Stigma as a barrier to suicide prevention efforts in Iran.

Suicide and suicide attempt affect a considerable part of the general population, and in spite of their prevalence, the stigma associated with suicide remains an unsolved problem surrounding this important public health problem, especially in lower-income countries such as Iran. Evidence shows that help-seeking from formal mental health services for suicidal people is low in countries like Iran. Previous studies on Iranian survivors of suicide attempts have shown that these people experience fear of stigma due to labels such as loss of faith in God, having forms of severe mental illnesses ("madness"), and being involved in unaccepted sexual relationships. The associated stigma prevents them from seeking appropriate health and social services. Although both self-stigma and public stigma contribute to an unwillingness to seek mental health care and suicide prevention efforts in Iran, public stigma may be of greater consequence, significantly impeding an individual's likelihood of accessing care for their suicidal thoughts or attempts. In such circumstances, many people with suicidal thoughts miss out on social and formal support programs offered by social and healthcare providers. In this perspective article, focusing on the public stigma regarding suicide in Iranian society, we address the challenges and barriers to seeking suicide prevention efforts in Iran and discuss culturally appropriate strategies to improve the current situation.

A Short Course Computer-assisted Cognitive Remediation in Patients with Schizophrenia Spectrum Disorders: A Randomized Clinical Trial.

INTRODUCTION: Cognitive Remediation Therapy (CRT) is used to improve cognitive functioning in patients with Schizophrenia Spectrum Disorders (SSDs). Most of the previous studies had incorporated a long rehabilitation program. This study aimed to evaluate the effects of a short and easy to implement computer-based CRT on cognitive performance in patients with SSDs using a randomized controlled trial design. METHODS: Sixty-Two patients with SSDs were enrolled in Roozbeh Hospital (Tehran City, Iran); they were randomized to either receive a CRT program added to the standard pharmacological treatment (n=31) or the standard treatment alone (n=31). The remediation consisted of 10 sessions of CRT provided 2-3 times a week applying the Cogpack software. The cognitive performance was assessed in attention, memory, and executive functions before and after the intervention using the respective tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). RESULTS: This study did not demonstrate any significant improvement in attention and executive function between the experimental and control group. However, we observed modest improvements in some aspects of visual memory (first trial memory score, F=9.152, P<0.001, Cohen's d=0.40; mean errors to success, F=6.991, P=0.011, Cohen's d=0.14; stages completed on the first trial, F=7.155, P=0. 010, Cohen's d=0.71; total errors, F=5.730, P=0.020, Cohen's d=0.53). CONCLUSION: We observed only modest improvements in the patients' cognitive functioning after a short course of CRT. The short duration of the training and lack of a comprehensive rehabilitation plan may explain the obtained findings.