Randomized controlled trial for the efficacy of three versus five sessions of grief counseling on the psychological aspects following COVID-19 bereavement: A study protocol.

Background: During the COVID-19 pandemic, many people have experienced traumatic losses and therefore are at risk of developing complicated grief regarding the restrictions on the performance of routine mourning rituals. This study is a randomized controlled trial for assessing the efficacy of three versus five sessions of grief counseling on grief intensity, psychological distress, and quality of life of grief among bereaved people due to COVID-19. Methods: A total of 120 bereaved people, due to COVID-19, will be enrolled in this multi-center randomized controlled trial after assessment for inclusion and exclusion criteria. Following the informed consent procedure, participants will be allocated into two groups equally by the Stratified Balanced Block Randomization, one of them delivering a three-session grief counseling intervention and the other delivering a five-session grief counseling intervention. The intervention will be delivered by trained psychologists via in-person individual sessions. The primary outcome is grief intensity, and the secondary outcomes are psychological distress, quality of life, and satisfaction of the participants. These outcomes will be measured by the Grief Intensity Scale (GIS), the General Health Questionnaire-28 (GHQ-28), the Short Form Health Survey-12 (SF-12), and the Client Satisfaction Questionnaire (CSQ-8), respectively. The assessments will be done at three time points, one before the intervention and the others 1 month and 3 months after the intervention. The data will be analyzed using the SPSS V.18 and Stata V.11 software. The analysis approach will be "intention to treat." Discussion: Results of this study can be applied for selecting the most suitable intervention leading to the prevention of complicated grief and the maintenance and promotion of the mental health of bereaved people due to COVID-19. Clinical trial registration: [irct.ir], identifier [IRCT20200505047305N1].

Mental Health, Burnout, and Job Stressors Among Healthcare Workers During the COVID-19 Pandemic in Iran: A Cross-Sectional Survey.

Introduction: The COVID-19 pandemic has caused increasing levels of mental health problems such as anxiety and depression among doctors, nurses and other healthcare workers in hospitals or health centers. The main objective of this study was to assess the mental health, job stressors, and burnout among healthcare workers in Iran. Materials and Methods: A cross-sectional study was performed in the primary healthcare centers and hospitals affiliated with six of the medical universities in Iran. The selection of participants was done using multi-center convenient sampling. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Copenhagen Burnout Inventory were used for gathering data through an online platform. Data related to job stressors were obtained using a validated checklist. Data analysis was performed using Chi-square and multiple regression tests and the phi coefficient. Results: The results of our study showed that 53% of the healthcare workers of the hospitals and primary healthcare centers enrolled in our study either had generalized anxiety disorder or major depressive disorder or both disorders. Moderate and high levels of burnout were seen among 48.9% of the study participants. The prevalence of mental disorders and burnout were significantly higher among the female healthcare workers compared to the male (p = 0.0001) and a higher rate of mental disorder and burnout was also seen among healthcare workers of hospitals compared to those working in primary healthcare centers (p = 0.024). "Worry about children and old members of family," "family worries for my health condition" and "lack of specific effective treatment for COVID-19" were found to be predictive of mental disorder and burnout. The most prevalent job stressor among the total sample was "low payment or income during the COVID-19 period". Conclusion: The results of our study revealed high psychological distress and burnout among healthcare workers of the hospitals during the fourth peak of the COVID-19 pandemic in Iran. This study highlights the need for health officials to pay attention to the job stressors of healthcare workers and obliges them to perform effective interventions to address their needs and concerns.

Mental Health and Prevention of Substance Use Programs in Iran: Component of the National Action Plan for Prevention and Control of Non-communicable Diseases.

Background: Mental disorders have a high prevalence and significant burden among all health conditions across the world and in Iran. Therefore, some targets in the field of mental health and substance and alcohol use prevention have been included in the National Action Plan for Prevention and Control of Non-communicable Diseases and Related Risk Factors. Methods: Keeping in mind the key priorities, important strategies have been considered for attaining the main targets in this field. These strategies fall under four categories of governance, prevention and reduction of risk factors, health care, and surveillance, and monitoring and evaluation strategies. Conclusion: The success of mental health and substance and alcohol use prevention programs in Iran can be partly related to the evidence-based approach adopted and also to the commitment of high-rank officials of the Ministry of Health and Medical Education to the principal strategy of increasing access to the general population to basic mental health services, among all other non-communicable diseases.

Integrating Mental Health Services into the Primary Health Care System: The Need for Reform in Iran.

Objective: The main objective of this study was to review aspects of the current situation and structure of the integrated mental health care services for planning a reform. Aspects of the newly designed infrastructure, along with specification of duties of the various human resources, and its relation with Iran's Comprehensive Mental and Social Health Services (the SERAJ Program), will also be presented Method : This is a study on service design and three methods of literature review, deep interview with stakeholders, and focused group discussions. In the literature review, national and international official documents, including official reports of the World Health Organization (WHO) and consultant field visits, were reviewed. Deep semi-structured interviews with 9 stakeholders were performed and results were gathered and categorized into 3 main questions were analyzed using the responsibility and effectiveness matrix method. The Final results were discussed with experts, during which the main five-domain questions were asked and the experts' opinions were observed. Results: In this study, the main gaps of the public mental health care (PHC) services in Iran were identified, which included reduction of risk factors for mental disorders, training the general population, early recognition and treatment of patients with mental disorders, educating patients and their families, and rehabilitation services. The new model was then proposed to fill these gaps focusing on increasing access, continuity of care, coordination in service delivery, and comprehensiveness of care. A mental health worker was placed besides general healthcare workers and general practitioners (GPs). Services were prioritized and the master flowchart for mental health service delivery was designed. Conclusion: A reform was indeed necessary in the integrated mental health services in Iran, but regarding the infrastructure needed for this reform, including human and financial resources, support of the senior authorities of the Ministry of Health (MOH) is necessary for the continuity and enhancement of services. In this model, attention has been given to the principles of integrating mental health services into primary health care. Current experience shows that the primary health care system has been facing many executive challenges, and mental health services are not exclusion to this issue. Monitoring and evaluation of this model of service and efforts for maintaining sustainable financial resources is recommended to make a reform in this system and to stabilize it.

Identifying pathways for large-scale implementation of a school-based mental health programme in the Eastern Mediterranean Region: a theory-driven approach.

Globally there is a substantial burden of mental health problems among children and adolescents. Task-shifting/task-sharing mental health services to non-specialists, e.g. teachers in school settings, provide a unique opportunity for the implementation of mental health interventions at scale in low- and middle-income countries (LMICs). There is scant information to guide the large-scale implementation of school-based mental health programme in LMICs. This article describes pathways for large-scale implementation of a School Mental Health Program (SMHP) in the Eastern Mediterranean Region (EMR). A collaborative learning group (CLG) comprising stakeholders involved in implementing the SMHP including policymakers, programme managers and researchers from EMR countries was established. Participants in the CLG applied the theory of change (ToC) methodology to identify sets of preconditions, assumptions and hypothesized pathways for improving the mental health outcomes of school-aged children in public schools through implementation of the SMHP. The proposed pathways were then validated through multiple regional and national ToC workshops held between January 2017 and September 2019, as the SMHP was being rolled out in three EMR countries: Egypt, Pakistan and Iran. Preconditions, strategies and programmatic/contextual adaptations that apply across these three countries were drawn from qualitative narrative summaries of programme implementation processes and facilitated discussions during biannual CLG meetings. The ToC for large-scale implementation of the SMHP in the EMR suggests that identifying national champions, formulating dedicated cross-sectoral (including the health and education sector) implementation teams, sustained policy advocacy and stakeholders engagement across multiple levels, and effective co-ordination among education and health systems especially at the local level are among the critical factors for large-scale programme implementation. The pathways described in this paper are useful for facilitating effective implementation of the SMHP at scale and provide a theory-based framework for evaluating the SMHP and similar programmes in the EMR and other LMICs.

Trends of Mental Health Status in Iranian Population Aged 15 and above between 1999 and 2015.

INTRODUCTION: The main objective of this study was to compare the results of mental health surveys on adult populations of all provinces in Iran, between 1999 and 2015. METHODS: This study was an overview of two cross-sectional, descriptive studies that were performed in 1999 and 2015. The study population of these two studies consisted of urban and rural residents of all provinces in Iran. Samples were recruited by systematic random cluster sampling. In both studies, the General Health Questionnaire (GHQ-28) was used to assess mental health status of respondents. Trained psychologists completed questionnaires, and data were analyzed using SPSS software-18. RESULTS: The results showed that in the survey of 1999, 21% of participants suffered from mental disorders (25.9% of females and 14.9% of males). In the survey of 2015, 23.4% of samples were suspected of having mental disorders (27.6% of females and 19.3% of males). The prevalence of mental disorders increased from 1999 to 2014 by about 1.12 fold (1.06 fold in females and 1.3 fold in males). In the survey of 1999, rural residents were more at risk of mental disorders, while in the survey of 2015, urban residents were more prone to mental disorders. In both studies, the risk of suspicion for mental disorders increased with increasing age, and was higher in people aged 65 and above, as well as widowed, divorced and illiterate individuals. CONCLUSION: The results of this study showed an increase in suspected cases of mental disorders in Iran from 1999 to 2015. Therefore, it is vital for policymakers and health officials to take action in order to improve and maintain mental health status of the people who are at risk in the country.

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

INTRODUCTION: This research aims to determine the mental health status of population aged 15 and over in the province of Tehran in 2015. METHOD: This cross-sectional survey was performed on 1,200 individuals aged fifteen years and older, living in urban, and rural areas of the three main districts of Tehran, Shahriar, and Nasimshahr of Tehran Province. Individuals were enrolled in the study by clustered and systematic randomization. The General Health Questionnaire-28 (GHQ-28) was used for screening for common mental disorders. Those scoring above the cut-off point of the GHQ-28 were considered to be suffering from at least one mental disorder. All data was analyzed using the SPSS-18 software. RESULTS: According to our data, 30.2% of the subjects (34.2% of females and 26.4% of males) were suspected of having mental disorders. The prevalence of suspected psychiatric disorders in urban areas (35.1%) was higher than the prevalence of these disorders in rural areas (18.2%). Scoring above the cut-off point of the GHQ-28 also had a positive correlation with age, especially among those aged 65 years old and above. Somatization and also symptoms of anxiety were more prevalent than social dysfunction and depressive symptoms, and also more prevalent among females compared to males. Being suspected of a mental disorder was also more prevalent among those who had been divorced, widowed, unemployed, and having post-graduate university education. CONCLUSION: The results of this study show that about one third of our sample population were suspected of suffering from a mental disorder. The prevalence of common mental disorders has increased from 21.2% in 1999 to 31.7% in 2015. Therefore, it is strongly recommended that public health authorities put more effort to ensure necessary requirements encompassing prevention and promotion of mental health of the Iranian population residing in Tehran province.

Physicians' attitudes toward integrating consultation-liaison psychiatric services in four major general hospitals in Tehran.

OBJECTIVE: Our objective was to validate a scale for the evaluation of attitudes of physicians toward integrating consultation-liaison psychiatric services and then apply it among the nonpsychiatrist attending physicians of four major general hospitals in Tehran. METHOD: The eight-item Doctors' Attitudes toward Collaborative Care for Mental Health (DACC-MH) Scale was translated to Persian and back-translated to English by nonphysician translators and was presented for expert opinion to four psychiatrists for assessment of face validity. The validated questionnaires were presented to nonpsychiatrist attending physicians of four major general university-affiliated hospitals with consultant-liaison psychiatric services in Tehran, and the returned questionnaires were analyzed using the 21st version of SPSS software. The score for each physician was generated by counting positive responses of the eight items questioned. RESULTS: Of the 300 questionnaires presented, 193 (64.3%) were returned. The mean score of the respondents was 6.62 (±1.33) for the Farsi version of the DACC-MH which was significantly higher than the assumed mean score of 4, according to the independent-sample t test (P<.001). The mean score of the respondents for the first four items of the DACC-MH was 3.49, which was significantly higher than that of the second four items of the scale which was 3.13 (P<.01) according to the Wilcoxon test. CONCLUSION: The respondents have an above-average positive attitude toward integrating consultation-liaison psychiatric services for the management of psychiatric disorders among inpatients. They had a more positive attitude toward requesting psychiatric consultations than managing the patients' psychiatric disorders themselves.