Mourning During Corona: A Phenomenological Study of Grief Experience Among Close Relatives During COVID-19 Pandemics.

Considering the need for observing health protocols, the experience of the loss and the grieving process has changed in nature during this disease. Therefore, this study aims to gain a deep understanding of the experience of mourning during COVID-19 pandemic by exploring the experiences of survivors of the death of their loved. During COVID-19 pandemic, the inability to hold the usual ceremonies for mourning and receive the social support needed in this period, the relatives of the deceased encounter various conditions that disrupt the grieving process and may lead to the spread of unresolved grief in future.

Virtual reality exposure and response prevention in the treatment of obsessive-compulsive disorder in patients with contamination subtype in comparison with in vivo exposure therapy: a randomized clinical controlled trial.

BACKGROUND: Obsessive-Compulsive Disorder (OCD) is characterized by disturbing and unwanted thoughts as well as repetitive and time-consuming behaviors that interfere with performance. Cognitive Behavior Therapy (CBT) has shown to have beneficial effects on reducing OCD symptoms as the first line of treatment. Moreover, Virtual Reality (VR) has been a more feasible and accessible intervention for OCD in recent years. Regarding the point, the objective of this study was to evaluate the effectiveness of virtual reality exposure and response prevention (VRERP) in the treatment of the OCD contamination subtype. METHODS: A total number of 36 adults with OCD-contamination subtype were registered and randomly assigned to the intervention and control groups. The intervention group received a 60-min CBT including a "contaminated" virtual environment while the control group received CBT as a standardized treatment. Out of these, 29 patients completed the treatment in 12 weekly sessions. The patients completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Obsessive Beliefs Questionnaire-44(OBQ-44), and World Health Organization Disability Assessment Scale-2 (WHODAS-2) at week 0, week 12 and after 3 months follow-up. RESULTS: Based on the results of the repeated measure analysis of variances, the total score of obsession and compulsion subscales of Y-BOCS significantly decreased as a primary outcome in the intervention group (F = 60.97, P < 0.001, partial eta squared = 0.82; F = 20.46, P < 0.001, partial eta squared = 0.61; F = 29.57, P < 0.001, partial eta squared = 0.69; respectively). The total score of BDI-II and BAI was reduced in both groups but there was no significant difference between them (BDI-II: F = 0.54, P = 0.47, partial eta squared = 0.02; BAI: F = 3.12, P = 0.06, partial eta squared = 0.19). However, there was a significant difference in the OBQ-44 (F = 16.78, P < 0.001, partial eta squared = 0.56) and the total WHODAS-2 score between the groups (F = 14.64, P < 0.001, partial eta squared = 0.53). CONCLUSIONS: This study demonstrated the effectiveness of VRERP in the treatment of the OCD-contamination subtype. Therefore, VRERP can be used in CBT as an alternative exposure tool. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT ID: IRCT20210214050353N1 , Registered on 16/10/2021.

COVID-19 in Older Adults: Iran Health Care System Response.

Cite this article as: Shati M, Mortazavi SS, Moghadam M, Solbi Z, Barakati SH, Rezaei F. COVID-19 in Older Adults: Iran Health Care System Response. Med J Islam Repub Iran. 2022 (25 Apr);36:41. https://doi.org/10.47176/mjiri.36.41.

Vitamin D deficiency and depression in obese adults: a comparative observational study.

BACKGROUND: Amongst the contributing factors of depression, vitamin D deficiency has increasingly drawn attention in recent years. This paper seeks to examine the association between serum vitamin D level and depression in patients with obesity. METHODS: In this comparative observational study, serum 25-hydroxyvitamin D [25(OH)D] levels were compared between obese individuals with depression (n = 174) and those without depression considering the effect of potential confounders. Participants were selected from males and females aged 18 to 60 years old visiting the outpatient obesity clinic of Rasoul-e Akram hospital, Tehran, Iran. The diagnosis of depressive disorder was made based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Additional clinical and laboratory data were collected from hospital electronic records. Mann-Whitney U test (nonparametric), Student's t-test (parametric), and Chi-squared test were used to analyze the differences between the two groups. To examine age and gender differences in the relationship between vitamin D deficiency and depression, stratified analyses were conducted by age and gender groups. RESULTS: The mean 25(OH) D levels were significantly different between depressed and non-depressed groups (20 ± 15 vs. 27 ± 13, P <  0.001). Vitamin D insufficiency/deficiency was detected in 78 and 67% of the depressed and non-depressed groups, respectively, which was significantly different (P = 0.03). The associations between depression and the serum 25(OH) D levels were observed regardless of gender and age. The overall average vitamin D levels were not significantly different between total males and females (22 ± 13 vs. 23 ± 14, P = 0.49). The average level of vitamin D was higher in the older age group (40-60 years) compared to younger participants (18-39 years) (26 ± 15 vs. 21 ± 13, P = 0.004). CONCLUSION: The present study provides additional evidence for the hypothesis that low vitamin D serum concentration is associated with depression in obese adults, and highlights the need for further research to determine whether this association is causal.

Psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-PV) and its short form.

Background: Despite studies about anxiety in the older adult, the prevalence of anxiety in this age group is not exactly clear, which may be due to the use of tools and criteria that were not born for this age group. One of the instruments designed to assess anxiety in the elderly is the Geriatric Anxiety Inventory (GAI). The aim of this research was to analyze the psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-PV) and its short form (GAI-PV-SF) in a sample of older adults in Iran. Methods: In this cross-sectional study, a sample of 150 community-dwelling and a psychogeriatric sample of 48 adults older than 60 years completed the GAI-PV and GAI-PV-SF, the anxiety sub-scale of the General Health Questionnaire (GHQ-28), the Geriatric Depression Scale (GDS-15), and the Structured Clinical Interview for DSM-IV (SCID-I). Different types of validity and reliability were evaluated for GAI-PV and GAI-PV-SF using SPSS and the LISREL software. Results: Both the GAI-PV and GAI-PV-SF exhibited excellent internal consistency (over 80 %) and desirable concurrent validity against GHQ-28 and GDS-15. The optimal cutpoint score to detect current generalized anxiety disorder (GAD) was 10/11 and 13/14 for GAI-PV in the community-dwelling and psychogeriatric samples, respectively, and 3/4 for GAI-PV-SF in both study samples. Good test-retest reliability (correlation coefficient: 0.96 and 0.88 for GAI-PV and GAI-PV-SF, respectively) and a single-factor structure were also demonstrated. Conclusion: Sound psychometric properties of the GAI-PV in both subsamples suggest that the instrument could be used successfully as an accurate screening instrument in the elderly Iranian population.

Psychometric properties of the Persian version of the Patient-Weighted Quality of Life in Epilepsy Inventory-10-P.

BACKGROUND: The purpose of the study was to evaluate psychometric properties of the Persian version of the Patient-Weighted Quality of Life in Epilepsy Inventory-10-P (PV QOLIE-10-P). METHODS: The Persian version was obtained from the original version by standard forward/backward translation. We assessed content validity, construct validity by factor analysis, internal consistency, test-retest reliabilities, criterion validity by calculating Pearson/Spearman correlation to the Persian version of the SF-36 inventory the Persian version of the 36-Item Short Form Health Survey (PV SF-36), and discriminant validity by calculating Pearson/Spearman correlation to demographic features and epilepsy-specific characteristics. RESULTS: One hundred and fifty-five adult patients with epilepsy were enrolled in the study. The 10 items of PV QOLIE-10-P were grouped into two factors: epilepsy effects/role function scale (driving, work, social, memory, physical effect, and mental effect) and mental health scale (energy, depression, seizure worry, and overall quality of life). The Cronbach's alpha value was 0.859. Test-retest analysis revealed statistically significant correlations for total score and the scales (correlation coefficient for total score, epilepsy effects/role function, and mental health were 0.7, 0.66 and 0.7respectively). The Pearson correlation coefficient between total scores of the Persian version of QOLIE10-P and SF-36 was 0.822 (p < 0.001). The PV QOLIE-10-P was able to differentiate patients with marriage, education, job, seizure type, seizure frequency, and antiepileptic treatment. CONCLUSION: The Persian version of QOLIE-10-P is a valid and reliable tool to assess the quality of life of patients with epilepsy in Iran.

First line in psychiatric emergency: pre-hospital emergency protocol for mental disorders in Iran.

INTRODUCTION: This article is a report of designing a rapid and effective guide for paramedics who take care of patients in a pre-hospital setting to answer developing demands. METHODS: The relevant literature was reviewed, and the topics were extracted. Then, the extracted items were discussed in an expert panel. Finally, items were discussed in a meeting including emergency technicians and emergency technical assistants to identify implementation problems. RESULTS: Important topics for managing psychiatric patients were categorized at three levels: 1) Patient safety and security issues, 2) Patient status assessment and diagnosis, and 3) Patient management (medical, behavioral management, and referral to a treatment center). DISCUSSION: This protocol can be a solution to improve emergency technician training. Such summarized protocols can be used for rapid review immediately before exposing a patient with an acute psychiatric condition. Due to specific cultural and different access to medicines in Iran, some issues are different.

Adherence to Self-isolation measures by older adults during coronavirus disease 2019 (COVID-19) epidemic: A phone survey in Iran.

Background: Older adults are at higher risk for severe illness and death associated with coronavirus disease 2019 (COVID-19). As Iran was affected by COVID-19 pandemic, the elderly population soon were told to self-isolate for a very long time. We aimed to identify the coverage, efficacy, and integrity of self-isolation and its predictors in the Iranian older adults (≥60 years) from February 19 to 19 March 2020. Methods: Quota sampling was performed to recruit respondents from 16 cities that were selected based on their population size (4, 7, and 5 cities for localities with ≤500 000, 500 000-1 000 000, and ≥1 000 000 populations) and geographical direction (West = 4 cities; North, East, South, Center = 3 each). At least 30 respondents per locality were selected. Phone interviews of 558 respondents (out of 560; response rate = 99.6%) were performed by local trained interviewers using a validated interview form. Association between age, sex, and living condition (with family vs alone) was assessed with Pearson Chi Square and logistic regression analyses. Results: Complete self-isolation was reported by 61% of the respondents. In 72%, self-isolation led to 80%-100% contact reduction. Self-isolation was broken by 26% of the respondents. Females had better self-isolation behaviors (OR adjusted: 2.3, 95% CI: 1.5, 3.3) and higher contact reduction rates (p: 0.067). They kept the integrity of self-isolation better (OR adjusted: 1.8; 95% CI: 1.2, 2.7). Those aged older than 80 years were 2.3-folds more likely to completely self-isolate than younger elderly (95% CI adjusted: 1.2, 4.3). Living alone did not significantly predict self-isolation features in the elderly. Conclusion: About one third of the interviewed Iranian older adults did not adhere to important self-isolation measures, with males and younger ages showing lower adherence. With the relaxation of social distancing measures, protection measures of the elderly should be strengthened. Given that prolonged self-isolation adversely affects physical and mental health status of the elderly, it is highly recommended to think of creative and gender-specific methods that best tailor the needs of this population in Iran.

Self-medication among the elderly in Iran: a content analysis study.

BACKGROUND: Self-medication is described as the use of drugs without a physician's prescription to treat self-recognized illness or symptoms, and an important health issue among the elderly. Despite the wide range of different definitions, recognizing all forms of self-medication among older adults, particularly, in developing countries, help healthcare professionals and providers to reduce harmful effects of self-medication. The purpose of this study is to describe the practice of self-medication and its related factors among elderly people in Iran based on the experiences of people who are involved in this phenomenon. METHODS: This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until saturation. The participants were the elderly, their care-givers, physicians, and pharmacists. Data was collected using semi-structured interviews, and analysis was done using an inductive approach. The theory of planned behavior was used as a framework to explain the role of the emerged factors in the occurrence of self-medication behavior. RESULTS: Based on the expressed experiences of the participants, factors related to the practice of self- medication among the elderly in Iran fit in these 5 categories: "patient's attitudes towards disease, treatment, and physicians", "living with disease", "unfriendly environments", "enabling health system", and "influential others". CONCLUSIONS: Based on the results of this study, self-medication of the elderly in Iran has commonalities with many countries in regard to over-the-counter medications and complementary and alternative medicine; however, self-medication is also seen with drugs that require a prescription but can easily be obtained from pharmacies. Contributing factors, apart from the elderly themselves, include their families, caregivers, and social circle, the physical environment where they live, and the health system from which they receive services.

Assessment of Hemoglobin A1c Management and Prescription Cost Due to Polypharmacy Among Patients With Diabetes in Iran Based on the STEPS Iran 2016 Survey and a Prescription Database: A Multi-level, Cross-sectional National Study.

BACKGROUND: Diabetes frequently results in the need for multiple medication therapies, known as 'Polypharmacy'. This situation can incur significant costs and increase the likelihood of medication errors. This study evaluated the prescriptions of patients with diabetes regarding polypharmacy to assess its effect on the control of hemoglobin A1c (HbA1c) levels and prescription costs. METHODS: A cross-sectional national study was conducted based on data from linking the Iranians Health Insurance Service prescriptions in 2015 and 2016 with the STEPS 2016 survey in Iran. The association of the individual and sociodemographic factors, as well as polypharmacy, as independent variables, with control of HbA1c levels and the cost of the prescriptions were assessed among diabetic patients using logistic and linear regression, respectively. RESULTS: Among 205 patients using anti-diabetic medications, 47.8% experienced polypharmacy. The HbA1c of 74 patients (36.1%) was equal to or less than 7, indicating controlled diabetes. HbA1c control showed no significant association with gender. However, prescription costs were notably lower in females (ß=0.559 [0.324‒0.964], P=0.036). No significant correlation was found between the area of residence and prescription costs, but HbA1c was significantly more controlled in urban areas (OR=2.667 [1.132‒6.282], P=0.025). Prescription costs were significantly lower in patients without polypharmacy (ß=0.211, [0.106‒0.423], P<0.001), though there was no significant association between polypharmacy and HbA1c levels. CONCLUSION: Our results demonstrated that diabetics with polypharmacy paid significantly more for their prescriptions without experiencing a positive effect on the control of HbA1c levels.

The levels and trends of cancer incidence in the elderly population at national and sub-national scales in Iran from 1990 to 2016.

BACKGROUND: Cancer is most commonly associated with aging. It is necessary to gain a better understanding of cancer's trend and distribution among elderlies and provide comprehensive cancer care for this population. AIMS: The aim of the current study was to show the trends in cancer incidence focusing on the population aged 60+ from 1990 to 2016 in Iran. MATERIAL AND RESULTS: We used the dataset of the Iran Cancer Registry to estimate cancer incidences by sex, age, province, and year. In order to account for incomplete data we used a two-stage spatiotemporal model along with random intercept mixed effect models. We calculated annual age-standardized incidence rates (ASIRs) for age groups 60+ and 5-interval age groups. There was an increasing trend of 25.3% to 936.9% (95% uncertainty interval: 769.6-1141.8) in ASIR in the elderly in 2016. ASIR of all cancers were 889.7 (731.3-1083.6) in women and 988.1 (811.1-1205) in men in 2016, per 100 000 respectively, which had an increasing trend comparing 1990. Skin, breast, and stomach cancers in women and prostate, skin, and stomach cancers in men were the most common types in 2016. All the most incident cancer subtypes underwent an increasing trend in both sexes, except for the bladder, esophageal, and skin cancers which almost had a similar level in 1990 and 2016. Most provinces had an increasing trend in ASIR in all cancers combined from 1990 to 2016 except Zanjan with a decreasing trend. CONCLUSION: Regarding the persistent increasing trend of most elderly cancers' incidence, this is crucial for policymakers to establish preventive plans, determine proper resource allocation, and develop specific treatments for elderly cancer patients.

The levels and trends of metabolic risk factors in the elderly population at the national and sub-national scale in Iran from 1990 to 2016.

Purpose: Describing the trends of metabolic risk factors (MRFs) in the elderly population. Methods: We used modeled data from previous comprehensive systematic reviews for MRFs among adults aged ≥ 60 years. Two stages of age-specific Spatio-temporal modeling and Gaussian process regression were used to estimate the mean of MRFs. We used crosswalk modeling to estimate the prevalence of elevated and raised Total cholesterol (TC), overweight/obesity and obesity, hypertension, and diabetes. Estimates were analyzed based on combinations of sex, age, year, and province from 1990 to 2016. Results: Comparing prevalence estimates from 2016 with those of 1990, in the elderly population, the age-standardized prevalence of overweight/obesity, obesity, diabetes, and hypertension increased, conversely, the prevalence of hypercholesteremia decreased. The prevalence of hypertension increased about 141.5% and 129.9% in men and women respectively. The age-standardized prevalence of diabetes increased about 109.5% in females, and 116.0% in males. Prevalence of elevated TC at the national level decreased to 67.4% (64.1-70.4) in women and to 51.1% (47.5-54.8) in men. These findings were almost shown across provinces. In general, the northern and western provinces had the highest prevalence of overweight/obesity in women in 2016. Conclusion: The rising prevalence of most MRFs, as well as the greater prevalence and mean of all MRFs in women, necessitate effective public health policies to reduce the burden of non-communicable diseases and run preventive programs. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01297-z.

The impact of computer-based cognitive training intervention on the quality of life among elderly people: a randomized clinical trial.

BACKGROUND: Through the process of normal aging, cognitive decline would cause a lower level of functioning in real life. This flow might interfere with health-related quality of life (QoL). The purpose of this study is to investigate the effect of computer-based cognitive intervention on increasing QoL of elderly people. METHODS: A total number of 52 community-dwelling older adults participated in this study. This community scored ≥ 21 in the Mini-Mental State Examination (MMSE) and a clock drawing test score ≥ 4 from health centers in Tehran, Iran. This study is a parallel group stratified randomized clinical trial. The intervention group received a 45-min cognitive training session twice a week for 10 sessions, using Attentive Rehabilitation of Attention and Memory (ARAM) software focusing on selective attention and working memory. QoL was evaluated as a primary outcome. The control group participated in educational workshops. RESULTS: From fifty-two persons, only one participant was excluded from the study in the intervention group during follow-up. Results revealed by increasing cognitive function, improvement occurred in QoL (F = 13.417, p value < 0.001, partial eta-squared = 0.324) as a primary outcome in the intervention group. Among eight domains of QoL, there was significant increasing in domain of role limitations due to emotional problems (F = 4.007, p value = 0.021, partial eta-squared = 0.059), social functioning (F = 2.423, p value = 0.044, partial eta-squared = 0.004), and role limitations due to physical health (F = 10.749, p value < 0.001, partial eta-squared = 0.026). CONCLUSIONS: Based on the results, ARAM showed transition and long-term effects on QoL in elderly people by improving cognitive functions such as selective attention and working memory. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT2016122731602N1 . Registered on June 21, 2017.

A Systematic Review of Potentially Inappropriate Medications Use and Related Costs Among the Elderly.

OBJECTIVE: Potentially inappropriate medications (PIMs) use is a common phenomenon among older adults. This paper aimed to perform a systematic literature review to assess PIMs use and related costs among elderly persons. METHODS: This study was a systematic review. PubMed, Scopus, and the Institute for Scientific Information engines were used to search for all relevant studies published until 2020. Studies were excluded if they did not estimate the cost of PIMs for the elderly. In addition, non-English articles, editorials, letters, and review articles were excluded. All eligible articles were assessed for methodological quality. Finally, we extracted general characteristics from each eligible study. RESULTS: This study showed that the prevalence of PIMs use among older adults was more than 30%. Drugs related to the central nervous system and cardiovascular disease, benzodiazepines, analgesics, and nonsteroidal anti-inflammatory drugs were most commonly used as PIMs. These studies concluded that PIMs could impose a high economic burden on the elderly and society. The mean cost for older adults with PIMs use was almost USD$2000 more than the mean cost for older adults without PIMs. Additionally, the total cost of PIMs use for all elderly persons in Canada in 2013 was estimated at USD$419 million. CONCLUSIONS: Focusing on the most common PIMs, such as benzodiazepines and nonsteroidal anti-inflammatory drugs, helps implementing cost-effective strategies for reducing PIMs use and decreasing their clinical and economic effects.

Fear, Loss, Social Isolation, and Incomplete Grief Due to COVID-19: A Recipe for a Psychiatric Pandemic.

The experience of the loss of the relatives, which is naturally one of the most stressful events in a person's life, has turned into a new concept and challenge for survivors and mental health professionals during the coronavirus era. We discussed how restrictions caused by social distancing potentially increase the likelihood of a phenomenon called complicated grief or prolonged bereavement disorder and multilayer response by case finding to increase the access to public education to manage this complicated situation.

Physicians' role in the development of inappropriate polypharmacy among older adults in Iran: a qualitative study.

OBJECTIVES: The use of unnecessary or excessive medications (inappropriate polypharmacy) is a major health challenge among older adults which is driven by several factors. This study aims to provide in-depth descriptions of the physician's role in the development of inappropriate polypharmacy among older adults in Iran. DESIGN: Qualitative content analysis of interviews, field notes and other relevant documents available (eg, medical records). Data collection and analyses were done concurrently to guide the sampling process. SETTING: Three purposively selected referral hospitals in Tehran, Iran. PARTICIPANTS: A total of 7 physicians, 10 older adults, 3 caregivers and 3 pharmacists with a median age of 54 (IQR 23) years were recruited through convenience sampling. RESULTS: Emerged categories included misdiagnosis, inappropriate prescribing, insufficient patient education, poor communication, unprofessional behaviour and limited perspectives which highlight the role of physicians in the development of inappropriate polypharmacy among older adults in Iran under the main concept of poor medical practice. CONCLUSION: This study provides valuable insight on the role of physicians in the development of inappropriate polypharmacy among the elderly in the healthcare setting in Iran by exploring the viewpoints of physicians, patients, caregivers and pharmacists. Physicians can be an influential factor in tackling this challenge through proper diagnosis, prescription, patient education and follow-up. In Iran, physicians' practice styles are affected by potentially adverse factors such as the novelty of geriatric medicine, lack of a referral system, patient unfamiliarity with the system and lack of a monitoring system for multiple prescriptions. Furthermore, clinics tend to be overcrowded and visit fees can be low; in this setting, lack of physician assistants leads to limited time allocation to each patient and physician dissatisfaction with their income.

Defining polypharmacy in the elderly: a systematic review protocol.

INTRODUCTION: Ageing--along with its associated physiological and pathological changes--places individuals at a higher risk of multimorbidity and treatment-related complications. Today, polypharmacy, a common and important problem related to drug use, occurs subsequent to this multimorbidity in the elderly in all populations. In recent decades, several scientific investigations have studied polypharmacy and its correlates, using different approaches and definitions, and their results have been inconclusive. Differences in definitions and approaches in these studies form a barrier against reaching a conclusion regarding the risk factors and consequences of polypharmacy. It is therefore imperative to establish an appropriate definition of polypharmacy. METHODS AND ANALYSIS: A systematic review will be conducted using PubMed, Scopus, Web of Science, EMBASE, PsycINFO and AgeLine bibliographic databases, as well as the grey literature on polypharmacy in older adults to answer these two questions: What definitions in the literature are being used for polypharmacy in older people?, and Which definitions are more comprehensive and applicable? 2 independent reviewers will conduct the primary screening of the articles and data extraction, and eligible sources will be selected after discussing non-conformities. All extracted data from selected articles will be categorised based on the type of study participants, study design and setting, the methodological quality of primary studies and any other potential source of heterogeneity, and results will be summarised in a table, which will contain the levels of evidence and methodological quality of the included studies. The most comprehensive definition of polypharmacy will be selected from the final list of definitions through an international expert webinar. ETHICS AND DISSEMINATION: This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.

Psychiatric comorbidities among Iranian elderly patients on methadone maintenance treatment.

BACKGROUND: Comorbidity of psychiatric disorders and substance abuse can intensify both conditions, and when advanced age is added to the combination, the patient will face a distinctive array of issues. This study evaluated the prevalence of psychiatric disorders in elderly substance users as well as certain related factors. METHODS: This cross-sectional study was performed on 160 consenting elderly substance users 60 years and over who had been on methadone maintenance. The subjects were selected from rehabilitation centers affiliated with the Welfare Organization in Tehran through convenience sampling, and were assessed for current or lifetime axis-I psychiatric disorders using the SCID questionnaire. RESULTS: In this study, 28.1% of substance abusers were diagnosed with at least one current psychiatric disorder. Psychiatric disorders were more common in subjects whose dependence had started prior to the age of 35, or those who had a family history of substance use. Also, 34.4% had a lifetime history of at least one psychiatric disorder, with a higher incidence among those simultaneously dependent on other substances in addition to opioids. Major depression was the most prevalent disorder among the study subjects. CONCLUSION: Based on the findings of the present study, axis-I psychiatric disorders are rather common among elderly substance users, and approximately a third of this population have a lifetime history of at least one such disorder. The type of abused substance can affect the incidence of psychiatric disorders, and simultaneous use of non-opioids and other substances can increase their prevalence.

Comparing the Effects of Group and Home-based Physical Activity on Mental Health in the Elderly.

BACKGROUND: The present study focuses on comparing the effects of home-based (HB) and group-based (GB) physical activity on mental health in a sample of older adults in Shahr-e-kord. METHODS: In this quasi-experimental study, a twice-weekly physical activity program for 2 months was provided either individually at home or in a group format for 181 people who were divided into two groups (HB and GB). The outcome, mental health, was measured with the 28-item General Health Questionnaire (GHQ-28). RESULTS: Mental health status improved after participation in the physical activity program. The decrease in GHQ-28 total score in GB group, 3 months after intervention, was 3.61 ± 2.28 (P < 0.001). In HB group, this reduction was 1.20 ± 2.32 during the same period (P < 0.001). The difference of these "before-after differences" between the two groups in the GHQ-28 and all its subscales was statistically significant (P < 0.001). Also, the effects of GB physical activity on mental health compared with HB physical activity, adjusted for related baseline variables, were significant. CONCLUSIONS: These findings reveal the probable effects of GB rather than HB physical activity on mental health among the elderly.

Mental disorder prevention and physical activity in Iranian elderly.

OBJECTIVES: Mental disorders such as depression, anxiety and dementia are common in elderly. However, physical activity is suggested to be effective in preventing such aging-related disorders. The aim of this study was to investigate the role of physical activity on mental health in later life. METHODS: Four hundred elderly people were randomly divided into the intervention and control groups. The intervention consisted of exercise twice a week for two months. Mental health status before, just after, and three months after the study was assessed with the 28-item General Health Questionnaire (GHQ-28). RESULTS: The mean of the GHQ-28 total scale decreased in the case group and this change remained significant after three months (before: 8 ± 5.5, after three months: 5.6 ± 4.6, p < .001). GHQ subscales including somatization, anxiety, social dysfunction, and depression decreased significantly in the case group just after and three months after the intervention. CONCLUSIONS: Physical activity significantly prevents mental disorder in older adults. Although it has effects on anxiety, social dysfunction, and depression, the greatest influence is on improving the somatization symptoms.