Development of attributes and levels of mental health insurance services using a discrete choice experiment.

BACKGROUND: Despite the fact that mental illness is among the ten top diseases with the highest burden, the health services required by these patients do not have adequate insurance coverage. The purpose of this study is to develop the attributes and levels of mental health insurance services using a discrete choice experiment (DCE). MATERIALS AND METHOD: This study involved a qualitative phase of the DCE that was conducted in Iran in 2020-2021 and included several stages. First, during a literature review, the attributes and levels were determined. Then, the attributes of health insurance were identified and weighed through virtual and in-person interviews with 16 mental health insurance professionals and policymakers in this field who were selected by purposive sampling. Finally, after a few sessions, through review studies, interviews, and a group of the expert panel, attributes and levels were finalized. RESULTS: This study showed that coverage of inpatient services, outpatient services, place of receiving services, use of online internet services, limitation of services, and monthly premiums were the most important attributes of mental health insurance services. CONCLUSION: To promote mental health insurance, policymakers and health insurance organizations should pay attention to premiums to be commensurate with the payment of people, packages of mental health services, and the ability of people to pay in appropriation with inflation. Identifying these attributes can determine people's willingness to pay and preferences for mental health insurance and lead to better planning for more comprehensive coverage for patients and increase the desirability of individuals in receiving services.

Assessing the Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Obsessive- Compulsive Disorder.

Objective. Obsessive-compulsive disorder (OCD) is a frequent and disabling neuropsychiatric disorder with a lifetime prevalence of 3%. About 40% to 60% of patients show no or just partial symptom improvement to treatment with a first-line drug and cognitive behavior therapy. Ten percent of patients remain treatment refractory despite several treatments. For these patients, repetitive Transcranial Magnetic Stimulation (rTMS) has been suggested as a treatment option. Method. We investigated the efficacy of rTMS on the Supplementary Motor Area (SMA) in 16 right handed pharmaco-resistant OCD patients in an outpatient setting. The patients have been diagnosed with OCD by two psychiatrists and referred for rTMS intervention. Patients received 16 sessions of low frequency (0.5 HZ) rTMS on SMA,100% motor threshold, 1200 stimuli/day for 40 minutes every other day. OCD, depression, and anxiety symptoms were measured at baseline, 2, 6, and 12 weeks by Yale-Brown Obsessive Compulsive Scale(Y-BOCS) and Hamilton Depressive and Anxiety rating scales (HAM-D and HAM-A). We assessed the side effects of rTMS by a self-administrative questionnaire. Results. Patients' scores in Y-BOCS, HAM-D, and HAM-A were significantly decreased following rTMS treatment. The baseline and 12 weeks scores of Y-BOCS were 28.94 and 18.31 (P-value < 0.01), HAM-D were 14.69 and 7.94 (P-value <0.01) and HAM-A were 16.38 and 6.94 (P- value < 0.01), respectively. The patients reported no serious side effects of rTMS except two case that reported light headach. Conclusion. This study showed that low-frequency rTMS on SMA improved OCD, anxiety, and depression symptoms after 16 sessions.

Health Care Professionals' Perception of Stress During COVID-19 Pandemic in Iran: A Qualitative Study.

BACKGROUND: The health care professionals have a unique role in controlling the pandemic of COVID-19 and decreasing its mortality and morbidity. The burden of care and psychological impact of working in this circumstance can be unfavorable for many caregivers. In this qualitative study, the health care professionals' perception of stress during COVID-19 pandemic in Iran was assessed and several implications were proposed. MATERIALS AND METHODS: The participants were selected among staff who were providing medical services to patients with COVID-19 infection at the largest teaching hospital in Iran. Quota sampling was used to include physicians, nurses, and other paramedics. The grounded theory was selected to develop interview questions. Moreover, the thematic approach was applied to analyze the data content and data analysis was performed based on open and axial coding following the implementation of codes in MAQDA software. RESULTS: A wide range of psychological reactions including anxiety, feelings of guilt, depression, and anger were detected in the staff. Uncertainty accompanied by the pandemic of COVID-19 and shortcomings in preparation for crisis management were recognized as the two main sources of stress among health care professionals. CONCLUSION: Based on the findings of the study, it is important to identify and evaluate the mental health needs of healthcare professionals. To reduce stress among health staff at COVID-19 care centers, it seems that the optimal strategy is simultaneous improvement in equipment and crisis management.

A Survey on Mental Health Status of Adult Population Aged 15 and above in the Province of Isfahan, Iran.

INTRODUCTION: This research aims to determine the mental health status of population aged 15 and over in the province of Isfahan in 2015. METHODS: The statistical population of this cross-sectional field survey consisted of residents of urban and rural areas of Isfahan in Iran. Through systematic random cluster sampling, 1200 individuals were selected from the residents of urban and rural areas of Isfahan, Kashan and Shahin shahr. The 28-item version of the General Health Questionnaire was applied as the screening tool. The data were analyzed using SPSS, version 18.0 for windows. RESULTS: This study showed that using the traditional scoring method, 30.6% of the subjects (38.5% of females and 22.5% of males) were suspected of having mental disorders. The prevalence of suspected psychiatric disorders in urban areas (32.1%) was higher than the prevalence of these disorders in rural areas (27%). The prevalence of suspected anxiety and the somatization of symptoms was higher than the prevalence of social dysfunction and depression, and the prevalence of these components in women was higher than men. The findings of this study also showed that the prevalence of suspected mental disorders increased significantly with age. The prevalence of suspected cases of these disorders among women, the age group of 65 and older, people living in urban areas, divorced and widowed, illiterate, and housewives was higher than other groups. CONCLUSION: The results of this study show that more than one third of the sample are suspected of mental disorders, and the prevalence of these disorders has increased from 21.3% in 1999 to 30.6% in 2015; therefore, it is up to the authorities and health managers of the province to take the basic steps to supply, maintain, and preserve the mental health of those in need and promote the mental health of the community.