Ameneh Setareh Forouzan

How Iranian lay people in three ethnic groups conceptualize a case of a depressed woman: an explanatory model.

Objective(s). Although depression is a major public health problem, little is known about lay peoples views of this subject in Iran. The aim of this study was to explore how depression in women is viewed among lay people in three major ethnic groups – Kurd, Turk, and Fars. Design. Participants were selected from public urban healthcare centers. Four focus group discussions were conducted for each of the three ethnic groups and classified by level of education from three locations, in the capital city (Tehran), west (Ilam), and the northwest (Tabriz) of Iran. Twelve focus groups; 38 men and 38 women have been conducted by using a case vignette describing a woman with major depression. Results. Depression symptoms were perceived as a temporary phenomenon. It was regarded as a colloquial term for feeling blue, mostly related to external stressors (social model). The common terms used in all ethnic groups were depression, and nerve/soul distress. Environmental cause and war were considered as external causes of the symptoms, and emotional factors, cognition distortion, and biological reasons, as internal factors. The participants believed it was necessary to seek help from religion, family and friends, positive thinking, and distraction from social problems, besides consultations with psychologists as counselors. Medication was often seen as the last resort. Stigma was mentioned as an important factor that makes people avoid visiting psychiatrists. Conclusion. These data may have implications for mental healthcare practice, especially for the approach to diagnosis of depression. Moreover, there is a need for developing and integrating gender-relevant and cultural indicators in the existing national mental health systems in Iran.

A Systematic Review of the Prevalence and Risk Factors of Depression among Iranian Adolescents

Depression is the most common mood and psychiatric disorder. The aim of this comprehensive study was to provide a complete picture of the prevalence and risk factors of depression. The study employed a systematic review methodology, searching Iranian and international databases. After screening and evaluating the articles, a synthesis of 53 articles was accumulated. A meta-analysis of the studies showed that the prevalence of children and adolescent depression was 43.55% using the BDI, 15.87 % using SCL-90, and 13.05% using CDI. Also, the prevalence of depression was higher among girls than boys based on the BDI and CDI results. The most important factors contributing to depression were: the female sex, poor inter-parental relationship, poor adolescent-parent relationship, low socio-economic status (SES), state of parenting styles, low level of parental education, and poor academic performance. The comparatively high prevalence of depression among Iranian adolescents call for further investigation and measures.

Are the Predictors of Sexual Violence the Same as Those of Nonsexual Violence? A Gender Analysis

INTRODUCTIONnViolence manifests itself in such multifarious ways as sexual, physical, and psychological abuse. What has hitherto eluded the medical community, however, is whether sexual and nonsexual abuse share the same predictors.nnnAIMnDrawing upon a representative sample of married men and women in the Iranian capital, Tehran, we aimed to determine: (i) the overlap between sexual abuse and physical and psychological violence, and (ii) the predictors that sexual violence victimization share with physical and psychological violence victimization.nnnMAIN OUTCOME MEASURESnVictimization through any type of sexual coercion by the husband in the context of the current marital relationship, as determined via the conflict tactic scales-revised (CTS-2).nnnMETHODSnIn a cross-sectional survey in Tehran in 2007, 460 married Iranian men and women were selected via a multicluster sampling method from four different randomized regions. Independent variables comprised sociodemographic characteristics, subscores of psychological, and personality characteristics known to be allied with intimate abuse (personal and relationship profile), and dichotomus data on victimization history through all types of violence by the spouse including psychological aggression, physical assault, and sexual coercion (CTS-2).nnnRESULTSnIn both genders, the experience of physical or psychological violence increased the likelihood of sexual violence victimization. In both genders, higher conflict was a predictor of sexual and psychological violence victimization. In addition, the common predictors of sexual and physical violence victimization were low self-control and high violent socialization in the men and women, respectively.nnnCONCLUSIONSnSexual violence victimization shares some factors with the victimization of nonsexual types of marital abuse, but this seems to be partially gender dependent.

Social Support Network among People Living with HIV/AIDS in Iran

This study considers social network interactions as a potential source of support for individuals living with HIV/AIDS in Iran. This cross-sectional study was conducted on 224 people with HIV/AIDS who refer to behavioral counseling centers. Participants were randomly selected among all people with HIV/AIDS from these centers. Relatives were more reported as sources of support than nonrelatives. They were closer to participants, but there was difference between the closest type among relative and nonrelative supporters (P = 0.01). Mean of functional support with considering the attainable range 0–384 was low (126.74u2009u2009(SD = 76.97)). Social support of participants has been found to be associated with CD4 cell count (P = 0.000), sex (P = 0.049), and network size (P = 0.000) after adjusted for other variables in the final model. Totally, in this study, many of participants had the static social support network that contained large proportions of family and relatives. The findings contribute to the evidence for promotion of knowledge about social support network and social support of people living with HIV/AIDS.

Preterm Delivery and Psycho–Social Determinants of Health Based on World Health Organization Model in Iran: A Narrative Review

Background: Preterm delivery is still the primary cause of mortality and morbidity in infants, which shows a problematic condition in the care of pregnant women all over the world. This review study describes prevalence and psycho - socio-demographic as well as obstetrical risk factors related to live preterm delivery (PTD) in the recent decade in Iran. Methods: A narrative review was performed in Persian and international databases including PubMed, SID, Google Scholar, Iran Medex, Magiran and Irandoc from 2001 to 2010 with following keywords: preterm delivery and pregnancy outcomes with (prevalence, socioeconomic condition, structural determinant, Intermediary determinants, Psychosocial factor, Behavioral factor and Maternal circumstance, Health system) All of article was reviewed then categorized based on WHO model. Results: Totally 52 article were reviewed and 35 articles were selected, of which 26 were cross-sectional or longitudinal, 9 were analytical (cohort or case-control). The prevalence rates of preterm delivery in different cities of Iran were reported between 5.6% in Quom to 39.4% in Kerman. The most common social factors in structural determinant were educational level of mother, and in intermediary determinants were Psychosocial factor (maternal anxiety and stress during pregnancy), Behavioral factor and Maternal circumstance (violation and trauma) and in Health system, lack of prenatal care. Conclusion: The prevalence rate of preterm delivery is a matter of concern. Since many psycho-social factors may affect on the condition and its high rate in poor communities might reveals a causal relationship among biological and psychosocial factors, performing etiological investigations is recommended.

Associations Between Coerced Anal Sex and Psychopathology, Marital Distress and Non‐Sexual Violence

BACKGROUNDnThere is a dearth of scientific data on anal intercourse in heterosexual relationships. Likewise, anal sex within marital relationships has yet to be fully explored.nnnOBJECTIVESnAmong a representative sample of married women in the Iranian capital, Tehran, we aimed to determine the association of self-reported coerced anal sex with: (i) self-reported coerced vaginal sex; (ii) self-reported non-sexual violence; (iii) psychopathology; and (iv) marital attitude.nnnMETHODnThe data presented here were obtained from the Family Violence Survey conducted in Tehran in 2007. A total of 230 married Iranian women were selected via a multi-cluster sampling method from four different randomized regions. The subjects sociodemographic data, psychological distress (Symptom Check List; SCL-90-R), personality, and relationship characteristics (Personal and Relationships Profile), and marital attitude (Marital Attitude Survey) were gathered. In addition, the participants self-reported histories of lifetime victimization through all types of violence by the husband, including coerced anal and vaginal sex as well as psychological and physical assault (Conflict Tactic Scales-Revised; CTS-2), were collected.nnnRESULTSnThere were associations between self-reported victimization through coerced anal and vaginal sex (P < 0.001), psychological (P < 0.001), and physical aggression (P < 0.001). Those reporting to have been forced into anal intercourse cited higher rates of paranoid and psychotic features, jealousy, attribution of problems to ones own behavior, conflict, and male dominance, as well as lower expectations of improvement in ones marital relationship.nnnCONCLUSIONnIn marital relationships, women are at a higher risk of coerced anal sex if subjected to other types of sexual or non-sexual violence. Higher rates of psychopathology and poorer marital relationships are also allied to self-reported anal sexual coercion.

Testing the WHO responsiveness concept in the Iranian mental healthcare system: a qualitative study of service users

BackgroundIndividuals experience of interacting with the healthcare system has significant impact on their overall health and well-being. To relate patients experiences to a common set of standards, the World Health Organization (WHO) developed the concept of health system responsiveness. This study aimed to assess if the WHO responsiveness concept reflected the non-medical expectations of mental healthcare users in Teheran.MethodsIn this qualitative study, four mixed focus group discussions were formed, comprising 53 mental health service users in Tehran, Iran, in 2010. Content analysis was performed for data analysis. Responses were examined in relation to the eight domains of the WHOs responsiveness model.ResultsThere were many commonalities between the findings of this study and the eight domains of the WHO responsiveness model, although some variations were found. Effective care was a new domain generated from our findings. In addition, the domain of prompt attention was included in two new labelled domains: attention and access to care. Participants could not differentiate autonomy from choice of healthcare provider, believing that free choice is part of autonomy. Therefore these domains were unified under the name of autonomy. The domains of quality of basic amenities, access to social support, dignity and confidentiality were considered to be important for the responsiveness concept. Some differences regarding how these domains should be defined were observed, however.ConclusionsThe results showed that the concept of responsiveness developed by the WHO is applicable to mental health services in Iran. These findings might help policy-makers better understanding of what is useful for the improvement of mental health services.

DISCLOSURE OF HIV STATUS AND SOCIAL SUPPORT AMONG PEOPLE LIVING WITH HIV

Background: Disclosure of HIV is important for improving self-care behaviors, psychological well-being, commitment to the treatment, and reducing risk of transmission. One of the major benefits of disclosure is social support, which is an essential resource for effective coping with HIV infection. However, receiving any social support requires disclosing of HIV status. Objectives: This study aimed to determine the disclosure of HIV status and its related factors such as social support in addition to demographic and disease characteristics among people living with HIV in Iran. Patients and Methods: This cross-sectional study, using simple random sampling, was carried out on 175 people with HIV/AIDS who referred to Behavioral Counseling Centers. The self-administrated, Norbeck Social Support Questionnaire was used to measure social support. Disclosure of HIV status was assessed with an investigator-designed questions. Multiple logistic regression analysis with backward Likelihood Ratio method was applied to identify the adjusted odds ratio between disclosure as dependent variable and demographic variables, social support as independent variables. Results: Participants were often disclosed their HIV status to family members. But there were differences about disclosure of HIV status within the context of the family. Family members were perceived as more supportive. Multiple logistic regression analysis demonstrates that the gender (adjusted OR = 0.181; 95% CI .068-0.479), CD4 cell count (adjusted OR = 0.997; 95% CI 0.994-0.999), route of transmission (injection-drug user [adjusted OR = 9.366; 95% CI 3.358-26.123] and other routes [tattooing, mother to child, dental services, etc.], [adjusted OR = 3.752; 95% CI 1.157-12.167]), and functional support variable (adjusted OR = 1.007; 95% CI 1.001-1.013) remained in the model as significant predictors for disclosure. Conclusions: The results of this study regarding disclosure of HIV status and its relations to social support and some demographic variables can provide an understanding based on the evidence for promotion of knowledge and coping interventions about people living with HIV/AIDS and their perceived social support status.

HIV/AIDS related knowledge and attitude among female sex workers in Tehran/Iran

Methods This study includes two phases. Phase one: A cross-sectional survey was conducted among 280 female sex workers in various urban areas in Tehran. During the survey a 114 item researcher designed questionnaire was used. The validity and reliability of questionnaire was assessed during a pilot study. Phase two: Following the quantitative survey a qualitative study was done which 39 in-depth interviews were conducted to gain insights into the context of their risky sexual behaviors and suggestions for feasible HIV primary prevention interventions.

The Main Advantages of Community Based Participatory Health Programs: An Experience from the Islamic Republic of Iran

Introduction: Community based participatory program is an approach that emphasize on community empowerment as an important tool in health promotion especially in low and middle income countries. The aim of this study is in-depth understanding the strengths point of active community based participatory programs in Iran in order to develop a scientific foundation and basis for future policy and decision making. Methods: This study was a qualitative study using focus group discussions. Thirteen community based programs related to health that were active for last five years were selected and assessed. Data analysis was based on deductive-inductive content analysis approach considering the predetermined structure according to study questions. Results: In this study, strengths points of community participatory health programs based on the locality of the implementation of the programs; governmental organization and nongovernmental organizations (NGO’s) were evaluated. The main strengths of these programs were the presence of the spirit of empathy and high motivation in working for community, absorbing the community assistance, community empowerment, presence of female volunteers, using local volunteers, creation of social prestige and evidence based decision making for community problem solving. Conclusion: Capacity building of the community, NGOs and policymakers plays key role in participation mechanisms, partnership, team working and mobilizing of necessary resources in the promotion of participatory community based health programs.