Afarin Rahimi-Movaghar

Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of WHO recommendations.

Shekhar Saxena and colleagues summarize the recent WHO Mental Health Gap Action Programme (mhGAP) intervention guide that provides evidence-based management recommendations for mental, neurological, and substance use (MNS) disorders.

HIV prevalence amongst injecting drug users in Iran: A systematic review of studies conducted during the decade 1998-2007

BACKGROUND AND OBJECTIVES Iran is a country with low HIV prevalence in the general population and concentrated prevalence amongst injecting drug users (IDUs). Various studies have been carried out on HIV prevalence amongst IDUs in Iran and diverse results have been reported. This systematic review intended to find and collect all relevant studies, assess the quality of data and provide estimations on the national prevalence over time. METHODS A broad search strategy was used, including searching international and local databases, research reports, and extensive personal contacts. All studies of IDUs conducted between 1998 and 2007 including clear description of method and HIV testing and confirmative western blot test were entered and qualitatively assessed. HIV prevalence rates were pooled for gender and stratified into several categories. RESULTS Twenty-two studies involving 3916 IDUs were included. Half of the studies had been conducted in Tehran. Ten studies were conducted in prisons, seven in treatment centres and five in the Drop-in-centres or communities. After 2005 the pooled HIV prevalence was 18.4% [95% Confidence Interval (CI) 16.7-20.2] significantly higher than the prevalence rate before 2005 [8.7% (95% CI 7.5-10]. CONCLUSION HIV prevalence amongst IDUs has increased over time and has the potential to increase exponentially. Scaling up harm reduction measures, increasing their availability and coverage, and improving the quality of services is highly recommended in order to prevent a future catastrophic epidemic.

Epidemiology of Illicit Drug Use Disorders in Iran: Prevalence, Correlates, Comorbidity and Service Utilization Results from the Iranian Mental Health Survey

BACKGROUND AND AIMS Drug abuse is a significant social and public health problem in Iran. The present study aimed to provide prevalence estimates and information on correlates of illicit drug use disorder and opioid dependence, as well as service use for these disorders in Iran. DESIGN, SETTING AND PARTICIPANTS This report is based on the Iranian household Mental Health Survey (IranMHS) conducted in 2011. A three-stage probability sampling was employed. Face-to-face interviews by trained psychologists were carried out with a nationally representative sample of 7841 individuals (3366 men and 4475 women) aged 15-64 years. MEASUREMENTS The Composite International Diagnostic Interview and questionnaires for socio-demographic correlates and service use. FINDINGS The prevalence of 12-month use disorders for any illicit drug according to DSM-IV and DSM-5 criteria were 2.09% [95% confidence interval (CI) = 1.70-2.47%] and 2.44% (95% CI = 2.03-2.85%), respectively. Opioid use disorders, and opium in particular, were the most common use disorder. The odds of drug use disorders were greater in men than in women, in previously married participants than in currently or never married participants, and in participants with lower socio-economic status than in those with higher socio-economic status (all P-values <0.05). Approximately half of those with drug use disorders and 40% with opioid dependence had a 12-month unmet need for treatment. Self-help groups were the most common type of service used, followed by obtaining medication from pharmacies directly and outpatient treatment services. CONCLUSIONS Opioid use disorders are the most common type of drug use disorders in Iran, setting Iran apart from many other countries. Patterns of service use suggest a large unmet need for drug use disorder treatment in Iran.

Factors Correlated With Hepatitis C and B Virus Infections Among Injecting Drug Users in Tehran, IR Iran

Background In Iran, the number of injecting drug users (IDUs) has increased in recent years. The rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections among IDUs are reportedly high. Objectives The purpose of this study was to assess factors correlated with HCV and HBV infections among IDUs in Tehran. Patients and Methods A cross-sectional study included 899 IDUs recruited from the community, drug treatment centers, and drop-in-centers. The study involved interviews conducted using an adapted version of the WHO Drug Injection Study Phase II (Version 2b) questionnaire and blood testing for the HCV antibody, hepatitis B surface antigen, and hepatitis B core antibody. A logistic regression model was used to identify independent factors correlated with HCV and HBV infections. Results HCV infection was found to be primarily associated with female gender [odds ratio (OR) 5.0, 95% confidence interval (CI) 2.0-10.0)], unmarried status (OR 2.9, 95% CI 1.9-4.4), drug use for more than 10 years (OR 2.7, 95% CI 1.8-3.9), drug injection frequency of more than once per day (OR 2.6, 95% CI 1.6-4.2), history of imprisonment (OR 2.5, 95% CI 1.6-4.0)], and a history of shared injection needles in prison (OR 2.3, 95% CI 1.5-3.6). HBV infection was mainly correlated with a history of imprisonment (OR 1.9, 95% CI 1.4-2.7) and drug use for more than 10 years (OR 1.4, 95% CI 1.1-1.9). Conclusions Because a considerable number of IDUs in Iran are receiving reduction services, tailoring services for prevention of hepatitis infection are necessary.

A follow-up study of drug users in Southern Iran

Iran has the highest rate of opium addiction per capita in the world. The aim of this study was to examine the outcome of substance use among a cohort of drug users living in a rural area in Southern Iran. A semi-structured interview was conducted at baseline and at each follow-up visit on 211 substance users. Of the total of 211 drug users, 145 were non-injection drug users (non-IDUs) and 66 were injection drug users (IDUs). The most common method of drug use among all participants was revealed to be opium smoking. Other methods of choice were injection drug use (IDUs) and opium ingestion among 31% and 20% of participants, respectively. From the total of 211 participants in this cohort, on average (SD), each drug user gave up drugs 3.2 (2.7) times over the study period. Among those who were non-IDUs at the base line visit (145), 17 (12%) were abstinent for more than 6 months compared to 9 of 66 non-IDUs (14%) at the end of the study. By the end of the study period, 9 of 145 non-IDUs switched to non-IDUs while 11 of 66 IDUs (17%) switched to non-IDUs (chi-square = 5.78; p = 0.016). One main reason for a higher rate of transition among IDUs was mentioned by them as observing the deaths of several IDUs in their community that were a result of overdose.

The change in attitude and knowledge of health care personnel and general population following trainings provided during integration of mental health in Primary Health Care in Iran: a systematic review.

BackgroundMental health has been integrated in the primary health care program in small cities and villages of Iran in a national level since the late 1980s. We performed a systematic review of literature to investigate the effect of education on change in attitude and knowledge of mental health care providers and the population covered in the program during the recent two decades in Iran.MethodsElectronic bibliographic databases including Pubmed, PsycINFO and EMBase as well as the main Iranian databases (Scientific Information Database, IranMedex, IranPsych, and IranDoc) were searched. Additionally, hand searching, personal contacts and tracking of reference lists were performed. All of the studies which compared the attitude and knowledge of the related population before and after an educational intervention were recruited.ResultsSix articles met the inclusion criteria and entered the review. All of these studies showed an improvement in the attitude and knowledge of the studied population. Although the studies were different in many respects, a meta-analysis on the two more similar studies showed a significant effect of training on long term improvement of the knowledge and attitude of the population.ConclusionA short term training improved knowledge and attitude of the population and health personnel immediately after the intervention. There is also evidence for a long term change in the attitude and knowledge of general population after short term training.

Prescription Drugs, Alcohol, and Illicit Substance Use and Their Correlations Among Medical Sciences Students in Iran

Background: Substance use among young people is a major public health problem in Iran. Objectives: The aims of the present study were to determine the prevalence of substance misuse and its determinants in medical sciences students in Tehran, Iran. Patients and Methods: A cross-sectional study was performed on a randomly selected sample of 1992 medical sciences students during 2012-2013. Anonymous, structured questionnaires were distributed among the students in each selected class. Substance misuse was defined according to cultural and epidemiological features. Data analysis was performed using chi-squared test, Fisher’s exact test, and binary logistic regression. Results: The prevalence of prescription drug misuse, last year alcohol use, and ever illicit substance use was 4.9%, 6.9%, and 2.9%, respectively. The result of multiple logistic regression model showed that being a male (OR = 4.0), hookah use in the last year (OR = 3.2), prescription drug misuse (OR = 3.2), and alcohol use in the last year (OR = 3.3) were associated with the students’ illicit substance use. Last year alcohol use (OR = 5.3), ever illicit substance use (OR = 3.2), and illicit substance use in friends (OR = 2.6) were associated with prescription drug misuse. Conclusions: Our results suggested that the prevalence of prescription drugs, alcohol and illicit substance use was relatively low, though still significant, among Iranian students, which was strongly associated with family and friends’ use. The findings of this research can be used for planning and evaluating interventions by considering the risk factors and protective factors in Universities.

Estimating the Prevalence of Illicit Drug Use Among Students Using the Crosswise Model

Objective: The aim of our study is to compare the prevalence of illicit drug use estimated through a technique referred to as the “crosswise model” (CM) with the results from conventional direct questioning (DQ). Method: About 1,500 students from Tehran University of Medical Sciences 2009–2010 were first interviewed by DQ and, then three months later, by the CM. Result: The CM yielded significantly higher estimates than DQ for lifetime prevalence of use of any illicit drug (CM = 20.2%,DQ = 3.0%, p < .001) and for lifetime prevalence of use of opium or its residue (CM = 13.6%, DQ = 1.0%, p < .001). Also, for use of any illicit drug in the last month and use of opium or its residue in the last month, the CM yielded higher point estimates than DQ, although these differences were not significant (any drug: CM = 1.5%, DQ = 0.2%, p = .66; opium: CM = 3.8%, DQ = 0.0%, p = .21). Conclusion: Our findings suggest that the CM is a fruitful data collection method for sensitive topics such as substance abuse.

Evidence of HIV epidemics among non‐injecting drug users in Iran: a systematic review

AIMS In Iran, injecting drug users have been recognized as a high-risk group for HIV/AIDS for years. However, evidence of HIV epidemics in non-injecting drug users (non-IDUs) has also been found in recent years. The aim of this systematic review was to determine the prevalence of HIV in non-IDUs in Iran. METHODS International and regional databanks, including Pubmed, ISI, CINAHL, ASCI and IMEMR, as well as domestic databanks such as IranPsych, IranMedex SID and research reports were searched, and extensive personal contacts were made. All studies with HIV testing conducted between 1998 and 2007, which included non-IDU subjects, were gathered and their qualities were assessed. HIV prevalence was pooled for each gender and stratified to several categories. The prevalence of HIV in non-IDUs and IDUs was compared using pooled odds ratios in a fixed meta-analysis model. RESULTS Overall, 10 studies with 2275 non-IDU samples were included. Six of the studies were conducted in prison settings, two in treatment centres, one in a community setting and one in a shelter setting. Four studies were performed in Tehran, the capital city of Iran. The pooled HIV prevalence was 5.4% [95% confidence interval (CI) 3.7-7.4] after 2005, which was significantly higher than the prevalence before 2005 [1.6% (95% CI 1.0-2.3)]. IDUs were 4.36 (95% CI 2.63-7.24) times more likely to be infected with HIV than non-IDUs. CONCLUSION Iran is facing a major HIV epidemic among non-injecting illicit drug users, which necessitates an urgent preventive response.

Gaming disorder: Its delineation as an important condition for diagnosis, management, and prevention

Online gaming has greatly increased in popularity in recent years, and with this has come a multiplicity of problems due to excessive involvement in gaming. Gaming disorder, both online and offline, has been defined for the first time in the draft of 11th revision of the International Classification of Diseases (ICD-11). National surveys have shown prevalence rates of gaming disorder/addiction of 10%–15% among young people in several Asian countries and of 1%–10% in their counterparts in some Western countries. Several diseases related to excessive gaming are now recognized, and clinics are being established to respond to individual, family, and community concerns, but many cases remain hidden. Gaming disorder shares many features with addictions due to psychoactive substances and with gambling disorder, and functional neuroimaging shows that similar areas of the brain are activated. Governments and health agencies worldwide are seeking for the effects of online gaming to be addressed, and for preventive approaches to be developed. Central to this effort is a need to delineate the nature of the problem, which is the purpose of the definitions in the draft of ICD-11.