess the potential source of heterogeneity. Stata software, version 11 (StataCorp, TX) was used for all statistical analysis. Results: We included 60 eligible articles in our study. The pooled prevalence of cigarette smoking at least once in the lifetime was 19% (95%CI: 17-22). The I2 index indicated considerable between-study heterogeneity (I2 =98%, p

Background: The strengths and difficulties questionnaire (SDQ) is one of the most common screening tools to detect children and adolescents who are at risk of mental health problems or have psychiatric disorders. The standard mode of SDQ completion is on paper; however, some studies used phone administration and argued that this is a feasible and valid method that can substitute in-person administration. However, few studies have investigated the validity and reliability of phone administration of the SDQ. Objectives: The current study aimed to compare the telephone versus paper-and-pencil administration of the SDQ among Iranian child and adolescent outpatients. Methods: Sixty six parents with children aged 3 to 15 years completed the SDQ questionnaire using paper-and-pencil and telephone interview techniques. The study was performed in 2016, and participants were from the city of Tehran (capital of Iran). Participants were first divided into two groups. Then, one of them first completed the questionnaire using the face-to-face interviews, and 3 to 4 days later, they again completed the questionnaire using the telephone interview. And the vice versa occurred for the other group. The Pearson correlation analysis was used to calculate the correlation between the two methods in each group separately. Intra-class correlation (ICC) analysis was used to investigate the association between the two administration methods. Results: A significant positive correlation was found between the two types of administration in both groups (P < 0.05). Intra-class correlation coefficients indicated a good correlation between the scores obtained from each method of administration (all P values were < 0.001). Conclusions: Telephone administration of SDQ is a reliable method for collecting data when studying emotional and behavioral symptoms in children and adolescents attending outpatient psychiatric centers.

The Islamic Republic of Iran is a majority Muslim country, with a culturally low acceptance of high-risk behaviours.To investigate co-occurrence of risk behaviours in the Iranian general population.This was a cross-sectional study. Data were obtained from a random subsample of 3508 participants in the Iranian Mental Health Survey conducted in 2011 who completed a self-administered questionnaire about risk behaviours. The latent class analysis was performed on 7 behaviours consisting of cigarette smoking, alcohol consumption, opium use, use of other illicit drugs, having multiple sexual partners, imprisonment, and running away from home. Unordered multinomial logistic regression was performed to examine characteristics of participants in the latent classes.In the past 12 months, the rates of cigarette smoking, alcohol consumption, opium use, and use of other illicit drugs were 19.4%, 6.3%, 4.4%, and 4.2%, respectively. Three classes were identified: 1, a large class with low prevalence of risk behaviours [89.2%; 95% confidence interval (CI): 88.2-90.2%]; 2, high prevalence of all risk behaviours except drug use (6.1%; 95% CI: 5.3-6.9%); and 3, high prevalence of all risk behaviours (4.7%; 95% CI: 4.1-5.5%). Men and individuals with psychiatric disorders were over-represented in both classes 2 and 3.Alcohol consumers and opium users were at risk of other risky behaviours.تقييم السلوكيات الخطرة لدى عموم السكان في إيران: نتائج مستقاة من دراسة استقصائية عن الصحة النفسية في جمهورية إيران الإسلامية.معصومه أمین إسماعیلی، شهاب باحشمت، محمدجواد طراحی، سید عباس متولیان، ونداد شریفی، أحمد حاجبی، رامین مجتبایی، آفرین رحیمی موقر.جمهورية إيران الإسلامية بلد ذو أغلبية مسلمة، وقبوله منخفض للسلوكيات الشديدة الخطورة بحكم خلفيته الثقافية.هدفت هذه الدراسة الى استقصاء حدوث السلوكيات الخطرة ب ين عموم السكان الإيرانيني.تُعَد هذه الدراسة دراسة مقطعية. وجُعت البيانات من عينة فرعية عشوائية ضمت 3508 مشاركا في استقصاء الصحة النفسية في إيران الذي أُجري في عام 2011، حيث استكمل المشاركون استبيانًا بأنفسهم عن السلوكيات الخطرة. وأُجري تحليل الفئة الكامنة على 7 سلوكيات تتمثل في تدخين السجائر، وتعاطي الكحول، وتعاطي الأفيون، وتعاطي مخدرات غير مشروعة أخرى، ووجود شركاء جنسيني متعددين، والسجن، والهروب من المنزل. وأُجري تحليل انحدار لوجستي متعدد الحدود غير مُنظَّم لدراسة سمات المشاركين في الفئات الكامنة.بلغت معدلات تدخين السجائر، وتعاطي الكحول، وتعاطي الأفيون، وتعاطي مخدرات غير مشروعة أخرى 19.4٪ و6.3٪ و4.4٪ و4.2٪ على التوالي خلال الاثتني عشر شهرًا الماضية. وحُدِّدت ثلاث فئات: 1) فئة كبيرة ذات معدل انتشار منخفض للسلوكيات الخطرة [89.2٪؛ فاصل ثقة 95٪: 88.2–90.2٪ ]؛ 2) معدل انتشار مرتفع لجميع السلوكيات الخطرة ما عدا تعاطي المخدرات (6.1٪؛ فاصل ثقة 95٪: 5.3–6.9٪)؛ 3) معدل انتشار مرتفع لجميع السلوكيات الخطرة (4.7٪؛ فاصل ثقة 95٪: 4.1–5.5٪). وكان الرجال والأفراد المصابون باضطرابات نفسية ممثَّل ين تمثلًي زائدًا في الفئت يْ الثانية والثالثة.المتعاطون للكحول والأفيون مُعرَّضون لسلوكيات أخرى محفوفة بالمخاطر.Évaluation des comportements à risque dans la population générale iranienne : résultats de l’enquête iranienne sur la santé mentale.La République islamique d’Iran est un pays majoritairement musulman, où les comportements à haut risque sont culturellement peu acceptés.Étudier la co-occurrence des comportements à risque dans la population générale iranienne.Il s’agissait d'une étude transversale. Les données ont été obtenues auprès d'un sous-échantillon aléatoire de 3508 participants à l'enquête iranienne sur la santé mentale menée en 2011 qui ont rempli un questionnaire d'autoévaluation sur les comportements à risque. L'analyse en classes latentes a été effectuée sur sept types de comportement, à savoir la consommation de cigarettes, d'alcool, d'opium et d'autres drogues illicites, les rapports sexuels avec des partenaires multiples, l'emprisonnement et les fugues. Une régression logistique multinomiale non ordonnée a été réalisée pour examiner les caractéristiques des participants dans les classes latentes.Au cours des 12 derniers mois, les taux de tabagisme par cigarette, de consommation d'alcool, d'opium et d'autres drogues illicites étaient respectivement de 19,4 %, 6,3 %, 4,4 % et 4,2 %. Trois classes ont été identifiées : 1) une grande classe caractérisée par une faible prévalence des comportements à risque [89,2 % ; intervalle de confiance (IC) à 95 % : 88,2-90,2 %] ; 2) une prévalence élevée de tous les comportements à risque, à l'exception de la consommation de drogues (6,1 % ; IC à 95 % : 5,3-6,9 %) ; et 3) une prévalence élevée de tous les comportements à risque (4,7 % ; IC à 95 % : 4,1-5,5 %). Les hommes et les personnes présentant des troubles psychiatriques étaient surreprésentés dans les classes 2 et 3.Les consommateurs d’alcool et d’opium étaient exposés à d’autres comportements à risque.

Globally, alcohol use is one of the leading contributors to the burden of disease. The aim of this study was to provide data on prevalence and correlates of lifetime alcohol use among Iranian adults living in urban areas. This cross-sectional study investigated knowledge, attitude, and practice (KAP) of Iranian adults towards drug and alcohol use. Participants were recruited from the capital cities of five provinces-Tehran, West Azerbaijan, Markazi, Kerman, and Khorasan Razavi-in 2015. We used multivariate logistic regression models to conduct data analysis. Completing the questionnaire were 2,065 participants (44.06% female). Prevalence of lifetime alcohol use was 28% (95% CI: 25-29%). Lifetime alcohol use was significantly associated with male gender (Odds Ratio (OR) = 1.74, 95% Confidence Interval (CI): 1.26- 2.39), positive attitude towards alcohol (OR = 2.15, CI: 1.60-4.34), lifetime stimulants use (OR = 5.73, CI: 3.56- 9.23), and lifetime opioids use (OR = 4.47, CI: 3.12- 6.39). Estimated lifetime prevalence of alcohol use in our study was higher than the regional average. Primary alcohol prevention programs need to target sub- populations who are at risk for alcohol use and provide services that impede the development of positive attitudes towards alcohol.

Background: It is not always easy to put mental health on the agenda of sectors other than the health sector. However, it is now confirmed that mental health promotion policies need innovations beyond the scope of the health sector to be efficient. Thus, in this study, an attempt was made to identify the most effective stakeholders of the public sector in the field of mental health promotion in Iran to help the policy-makers of said sector and to encourage the inter-sectoral cooperation and further involvement of these effective sectors in mental health promotion plans.Methods: This was a mixed-methods study. From the data of the first step (literature review and a survey involving professors of relevant disciplines), the names of government agencies related to the domain of mental health were extracted. In the second step, a checklist was developed, the horizontal axis of which was the relevant organizations and the vertical axis was the social risk factors effective on mental health promotion. The data of this step were analyzed by the simple additive weighting method. In the final step, a table was plotted in the form of institutional mapping in order to summarize the organizations affecting each risk factor.Results: The Islamic Consultative Assembly, the Ministry of Interior, the Islamic Republic of Iran Broadcasting, the Ministry of Cooperatives, Labor, and Social Welfare, and the Ministry of Education were identified as five organizations with the greatest impacts on the social determinants of mental health promotion in Iran. Conclusions: Significant impacts can be exerted by institutions such as the Islamic Consultative Assembly (as the legislator), the Ministry of Interior and its subsidiary entities such as municipalities and governors (as the administrators of homeland security and support for safe and appropriate urban and local facilities), the Islamic Republic of Iran Broadcasting (as the national media), the Ministry of Cooperatives, Labor, and Social Welfare (as the institution in charge of employment, job security, and social welfare), and the Ministry of Education (as the educational institution of the country).

Background: Sexual health is a human right, yet there is a lack of comprehensive, standardized and culturally appropriate instruments to assess sexual health in Iran.Objectives: This study aimed to assess the psychometric properties of the Persian version of the Sexual and Reproductive Health Illustrative Questionnaire (SRH-IQ).Material and methods: This was a methodological psychometric study conducted in Tehran, Iran, during 2014–2015, with a sample of 755 men and women aged 15–49 years. The SRH-IQ was translated and adapted via the method recommended by the world health organization.. Qualitative and quantitative face and content validity were evaluated and the construct validity assessed using exploratory and confirmatory factor analysis. The internal consistency and the stability of the tool were assessed using Cronbach’s alpha, Intraclass Correlations Coefficient (ICC) and test–retest method.Results: Several items were changed in accordance with the cultural and religious beliefs of Iranians. The mean item-level content validity index (I-CVI) was 0.98; the content validity ratio (CVR) was high at 0.976; and scale-level content validity average (S-CVI/Ave) and scale level content validity universal agreement (S-CVI/UA) were found to be 0.97 and 0.94, respectively. Exploratory and Confirmatory factor analysis confirmed that all items in domains were significant, and the results supported goodness of fit indices, too. The final Cronbach’s alpha coefficients of all sub-scales were > 0.60 indicating acceptable internal consistency. Test-Retest data analysis showed that the ICC was higher than 0.88 for most items (0.75–0.99). Kappa coefficients were above 0.8 in most instances (0.65–0.99).Conclusion: Given the appropriate validity and reliability of the Persian version of the SRH Questionnaire, it can be used to assess sexual health knowledge, attitudes, behaviour and outcomes of Iranian adults.Plain English Summary Sexual health is an integral component of human right, and it is an important basis for an individual’s physical and psychological well-being, as well as the social and economic development of communities. Evaluating the sexual health needs of people is necessary to address sexual health goals. Several studies have been conducted within the field of sexual health in Iran, however, no Persian instrument is available to assess the sexual health needs of adults within the reproductive ages. In order to make it applicable within the context of Iranian culture, we have investigated the psychometric properties of the Persian version of the Sexual and Reproductive Health Illustrative Questionnaire (SRH-IQ) among Iranian men and women in reproductive age. With this aim, we have recruited 755 men and women aged between 15-49 years in urban Tehran, Iran. Several items of the questionnaire were changed in accordance with the cultural and religious beliefs of Iranians. Exploratory and Confirmatory factor analysis confirmed that all items in domains were significant, and the results supported goodness of fit indices, too. All in all, this study has given the appropriate validity and reliability of the Persian version of the SRH Questionnaire, and it can be used to assess sexual health knowledge, attitudes, behaviour and outcomes of Iranian adults.

Background: The worldwide emergence and rapid expansion of COVID-19 emphasizes the need to assess the knowledge gap and to predict the disease-related behaviors and reactions during this epidemic. Methods and design: COVID19 Population Survey of Iran (COPSIR) is a repeated cross sectional survey that will be conducted in 8 waves. In each wave, 515 Iranian adults aged 18 years or older will be randomly selected and interviewed by phone. The study waves will be performed at approximately weekly intervals. The survey tool is adapted from COSMO (COVID-19 Snapshot MOnitoring) study. This study will provide information on trends of knowledge, risk perception, preventive behaviors, psychological problems, essential needs, and public trust among Iranian adults during COVID-19 epidemic. Discussion: The key findings of each wave will be immediately reported to the National Headquarters for Coronavirus Control to set better policies for disease control and prevention. Moreover, if a message is extracted from the results of this study that needs to be communicated to the public, it will be done through the mass media.

Objective: The main objective of this study was to review aspects of the current situation and structure of the integrated mental health care services for planning a reform. Aspects of the newly designed infrastructure, along with specification of duties of the various human resources, and its relation with Iran’s Comprehensive Mental and Social Health Services (the SERAJ Program), will also be presented Method: This is a study on service design and three methods of literature review, deep interview with stakeholders, and focused group discussions. In the literature review, national and international official documents, including official reports of the World Health Organization (WHO) and consultant field visits, were reviewed. Deep semi-structured interviews with 9 stakeholders were performed and results were gathered and categorized into 3 main questions were analyzed using the responsibility and effectiveness matrix method. The Final results were discussed with experts, during which the main five-domain questions were asked and the experts’ opinions were observed. Results: In this study, the main gaps of the public mental health care (PHC) services in Iran were identified, which included reduction of risk factors for mental disorders, training the general population, early recognition and treatment of patients with mental disorders, educating patients and their families, and rehabilitation services. The new model was then proposed to fill these gaps focusing on increasing access, continuity of care, coordination in service delivery, and comprehensiveness of care. A mental health worker was placed besides general healthcare workers and general practitioners (GPs). Services were prioritized and the master flowchart for mental health service delivery was designed. Conclusion: A reform was indeed necessary in the integrated mental health services in Iran, but regarding the infrastructure needed for this reform, including human and financial resources, support of the senior authorities of the Ministry of Health (MOH) is necessary for the continuity and enhancement of services. In this model, attention has been given to the principles of integrating mental health services into primary health care. Current experience shows that the primary health care system has been facing many executive challenges, and mental health services are not exclusion to this issue. Monitoring and evaluation of this model of service and efforts for maintaining sustainable financial resources is recommended to make a reform in this system and to stabilize it.

Background Past research suggests that individuals suffering from depressive disorders with bipolar features might have different clinical outcomes resembling bipolar disorders. The objectives of this study are to determine the prevalence of bipolar features among individuals meeting the criteria for 12-month major depressive disorder (MDD) in the Iranian population and to examine the demographic and clinical characteristics associated with these features. Methods Data were drawn from the Iranian Mental Health Survey (IranMHS), a representative household survey of the Iranian population aged 15–64 years. The study sample consisted of all individuals with a 12-month MDD (n = 1014) ascertained by the Composite International Diagnostic Interview (CIDI 2.1) without a lifetime history of bipolar I or II disorders. Mood Disorder Questionnaire (MDQ) was used to screen for the lifetime history of bipolar features among participants with MDD. Results Among participants meeting the 12-month MDD criteria, 22.1% (95% CI: 19.6–24.7) had a lifetime history of bipolar features. Compared with those without these features, participants with bipolar features had higher odds of endorsing suicidal ideations and suicide attempts, comorbid anxiety and substance use disorders, severe impairment, history of psychotic symptoms, some features of atypical depression and fewer depressive symptoms. Associations with comorbid anxiety disorders [Odds Ratio (OR) = 1.43; 95% confidence interval (CI): 1.00–2.03] and history of psychotic symptoms (OR = 2.63 95% CI: 1.81–3.81) persisted in multivariable models. Limitation Relying on self-reports of lifetime bipolar symptoms which is open to recall bias, and cross-sectional study design which limits interpretation of outcome and course of MDD are two major limitations of this study. Conclusion The presence of bipolar features is associated with a distinct demographic and clinical profile in MDD. Identifying these cases would enhance the homogeneity of the depressive disorder phenotype in general population surveys. Identifying MDD patients with these features has potential clinical implications.

Background: Positive health as a "health asset" goes beyond risk factors for diseases and produces longer and healthier life, as well as, better prognosis when illness strikes, against traditional medicine focusing on treating people in negative health to a state that is neutral or free from disease. The aim of present study was to conduct a national survey estimating positive health indicators of Iranians Methods: This survey was performed on September 2014 in all provinces of Iran with 10500 samples. The psychometrics of employed scale was examined in separate study. To estimate positive health indicators, each question included a series of declarative statements and each respondents answer to questions based on a five-point Likert type scale. Results: From a total of 10500 respondents, 10244 fulfilled questionnaire (Response rate= 97.5%). About 49% of participants were male. In a scale from 1 to 5, mean of score of life satisfaction, happiness, quality of life, and self-perceived health were 3.45, 3.28, 3.56 and 3.66, respectively. The highest level of positive health indicators was achieved in provinces of Guilan and West Azerbaijan. Conclusion: The result of the study shows majority of Iranian people assess their perception of health, quality of life, life satisfaction and happiness as ‘moderate’ or ‘good’ (between 66 to 82% of respondents. It would seem that measured positive health indicators in comparison with the rates of past national studies, have been decreased between 3.5 to 4% that should be noticed in social health policy making.

INTRODUCTION AND AIMS There is a paucity of data on volume of alcohol use from Muslim majority countries. We aimed to present estimation methods for alcohol consumption with the use of survey data for these societies and provide an estimation for age 15+ per capita consumption of pure alcohol for Iran. DESIGN AND METHODS The Iranian Mental Health Survey was a nationally representative household survey on individuals aged 15-64 years, with a multistage, cluster sampling design. We used the 'Last Week' method and 'Quantity-Frequency' methods for gathering data on alcohol consumption and combined these to provide more complete estimates. RESULTS The response rate was 85.7%. From the total of 7840 respondents, 5.7% and 1% reported past 12 months and past week alcohol use, respectively. The highest estimation for age 15+ per capita consumption of pure alcohol was yielded by the 'combination method' (0.108 L ethanol/person/year) followed by the Quantity-Frequency method (0.079 L). The 'Last Week' method provided the lowest estimate (0.059 L). DISCUSSION AND CONCLUSIONS Unlike in surveys of non-Muslim countries, frequency of drinking from recent recall (last week) was much lower than from recall of usual drinking in the last year. We conclude that 0.108 L (SE = 0.03) is the best survey-based estimate of age 15+ per capita consumption, which translates to about 5 750 000 L of national consumption per year in Iran. However, this method is still likely to under-estimate per capita consumption due to evidence of under-reporting in the survey.

Background For nearly four decades, alcohol production and consumption has been banned in the Islamic country of Iran. However, little is known about the extent of alcohol use and associated problems in the country. The paper aims to present findings on the 12-month prevalence, symptoms, severity, correlates, and comorbidity of alcohol use disorders in the Iranian population. Methods This report is based on the 2011 Iranian household Mental Health survey (IranMHS), a nationally representative face-to-face household survey with a multi-stage, cluster sampling design. A total of 7840 individuals aged 15–64 responded to the alcohol section. We assessed 12-month alcohol use disorders according to DSM-IV and DSM-5 criteria and harmful use according to the ICD-10 criteria. Results Weighted prevalence of using alcohol at least once in the past 12 months was 5.7%. The prevalence of 12-month alcohol use disorders was 1% according to DSM-IV criteria and 1.3% according to DSM-5. Harmful use was reported in 0.6%. Alcohol use disorders were markedly more common in men than women with an odds ratio (OR) of 13.3. It was also more prevalent in never-married versus married individuals (OR = 2.5) and in those living in urban versus rural areas (OR = 2.4). Among those with alcohol use disorders, 46.3% had a concurrent mood or anxiety disorder. Aggressive behaviors and injuries were more likely in those with alcohol use disorders. Conclusion Although Iran has a low level of alcohol use, its adverse consequences including use disorders, aggression, and injuries are moderately common and raise serious public health concerns.

Background: The healthcare sector has a small share in community health, and other sectors are actively involved in this domain. Therefore, only by a collective and collaborative action can health promotion interventions be properly implemented. In order to have intersectoral collaboration in the domain of healthcare, basic criteria are required as an operational guide for the successful implementation of such collaborations. A specific framework is also required so that the programs can be properly implemented accordingly. After the implementation, the success or failure of the collaborative action will be determined by assessing the effectiveness of the actions taken using an appropriate assessment system (e.g., indicators). In this study, the basic criteria, models, and indicators of intersectoral collaboration in health promotion were investigated to facilitate the implementation of collaboration. Methods: This scoping review was conducted using datasets of Embase, Web of Science, Scopus, and PubMed, and search engines of Google, Google Scholar, and ProQuest. Original articles, review articles, and reports were included in this study. In terms of subject, articles which referred to the basic criteria, models, or indicators of intersectoral collaboration in health promotion were included. Results: A total of 52 studies were included in the final analysis, and 32 codes in three categories (micro, meso, and macro) were obtained. Micro-level intersectoral collaboration criteria had the highest frequency. Among the models used in the reviewed studies, social network analysis (SNA), Diagnosis of Sustainable Collaboration (DISC), Bergen, and logic models had the highest frequency in health promotion. Among the indicators studied, the number of participants and the level of collaboration as well as its sustainability were the most frequent indicators. Conclusion: The findings identified the most important and widely used criteria, models, and indicators of intersectoral collaboration in health promotion which can be useful for decision-makers and planners in the domain of health promotion, in designing, implementing, and evaluating collaborative programs.

Objective: Three categories of interventions are considered for reducing the prevalence of mental disorders in Iran: mental health promotion, increasing mental health and social service utilization and controlling mental health risk factors. In this regard, we designed a community action program in a national plan to provide comprehensive social and mental health services (SERAJ) that were implemented as a pilot in three districts of Iran: Bardasir, Oslo, and Quchan. In this study, we have reviewed the results of this pilot project. Method: This study was conducted based on the collaborative evaluation model; first, the program was described and the evaluation indicators of each component of the program were determined. Stakeholders were determined; also, data were collected through literature review, semi-structured interview, and focused group discussion and were analyzed by thematic analysis methods. Results: The community action program consists of four components: A Memorandum of Understanding (MoU) between the departments of the districts, People’s Participation House (PPH), Self-reliance Unit (SRU), and actions taken for stigma reduction. A total of 48% of the actions set out in the three MoU of three districts have been executed. The PPH was formed in all three districts. A total of 816 social referrals were admitted to SRU for which a self-reliance process has been initiated. Moreover, 47% of referrals have received services and at least 10 messages for stigma reduction and promoting mental disorders have been sent from different sources at the district level. Conclusion: Strengthening vertical cooperation between the national and provincial levels is essential for the full implementation of the Memorandum of Understanding (MoU) and self-reliance processes. Referring individuals for receiving social support with collaboration between the primary and secondary programs reported to be successful, but feedback to the primary and secondary levels which provides basic and specialized services, is not transparent. Therefore, we suggest an electronic system as an option to solve this problem. The careful selection of representatives of the people's network and empowerment of PPH and directors of the district on community action skills are essential. The experiences of the governors and chairs of health networks of the three districts should be presented at a national conference.

Drug abuse has significant cost to the individual, the family and the society. This study aimed to assess out of-pocket costs of consequences of drug use disorder. Data were drawn from the Iranian Mental Health Survey (IranMHS) through face-to-face interviews with 7841 respondents aged 15-64 years. We used a bottom-up cost-ofillness method for economic analysis. Out-of-pocket costs for treatment of mental and drug problems, treatment of medical illnesses, as well as costs of crimes were assessed. The average of total annual expense was US$ 2120.6 for those with drug use disorder, which was 23.5% of annual income of an average Iranian family in the year 2011. The average of total out-of-pocket cost was US$ 674.6 for those with other mental disorder and US$ 421.9 for those with no mental disorder. Catastrophic payment was reported in 47.6% of the patients with drug use disorder and 14.4% of those with other mental disorder. Thus, considerable amount of family resources are spent on the consequences of drug use.التكلفة الشخصية للعواقب الناجمة عن تعاطي المخدرات: نتائج مسح الصحة النفسية الوطني الإيراني.معصومة أمين-إسماعيلي، ميترا حفاظي، رضا رادجودارزي، عباس متوليان، فانداد شريفي، أحمد حاجبي، أفارين رحيمي-موقّر.ينطوي تعاطي المخدرات عى تكلفة كبرة للفرد والأسرة والمجتمع. تهدف الدراسة الحالية إلى تقييم التكاليف الشخصية الناجمة عن الاضطراب الناجم عن تعاطي المخدرات. واستُمدت البيانات من مسح الصحة النفسية الإيراني عن طريق إجراء مقابات مباشرة مع 7841 مستجيب للمسح، تراوحت أعمارهم بن 15 و 64 عاماً. واستخدمنا أسلوب حساب تصاعدي لتكلفة المرض لأغراض التحليل الاقتصادي. وتم تقييم التكاليف الشخصية لعاج المشكلات النفسية ومشكلات المخدرات، وتكلفة عاج الأمراض، إلى جانب تكاليف الجرائم. ولقد بلغ متوسط إجمالي المصروفات السنوية 2120.6 دولاراً أمريكياً للمصابن باضطراب ناجم عن تعاطي المخدرات، ما مثّل 23.5 % من الدخل السنوي لأسرة الإيرانية العادية في عام 2011. كا بلغ متوسط إجمالي التكلفة الشخصية 674.6 دولاراً أمريكياً لمن يعانون من اضطرابات عقلية أخرى و 421.9 دولاراً أمريكياً لمن لا يعانون من اضطراب عقي. وأُبلغ عن صرف مبالغ لمواجهة الكوارث في 47.6 % من حالات المرضى الذين يعانون من اضطراب ناجم عن تعاطي المخدرات و 14.4 % ممن يعانون من اضطرابات عقلية أخرى. وبذلك، تُنفق مبالغ كبرة من موارد الأسرة عى العواقب الناجمة عن تعاطي المخدرات.Coût des paiements directs engendrés par l’abus de substances psychoactives : résultats de l’enquête nationale iranienne sur la santé mentale.L’abus de substances psychoactives entraîne un coût important pour les individus, les familles et la société. La présente étude avait pour objectif d’évaluer le coût des paiements directs engendrés par les troubles liés à l’utilisation de substances psychoactives. Les données ont été extraites de l’enquête nationale iranienne sur la santé mentale au moyen d’entretiens en face à face avec 7841 participants âgés de 15 à 64 ans. Nous avons utilisé une méthode du coût de la maladie de type ascendant pour l’analyse économique. Les coûts des paiements directs pour le traitement des troubles mentaux ou des problèmes de drogue, le traitement des maladies, ainsi que les coûts engendrés par les crimes ont été évalués. La moyenne des dépenses annuelles totales était de 2120,6 dollars US pour les personnes atteintes de troubles liés à l’utilisation de substances psychoactives, soit 23,5 % du revenu annuel d’une famille iranienne moyenne pour l’année 2011. Le coût total moyen des paiements directs était de 674,6 dollars US pour ceux souffrant de troubles mentaux, et de 421,9 dollars US pour ceux exempts de troubles mentaux. Des dépenses catastrophiques ont été rapportées pour 47,6 % des patients souffrant de troubles liés à l’utilisation de substances psychoactives, et pour 14,4 % de ceux souffrant d’autres types de troubles mentaux. Une part considérable des ressources des familles est donc dépensée du fait de l’utilisation de substances psychoactives.

Background To assess the clinical course and outcome of patients with methamphetamine-induced psychosis in comparison with patients with primary psychotic disorders. Methods This prospective study was conducted on patients with methamphetamine-induced psychosis, and 2 groups of primary psychotic disorders: affective psychosis and non-affective psychosis admitted to 2 psychiatric hospitals in Tehran, Iran, with a first episode of a psychotic illness. A total of 165 subjects (55 in each group) were selected using convenience sampling. They were assessed at the time of admission, discharge and 6 and 12 months after discharge using the Positive and Negative Syndrome Scale, the Young Mania Rating Scale and the Global Assessment of Functioning Scale. The frequency of readmissions and suicide attempts were also assessed. Results Significant differences were found in the trend of changes of symptoms and functioning among the 3 groups. At all-time points, the severity of negative psychotic symptoms and dysfunction in the non-affective psychosis group were greater than those in affective or methamphetamine-induced psychosis groups, with latter 2 having similar profiles. However, the course of positive symptoms in methamphetamine-induced psychosis was more similar to non-affective psychosis. Number of suicide attempts and readmissions were non-significantly higher in methamphetamine-induced psychosis than in the other groups. Conclusion Methamphetamine-induced psychosis does not have a satisfactory course and in some cases symptoms may remain even after many months of follow-up. Rate of certain outcomes such as re-hospitalization is also considerably high. It is a challenge for the health-care system that requires evidence-based interventions.

Background and aims Drug abuse is a significant social and public health problem in Iran. The present study aimed to provide prevalence estimates and information on correlates of illicit drug use disorder and opioid dependence, as well as service use for these disorders in Iran. Design, setting and participants This report is based on the Iranian household Mental Health Survey (IranMHS) conducted in 2011. A three-stage probability sampling was employed. Face-to-face interviews by trained psychologists were carried out with a nationally representative sample of 7841 individuals (3366 men and 4475 women) aged 15–64 years. Measurements The Composite International Diagnostic Interview and questionnaires for socio-demographic correlates and service use. Findings The prevalence of 12-month use disorders for any illicit drug according to DSM-IV and DSM-5 criteria were 2.09% [95% confidence interval (CI) = 1.70–2.47%] and 2.44% (95% CI = 2.03–2.85%), respectively. Opioid use disorders, and opium in particular, were the most common use disorder. The odds of drug use disorders were greater in men than in women, in previously married participants than in currently or never married participants, and in participants with lower socio-economic status than in those with higher socio-economic status (all P-values

Background: Needle and syringe programs (NSPs) have been developed and implemented since 2002 in Iran. NSPs are largely delivered through fixed site and outreach services. Characterizing people who inject drugs (PWID) primarily using different sources of injecting equipment can help service design.Objective: The objective of the present study was to characterize and compare the risk behaviors of PWID according to their primary sources of clean needles and syringes in Kermanshah, Iran.Methods: We used data from a cross-sectional study of 500 PWID in Kermanshah. Behavioral and program data were also assessed to identify their main source of injection equipment, demographic characteristics, and risk behaviors. The Cochran–Armitage trend test was used to test for trends in characteristics and risk behaviors among the three sources for clean needles. We also ran a multinomial logistic regression to assess the individual characteristics of those who have reported the outreach or other sources of NSP ove...

To compare the performance of the general practitioners (GPs) in a collaborative care (CC) program in Iran with a control group of GPs in the usual care by employing simulated patients. Six trained simulated patients (SPs) made unannounced visits to 26 GP offices participating in the CC program and to 26 age and sex matched controls. The SPs role played five clinical scenarios of mental disorders and filled out checklists to evaluate the GPs’ performance regarding interviewing, taking history, establishing rapport, showing empathy, and giving advice to patients. Additionally, the GPs’ plan of care and prescriptions were evaluated later by a psychiatrist based on the documents provided by the SPs. There was a significant difference between collaborative care and control group physicians in their global performance; CC physicians built up better patient–physician relationship. They performed better in evaluating a psychotic patient, although not better in their management. CC physicians were marginally better in approach to patients with generalized anxiety disorder (GAD) and mild major depressive disorder. The overall performance of physicians in CC was better than the GPs in the control group in making an effective patient–physician relationship, and evaluating a psychotic patient. The main weakness of the GPs was in proper treatment of the minor and more common psychiatric disorders and in evaluation of patients with suicidal ideations who were in need for emergent referral. Evaluating performance of the practitioners is feasible employing SPs and the findings can be translated into improvements in the available services.

Sexual and reproductive health (SRH) knowledge is an important predictor of an individual's sexual behavior; however, little is known regarding this issue among Iranians. This study assessed sexual and reproductive health knowledge among men and women aged 15 to 49 years in Tehran. A total of 755 men and women aged 15 to 49 years were recruited using multistage, random cluster sampling in June 2014. An illustrative anonymous questionnaire endorsed by the World Health Organization (WHO) was used to collect the data. Bivariate and multivariate analyses were performed. The results showed that men and women were moderately knowledgeable about sexual and reproductive health (mean score of SRH knowledge = 39, range: 26 to 52); however, myths and misperceptions prevailed in different aspects of SRH. For example, only 45% of women and 38.7% of men accurately knew that a person infected with human immunodeficiency virus (HIV) can look healthy. Friends were identified as the primary or secondary source of knowledge about puberty and sex-related issues. A multivariate analysis showed that being female (coefficient = 0.139, p

Background: Extra/pre-marital sexual behaviors (EPSB) are considered as an important problem, especially among the young generation. Objectives: This study was conducted to estimate the prevalence and determinants of EPSB among university students in Kerman, Iran. Patients and Methods: This cross-sectional study was conducted on 2157 students in 2016. This study used different data collection methods such as direct and network scale-up (NSU). A self-administrated questionnaire was completed by the participants for direct data survey. Then NSU data were gathered through the interview by a trained same-sex interviewer. Results: Total of 1035maleand695female students (n=1730)werestudied with themeanage of 20.5 years (range 18 - 29). In the direct method, 14.9 of the studentshadsex with non-student partners (SNSP) (3.4 femalesand22.6 males). Corresponding percentages in the NSU method were 2.5 and 7.9. Comparing direct method results of two groups, it was determined that males' last year SNSP (22.6 ,) was more prevalent but in females, last year sex with student partner (SSP) (4.7) was more prevalent. Comparisons revealed that in the direct method, 41.7 of the students watched pornography (16.6 females and 58.8 males). There was a significant association between watching pornography and gender (OR male to female = 7.2), as well as between SSP and SNSP without any payment regarding the gender (OR male to female = 5.3 and 7.7). Conclusions: Our findings showed that extra/pre-marital sexual relationships are relatively common among university students, especially males.We found lower percentages in the indirect NSU method, which is mainly because of nature of such behaviors that are invisible in society and we could not provide estimation for visibility. © 2019, Author(s).

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.

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 Psychiatric Ward 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 methamphetamine were negative. At the three-month follow-up, the older sister of the only one 15-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.

Background: Deinstitutionalization of patients with schizophrenia shifted the primary locus of care from psychiatric hospitals to family and informal caregivers. Family members often play a vital role as caregivers in the lives of individuals with schizophrenia and other serious mental illnesses. This study aimed to assess the burden experienced by the caregivers of patients with schizophrenia and to evaluate its correlation with some demographic characteristics of patients, their caregivers, and the level of expressed emotion in the family. Methods: This descriptive-analytic study was conducted on 172 schizophrenic patients and their primary caregivers, selected from the outpatient department of a psychiatric hospital in Tehran, Iran, using convenience sampling. Caregivers were evaluated with Zarit Burden Interview and Family Questionnaire to assess the burden experienced by the caregivers and the level of expressed emotion in the family, respectively. Data were analyzed using Spearman correlation coefficient and linear regression method. Data were analyzed using SPSS software (Version 21) and significance level was set at p< 0.05. Results: The level of burden experienced by most of primary caregivers was higher than moderate. The scores obtained in the subscales of emotional over involvement and critical comments were higher than the cutoff point in 51.7% and 64.5% of caregivers, respectively, and the scores had a significant direct correlation with the burden experienced by the caregivers. The findings of multiple linear regression showed that lower family income (β= -0.33, p< 0.001), higher duration of disorder (β= 0.19, p= 0.006), and younger age at onset of the disorder (β= -0.26, p= 0.001) were predictive of higher burden of disease on caregivers. Conclusion: Based on the results, some demographic factors of the primary caregivers, patients, and their family significantly affected the burden experienced by the primary caregivers. Most of the caregivers had high expressed emotions and a significant direct association existed between the expressed emotions and the burden experienced.