Out-of-pocket cost of drug abuse consequences: results from Iranian National Mental Health Survey

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-of-illness 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 dollar 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 dollar 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

Measuring self-perceived social health of Iranians; finding from Iran social health survey

Background: The novelty of the study is to measure self-perceived social health of Iranians as one of the main dimensions of health

Materials and Methods: This cross-sectional study was conducted in all provinces of Iran in September 2014 with 10500 participants to measure self-perceived social health on a scale from 33 to 165 arranged in three areas; family, friends and relatives, and community. Area of "family" was measure in a range from 6 to 30; area of "friends and relatives" was from 9 to 45; and area of "community" was from 19 to 95. The psychometrics of scale was examined in separate previous study

Results: From a total of 10500 participants, 10244 fulfilled questionnaire [Response rate= 97.6%]. 49.2% of participants were male. Mean of the total social health score was 99.91; area of "family" was 22; area of "friends and relatives" was 27.6; and area of "community" was 51.2. The main factors negatively influences on social health were low house size, unemployment, being divorced or widow and being at the age of 18-30. There was no significant relationship between social health score and educational level

Conclusion: It is magnificently attained that standardized social health rate in the present study was 3.9% lower than the rate has been estimated in comparison to similar previously conducted study in three big cities of Iran, two years earlier. Area of "community" is also the main accountant for this drop. To continue monitoring the social health of Iranians, we recommend conducting the next rounds every 3-5 years

Assessing measurement error in surveys using latent class analysis: application to self-reported illicit drug use in data from the Iranian Mental Health Survey / 한국역학회지

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.

Impact of HIV status notification on risk behaviors among men who inject drugs in kermanshah, west of Iran

Background: It is unclear whether knowing of current HIV status is associated with change injecting behaviors among people who inject drugs [PWID] in Iran. The objective of the prese study was to determine whether awareness of HIV positive status is associated with a reductn in injecting risk behaviors, after matching for socio-demographic characteristics

Methods: Five hundred male PWID were recruited in 2014 from two drop-in centers [DICs] Kermanshah west of Iran

Trained interviewers collected data on socio-demograp characteristics, HIV testing and drug-related risk behaviors over the last month prior to intervi using a structured questionnaire

Our primary exposure of interest was awareness of HIV sts used to group participants into three categories: positive, negative, unaware. We u coarsened exact matching to make the three groups statistically equivalent based on age, pi of residence, education and income, and then compared them regarding the proportior borrowing, lending and reuse of syringes

Results: Matched sample [n=320] had a mean age +/- standard deviation [SD] of 33.5 +/-7J Overall, 25% [95% Cl: 14%, 32%] of participants reported [borrowing a syringe] in the month and 15% [95% Cl: 7%, 22%] of them reported [lending a used syringe] to others ii past month. In comparison to PWID who were unaware of their HIV status, those knew were HIV positive [OR 1.68, CI95%1.32-2.81] or negative [OR 1.54; 95% Cl: 1.28, 2.71] both more likely to report borrowing syringes in past month

Conclusions: PWID WHO know they are positive for H//V are more likely to borrow are person's syringe, to report reuse of their own used syringes and less likely to report lending syringes to others. Strategies to scale up HIV testing and counseling for PWID, whicl increase awareness of HIV status, may decrease injecting related the risk behaviors

Independent and Social Living Skills Training for People with Schizophrenia in Iran: a Randomized Controlled Trial

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 singleblinded. 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. 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.

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

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, according to our review, 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. We conducted a survey using cross sectional method in three cities of Iran [Tehran, Isfahan, Urmia] 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. 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 Uremia as a small city in comparison with big cities-Tehran and Isfahan [p<0.001] and was lower for unemployed people [p=0.029]. There was no association between social health score and other factors such as sex, age and educational level [p>0.05]. 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

[ role of depression, stress, happiness and social support in identifying suicidal thoughts in students]

This study has investigated the predictive value of psychological constructs including stressfulness of life, depression, happiness and social support on the rate of suicidal thoughts in students. The study sample included 1094 boys and girls residing in the Tehran University's student dormitory. The participants completed Suicidal Ideation Scale [SIS], Student Depression Scale [SDS], Student Life Stress Inventory [SLSI], Oxford Happiness Scale [OHS], and Social Support [SS] scale. The statistical data analysis using multiple regression techniques showed that happiness, depression, stress and social support account for 76 percent of the changes in students' suicidal thoughts. In addition, the results showed that depression has the strongest predictive power of suicidal thoughts. Depression and related structural variables could be used for predicting and efficiently identifying students' suicidal thoughts

[Evaluation of mental health program integration into the primary health care system of Iran]

The aim of the current study was to evaluate the integration of mental health program into primary health care system. In a cross-sectional, quantitative and qualitative study, the knowledge, attitude and performance of 1209 individuals of general population, 146 behvarzes, 35 health technicians and 51 general practitioners from rural health centers of Gilan, Tehran, Meshad, Iran, Kerman and Kermanshah universities of medical sciences who were undercoverage and out of coverage of mental health program in the rural areas of selected centers, were selected by randomized cluster sampling. The data was gathered using knowledge, attitude and performance questionnaires of behvarzes, general population and general practitioners toward mental health, behvarzes' performance on training, following up and referral of mentally patients based on primary health care [PHC] program, knowledge and attitude of general population toward mental illnesses, epilepsy, mental retardation, their causes and treatments, general physicians awareness about treatment, referral and integration of mental health program into PHC, general practitioners's performance of health centers and a semi-structured questionnaire for focus group discussion sessions [FGD]. Thirty trained mental health experts from neighborhood of selected provinces, completed questionnaires and analyzed. Descriptive statistics and independent t-test were executed. There was significant difference between behvarzes in areas under coverage and out of coverage in knowledge [p

[Designing a registration system for suicide in Iran]

The goal of the present study was to design a registration system for recording suicide in Iran, capable of designing identification pathways, registration, and report and follow-up of suicide cases and deaths due to suicide. Through library assessments and surveying suicide registration systems in other countries [Denmark, India and WHO], potential methods of suicide in Iran were identified; also, potential methods of identifying suicide cases in the country were designed and finalized subsequent to group consultation. Suicide registration forms were designed, using the collected data. In this system: 1- The Health and Treatment Network is considered to be the appropriate site for the collection of data related to suicide, 2- Instances of suicide deaths and suicide attempts will be completely registered, 3- Data will be gathered from treatment centers and other contributing centers in general monthly forms, 4- Mental health attendants will enter the data into the computer system each month, in the suicide registration center affiliated to the health and treatment center, 5- The system will be primarily executed in two universities, 6- Training of target group [managers and personnel] in the primary stages of execution is important. The launch of the system for recording suicidal behavior in the country is the first essential step in the control and prevention of suicide

[Geographical distribution of human resources in mental health provision system in 2007]

The present research was carried out with the aim of providing a geographical map and the distribution of indices related to the distribution of human resources in the mental health system in Iran according to regions covered by different medical universities. This study was carried out using the data present in mental health system reports in the year 2007. Subsequent to the adjustment of indices, data were presented by drawing descriptive and interpolated maps using Arc GIS 9.2. Also, the amount of each evaluated index, minimum, maximum and standard deviation of each index in different areas were reported. In 2007 the nationwide means of covered population to total population of the country, covered urban population to total urban population, covered rural population to total rural population, proportion of covered health centers, to total health centers, proportion of covered health and treatment rural centers to the total, proportion of covered urban health and treatment centers to the total, and the proportion of covered health headquarters to the total were 54.8%, 36.9%, 96.2%, 97.5%, 97.1%, 50.4%, and 41.4% respectively. The individuals providing mental health services comprised: 29282 assistants in nursing, 6529 health workers, 4595 trained general practitioners, 61877 health messengers, 692 psychiatrists, 27 child psychiatrists, 126 psychologists [56 clinical, 70 other], 652 professionals with master's degree in psychology [183 clinical, 469 other], 651 social workers, and 214 psychiatric nurses. There is favorable distribution of specialized human resources in the country's health system, however, there is an disparity between the distribution of specialized human resources and covered population