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Abstract Background Social capital has long been recognized as a determinant of various health outcomes. However, the existence and magnitude of these associations may vary across different health conditions, different communities, and periods. This study aimed to investigate the association between social capital and major depressive disorder (MDD) among participants of the Persian Youth Cohort (PYC) study. Methods The PYC study enrolled 11,592 participants aged 15–34 years, from four cities in Iran representing a range of geographic areas. Baseline assessments included measuring lifetime MDD using the Persian version of the Composite International Diagnostic Interview (CIDI-2.1) and a 27-item social capital questionnaire to evaluate voluntary participation, trust, and sense of cohesion. We analyzed the baseline data using logistic regression to identify potential associations. Results The prevalence of lifetime MDD was 18.3%. The mean social capital-total score was 73.93 (SD = 13.93). A higher social capital-total score was inversely associated with the likelihood of MDD (AOR: 0.70, 95% CI: 0.66–0.74). Moreover, participants with higher scores in voluntary participation (AOR: 0.88, 95% CI: 0.83–0.92), trust (AOR: 0.65, 95% CI: 0.62–0.68), and sense of cohesion (AOR: 0.72, 95% CI: 0.68–0.75) were less probable to suffer from MDD. Conclusion Our study corroborates the existing evidence of the association between MDD and the three dimensions of social capital- participation, trust, and sense of cohesion- highlighting the consistency of these findings across diverse settings including young adults in Iran. The use of a valid diagnostic tool for assessing MDD adds robustness to our results, offering valuable insights for regions with similar social and cultural contexts. These findings suggest that interventions fostering social capital, particularly trust and cohesion, may help reduce the burden of MDD in youth.

Abstract Background Vaccination is one of the most effective ways to manage infectious disease epidemics such as Covid-19. However, the low rates of vaccination in populations at risk including people using illicit substances, hinders the effectiveness of preventive vaccines in reducing transmission. The aim of this study was to investigate the rate of Covid-19 vaccination and its related factors among people who use substances in Tehran, Iran. Methods Between July and December 2022, 386 people who use substances aged ≥ 18 years old were recruited by convenience street-based sampling in Tehran. The outcome variable in this study was self-reported completion of at least two doses of the Covid-19 vaccine. Logistic regression was used to investigate the factors related to Covid-19 vaccination. Data were analyzed using SPSS software version 20 at the 0.05 level of significance. As a measure of risk, 95% Confidence interval (CI) was used. The level of significance was considered at 0.05. Results Almost three-quarters (n = 286) of the participants reported receiving at least two doses of the Covid-19 vaccine (95% CI, 70.2–79.3). Those participants with high school diplomas were 1.17 times more likely than less educated participants to report having had 2 vaccinations (OR of 1.17, CI 95%: 1.03–1.81). Participants with a higher mean score of having a positive attitude towards Covid-19 vaccination were more likely to have received a vaccination (OR of 1.12, CI 95%: 1.08–1.17). Ethnicity was also an influential variable, people with non-Fars ethnicity were less likely to be vaccinated than those of Fars ethnicity (OR of 0.33, CI 95%: 0.13–0.81). People with higher-than-average monthly income were more likely to report vaccination than those with low monthly incomes (OR of 1.27, CI 95%: 1.09–1.8). Also, participants reporting less access to vaccination centers had a lower chance of reporting having been vaccinated than those who reported high access to vaccination centers (OR of .17, CI 95%: .08-.36). Conclusions Covid-19 vaccine uptake was found to be relatively high among people using illicit substances in this study. Higher levels of education, Fars ethnicity, higher income levels, having a positive attitude towards vaccination and access to vaccination centers were the most important predictors of Covid-19 vaccination in this study.

Abstract Background Despite the high occurrence of floods in Iran, its psychological consequences have been less discussed. The present paper addresses the prevalence of Post-traumatic Stress Disorder (PTSD) and its determinants among the affected adults by the huge flood of 2019. Methods An analytical cross-sectional study was conducted through household face-to-face surveys in August and September 2019. Individuals who were affected by floods and were at least 16 years old were randomly selected from three provinces in Iran: Lorestan and Khuzestan in the west and southwest, and Golestan in the northeast. The questionnaire of demographic and flood related variables in addition to the Impact of Event Scale-Revised (IES-R) were utilized to collect the data. We applied a complex sample analysis to describe the prevalence of PTSD and logistic regression analyses to find its determinants. Results Out of the 2,305 individuals approached for surveys, 1,671 (72.5%) adults affected by the floods participated in the study. The majority of participants were housewives, married, had either no formal education or primary education, and resided in rural areas. The prevalence of PTSD in the participants was 24.8% (CI 95%: 20.7–28.8%) and was significantly higher in Lorestan province (39.7%, P

Abstract Background and objectives Due to an increased rate of inflammation in generalized anxiety disorder (GAD), insight into the mediating factors in the onset and recurrence of the inflammatory response can help to achieve novel treatments for alleviating the risk of GAD. In the current study, we aimed to evaluate the possible relationship between visceral adipose tissue (VAT) as an important intermediary in inflammation pathways and GAD in participants of the Employees’ Health Cohort Study of Iran (EHCSIR). Method We analyzed the data from 3889 included participants aged > 18 years in the EHCSIR study, which were collected from 2017 to 2020. Lifetime and 12-month GAD were assessed using the Composite International Diagnostic Interview (CIDI-2.1) questionnaire. The adjusted prevalence ratio was computed to evaluate the association between GAD and visceral adiposity index (VAI), GAD and visceral fat area (VFA), GAD and body mass index (BMI) and ultimately GAD and waist circumference (WC) in males and females using STATA software. Results Log-binomial analysis showed a higher prevalence ratio of 12-month GAD associated with VFA in women [PR: 1.42, CI: 1.07–1.87, P: 0.015]. The prevalence of lifetime GAD was higher in obese women (BM1 > 30) [PR: 2.35, CI: 1.07–5.13, P:0.03] than in women with normal BMI. Women with higher VAI were also significantly more likely to suffer lifetime GAD [PR: 1.25, CI: 1.05]. 1.48, P:0.01]. In males, the prevalence of lifetime diagnosed GAD per 1 standard deviation increase in VFA was 0.65 [CI: 0.46–0.91, P: 0.01]. Conclusion Visceral adiposity as a positive agent was associated with GAD prevalence in women. The presence of GAD symptoms showed no relationship to VFA in men.

Abstract Background Depression can have negative effects on a person’s physical health. However, the available evidence on the risk of susceptibility to COVID-19 and its adverse outcomes in people with mental disorders, including depression, is limited and inconsistent. Therefore, we investigated the relationship between major depressive disorder (MDD) and the risk of susceptibility to COVID-19 infection and hospitalization. The data used in the study were obtained from the Employees’ Health Cohort Study of Iran (EHCSIR). Methods We conducted a cohort study that included 3355 participants who had complete data on major depressive disorder at baseline assessment and two annual telephone follow-ups between January 2020 and March 2022. Trained psychologists used the Persian version of the Composite International Diagnostic Interview (CIDI-2.1) to identify major depressive disorders during the baseline assessment. We applied log binomial regression models to adjust for sociodemographic factors and background health conditions. Results We found that 11.4% of participants had lifetime MDD and 7.3% had MDD in the past 12 months. During the pandemic, 26.1% of participants were infected with COVID-19, and 14.4% of those who were infected were hospitalized. The risk of susceptibility to COVID-19 infection was significantly higher among participants with lifetime MDD than among those without MDD (adjusted risk ratio (ARR) = 1.24, 95% CI: 1.06–1.47). However, lifetime MDD or 12-month MDD was not independently associated with hospitalization among COVID-19 cases. Conclusions Preexisting major depressive disorder may increase the risk of susceptibility to COVID-19.

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.

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

Background and Objectives: As a health emergency of the 21st century, Diabetes is associated with an increased risk of cardiovascular diseases, stroke, diabetic nephropathy, neuropathy, retinopathy, pregnancy complications, psychological problems, lower quality of life experience, as well as a high economic burden and high risk of premature death. This study aimed to develop psychological interventions headings for patients referring to healthcare service centers based on local needs assessment through content analysis method of experts' opinion to provide services in the primary healthcare system. Material and Methods: This study was conducted on 19 mental health specialists, professors, and the health team providing services in healthcare service centers (family doctor and mental health expert) in 2018-19. The data obtained from the semi-structured interviews were analyzed using the directed content analysis technique. Results: The essential finding themes related to the closed headings of psychological interventions in diabetes for improving disease management included "collaborative care," "psychological assessment," the importance of "diabetes coexistence with psychiatric disorders," "creating health behaviors," "self-management training," and "intervention" In crisis" for the management of type 2 diabetes. Conclusion: This qualitative study was conducted with the participation of mental health experts. Therefore, the mentioned themes and categories can be used in developing the headings of psychological intervention programs for type 2 diabetic patients, focusing on the needs of Iranian patients and the structure of the health system.

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

IntroductionThe fear and embarrassment associated with stigmas discourage patients from help seeking behavior, which may explain why even the patients' loved ones advise them to discontinue treatment to avoid being labeled. In addition, stigmas can lead to personal and family issues, causing patients to disregard their illness. As such, their disease may develop into a chronic condition. This being said, the present study aims to investigate the challenges, solutions, and successes associated with stigmatization in Iran from the perspective of mental health stakeholders.MethodA qualitative study was conducted in the summer of 2022. Purposive sampling was utilized to recruit participants. The primary data collection method involved a focus group interview that lasted 110 min. The project manager monitored the interviews, and all research team members attended the meetings, took notes, and made the necessary preparations. After explaining the study's purpose and ensuring the data's confidentiality, the interviewer led a focus group discussion. The interviews were recorded with the participants' consent. A focus group was used to conduct interviews with 13 individuals until data saturation was reached.FindingsTen psychologists, psychiatrists, and managers responsible for mental health, two patients, and one patient's family member participated in the current study as eligible participants. Repeated readings led to the emergence of three main classes under the headings of challenges, solutions, and successes of stigma management in Iran, each containing subclasses.ConclusionThe majority of the proposed solutions in this study centered on raising awareness and training diverse individuals and groups to lessen stigmas. The most crucial de-stigmatization measure is to offer training that will cause the current stereotypes to change. This must be taken by patients and their families as well as therapists, leaders, policymakers, the general public, and the media. Ideally, younger members of the target groups should be considered for these pieces of training, which must be based on research and derived from cultural and localized needs.

Abstract 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: 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

Abstract: Background and aims: Pars Special Energy Economic Zone is the second largest source of gas in the world and Iran’s energy capital. The oil and gas industries in many respects affect the health of the inhabitants of the region. The creation and development of this industry creates major stressors in the communities around these areas; include air pollution, surface water and groundwater pollution, heavy vehicle traffic, noise pollution, accidents, functional disorders, and psychosocial stresses associated with social change. Studies conducted in this area have shown that the physical, mental and social health status of workers and employees and their families is not good. Due to the special importance of this region in financing the countrychr('39')s development programs, providing, maintaining and promoting its sustainable health is of strategic importance. Community participation in health issues has many benefits in terms of health care and development; because it increases problem-solving skills in communities so that they take responsibility for their health and well-being as much as possible and ensure that the needs and issues of the community are properly addressed. There are different patterns for peoplechr('39')s participation. However, in a wide and public participation, the use of peoplechr('39')s representation has been emphasized, which accelerates the participation of the people. These representatives could be the leaders and elders of the target community, official and legal representatives of the people, non-governmental organizations, self-help groups, volunteers, popular people in the community and special groups. Content analysis method was used to summarize the obtained information. The completed questionnaires and oral comments recorded in the group discussion sessions were manually coded and then were classified as the main themes Includes the benefits, disadvantages, main problems and strategies for improving health and how to operationalize the role of people.This study is aimed to examine the challenges and strategies for health promotion of the people from the viewpoint of the mediators of the region. Methods: This is a qualitative study with intentional sampling which the snowball method was used to complete the list of participants and 20 mediators participated in this study. First, a list of popular networks was prepared using purposive sampling method. After identifying the networks, they were asked in an official letter to introduce an informed and interested representative to identify and address the health challenges of the region. After identifying the networks, they were asked in an official correspondence to introduce an informed and interested representative to identify and address the health challenges of the region. Then, in a two-hour meeting with the presence of the introduced representatives, a poll was conducted on them through a focused group discussion method. In this meeting, while stating the goals and ensuring the confidentiality of the collected information, a written questionnaire was distributed among them and after answering within 15 minutes, peoplechr('39')s opinions about the problems of the region and solutions were taken orally. Finally, the draft prepared by the research team was reviewed and the necessary amendments were made with the opinion of the majority of members. Results: According to the mediators, the existence of industry in the region has led to the benefits such as job creation, cultural and educational development and extending urban services. Moreover, gas extraction and the creation of the countrychr('39')s economic capital have led to the acquisition of knowledge and skills comparable to other countries. Disadvantages of industry are including air, watersoil and sea contamination. The usable lands have been destroyed and the traditional jobs such as agriculture, animal husbandry and fishing have been destroyed. Following the entry of subcultures into the original culture of the people, cultural tensions have occurred and a deep gap has been created between people and companies;and crimes have increased. The three main problems were lack of facilities and medical infrastructure with equitable distribution; high prevalence of diseases due to environmental contamination and Unemployment. Consideration of health centers and health houses, drinking water health and people engagement in regional decision making have been suggested. Conclusion: In this study, the maximum effort of researchers has been made to involve peoplechr('39')s representatives and mediators, which is one of the preconditions for the development of the region and one of the most obvious requests of the mediators. The use of a focused group discussion method not only led to researchers gather the views of different groups of people but also made the mediators themselves interacted more effectively and were aware of each otherchr('39')s view points. In conclusion, peoplechr('39')s opinions refer more to the roots and causes and indicate that the trust between the people and the officials in the region has been severely damaged, however, they are grateful and aware that they should be empowered to improve their situation. Interaction between these three groups is essential to improve the regionchr('39')s health: people, the oil industry and sovereignty of the local government. It is recommended that the health council of the region is formed with the participation of peoplechr('39')s representatives after the process of applying peoplechr('39')s opinion and designing a comprehensive health plan

IntroductionThe COVID-19 pandemic has caused increasing levels of mental health problems such as anxiety and depression among doctors, nurses and other healthcare workers in hospitals or health centers. The main objective of this study was to assess the mental health, job stressors, and burnout among healthcare workers in Iran.Materials and MethodsA cross-sectional study was performed in the primary healthcare centers and hospitals affiliated with six of the medical universities in Iran. The selection of participants was done using multi-center convenient sampling. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Copenhagen Burnout Inventory were used for gathering data through an online platform. Data related to job stressors were obtained using a validated checklist. Data analysis was performed using Chi-square and multiple regression tests and the phi coefficient.ResultsThe results of our study showed that 53% of the healthcare workers of the hospitals and primary healthcare centers enrolled in our study either had generalized anxiety disorder or major depressive disorder or both disorders. Moderate and high levels of burnout were seen among 48.9% of the study participants. The prevalence of mental disorders and burnout were significantly higher among the female healthcare workers compared to the male (p = 0.0001) and a higher rate of mental disorder and burnout was also seen among healthcare workers of hospitals compared to those working in primary healthcare centers (p = 0.024). “Worry about children and old members of family,” “family worries for my health condition” and “lack of specific effective treatment for COVID-19” were found to be predictive of mental disorder and burnout. The most prevalent job stressor among the total sample was “low payment or income during the COVID-19 period”.ConclusionThe results of our study revealed high psychological distress and burnout among healthcare workers of the hospitals during the fourth peak of the COVID-19 pandemic in Iran. This study highlights the need for health officials to pay attention to the job stressors of healthcare workers and obliges them to perform effective interventions to address their needs and concerns.

BackgroundAs stigma is one of the main barriers in promoting the mental health, the present study was designed with the purpose of reviewing clergy's viewpoint regarding the effect of mental health workshops on these barriers.MethodsFor this study, by order of Iran's Health Ministry, a questionnaire was designed to examine the clergy's viewpoint related to mental illnesses and the consequent stigma. Ten faculty members and psychiatrists confirmed the questionnaire's validity after some modifications. In this research, 30 members of the clergy from the main religious city in Iran's “Qom” Seminary attended the training workshops for 2 days. The data obtained from the clergy's responses were analyzed using the SPSS software (ver.16) and descriptive and analytical tests. Also, the significance level was considered p < 0.05 in all tests. The results exhibited that the mean and standard deviation (Mean ± SD) of the clergy's attitude domain and awareness before the workshop was 1.90 ± 26.30 and 8.31 ± 1.64, respectively. Also, average and standard deviation (Mean ± SD) of their attitude domain and awareness after the workshop was 1.95 ± 29.73 and 1.18 ± 10.70, respectively.DiscussionThe present study, which was designed to examine the clergy's viewpoint toward mental illnesses and the consequent stigma in the most considerable religious base in the country, illustrated that one strategy for reducing mental illness stigma in religious communities can be by holding training sessions to promote the clergy's awareness of and attitude toward mental health.ConclusionThere was a significant statistical difference between their awareness and attitude scores before and after the workshop (p < 0.01). In the present research, the awareness and attitude of clergy toward mental health and stigma due to mental illness was relatively good and significantly increased by holding the workshop.

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

Background: Estimating the population who use drugs is essential for planning, monitoring, and evaluation of substance use prevention and treatment. This study aims to estimate the population who misuse tramadol in urban population in Iran. Methods: We used the wisdom of the experts (WOTE) and network scale-up (NSU) methods to calculate the population of tramadol misusers in 10 provincial capitals of Iran, in 2016. The WOTE was conducted among pharmacists in drugstores and the personnel of traditional medicinal herbs stores. They guessed the best estimation of tramadol misusers population in their cities. The NSU method was conducted among the general population and participants were questioned about ever and daily, non-medical use of tramadol during last 12 months in their network. The median of the methods was used to calculate the proportion of the adult population (15-49 years old). Findings: The population size of tramadol misusers in studied cities was 83300 [95% uncertainty limits (UL): 47960-256220]. This corresponded to 6.6 per 1000 (95% UL: 3.88-20.30) of the 15-49-year-old population. The projected number of tramadol misusers for all 31 provincial capitals was 118290 (95% UL: 68100-363130840) and 212440 (95% UL: 122310-653410) for all urban areas. NSU also estimated the number of people who misuse tramadol on daily basis. These numbers were 52000 (95% UL: 19940-176570) for studied cities, 73840 (95% UL: 28320-250740) for all 31 provincial capital cities, and 132610 (95% UL: 50860-450310) for all urban areas in Iran. Conclusion: This study presents information on high prevalence of tramadol misuse in urban population. We need national control measures and demand reduction programs to control tramadol misuse.

Introduction: Drug addiction has always been considered as one of the most pervasive social problems. Although the risk of drug addiction is high in men, but this risk has been increased in women as well. Method: This qualitative study was conducted on 21 addicted women in Bushehr who were selected using purposive sampling method. Data were collected using semi-structured in-depth interview. All interview were recorded, immediately written, and analyzed using qualitative content analysis. Results: After data analysis, 3 main themes including personal, family, and social factors with 17 items were obtained. Conclusion: The main factors affecting drug addiction in women in Bushehr were personal and family factors. Some interventions such as increasing the knowledge of people about factors affecting drug addiction and family education can be effective in the prevention of drug addiction in women.

Background Providing population-based data on awareness, attitude and practice of drug and stimulant use has policy implications. A national study was conducted among Iranian general population to explore life time prevalence, awareness and attitudes toward opioids and stimulant use. Methods We recruited subjects from 5 provinces with heterogenic pattern of drug use. Participants were selected using stratified multistage cluster sampling. Data were collected using a validated self-administered questionnaire. Logistic regression model was applied to identify the variables that are associated with drug and stimulant use. Results In total 2065 respondents including 1155 men (33.96 ± 10.40 years old) and 910 women (35.45 ± 12.21 years old) were recruited. Two-third of respondents had good awareness about adverse effects of opioid use. Corresponding figure in terms of stimulants was 81.4%. Almost 95% of participants reported a negative attitude towards either opioid or stimulant use. The lifetime prevalence of opioid use and stimulant use were 12.9% (men: 21.5%, women: 4.0%) and 7.3% (men: 9.6%, women: 4.9%), respectively. Gender (adjusted odds ratio [AOR]M/W = 6.92; 95% CI: 2.92, 16.42), education (AORundergraduate/diploma or less = 0.49; 95% CI: 0.26, 0.90), and marital status (AORothers/single = 2.13; 95% CI: 1.36, 3.33) were significantly related with opioid use. With respect to stimulant use, age was negatively associated with the outcome (AOR60+/20-29 years = 0.08: 95% CI; 0.01, 0.98) and men were 2 times more likely than women to use stimulants (ORM/W=2.15: 95% CI: 0.83, 5.56). In addition, marital status (AOROthers/singles = 3.45; 95% CI: 1.09, 10.93), and awareness (AORWeak and moderate/good = 0.40; 95% CI: 0.25, 0.61) were independently correlated with stimulants use. Conclusion While the attitude of Iranian adults toward opioid and stimulant use was negative, their awareness was not that adequate to prevent the drug use. Men and those with lower socio-economic status (SES) should be the focus of health promotion programs regarding opioid use. However, regarding stimulants use, promotion programs should target younger age groups and those with higher SES status.

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 aims to thoroughly explain the educational needs for implementing the provision of comprehensive mental and social health services in districts of Iran (SERAJ). Method: In this study, we have interviewed service providers, held focused group discussions (FGDs) and used the knowledge, attitude, and practices (KAP) model for analyzing the duties of the service providers. Results: To implement SERAJ, Mental and Social Health Professionals and Healthcare professionals should be trained on various contents in the fields of mental health, social health, and addiction to provide ‎primary care services in Iran. Such training materials and schedules are necessary for providing secondary, and community action care ‎services as well. Conclusion: The educational program resulting from this study should be piloted and after removing the barriers and solving the limitations, it should be expanded throughout the country.

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

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

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.

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) indicated that almost 1 in 4 people had one or more psychiatric disorders (23.6%); however, two-thirds of patients did not benefit from health interventions, many provided services were inadequate and imposed a high burden on Iranian families. Therefore, the development of a national program on providing comprehensive social and mental health services, entitled “SERAJ”, became necessary. The present study aims to develop and outline the protocol for the pilot implementation of SERAJ. Method: This study is an action research with the collaborative mode. To compile the protocol, a broad review of the literature, interviews with experts and stakeholders, and focused group discussions were conducted. Results: The pilot implementation should be divided into 4 phases: (1) preparing documentation and work team, (2) preparing the prerequisites for providing pilot services, (3) providing pilot services, and (4) implementation and evaluation. Conclusion: SERAJ considered both preventive and treatment measures for mental and social health disorders and their risk factors. Moreover, the entire population can have access to primary and secondary services. Therefore, SERAJ is more comprehensive than the current situation in the country's mental health services. We suggest piloting and evaluating SERAJ in three districts of Iran.

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.

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

Background: Drug addiction is known as one of the health, medical and social problems of the present century. Beyond the harmful physical and mental consequences for addicts, drug abuse can cause serious social problems. The aim of this study was to evaluate drug and alcohol abuse in individuals aged 15 yr and over in Iran in 2015. Methods: This descriptive cross-sectional study was done on individuals aged 15 yr and older who lived in urban and rural areas of Iran. Overall, 36,600 individuals were selected by systematic and cluster random sampling. The postal code was used to access the samples in 31 provinces of Iran. In each province 1200 individuals (50% men, 50% women) were evaluated. The used instrument was the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and data were analyzed using SPSS software. Results: The results showed 4.6% of individuals used Opium and its derivatives, 0.4% used Cannabis, 0.4% used Amphetamine stimulants, 6.1% used Sedative drugs, and 2.6% used Alcoholic beverages on a regular basis. Within the last 12 months, 3.9% of individuals used Opium and its derivatives, 0.4% used Cannabis, 0.3% used Amphetamine stimulants, 5.8% used Sedative drugs, and 1.9% used Alcoholic beverages. With the exception of Sedatives drugs men used more drugs than women and residents of rural areas used more opium and its derivatives than other groups of drugs. Based on the provincial distribution, Kerman and Qom used the highest and lowest prevalence percentage of Opium and its derivatives respectively. Conclusion: Overall, 2340000 individuals were addicts used Opium and its derivatives in 2015, therefore, medical and health officials should take all necessary measures to deal with these serious social problems.

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: South Pars gas field is the world's largest gas field and the capital of energy in Iran. The oil and gas industry exerts potential effects on the health and culture of its surrounding community. The sustainability requirements of development projects include local participation, human sustainability and social sustainability. The present study was conducted to investigate health-associated challenges and their effective causes and solutions from the perspective of the residents of the camps and the staff of Pars Special Economic Energy Zone (PSEEZ) as stakeholders and participants in the development projects. Materials and Methods: The present qualitative study was conducted on a population comprising two groups, including the staff of the region’s industry and the residents of camps. Purposive sampling was used to collect data using four methods, including library studies, holding group discussion sessions and surveying the staff, ethnographic observations and focus group discussion. The data were collected from the questions raised and content analysis was performed. Results: Inadequate living facilities and space, insufficient facilities for recreation and exercise, failing to comply with health standards and requirements, addition and psychological illnesses were proposed as the main problems in the region. The solutions proposed by the employees in the region included planning and enforcing its implementation, forcing employers to meet the minimum health standards, financing or attracting investments for recreational and welfare facilities and teaching safety precautions and health points to the residents and employees. Conclusion: The root cause of the problems is mainly operational and structural. Most of the solutions are therefore compulsory, including obligations such as forcing contractors to meet the requirements, changing welfare regulations and following a legally-enforced program.

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.

Abstract Background It has been shown in the past two decades that anxiety disorders are the most common mental disorders in general population across the world. This study sought to assess the prevalence of major anxiety disorders, their sociodemographic correlates and mental health service utilization as part of the Iranian Mental Health Survey (IranMHS). Methods A national household face-to-face survey was carried out on a representative sample of Iranian adults from January to June 2011 using Composite International Diagnostic Interview (CIDI 2.1). A total of 7886 subjects between 15 and 64 years who can understand Persian language were included. The 12-month prevalence of anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), their socio-demographic correlates, health service use and days out of role were measured in this study. Results The 12-month prevalence of anxiety disorders (not including specific phobias) was 15.6%. The prevalence was 12.0% in males and 19.4% in females. The three most prevalent anxiety disorders were generalized anxiety disorder (5.2%), obsessive-compulsive disorder (5.1%) and social phobia (3.2%), respectively. Factors found to be significantly associated with anxiety disorders were: female gender (OR = 1.16, 95% CI: 1.09–1.23), middle (OR = 1.23, 95%CI: 1.01–1.50) or low (OR = 1.66, 95%CI: 1.31–2.10) socioeconomic status, unemployment (OR = 1.98, 95%CI: 1.49–2.62), and urban residence (OR = 1.31, 95%CI: 1.10–1.57). Comorbidity with non-anxiety disorders significantly increased service utilization. In all subgroups, service utilization was higher among females while the number of days out of role was higher among males. Conclusions Anxiety disorders are common conditions with a higher prevalence among the female gender, unemployed individuals, and people with low socioeconomic conditions living in urban areas. Comorbidity of anxiety disorders with other psychological disorders aggravates the disability and significantly increases the number of days out of role.

Introduction: Child abuse remains a significant public health and social problem in developing countries. Studies on this subject could provide valuable information regarding the scope and nature of this phenomenon and its impact on public health. This study aimed to determine the demographic characteristics and risk factors of children and parents involved in subtypes of child abuse in a psychosocial support department. Materials and Methods: This cross-sectional study was conducted in a pediatric hospital in Bandar Abbas, Iran from 2011 to 2013. The understudy population consisted of 519 child abuse cases that had been referred to psychosocial support departments for further investigations. Data regarding demographic characteristics and risk factors were collected using a questionnaire. Data analyzed through descriptive statistics, Logistic regression and SPSS software version 16. Results: From the total, 315 (60.7%) were boys and 355 (68.4%) were under 6 years. A total of 152 (29.3%) parents had mental disorders. The most common type of abuse in children was neglect (77%). Physical abuse was more commonly done by working mothers. Study results also revealed that physical abuse was less prevalent among children of less educated mothers and fathers. Physical abuse was also more common among children of parents with mental disorders and single parent families. Conclusion: This study showed that demographic characteristics of the child and parents and some related risk factors have a significant effect on child abuse subtypes.

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

Local poem is one of cultural manifestation for every nation. The study of the Iranian various ethnic pop cultures by poetry indigenous exploring results in better understanding of the cultural elements of these sub-cultures. Since nostalgic concepts are one of the leading indicators in the local systems, we can explore historical, social and cultural factors of the formation and evolution of these indicators in addition to by studying and comparing nostalgia components in different cultures in addition to extracting the elements of similarities and differences of these components.Two native poems of Yadeten by Saleh Sangbor and Marouvezou by Faramarz Shakouri which first has been said in a Persian dialect of Bandar Abbasi and second has been said in a Gilaki dialect of Abkenari reflect the view of the public culture of two people living in Bandar Abbas and Bandar Anzali. Both poems reflect the poet's nostalgic throwback to the old days. It has been attempted in this research that the nostalgic view components of the two poets to the cultural elements of the society be studied in which they lived. For this purpose, the nostalgic notions of the two systems have been compared and analyzed under the general title of individual and collective memory. In the individual memory nostalgia section, reversion to the childhood and reconstruction of the space of that era is one of the main pillars of both poems of "Yadeten" and "Marouvezou". Saleh Sangbor considers his childhood remembrance to his human right and identity. Shakouri in the poem of "Marouvezou" has a nostalgic return to his childhood and the memories of these days made such a magical and timeless impression in the soul of the poet that he has never been able to be removed from the charismatic influence of those days in later periods of his life. The throwback views to the childhood in the two aforementioned poems can be considered in reviewing local games, social customs and beliefs, persons, places and objects nostalgic and legends and folk songs mentioned in two works.Recursion to nature is another aspect of the nostalgic throwback of the two poets to the past days. Both poems start by citing the nostalgic memories of the land nature in which the poet lived and all over the two poems contain the citation of the elements of the primitive life in the rural heart of the nature. The distinction of the naturalism of the two poets refers to the climate in which they lived. Introspective and empathic understanding of the nature and its elements in both works is quite obvious and the elements of the nature have an important share in the two works in the descriptions and imagery. Both the poet attempt to present a kind of an absolutely ideal imagination from the past primitive and rural society of the past having more connection to the area nature. The critique of modern civilization and modernism imposed on ethnic minorities is another common aspect of the two poems. In both poems, the poet deals with criticizing the new civilization appearances after passing the childhood and adolescence. In Yadeten, these criticisms cover about one-third of the total poems. Both of the poets complain about the civilization which put enmity rather than friendship and sham rather than truth after citing sincerity and the past links and they hate some consequences such as addiction, unemployment and slaughtering of innocents. Sangbor and Shakouri consider greed and getting away from human nature as the most important negative consequence of the new era.In both systems, the general spirit of the two works in addition to stating the individual nostalgic multiple memories is the recursion of the collective memory of two people of Bandari and Gilaki. In fact, his individual memory is a page of the collective memory album of the people. In the systems of Yadeten and Marouvezou, the adudience is not the forest and wetland and a particular individual, but he is a collective memory of these nations. In this citation, the historical aspect is dominant on the mythological one. The representation of the cultural elements of the public of the two people shows that the cultural elements of the two parties contain many aspects in common in spite of the diversity and difference

Background: The rise in popularity of waterpipe smoking among younger people cause increase its deleterious effects on health in recent years. The aim of this study was to estimate the pooled prevalence of water-pipe smoking in university students in Iran. Methods: We performed the literature search from 1946 to January 21, 2019, in several international and national databases such as Medline/PubMed, Web of Science, Scopus, Google Scholar, Magiran, Iranmedex, and IranPsych. To investigate the between-study heterogeneity we used the chi-squared test and I2 index. We used a random-effects model to estimate the pooled prevalence of water-pipe smoking. The potential source of heterogeneity was assessed by subgroup analysis and meta-regression. Results: According to the eligibility criteria, we included 37 relevant studies in our meta-analysis. The pooled prevalence of lifetime water-pipe smoking was 25% (95% CI: 22-29) and in male and female subgroups was 37% (95%CI: 30-45), 17% (95%CI: 15-19) respectively. The pooled prevalence of water-pipe smoking in last year was 21% (95%CI: 16-25) and in last month was 8% (95%CI: 5-11). Results of meta-regression analysis showed that there was not any significant association between suspected variables and the prevalence of water-pipe smoking. Conclusion: The higher prevalence rate of water pipe smoking among university students indicates the emergency need for planning preventive program.

INTRODUCTION: Emergency prehospital providers (EPHP) who are constantly providing medical care in threatening conditions are more at risk of displaying psychological distress presentations in disaster situations. Problem-solving strategies are essential for effective and efficient management of event position. Therefore, the present study aimed to explore psychological distress promotion in Iranian EPHP. MATERIALS AND METHODS: A qualitative content analysis study was conducted based on 24 semi-structured interviews. A purposeful sampling method was applied until reaching data saturation. Interviews were transcribed verbatim, and then, data condensing, labeling, coding, and defining categories were performed by the qualitative content analysis recommended by the Landman and Graneheim approach. RESULTS: Based on the experience of study participants, two main themes with six categories developed. The main themes included emotion-based management and problem-based management when confronting with incidence scene. CONCLUSION: The main problems of EPHP in confronting with incidence and disasters scenes are psychological distress which some rescuers have emotional reactions while some others who are more resilience and experience manage this problem in the form of problem-based approach. It is recommended these practical strategies to be taught to less experienced rescuers for avoiding emotional-based reactions and better management of disaster scene.

Background: This study was aimed to determine the prevalence, predictors and cost of CAM practitioner use among traumatic patients in Iran. Methods: This cross-sectional household survey of a nationally representative sample of Iranians 15 to 64 yr old was conducted in 2011, using a three-stage cluster sampling. Short Form Injury Questionnaire 7 (SFIQ7) was utilized through face-to-face interviews and data on demographics, history of injuries, mechanism, site and type of injury, type and place of the treatment were attained. Via telephone calls, service use and costs of treatment were also collected. Results: The prevalence of CAM practitioner use in injured people and victims seeking medical care was 0.7% and 4.1%, respectively in 3-month interval in 2011. There were no significant sociodemographic differences between victims who seek unconventional settings and those who seek conventional treatment. The most common injury description treated by CAM providers was as follows: fracture (type of injury), upper limb (site of injury), fall (mechanism of injury) and cast, splint, and physiotherapy (type of treatment). The average medical cost of CAM practitioner was US$14.7 while this amount in the conventional setting was US$195.5. Conclusion: Use of CAM is not very common among injured people in Iran. However, due to lack of formal training, CAM usage has possible side effects.

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

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

Background & Aim: Nowadays, we have some data in different sciences which number of zeros is more than expected, such data are called zero-inflated which can be modeled by regressions for count data. Many researches have been conducted in the field of classical method on count data. Most of Bayesian analysis which is conducted for these data used zero-inflated Poisson regression. Therefore, the main purpose of this research is comparison of Bayesian and classic approaches in regression of zero-inflated negative binomial (NB) on data for determining the size estimation of people who have used alcohol more than once in last year. Methods & Materials: This research had been in two provinces of Fars and Kerman in 2011, a sample size of each province was formed proportional to people of that province, and totally the calculated sample size was 700. Zero-inflated NB regression was fitted to the data in two Bayesian and classical methods, and then two methods have been compared. Results of Bayesian method were extracted in OpenBUGS software and through related codes in R and results of classical method were extracted in R software too. Results: After fitting classical method, variables of province, gender, age groups, and education had been effective on identifying number of alcoholics, but in Bayesian method, three variables of gender, age groups, and education have become significant. In this research, it was specified that obtained probability intervals from Bayesian method are much Widder than classical method. Conclusion: Results of this research indicate that Bayesian method has better function than the classic

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

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

Objective: This study proposed a model for provision of an effective universal coverage for mental health services based on global and national experiences, available resources and the nature of primary health care system of Iran to reduce the burden of mental health conditions. Method: A framework with prioritized mental and social health services was devised through a review of literature and policy documents. It was then adapted using inputs from the stakeholders and experts. Results: The new model included 2 basic and specialized service strata: a PHC-based infrastructure and essential requirements needed to establish the service. Our proposed socio-mental health approach is based on a WHO recommendation. Conclusion: The key features of the model, which is going to be tested in a pilot study in 2015, are setting up a system for organized referrals to specialized mental facilities and compatibility with the existing primary health care system. Moreover, to achieve this goal, socio-mental health technicians should be employed.

Background: Injuries and psychiatric disorders, notably both major public health concerns, are associated with a high burden and are believed to be bi-directionally correlated. Those inflicted with injuries face increased risks of mental illnesses. Psychiatric disorders may make the individual prone to injuries. The objective of the study was to assess the correlation of mental disorders with non-fatal injuries. Methods: A total of 7886 participants aged 15 to 64 yr were interviewed in a national household survey in 2011 in Iran. Composite International Diagnostic Interview (CIDI v2.1) was implemented to assess the prevalence of psychiatric disorders in the past twelve months. Injuries were assessed using Short Form Injury Questionnaire (SFIQ-7). Results: Injury was reported in 35.9% and 22.8% of participants in the past twelve and past three months, respectively. Using multivariate logistic regression analysis, mental disorders were significantly associated with injuries in the past three months (OR=1.6, 95% CI:1.36-1.87), recurrent injuries (OR=1.7, 95% CI: 1.21-2.41) and road/traffic accidents (OR=2.4, 95% CI: 1.28-4.49). Conclusion: Psychiatric disorders were found to be associated with an increased risk of injuries. Early detection and treatment of mental illnesses can contribute to injury prevention.

Latent class analysis (LCA) is a method of assessing and correcting measurement error in surveys. The local independence assumption in LCA assumes that indicators are independent from each other condition on the latent variable. Violation of this assumption leads to unreliable results. We explored this issue by using LCA to estimate the prevalence of illicit drug use in the Iranian Mental Health Survey. The following three indicators were included in the LCA models: five or more instances of using any illicit drug in the past 12 months (indicator A), any use of any illicit drug in the past 12 months (indicator B), and the self-perceived need of treatment services or having received treatment for a substance use disorder in the past 12 months (indicator C). Gender was also used in all LCA models as a grouping variable. One LCA model using indicators A and B, as well as 10 different LCA models using indicators A, B, and C, were fitted to the data. The three models that had the best fit to the data included the following correlations between indicators: (AC and AB), (AC), and (AC, BC, and AB). The estimated prevalence of illicit drug use based on these three models was 28.9%, 6.2% and 42.2%, respectively. None of these models completely controlled for violation of the local independence assumption. In order to perform unbiased estimations using the LCA approach, the factors violating the local independence assumption (behaviorally correlated error, bivocality, and latent heterogeneity) should be completely taken into account in all models using well-known methods.

Introduction: This study evaluated the relationship between social support, mental health and also demographic factors in health staffs of Bushehr oil industry in 2006. Methods: This cross-sectional descriptive study enrolled all health staffs, except 9 subjects who refuse to participate (108 male and 41 female). Subjects were evaluated by demographic questionnaire, general health Questionnaire-28 and Social Support Scale. Statistical analysis was performed by two sample t test, ANOVA and Pearson correlation coefficient. Results: This study showed that female gender, 35-44 age range group, having college educations, marital status and families with 4-5 members have higher mental health and social support. Onshore shiftworker staffs in comparison with others have lower mental health and social support. Conclusion: Social support and mental health showed a direct and significant correlation. The changes of policies for promoting quality and quantity of supportive networks, especially for vulnerable staffs, can reinforce protective effects of social support.

Objective: The Sheehan Disability Scale (SDS) assesses disability in four domains of home management, work responsibilities, close relationships and social life. The main objective of this study was to develop the Persian version of the SDS. Method: Two steps of field work followed the Persian translation and cultural adaptation of the tool: First, the internal consistency and convergent validity was examined in 104 clinical cases recruited from inpatient and outpatient psychiatric services, using 36-item Short Form Health Survey (SF-36) and Global Assessment of Functioning (GAF). Then 88 individuals were randomly selected from the adult general population to assess internal consistency, inter-rater reliability and known group validity. Results: In the clinical settings, Cronbach’s α coefficient was 0.88 and item-total correlation ranged from 0.71 to 0.78 in various domains. The correlation between SDS and SF-36 (P

Objectives: Our objective was to design an RCT in order to assess the effects of adding a brief skill-based psychoeducation (PE) to routine Needle and Syringe Programs to reduce injection and high risk sexual behaviors associated with Human Immunodeficiency Virus (HIV) infection among referrals of Drop-in Centers (DICs). Method/design: This was a randomized control trial with the primary hypothesis that adding skill-based PE to the routine needle syringe program (NSP) provided in the DICs would be more effective in reducing injection and high risk sexual behaviors associated with HIV infection compared to the routine programs. We intended to randomly allocate 60 patients per group after obtaining informed written consent,. The intervention group receive a combination of brief psychoeducation consisting two individual sessions of skill-based education concerning blood borne viral infection, specifically HIV. The control group received the routine primary NSP services provided in DIC. Study assessments were und rtaken by a psychologist at baseline, 1 and 3 months after recruitment. The primary outcome measure was the comparison of the trend of alterations in high risk sexual and injection behaviors associated with HIV infection during 3 months after the initiation of the intervention between the two groups. Secondary outcome measures included the comparison of HIV/AIDS related knowledge and client satisfaction in the participants . Discussion: This paper presents a protocol for an RCT of brief skill-based PE by a trained psychologist to reduce the sexual and injection related high risk behaviors among drug users who received primary NSP services in DIC. This trial tried to investigate the efficacy of the intervention on increasing HIV/AIDS related knowledge and client satisfaction. The results of different indicators of high risk behaviors will be discussed.