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Drug addiction is a chronic mental disorder that significantly impacts all aspects of an individual's life, and substance use disorder in patients with bipolar disorder. The objective of this study is to assess the frequency of substance abuse among patients with bipolar spectrum disorder. This cross-sectional study evaluated the frequency of bipolar spectrum disorder in patients taking methadone through various screening measures, including Mini Mental State Examination (MMSE), DSM IV criteria, Mood Disorders Questionnaire (MDQ), Goodwin and Ghaemi's criteria, and Akiskal classification for bipolar disorders. Out of the total 197 participants in the study, 77 were identified as individuals engaging in poly-substance abuse. The investigation assessed the frequency of bipolar spectrum disorder based on various diagnostic criteria: 24% according to DSM-IV criteria, 29.9% using MDQ, 29.9% based on Ghaemi and Goodwin's criteria, and the highest rate at 48.2% when applying Akiskal's classification. This study highlights the high frequency of bipolar disorder among individuals with substance use disorder, especially those with concomitant depression. Therefore, it is crucial to pay special attention to individuals with substance use disorder with co-existing bipolar disorder. [ABSTRACT FROM AUTHOR]

Background: It has been proposed that a greater degree of adherence to a healthy dietary pattern is associated with a lower risk of depression and a poor quality of life (QoL). The Lifelines diet score (LLDS) is a new, evidence-base scoring system to define the quality of diet. We designed a cross-sectional study to investigate the association between LLDS with depression and QoL in Iranian adolescent girls. Methods: A total of 733 female adolescents were recruited from Mashhad and Sabzevar cities, Iran. Depression and QoL were assessed utilizing the Beck Depression Inventory (BDI) and SF-12v2 questionnaires, respectively. The LLDS was defined by dividing intakes of 12 food groups with negative or positive health effects into quintiles ranging 12 to 60 points. To explore the association between LLDS with QoL and depression, logistic regression was used in crude and adjusted models. Results: The prevalence of depression and poor QoL was 24% and 49%, respectively. After adjusting for confounding factors, adolescent girls in the highest quartile of LLDS compared with the participants in the lowest quartile had a 42% lower probability of reporting depressive symptoms (OR: 0.58; 95% CI: 0.35–0.97, P = 0.03). In addition, the participants in the highest quartile of LLDS had lower odds of poor QoL compared with the subjects in the lowest quartile (OR: 0.65; 95% CI: 0.42–0.92, P = 0.04). Conclusions: There is an inverse relationship between LLDS with risk of depression and poor QoL. Prospective and interventional investigations are needed to reach a clear vision. [ABSTRACT FROM AUTHOR]

Background: According to the report of the World Health Organization, mental disorders are one of the 10 most important causes of disability in the world. This study was conducted with the aim of determining the number and frequency of latent classes of depression and its determinants in Isfahan university of medical students. Materials and Methods: A total of 1408 medical students from Isfahan University of Medical Sciences, Iran, were enrolled in the study in 2017. The symptoms and severity of depression were assessed using the standard Hospital Anxiety and Depression scale questionnaire. Latent class analysis was applied to seven symptoms of depression, all of which had four levels. Latent class subgroups were compared using the Chi-square test and analysis of variance test. The regression model was used to check the relationship between identified classes and related factors. Analyzes were done using SPSS-21 and Mplus7 software. Results: In this study, three latent classes were identified, that is, the group of healthy people, the group of borderline people, and the group of people suspected of depression. The prevalence of identified latent classes among medical students is 0.52, 0.32, and 0.16%, respectively. The regression results showed that compared to the healthy group, the factors affecting depression in the borderline and suspicious group were increasing age, female gender, interest in the field of study, physical activity, history of depression, and history of anxiety. Conclusion: The three classes that were identified based on the students' answers to the depression symptoms questions differed only based on severity. The history of depression and anxiety were the strongest predictors of latent classes of depression. [ABSTRACT FROM AUTHOR]

Background: Different mental disorders may be associated with many work-related factors to which primary health care workers (PHCWs) are exposed. The current research aims to measure the rates of depression, anxiety, and stress among PHCWs, and their associated causes in primary health care (PHC) settings. Methods: An explanatory sequential mixed methods design was employed in this research from January 2021 to January 2022 in Tabriz, Iran's PHC centers. First, this study followed an online-based cross-sectional survey using a self-reported questionnaire. The Depression, Anxiety and Stress Scale-21 Items (DASS-21) and questions on demographic and work-related characteristics were completed by 303 frontline PHCWs during the quantitative phase. In the qualitative phase, a semi-structured interview was held with 12 PHCWs who had the highest level of depression, anxiety, and stress to identify the reasons and sources of mental health prevalence. Quantitative data were analyzed using descriptive statistics via SPSS-26. A content analysis was performed to analyze qualitative data. Results: The results showed that self-reported stress, anxiety, and depression had a prevalence of 40.3%, 42.9%, and 42.6%, respectively. Symptoms of at least one mental disorder were experienced by 54% of respondents, while 28% had all three. Major sources of stress, anxiety, and depression among PHCWs were working environment conditions, organizational policies, job-related reasons, and interpersonal relations. Conclusions: The results of current study indicated that PHCWs experienced high levels of depression, anxiety, and stress. The main factors and reasons that contributed to these mental health issues among PHCWs were work environment conditions, organizational policies, job-related reasons and interpersonal relations. Therefore, interventions should be implemented to promote mental health of PHCWs. This can include measures such as psychological screening, supportive care, workload management, flexible scheduling, and access to mental health resources. Additionally, training programs can be implemented to enhance resilience and coping skills among healthcare professionals. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate depression, anxiety and stress in university students of a large university in Tehran. Iranians witnessed an extraordinary combination of natural and man-made disasters last year; the last of which was the outbreak of COVID-19. Participants: 234 students from Iran University of Medical Sciences. Methods: We designed an online survey to gather data related to General Health Questionnaire (GHQ)-28, Depression, Anxiety, and Stress Scale (DASS)-21, and demographic data. Results: The mean score of GHQ-28 was 34.4 (SD = 15.5, n=195), and 73.8% (n=144) of the sample had a score of higher than cut-point (23). According to DASS-21, varying degrees of depression, anxiety, and stress existed in 51%, 32%, and 56% of the students. Conclusions: Negative effects of stressful life events on mental health seems to be additive. More often than not, students need some kind of mental health care at the time of COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

Background: Psychological discomfort and sleep problems are considered separate disorders. Due to the high prevalence of both disorders among people living with HIV (PLWH), this study was designed to evaluate how those challenges are present among PLWH. Method: A cross-sectional study was conducted using data from a national survey of 1185 confirmed PLWH from 15 provinces in Iran from April to August 2019. Psychological discomfort and sleep quality were assessed using standardized versions of related Persian questionnaires. Logistic regression was used to assess the association between psychological discomfort and sleep quality in PLWH. Results: The overall prevalence of poor sleep quality, depression, anxiety, and stress was 47.71%, 50.95%, 44.26%, and 41.77%, respectively. The results of multivariate-adjusted logistic regression showed that each psychological discomfort covariate increased the odds of poor sleep quality. Depression by adjusting for anxiety and stress, anxiety by adjusting for depression and stress, and stress by adjusting for depression and anxiety all increased the odds of poor sleep quality. Conclusion: A high prevalence of psychological discomfort was observed in PLWH. Depression, anxiety, and stress were strongly associated with sleep quality. PLWH needed more attention and social support in order to reduce sleep and psychological issues. [ABSTRACT FROM AUTHOR]

Background & Aims Despite the significant impact of immunosuppressive drugs on controlling and treating certain diseases, their continued use can predispose patients to infectious diseases such as COVID-19, leading to anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms. This study aims to determine the levels of anxiety, depression, and PTSD symptoms in patients treated with immunosuppressive drug during the COVID-19 pandemic. Materials & Methods This descriptive cross-sectional study was conducted on 330 individuals treated with immunosuppressive drug such as those with autoimmune diseases, cancer, and transplant recipients in Firoozgar and Rasoul-e-Akram hospitals in Tehran, Iran, from July to December 2022. They were selected using a continuous sampling method. The instruments were a demographic/disease related questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Impact of Event Scale-Revised (IES-R). Data analysis was done in SPSS software, version 16 using descriptive (frequency, percentage, mean, standard deviation) and inferential (Independent t-test, analysis of variance, and Pearson’s correlation test) statistics. Results In this study, the mean age of participants was 51.35±12.95 years, and 148 (44.8%) were female. The majority of the patients had normal levels of anxiety and depression (91.2% and 92.1%, respectively). The mean total IES-R score was 27.71 out of 88. The anxiety and depression scores did not have a significant relationship with any demographic, disease-related, and COVID-related characteristics of the study participants, but a significant correlation between income level and total score of IES-R was observed (P=0.043). Conclusion The individuals receiving immunosuppressive drugs in this study, despite being susceptible to COVID-19, had normal levels of anxiety and depression and obtained lower than average score in the IES-R. This finding can reduce the concerns about the mental health of these patients. Further studies using other questionnaires or a qualitative study on the experiences of these patients during the COVID-19 pandemic are recommended. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the effectiveness of group Compassion-Based Acceptance and Commitment Therapy (ACT) and group Schema Therapy on depression, stress, psychological well-being, and resiliency in female intimate partner violence (IPV) victims in Iran. For this purpose, a sample of 60 women who reported ongoing experiences of IPV were selected. Out of these 60 women, 20 were randomly assigned to the ACT treatment group, 20 to the Schema Therapy group, and 20 to the no-treatment control group. Five participants withdrew from each group. For both the ACT and Schema groups, depression and stress decreased, and overall well-being and resiliency scores significantly increased between pre-test and post-test, and there was not a significant difference in depression levels between post-test and the follow-up for either group. For the control group, depression and resiliency scores did not significantly change between pre-test and post-test or between the post-test and follow-up. Stress scores significantly decreased between pre-test and post-test, but stress scores significantly increased between the post-test and the follow-up. Well-being scores significantly increased between pre-test and post-test and did not significantly change between post-test and follow-up. One-way analyses of variance examining change scores of depression, stress, overall well-being, and resiliency between the pre-test and the follow-up found that the ACT and Schema group's depression and stress levels lowered, and resiliency levels increased significantly more than the control group. There was no significant difference in depression and resiliency change score for the ACT and Schema group. The ACT group's overall well-being increased significantly more than the control group. [ABSTRACT FROM AUTHOR]

Nursing theories and conceptual models shape nursing knowledge. This study applied the philosophical and theoretical basis of the Neuman Systems Model, which focuses on the use of primary, secondary, and tertiary nursing prevention for retention, attainment, and maintenance of patient system wellness, to a patient with pre-existing mental health conditions struggling to cope with depression and COVID-19 in a dedicated COVID-19 hospital in an urban area of Iran. The single intrinsic case study design used interviews, nursing observations, and document analysis to evaluate environmental factors and intra-, inter-, and extra-personal stressors. An advanced, outcome-oriented nursing care plan was developed. [ABSTRACT FROM AUTHOR]

This study aimed to identify body mass index (BMI) trajectories from childhood and their relationships with depression, anxiety, and stress symptoms in young adulthood. A total of 687 children aged 4–18 years were recruited from the Tehran Lipid and Glucose Study. Throughout 18 years of follow‐up, BMI was measured every 3 years for a maximum of 6 data points. Participants completed the depression, anxiety, and stress scale in their young adulthood (aged 22–36). The group‐based trajectory modelling was applied to identify BMI patterns. The logistic regression model was used to assess the association between BMI trajectories and depression, anxiety, and stress symptoms in adulthood. Two BMI trajectories were identified from childhood to young adulthood: healthy weight (HW = 69.6%) and persistent increasing overweight/obesity (PIO = 30.4%). After adjusting for potential confounders, compared with the HW group, men in the PIO group were more likely to experience higher stress levels (OR: 1.62, 95% CI: 0.99–2.63; p = 0.05). No significant association was observed between the PIO trajectory and depression and anxiety among both sexes and stress symptoms in females. Our results highlight that developing overweight and obesity from childhood may be related to increased stress in males. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to assess the cost-effectiveness of the vitamin D supplementation program in Iranian adolescents reducing adolescent depressive Symptoms. Methods: In the current cost-effectiveness analysis, the viewpoint of Iran's Ministry of Health was selected. The target population was 1,519,762 Iranian high school students (733,657 girls and 786,105 boys). The total costs of the vitamin D supplementations program were based on the reports of the Nutrition Improvement Office of Iran's Ministry of Health and were adjusted to 2018. The variable of Quality-Adjusted Life Years (QALYs) was considered a suitable variable for estimating the effectiveness of vitamin D supplementation. We chose one year as the time horizon. A decision tree model was constructed in TreeAge Pro. The results of the cost-effectiveness analysis were reported in term of the Incremental Cost-Effectiveness Ratio (ICER). Results: The results of our study showed that the estimated cost per QALY gained of the vitamin D supplementation program is equal to 1528.6676 $, which indicates that vitamin D supplementation in adolescents(11-18Y) is a cost-effective and a dominant strategy in preventing depression through the cost-saving and QALYs increment compared to the no intervention. Sensitivity analysis showed that the possible variations in vitamin D supplement costs could not alter the results, and vitamin D supplementation may be a predominant and cost-effective strategy to prevent adulthood depression with a 100% probability. Conclusion: The national program of vitamin D supplementation among Iranian adolescents was a cost-efficient strategy reducing adolescent depressive Symptoms through the cost-saving and QALYs increment compared to the no intervention. [ABSTRACT FROM AUTHOR]

Background: Migraine negatively affects sufferers' physical and mental health and social and economic status. Objectives: This study compared the effectiveness of behavior management therapy and pharmacotherapy in reducing migraine-related disabilities with and without focusing on comorbid depressive symptoms. Materials & Methods: This quasi-experimental study has a pre-test-post-test design with a control group. The study was conducted on migrainous patients with comorbid depressive symptoms referred to neurology clinics in Rasht City, Iran, in 2021. A total of 18 female patients were selected using purposive sampling based on neurological diagnosis and the diagnostic and statistical manual of mental disorders (DSM-5) criteria for depressive disorder. The participants were randomly assigned to two groups after matching regarding age and severity of depression. Combined therapy (behavior management intervention [BM] and pharmacotherapy [P]) was performed in two groups during eight sessions, with (case group) and without (control group) focusing on comorbid depressive symptoms. The data were collected using the Beck depression inventory (BDI-II), the headache disability inventory (HDI), and the headache diary (HD) and analyzed using multivariate analysis of covariance. Results: The first therapeutic approach was significantly superior to the second in reducing migraine-related disabilities (F(2, 13)=10.43, P<0.05, Wilks Lambda=0.384, partial η²=0.616). Conclusion: Combined therapy (BM & P) focusing on comorbid depressive symptoms can be an alternative or complementary therapeutic method to reduce various disabilities in migraine patients. [ABSTRACT FROM AUTHOR]

Introduction: Since the introduction of the Food and Drug Administration (FDA)-approved repetitive transcranial magnetic stimulation (rTMS) intervention in 2008, a breakthrough has been made in treating major depressive disorder (MDD). However, many sessions of treatment and its cost make it inconvenient for those who seek treatment, especially in large cities as well as in developing countries. Methods: A total of 22 patients (out of initial 24 referrals) who met diagnostic and statistical manual of mental disorders, 4th edition (DSM IV) criteria for MDD were enrolled in the study. All subjects had to fail at least one prior treatment for depression. The patients received the FDA-approved protocol of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex. Results: Seventeen out of twenty-two cases showed significant improvements after two weeks of treatment. Only six patients continued their treatments for the next two to four weeks. Conclusion: We have replicated other studies showing that the use of rTMS is effective for many patients with MDD without major side effects and their improvements are measurable mostly after two weeks. Our data highlight the importance of the application of more convenient protocols that require fewer sessions on fewer days to help with compliance and outcome, particularly in large populated cities and countries, such as Iran going through economic hardship. [ABSTRACT FROM AUTHOR]

Introduction: Depression is the most common psychological health disorder. Considering that micronutrients have always played a significant role in all physical and psychological aspects of people, this study was conducted to investigate the relationship between nutrients intake and anthropometric profiles with depression in male medical students of Yazd University of Medical Sciences in2021. Materials and Methods: 245students participated in this cross-sectional study. The intake of nutrients in the diet was measured using a food recall questionnaire. Anthropometric evaluations including, body mass index, waist to hip ratio and waist to height ratio were measured using standard methods. Beck depression questionnaire was used to determine the depression score. SPSS26 was used for data analysis. Results: The average age of the examined samples was22.7±2.3 years, the average body mass index was23.56±8.35 kg/m2.the average waist to hip ratio of the samples was0.90 ±0.01 cm and the ratio of waist circumference to height of the samples was0.48 ±0.03. The depression score was significantly lower in group with normal BMI,WHpR and WHtR. Also, the average score of depression in the group with adequate intake of selenium, magnesium and vitamin D was significantly lower than the group with inadequate intake. Conclusion: According to the result, the increase in BMI, WHpR and WHtR and the decrease in consumption of selenium, magnesium and vitamin D can be associated with increase in the incidence of depression in medical students. Therefore, controlling body weight in ideal condition and getting enough selenium, magnesium and vitamin D can be preventive and perhaps a therapeutic factor to deal with some mood disorders, including depression. [ABSTRACT FROM AUTHOR]

Background: Lifelong provision of care to chronically ill patients increase the risk of physical and mental diseases in informal caregivers and adversely affects their quality of life. The present study examined the correlation between caregiver burden, depression, and quality of life among the informal caregivers of thalassemia and hemodialysis patients during the COVID-19 pandemic in southeastern Iran. Methods: This cross-sectional correlational study used convenience sampling to select 200 informal caregivers involved in providing direct care for patients undergoing hemodialysis (n = 70) and patients with thalassemia (130) for at least 6 months. A demographic questionnaire, Beck's Depression Inventory (BDI), the Quality-Of-Life Questionnaire (SF-36), and the Zarit Burden Interview were used to collect data in 2021. The data were analyzed with SPSS software (version 19) using frequency, percentage, independent samples t-test, ANOVA, and multivariate regression analysis. Results: Most of the informal caregivers of the thalassemia and hemodialysis patients (58% and 43%) reported moderate levels of caregiver burden. There were significant correlations between the caregiver burden and depression (P < 0.0001) and between the caregiver burden and the quality of life (P < 0.009). The level of depression in informal caregivers of patients undergoing hemodialysis was higher than that of the informal caregivers of patients with thalassemia, but the quality of life in the informal caregivers of the patient's undergoing hemodialysis was higher than that of the informal caregivers of the patients with thalassemia. Conclusion: Considering the significant correlations between caregiver burden, depression, and quality of life in this study, healthcare providers are recommended to develop educational and supportive interventions to meet informal caregivers' needs, mitigate their emotional distress, fears, and concerns, and prevent caregiver burden in times of greater uncertainty. [ABSTRACT FROM AUTHOR]

The current study aimed to evaluate the validity and reliability of the Persian version of the Cornell Scale for Depression in Dementia (CSDD) in 100 patients aged ≥ 60 with dementia in Tehran, Iran. Test–retest reliability and internal consistency were analyzed through intraclass correlation coefficient and Cronbach's alpha tests, respectively. The validity was assessed in the areas of face, content and structural validity. The Geriatric Depression Scale (GDS) and The Montgomery–Åsberg Depression Rating Scale (MADRS) were also used to determine the convergent validity. The intraclass correlation coefficient (ICC) was equal to or more than 0.8 between the results of determining depression twice via the CSDD. The internal consistency (Cronbach's α = 0.90) was excellent. The factor analysis, identified five main factors (mood-related signs, behavioral disturbance, physical signs, cyclic functions and ideational disturbance), aside from depression, demonstrated the variance to be 37.88%. Evaluating convergent validity showed satisfactory results (p < 0001). Using the MADRS as standard. the best cut-points for the CSDD via the use of the Youden index were scores of 5.5, 10.5 and 16.5 for mild, moderate and severe depression, respectively. The Persian version of the CSDD is sufficient in terms of validity and reliability for screening depression in the elderly with dementia in Iran. [ABSTRACT FROM AUTHOR]

Late-life depression is a severe problem leading to adverse consequences in the lives of seniors. Pervasive evidence emphasizes that childhood maltreatment is one of determining factors in late-life depression. The literature suggests a complicated mechanism underlying this relationship. This study aimed to examine whether the sense of coherence (SOC) mediated and moderated the relationship between childhood maltreatment and late-life depression. This study sample included 237 community-dwelling older adults (aged 60–97) with a mean of 69.23 years and standard deviation = 6.87, from November to December 2019 in Tehran. A face-to-face interview was done, and the data was collected based on a multistage sampling approach and analyzed with the structural equation modeling. Childhood maltreatment was positively associated with depression while negatively correlated with the SOC in older adults. A low level of SOC was also correlated with symptoms of depression. In addition, the SOC partly mediated the association between childhood maltreatment and late-life depression. However, no moderation effect of SOC was found. Childhood maltreatment may be linked with late-life depression. Part of this relationship is highly likely indirect, through the effect of SOC, which could inform intervention efforts to promote the level of SOC to alleviate symptoms of depression in seniors. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that the minor allele (C allele) for melanocortin 4 receptor (MC4R) rs17782313 may be associated with depressed mood. Moreover, dietary patterns have potentially adverse effects on depression. This study investigates the interactions between the MC4R gene variant (rs17782313) and dietary patterns on depression among Iranian obese and overweight women. Methods: A total of 289 Iranian overweight and obese women, aged 18–50 years, were enrolled in this cross-sectional study. Biochemical, anthropometric, and body composition indices were assessed in all participants. Moreover, MC4R rs17782313, by the restriction fragment length polymorphism (PCR-RFLP) method, and depression, using the 21-item Depression Anxiety Stress Scales (DASS) questionnaire, were assessed. Food intakes were assessed by completing a 147-item semi-quantitative food frequency questionnaire (FFQ). Results: By the use of factor analysis, 2 major dietary patterns were extracted: healthy dietary pattern (HDP) and unhealthy dietary pattern (UDP). Binary logistic analysis showed that individuals with minor allele risk (CC) with high adherence to the unhealthy pattern increased odds for depression (OR: 8.77, 95%CI: -0.86-18.40, P: 0.07), after controlling for confounders. Also, a logical inverse relationship was observed between CT genotype and HDP on depression in the crude and adjusted models (OR: -0.56, 95% CI: -3.69-2.57, P: 0.72) (OR: -4.17, 95% CI: -9.28-0.94, P: 0.11), although this interaction was not statistically significant. Conclusion: According to the above findings, adherence to unhealthy food intake pattern increases odds of depression in MC4R risk allele (C allele) carriers. To confirm these findings, more studies are needed in the form of clinical trials and prospective studies with higher sample sizes. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the effectiveness of transdiagnostic treatment on maladaptive personality traits and mentalized affectivity of patients with generalized anxiety disorder comorbid with depression. Methods: This was a quasi-experimental study with a single case method. The statistical population included people with generalized anxiety disorder comorbid with depression who were referred to counseling centers in Isfahan City, Iran in 2020. From this population, 5 people were selected via purposive sampling and they were intervened with transdiagnostic treatment through weekly sessions held individually. The subjects were assessed at the baseline, third, fifth, eighth, and tenth sessions, and during a 1-month follow-up period using the short version of the adult version of the diagnostic and statistical manual of mental disorders, fifth edition, personality questionnaire, and the mentalized affectivity scale. To report the data, we used visual analysis, reliable change index, improvement percentage, and statistical and clinical significance. Results: The visual analysis, percentage of improvement, and reliable change index (RCI=1/96), showed that transdiagnostic treatment created statistically significant changes and improvement in mentalized affectivity components, negative affectivity, and detachment; however, it did not have a significant effect on other personality traits (antagonism, disinhibition, and psychoticism). Conclusion: Transdiagnostic treatment is an effective treatment to modulate the mentalized affectivity, negative affectivity, and detachment of people with generalized anxiety disorder comorbid with depression. [ABSTRACT FROM AUTHOR]

Background: The inflammation accelerates the progression of bipolar disorder. Supplementation of anti-inflammatory supplements in adjuvant with medications may alleviate disorder signs. This study aimed to investigate the effects of omega-3 fatty acid supplementation on the serum concentrations of pro-inflammatory cytokines and depression status in patients with bipolar disorder. Materials and Methods: This randomized clinical trial study was conducted in Zahedan city in 2021. Patients with bipolar disorder (n = 60) were grouped into two groups: omega-3 fatty acid supplement group (n = 30, 15 men and 15 women) and placebo one using a permuted block stratified randomization. The patients in the omega-3 group received 2 g of omega-3 fatty acids daily for 2 months while patients in the placebo group received 2 g soft gels daily in the same form. Depression score and the serum concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) were assessed before and after the study. Results: Depression score and the serum concentrations of TNF-α, IL-6, and hs-CRP were decreased after intervention in the omega-3 fatty acid group also compared with the placebo group (P < 0.001). The results also show a positive correlation between the serum concentrations of TNF-α, IL-6, and hs-CRP with depression scores (P < 0.001). Conclusion: Prescription of omega-3 fatty acids can decrease inflammatory parameters and help to decrease depression in patients with bipolar disorder. This supplement can be used along with medications for decreasing the inflammatory markers in these patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the relationship between spiritual health and aging perception with depression in older adults in Bushehr city, 2019. The present cross-sectional study designed based on the STROBE statement on 430 elderly people. Systematic multi-stage sampling was performed with the informed consent of participants. The mean age of participants was 66.83 ± 7.91 years. The mean scores of spiritual health, physical health and aging perception were obtained 96.75 ± 10.02, 43.07 ± 4.86 and 58.65 ± 6.69, respectively. The results of the interaction between the variables of spiritual health and perception of aging on depression showed a significant relationship between these variables and depression. The results showed that spiritual health and perception of aging have a significant effect on depression. In other words, older adults who were more aware of their aging process and had higher spiritual health reported less depression. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spirituality and spiritual beliefs are among the factors playing key roles in preventing psychological disorders. The present study aimed to investigate the relationship between depression symptoms with emotional divorce and spiritual beliefs using artificial neural networks (ANN) in married university students. Methods: The statistical population of this descriptive-correlational study included all married students at the Islamic Azad University of Ahvaz (Khuzestan Province, Iran) during the 2021–22 academic year. The convenience sampling technique was adopted to select 301 married students as the research sample. An ANN was employed and data collection was done using the Beck’s depression inventory, emotional divorce scale, and religious orientation scale. Data analysis was performed through the Pearson correlation coefficient, stepwise regression, and an ANN. Results: The results showed a significant positive relationship between emotional divorce and depression symptoms, whereas there was a significant negative relationship between intrinsic religious beliefs and depression symptoms (P<0.001). However, a significant positive relationship existed between extrinsic religious beliefs and depression symptoms (P<0.001). Furthermore, depression symptoms were associated with emotional divorce and intrinsic/extrinsic religious beliefs in married university students. The results of the ANN also showed that emotional divorce had the most relationship with the depression symptoms of married students. Conclusion: The ANN appropriately predicted depression symptoms through an emotional divorce and spiritual beliefs among married university students. The results indicated the necessity of paying more attention to marital relationships, emotional divorce improvement, and depression alleviation. [ABSTRACT FROM AUTHOR]

Background & Aims According to the statistics, the number of older people in Iran is increasing. Considering the occurrence of major changes in old age and the high prevalence of stress, anxiety, and depression in the elderly, this study aims to examine the effect of coloring mandala patterns on depression, anxiety, and stress of older people in Tehran, Iran. Materials & Methods This is a quasi-experimental, single-group study (clinical trial) with a pre-test/post-test design. Participants were 40 older people referred to Yas Elderly Day Care Center in Tehran in 2021 who met the entry criteria and were selected non-randomly. They were asked to color the mandala patterns in 20 minutes (using colored pencils) for 4 consecutive weeks, two sessions per week. Their anxiety, depression, and stress were measured by the depression, anxiety, and stress scale-21 items (DASS-21) before and immediately after the intervention. The data were analyzed in SPSS software, version 23. Results Of 40 participants, 57.5% were women, 65% were married, and 67.5% had a diploma or higher education. Their mean age was 72.03±5.34 years. Data analysis showed that coloring mandalas significantly reduced depression (P=0.001), anxiety (P=0.001), and stress (P=0.001). Conclusion Coloring mandala designs can reduce the depression, anxiety, and stress of the elderly. Therefore, this method can be used as a simple and affordable method to improve the mental health of the elderly. [ABSTRACT FROM AUTHOR]

Background: The current study aimed to explore the correlation between depression and various aspects of social-emotional competence in gifted students. The study's statistical population comprised all gifted students enrolled in the National Organization for Development of Exceptional Talents, with the sample consisting of gifted students from this organization in Tehran during the 2020/2021 academic year. Methods: The statistical population of the current study comprised all gifted students studying in the National Organization for Development of Exceptional Talents, with the sample consisting of gifted students from this organization in Tehran during the 2020/2021 academic year. The Children's Depression Inventory (CDI) and the Social Emotional Competence Questionnaire (SECQ) were utilized as research tools. Data were analyzed using Pearson's correlation and multiple regression methods. Results: The findings indicate a significant negative correlation between self-awareness and depression, as well as between responsible decision-making and depression among gifted students. Conclusion: Given the correlation between emotional intelligence, social-emotional competence, and depression, it can be inferred that self-awareness and responsible decision-making are predictive factors for depression among gifted students. [ABSTRACT FROM AUTHOR]

Background & Aims: Every year, in Iran and the world, many researches are conducted in the field of stress, anxiety and depression, especially in the field of treatment, and on the other hand, the lives of people who are involved with these problems are greatly disturbed and the inefficiencies caused by these problems make their lives miserable. It seriously affects and in general due to the very high prevalence of these disorders, huge time, energy and costs are imposed on individuals and governments every year, both in the field of treatment and in the field of research. Mental disorders have gained special importance due to the current tense world, which among mental disorders, anxiety, stress and depression have a long history and high prevalence and have attracted the attention of researchers. Anxiety, stress and depression have been considered throughout the history of psychology due to their unfortunate consequences and high prevalence. Knowing the causes of these disorders and effective treatment solutions for these disorders have always been considered, and therefore, many researches have been conducted in this field and a large amount of financial and human resources have been allocated to them. Although a lot of money has been spent on these issues, the results of the conducted research are not consistent and even sometimes contradictory results are obtained in the research. Therefore, the application of contradictory research results, publication, interpretation, evaluation and recognition of their weak points requires a solution based on the correct review and analysis of the research background, the use of conflicting evidence and the use of a combined method. For this reason, we take help from meta-analysis for this matter. In fact, meta-analysis is a method that can be used to infer the differences in the conducted research and to combine the results of various and numerous researches and extract new and coherent results and remove what causes bias in the final results and to solve problems and reach it contributes to more accurate results. The result of the research that has been done in order to present and improve the treatment methods is a very high volume of studies that have contradictory and scattered results. Therefore, this issue makes it difficult for researchers and therapists to draw conclusions and provide treatment services. Therefore, the application and use of meta-analysis research method can play a significant role in organizing the scattered results and resolve the contradictions in the data. Statistically, meta-analysis discovers the relationships between characteristics and research findings by converting the results of previous research into a common scale. The necessity of this research and metaanalysis research in general is due to the low sample size studied in intervention studies. The results of such studies are estimated to be biased compared to studies with larger samples. In these cases, the meta-analysis method by combining related studies and calculating the effect size of the investigated hypotheses is actually evaluated with larger samples. The findings of this type of research will be fruitful both in the field of science and research development and in the field of application and treatment and will bring many advantages. Researchers, professors and students can use the information and results of the research to choose the exact and correct area of their research, in other words, by determining the areas that need more research, it becomes possible to expand the theoretical area, also if the results are, show the ineffectiveness of treatment, a research field will be provided so that those interested in that field of treatment can review and make effective changes in the treatment protocol and in future research, they can improve and improve treatment methods. Therefore, the aim of the current research is to analyze the results of the research conducted in the field of the effectiveness of integrative treatment approaches on the occurrence of depression symptoms by using the meta-analysis technique. Methods: The study method was meta-analysis, and its statistical population included Persian studies, which were searched for Persian language articles in the databases of specialized Persian journals with keywords integrative, integrative approach, integrative treatment, integrative therapeutic approaches, integrative group therapy, integrative positive psychotherapy and Depression, separately and in combination, were searched. As a result of the search process, 16 articles related to the topic were obtained and after the process of removing studies based on inclusion and exclusion criteria, 7 articles were removed and 9 articles were found suitable for this meta-analysis. CMA2 software was used for data analysis. Results: Examining the questions showed that the effect size of integrative treatment approaches on depression is equal to 62.3%. Conclusion: In general, it can be said that this research can greatly help therapists in the field of depression, and therapists using the results can make their patients' recovery more effective and efficient by choosing the correct method of treatment and implementing it effectively. Accelerate the treatment process and reduce the suffering of their patients. In the above explanation, it can be said that depressed people also suppress positive emotions. Strengthening the capabilities of gratitude, hope and vitality probably play a role in increasing positive emotions. It can be said that in the etiology of depression, the reduction of positive emotions indirectly helps the occurrence of depression symptoms through the increase of negative emotions. In this way, in addition to increasing positive emotions, strengthening the mentioned capabilities is also effective in regulating negative emotions. On the other hand, the increase in personality abilities may lead to the improvement of coping strategies in depressed people. Depressed people generally suffer from a sense of emptiness and meaninglessness in life. In the integrative therapeutic approach, various strategies are used to strengthen emotional regulation. For example, to strengthen the ability to forgive, the therapist helps clients identify negative emotions such as anger and hatred and express them during the therapy session. Also, in these meetings, clients face painful events from the past and reframe them if necessary. In the critical thinking sessions, ineffective cognitions related to negative emotions are identified and replaced with efficient cognitions. In this way, the client can better accept his inner experiences such as negative thoughts, anger and hatred. It can be said that by relying on an integrated program of treatment and introducing emotions to people, tracking mood and activity level, familiarizing with creating small behavioral changes and evaluating them, teaching common mental traps, preparing a list of pleasurable activities and other stages and steps presented in the research; There was a significant difference in the depression of people before and after the implementation and it has been effective in reducing depression. Also, with the effort that takes place in the integrative treatment approach for behavioral acceptance of the existing situation, and in practice, more patience and tolerance occurs in the relationship between the patient and his spouse, the platform for positive social exchange is provided, which is one of the platforms and areas for strengthening social capital. [ABSTRACT FROM AUTHOR]

Objective: Suicide is one of the leading causes of death in the world. The present research aimed to investigate the moderating role of thwarted belongingness, perceived burdensomeness, and suicidal capability in suicidal ideation, behavior, and attempts among the Iranian population. Method: The data were analyzed using cross-sectional regression models. The population of this study included 600 students of the University of Mohaghegh Ardabili. The tools used to collect the data in this study were the Patient Health Questionnaire-2, the Depressive Symptom Index-Suicidality Subscale (DSI-SS), the Suicide Attempt Questionnaire, the Interpersonal Needs Questionnaire (IPTS), the Suicide Capacity Scale-3, the Adverse Childhood Experiences, the Generalized Anxiety Disorder Questionnaire, and the Suicidal Behaviors Questionnaire-Revised. Results: The results of this study showed that there was an interaction between thwarted belongingness and perceived burdensomeness in suicidal behavior and DSI-SS. The results also showed that the acquired and practical capability subscales (suicidal capability) strengthen the relationship between suicidal behavior and the DSI-SS, on the one hand, and suicide attempt, on the other hand. Conclusion: The findings of the study showed that the interpersonal theory of suicide can pave the way to prevent suicidal ideation and behavior in Iranian society, and it is recommended that Iranian practitioners apply the theory in practice. [ABSTRACT FROM AUTHOR]

This study aimed to determine the predictive factors of depression among relatives of person deceased by brain death. In this study, 106 first-degree relatives of people who died of due to brain death were studied. Of the study units, 72.64% had levels of depression (severe, moderate, and mild). Among the dependent variables concerning deceased person, age and gender of the deceased were significantly correlated with the depression of their relatives. Among the variables concerning relatives, low level of education, unemployment and time elapsed after brain death have significant role in the incidence or prediction of their depression (p < 0.05). The results indicated a high prevalence of depression among relatives of men aged 30–50 who died because of brain death. It is recommended to consider this fact in planning to care relatives, especially among the low-educated, the unemployed and experiencing the first year of death, of people deceased by brain death. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate and identify the psychosocial factors that are associated with paternal postpartum depression. Materials and methods: A longitudinal correlation study with 150 fathers was performed with three time frames (late pregnancy, postpartum, and four weeks postpartum). The Edinburgh Postnatal Depression Scale assessed those with depression (38.7%; n=58) and those without depressive symptoms (61.3%; n=92). Psychological variables related to paternal depression were also assessed through questionnaires. Results: Psychological variables such as marital adjustment and stress had a significant relationship with paternal depression. In addition, depressed fathers experienced less marital compatibility and more tension than non-depressed fathers. Conclusion: These findings emphasize the importance of considering the psychosocial variables that affect paternal psychological health. Mental health professionals may be able to reduce mental disorders, stress, psychological distress, and marital maladjustment in fathers with appropriate psychological interventions. [ABSTRACT FROM AUTHOR]

Background: Macronutrients' quality may impact differently on mental health and quality of life (QOL). This study aimed to investigate the potential relationship between the carbohydrate quality index (CQI), fat quality index (FQI), protein quality index (PQI), the affective mental symptoms and QOL among Iranian adults.Methods: The LipoKAP is a cross-sectional study, conducted with 2456 adults in Iran. A validated food frequency questionnaire was used to evaluate usual dietary intakes. A validated Iranian version of the Hospital Anxiety and Depression Scale was used to assess the severity of anxiety and depression. QOL was assessed by EQ-5D.Result: In the fully adjusted model, participants in the highest tertile of CQI had lower QOL than those in the lowest tertile (OR = 1.35; 95 % CI: 1.06, 1.73). Individuals in the top tertile of FQI (OR = 0.71; 95 % CI: 0.55, 0.91) and PQI (OR = 0.78; 95 % CI: 0.60; 1.01) were less likely to report lower QOL than those in the bottom tertile. An inverse association was found between PQI and depressive symptoms (OR = 0.72, 95 % CI: 0.55, 0.95), but not for CQI and FQI.Limitations: The cross-sectional design of the study and the use of a memory-based dietary tool may limit the generalizability of our findings.Conclusion: Higher PQI was associated with lower risk of depressive symptoms and having a low-quality life. Although CQI and FQI were not related to depressive and anxiety symptoms, higher values of FQI were associated with better QOL, while CQI showed an inverse association. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes is one of the most common metabolic disorders during pregnancy. Some studies have reported the effect of vitamin D deficiency on the incidence of this disorder. Therefore, the purpose of the present study was to determine the effect of vitamin D supplementation on fasting blood glucose (FBG) levels, fasting blood insulin (FBI) levels and insulin resistance index (HOMA-IR) (primary outcomes) and symptoms of depression, musculoskeletal pain, frequency of gestational diabetes and the frequency of abortion (secondary outcomes). Methods: In this triple-blind randomized controlled trial, 88 pregnant women at 8–10 weeks of pregnancy who had the vitamin D of less than 30 ng/ml were randomly assigned to the vitamin D group (n = 44) and control group (n = 44) using block randomization. The vitamin D group received 4,000 units of vitamin D tablets daily and the control group received placebo tablets for 18 weeks. Independent t-test, Mann-Whitney U and ANCOVA tests were used to analyze the data. Results: After the intervention, there was no statistically significant difference between the two groups in terms of FBG (P = 0.850), FBI (P = 0.353), HOMA-IR (P = 0.632), mean score of depressive symptoms (P = 0.505), frequency of gestational diabetes (P = 0.187) and frequency of abortion (P = 1.000) and there was only a difference in terms of serum vitamin D level (P = 0.016) and musculoskeletal pain including knee pain (P = 0.025), ankle pain (P < 0.001) and leg pain (P < 0.001). Conclusion: Vitamin D could improve the musculoskeletal pain in pregnant women but couldn't decrease FBG, FBI, HOMA-IR, depression symptoms score, incidence of GDM and abortion. Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N59. Date of registration: 4/11/2020. URL: https://en.irct.ir/user/trial/50973/view; Date of first registration: 21/11/2020. [ABSTRACT FROM AUTHOR]

Anxiety and depression are among the most prevalent psychiatric problems that can be associated with patients' physical issues and illnesses. Consequently, the current study aimed to investigate the effect of anxiety and early depression on the chances of contracting the COVID-19 infection among the personnel of outpatient hospitals. Thus, 241 members (136 male and 105 female employees) of the personnel in Moharrari Hospital, Iran, took part in the study and returned the DASS-21 questionnaire. Moreover, follow-up procedures lasted for a year. Out of the overall sample, 62 members contracted the COVID-19 in that year, and 6 members were hospitalized. The findings indicated that the contraction rate of the people who had scored higher in terms of depression and anxiety was significantly higher than that of the people with no symptoms of depression and anxiety. Moreover, the findings showed that having a history of physical illnesses had a significant relationship with anxiety and depression. Finally, no significant difference was observed between men and women in terms of suffering from depression and anxiety. The findings implied that psychiatric and physical problems can have mutual relationships with each other, and considering it can help select and develop more effective and optimal interventions. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional study aimed to assess the effects of different coping strategies on the mood states (anxiety and depression) of healthcare providers in the novel coronavirus disease (COVID-19) pandemic. Method: From February to April 2020, we asked medical staff in 4 referral hospitals in Iran to voluntarily complete online questionnaires including: Generalized Anxiety Disorder (GAD-2) questionnaire, Patient Health Questionnaire (PHQ-2) and the Coping Strategies Questionnaire-28. Univariate and multiple logistic regressions were applied to identify the associations of coping strategies and mood states. Results: 258 people filled out the online questionnaire. Of them, 39.9% and 39.1% reported anxiety and depression, respectively, with age as a risk factor. Overall, participants used more emotion-based coping strategies. Anxiety and depression were associated with applying more of emotion-based and less of problem-based coping mechanisms. The findings remained stable even after adjustment for confounding variables including age, gender and direct contact with COVID-19 patients. Conclusion: Providing social support to health workers, planning to reduce their perceived stigma, and educating them about how to use more effective coping mechanisms can be beneficial in reducing the psychological impact on this segment of the population in the event of COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: In this study, the effect of cognitive‐behavioral therapy (CBT) on death anxiety and depression was investigated in patients with heart failure. Design and Methods: In this quasi‐experimental study, 66 patients with heart failure were randomly assigned to intervention (n = 33) and control (n = 33) groups. Data collection was done using a demographic questionnaire, Templer death anxiety scale, and Beck depression inventory. Findings: It was found that the overall scores of death anxiety and depression in posttest were significantly lower than those at the follow‐up stage in the intervention group. Practice Implications: CBT could significantly reduce death anxiety and depression in patients with heart failure. Therefore, it is recommended to equip nurses with CBT trainings to manage patients with heart failure better. [ABSTRACT FROM AUTHOR]

Background: Recent studies have shown that obesity is largely influenced by heredity and created by the interactions between several genes and environmental and behavioral factors. This study aimed to examine association between variant rs17782313 near melanocortin-4 receptor (MC4R) gene and behavioral and hormonal factors then evaluated interactions between variant MC4R rs17782313 with behavioral and hormonal factors on obesity. Methods: This cross-sectional study included 403 subjects, overweight and/or obesity, aged 20–50 years from Iran. The MC4R rs17782313 data were measured by the PCR–RFLP method. Dietary intake, physical activity, stress, anxiety, depression, appetite and emotional eating were assessed by using validated questionnaires. Ghrelin, glucagon-like peptide-1 and cortisol were measured by radioimmunoassay in plasma samples. Participants were also divided into three groups based on rs17782313 genotype and BMI. Results: After adjustment for age, gender, energy intake and PA, significant associations were observed between food intake, appetite, emotional eating, stress and physical activity with MC4R rs17782313 (p ˂0.05). Also, significant interactions were observed between fat intake (p-interaction = 0.002), protein intake (p-interaction = 0.01), energy intake (p-interaction = 0.01), emotional eating (p-interaction = 0.02), appetite (p-interaction = 0.04), stress (p-interaction = 0.04), ghrelin (p-interaction = 0.03), cortisol (p-interaction = 0.04) and physical activity (p-interaction = 0.04) and MC4R rs17782313 in terms of BMI. Conclusion: Interactions between the CC genotype and high intakes of fat and energy, emotional eating, high appetite, and too much stress with high levels of cortisol and ghrelin probably can have an effect on BMI in overweight/obese subjects. [ABSTRACT FROM AUTHOR]

The Core Beliefs Questionnaire (CBQ) has three versions (Trait, Contingent, Other) that assess different levels of beliefs about the self. The current study translated these CBQ versions into Persian and psychometrically evaluated these measures. A student sample (n = 289) and a sample of individuals with depression (n = 60) completed the CBQ and other measures of interest. In both samples, a 17-item one-factor model emerged for all CBQ versions, and each version had good internal consistency. Good test–retest reliability of the CBQ versions was evident in the student sample. The CBQ versions had stronger associations with depression than with social anxiety in the student sample and demonstrated strong associations with depression in the sample with depression. The sample with depression had higher scores on the CBQ compared to the student sample. These findings indicate the potential of these measures in research and clinical contexts to further our understanding of core beliefs in the Iranian population. [ABSTRACT FROM AUTHOR]

Introduction: The present study aimed to investigate sex differences in response to repetitive transcranial magnetic stimulation (rTMS) in Major Depressive Disorder (MDD) patients. Identifying the factors that mediate treatment response to rTMS in MDD patients can guide clinicians to administer more appropriate, reliable, and personalized interventions. Methods: In this paper, we developed a novel pipeline based on convolutional LSTM‐based deep learning (DL) to classify 25 female and 25 male patients based on their rTMS treatment response. Results: Five different classification models were generated, namely pre‐/post‐rTMS female (model 1), pre‐/post‐rTMS male (model 2), pre‐rTMS female responder versus pre‐rTMS female nonresponders (model 3), pre‐rTMS male responder vs. pre‐rTMS male nonresponder (model 4), and pre‐rTMS responder versus nonresponder of both sexes (model 5), achieving 93.3%, 98%, 95.2%, 99.2%, and 96.6% overall test accuracy, respectively. Conclusion: These results indicate the potential of our approach to be used as a response predictor especially regarding sex‐specific antidepressant effects of rTMS in MDD patients. [ABSTRACT FROM AUTHOR]

Background and Aims: The Healthy Beverage Index (HBI) is a valuable technique to estimate the synergistic effects of overall beverage consumption. Several studies have evaluated the associations between HBI and beneficial changes in the health status. however, there is no study on the association between patterns of beverage consumption and mental health status. Therefore, this study sought to examine the association between HBI and psychological disorders among overweight and obese women.Methods: 199 overweight and obese women, between the ages of 18 and 55 y, were enrolled in this cross-sectional study in Tehran, Iran. To collect beverage dietary data, a validated semi-quantitative food-frequency questionnaire (FFQ) was used. Furthermore, the DASS-21 questionnaire was used to assess psychological profile states.Results: The association of total depression anxiety stress (DASS) score with healthy beverage index (HBI) tertiles in models was marginally significant (OR =: 0.78; 95% CI 0.30-2.02; P-value = 0.074; (OR = 0.77; 95% CI 0.28-2.16; P-value = 0.062), respectively. In terms of stress, anxiety, and depression, after adjusting for confounders, participants with higher HBI in the third tertile had lower odds of depression vs. the first tertile (OR = 0.99; 95% CI 0.35-2.81; P-trend = 0.040).Conclusion: We demonstrate that the total DASS score was associated with HBI tertiles. We also found that participants with higher HBI had lower odds of depression. However, additional well-designed studies are needed to confirm the veracity of these findings. [ABSTRACT FROM AUTHOR]

Objective: The immediate impacts of coronavirus disease 2019 (COVID-19) on mental health of affected patients and psychiatric morbidities of these patients has been neglected by researchers. We assessed mental health outcomes and sleep status among inpatients and outpatients with COVID-19 who were initially referred to our COVID-19 clinic in Mashhad, Iran during April-October 2020. Method: In this ethically approved cross-sectional study, 130 patients with confirmed COVID-19 who were referred to outpatient clinics and wards of a referral hospital in Mashhad, Iran were surveyed during April-October 2020. Demographic data were collected after obtaining informed written consent. Validated Persian versions of insomnia severity index (ISI), 9-item patient health questionnaire (PHQ-9), and 7-item generalized anxiety disorder (GAD-7) and revised impact of event scale (IES-R) were used as main outcome measures (i.e. status of anxiety, depression, insomnia, and event-related distress). Analysis was performed with SPSS using binary logistic regression. P-values < 0.05 were considered significant. Results: Overall, 65 inpatients and 65 outpatients were surveyed. The two groups did not significantly defer in terms of insomnia and depression severity, but the outpatients showed higher levels of anxiety (52.3% vs. 24.6%, P = 0.005) and distress compared to inpatients (80.0% vs. 64.6%, P < 0.001). Male sex (OR = 0.017, 95%CI = 0.000-0.708, P = 0.032) exhibited independent and inverse association with depression in COVID-19 patients. Being married (OR = 0.102, 95% CI = 0.018-0.567, P = 0.009) was independently and inversely associated with anxiety. Insomnia was independently associated with event-related distress (OR = 7.286, 95%CI = 2.017-26.321, P = 0.002). Only depression was independently associated with insomnia (OR = 49.655, 95%CI = 2.870-859.127, P = 0.007). Conclusion: We found symptoms of psychological distress and anxiety to be more prevalent among outpatients with COVD-19 than inpatients. Insomnia can be a potential risk factor for adverse mental health outcomes in these patients. [ABSTRACT FROM AUTHOR]

Background: Recurrent pregnancy loss (RPL) and infertility are associated with significant psychiatric complications. The study aimed to investigate the effectiveness of cognitive behavioral therapy (CBT) and sertraline in the treatment of in depression, anxiety, and infertility stress of depressed infertile women with RPL in comparison with usual care. Materials and Methods: A triple-arm randomized controlled trial was carried out on the 60 depressed infertile women with RPL, a population of Infertility Center of Babol city, Iran, who were randomly assigned into three groups: pharmacotherapy with sertraline (n=20), psychotherapy with CBT (n=20), and a usual care as control group (n=20). The participants of psychotherapy received CBT sessions (90 minutes each) over 10 weeks. The participants in the pharmacotherapy group took 50 mg/day sertraline daily for 22 weeks. Outcomes were assessed using the Beck Depression Inventory (BDI-II), fertility problem inventory (FPI), and State-Trait Anxiety Inventory Form Y (STAI-Y) at the beginning of the trial, 10-weeks post-trial, and three months of follow-up. Using statistical package for the social sciences (SPSS) software, data were analyzed. Results: CBT considerably reduced the depression symptoms more than sertraline with a moderate effect size at the post-trial (g=0.11, 95% CI: -0.03 to -0.50). Sertraline showed reduced the scores of state-anxiety more considerably in comparison with control group by a large effect size of post-trial (g=-1.04, 95% CI: -1.70 to -0.38). CBT reduced the total scores of FPI more considerably than sertraline, with a large, small size at follow up-trial [95% CI=-0.03(-0.65, -0.58)]. Both CBT and sertraline were superior to the control group in reducing depression and infertility stress. Conclusion: Depression and infertility stress diminished under CBT and sertraline in depressed infertile women with RPL, with a significant advantage of CBT. Sertraline was superior to CBT in reduction of anxiety (registration number: IRCT201304045931N3). [ABSTRACT FROM AUTHOR]

Background Social gathering restrictions and quarantine for reducing the spread of coronavirus can reduce social interactions and cause mental health problems such as depression and anxiety. Objective This study aims to investigate the role of personality traits and health-promoting lifestyles in predicting anxiety and depression during the COVID-19 pandemic in Najafabad, Iran Methods This is a cross-sectional study conducted in April 2021 during the fourth wave of the COVID-19 outbreak. The study population consisted of people aged >18 years old living in Najafabad. Using a convenience sampling method, 225 people were selected and completed questionaries online. Of these, the data of 217 questionnaires were analyzed. Beck Depression Inventory, Corona Disease Anxiety Scale, short form of Big-Five-Factor Inventory, and Walker’s Health Promoting Lifestyle Profile were used to collect data. Data analysis was performed using Multiple Linear Regression and SPSS v. 24 statistical software. Results The personality traits of neuroticism (r=0.343, r=0.176) and extraversion (r=-0.503, r=-0.375) were positively and negatively correlated with depression and anxiety, respectively, and were the predictive of depression and anxiety (P<0.05). The agreeableness trait (r=0.233) was also negatively correlated with anxiety, and was its significant predictor (P<0.05). Among the health-promoting lifestyle domains, self-fulfillment (r=-0.489) and physical activity (r=-0.348) had a negative correlation with depression, while health responsibility (r=-0.285) had a negative correlation with anxiety; they were the significant predictors of depression and anxiety (P<0.05) during the COVID-19 pandemic. Conclusion Given the effect of personality traits and health-promoting lifestyles on depression and anxiety during the COVID-19 outbreak, the interventions focused on these components can be effective in improving the mental health of people. [ABSTRACT FROM AUTHOR]

Background & Aims: Marital infidelity is one of the most important factors threatening the performance, stability, and continuity of marital relationships. Marital infidelity refers to any sexual or emotional relationship beyond the framework of a committed relationship between two spouses, and research shows that about one-third of men and a quarter of women are likely to have sex at least once in their lifetime. Engage in extramarital affairs. Hidden relationships outside of marriage cause feelings such as depression, anger, frustration, lack of self-confidence, loss of identity, and feelings of worthlessness in a betrayed spouse. Marital infidelity also causes feelings of doubt, depression, and guilt in the unfaithful spouse. Couples who are treated for marital infidelity are more likely to separate and divorce than couples who present with other problems. Marital infidelity is one of the main reasons that bring couples to family counseling clinics for divorce. Research has shown that the harmful consequences of infidelity can last for a long time and may last forever, unless the couple receives proper treatment. One of the most important changes that can be made in the life of couples with extramarital affairs is to reduce the symptoms of depression and improve their sexual function psychologically, and it seems that the scheme of schema therapy can be effective in this regard. Various cognitive factors are influential in marital incompatibilities. One type of cognition that is important in a marital relationship is maladaptive schemas. Incompatible schemas are structures that are formed based on reality or experience and, as mediators, affect individuals' behavioral responses. Schemas are considered undeniable intellectual structures that are used as a framework for processing experiences. These schemas expand over time and define thoughts and relationships with others. According to Beck, early maladaptive schemas are essentially valid examples of traumatic childhood experiences that gradually become patterns of distorted thoughts and dysfunctional behaviors, and since the beginning of life, they are brought up in a habit and remain unquestioned, often forming human self-conceptions and views of the world. Even when there is evidence that schemas are refuted, many people distort their information to preserve the validity of the schemas. The usefulness of schema therapy in the treatment of severe marital problems and common problems in maintaining intimate relationships between couples has been confirmed. Considering the effectiveness of couple therapy based on the schema model and also the lack of research in Iran to evaluate its effectiveness on women affected by infidelity, in this study we tried to evaluate the effect of couple therapy based on the schema model on depressive symptoms and sexual function in women affected by infidelity in Bushehr should be examined. Methods: This research is in the group of quasi-experimental researches which was approved by Bushehr University of Medical Sciences with ethics code IR.BPUMS.REC.1399.169. The statistical population of the present study consisted of all women affected by infidelity in Bushehr who had been referred to counseling and family therapy centers in Bushehr. The sample consisted of 30 people (15 in the experimental group and 15 in the control group). In the present study, the library method was used to review research sources and the field method was used to collect information. Both groups completed the research tools in the pre-test and post-test stages. Research instruments included Beck and Stear's (1996) Depression Inventory and Rosen et al.'s (2000) Sexual Function Questionnaire. Results: The results of multivariate analysis of covariance showed that couple therapy based on the schema model had a significant effect on reducing depressive symptoms and improving sexual function in women affected by infidelity. Based on the effect size coefficient, 71.1% of the variance of the dependent variables of depressive symptoms and sexual function can be explained by the independent variable of couple therapy based on the schema model. Conclusion: The use of schema-based couple therapy can play an important role in reducing depression and improving sexual function in women affected by infidelity. Schema-based couple therapy is an approach consisting of cognitive, behavioral, interpersonal, attachment, and experimental approaches in the form of an integrated treatment model that uses four main cognitive, behavioral, relational, and experimental techniques in individuals in addition to questioning maladaptive schemas. This is the main cause of the formation of dysfunctional and irrational thoughts, emotionally drains the buried negative emotions and emotions and often leads to depression. It has been found that there is a theoretical link between early dysfunctional schemas and depressive symptoms. For example, the perfectionist schemas of emotional inhibition, social isolation, self-development, impairment, and emotional deprivation appear to be associated with depressive disorder. Therefore, recognizing these schemas and changing them has important clinical implications. In fact, by identifying depressive schemas in women affected by infidelity, they can be targeted for treatment, and with therapeutic interventions focused on schemas, they can be changed and corrected. Also, in explaining the effect of schema-based couple therapy on improving the sexual function of women affected by infidelity, it should be noted that in schema therapy, through behavioral techniques, clients are allowed to have intimacy with their lives by sharing memories. Bitter and unfortunate and allow the spouse to approach. Therefore, it can be said that couple therapy based on schema model through cognitive, emotional, and behavioral strategies can correct the schemas of the first people that lead to an increased tendency to marital infidelity and decreased marital satisfaction, and as a result, the person acquires enough power to stop marital infidelity and increase intimacy with the spouse. Therefore, it can be said that the couple therapy effected on depressive symptoms and sexual function in women affected by infidelity. It seems that schema-based couple therapy, by affecting intimacy and marital forgiveness, has a positive effect on increasing couples' sexual intimacy and will improve their sexual function. Although in this study, an attempt was made to reduce the disturbing variables and possible biases by randomly assigning the subjects to the experimental and control groups, but the most important limitation of this study was not to use follow-up. Another limitation was the limitation of the sample to couples referring to the Welfare Counseling Center in Bushehr. [ABSTRACT FROM AUTHOR]

Background: The growing prevalence of depression has become a major public health problem. There is limited evidence regarding the relationship between dietary behaviors and depression. The present study was designed to evaluate the association between dietary behaviors and depression score.Methods: A total of 933 Iranian adolescent girls aged 12 to 18 years were included in this cross-sectional study. Depression severity score was assessed using a validated Persian version of Beck's depression inventory. Dietary behaviors were pre-defined and assessed in ten domains using a standard questionnaire. To investigate the association between dietary behaviors and depression score, the linear regression analysis in crude and adjusted models was used.Results: 67.7% of participants had no or minimal depression symptoms and 32.3% of participants were categorized with mild-to-severe depression symptoms. There were significant inverse relationships between main meal consumption (Beta: -0.141; 95% CI: - 3.644 to - 1.000; P = 0.001), snack consumption (Beta: -0.100; 95% CI: - 2.400 to - 0.317; P = 0.002), regular meal consumption (Beta: 0.23; 95% CI: 0.13-0.42; P = 0.001) and food chewing (Beta: -0.152; 95% CI: - 2.279 to - 0.753; P = 0.03) with depression score. These associations remained significant after adjustment for confounding variables. In addition, frequency of intra-meal fluid intake (Beta: 0.096; 95% CI: 0.288 to 1.535; P = 0.004) and spicy foods consumption (Beta: 0.076; 95% CI: 0.098 to 1.508; P = 0.02) were directly associated with depression score in the crude model. These significant relations were disappeared in full adjusted model. No significant association was found between breakfast consumption, intake of fried foods, chewing ability, and tooth loss with depression score (P > 0.05).Conclusions: Significant associations were observed between specific eating behaviors with depression score. Prospective studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Pre-hospital emergency medicine (PHEM) personnel are at risk of developing psychological disorders during the Covid-19 pandemic. This study aimed to investigate depression, anxiety, and stress levels of the Iranian PHEM personnel during the Covid-19 pandemic.Methods: This descriptive cross-sectional study was performed on 544 PHEM personnel chosen by purposive sampling in North Khorasan, Khorasan-Razavi, South Khorasan, Sistan-Baluchestan, and Kerman provinces in eastern Iran from August to September 2021. Data collection tools included a demographic information questionnaire and the standardized 21-item Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed in SPSS 16 using one-way analysis of variance and linear regression.Results: The mean scores of depression, anxiety, and stress were 8.7 ± 9.2, 7.0 ± 7.8, and 11.6 ± 9.2, respectively. Depression, stress, and anxiety were more prevalent in the age group of 41-55 years, people with master's and higher degrees, people with a history of underlying diseases, and people with over 10 years of work experience(p < 0.05). Depression and stress also showed a significant relationship with the type of employment. Stress alone was also significantly associated with working less than 35 hours a week and living separately from family(p < 0.05).Conclusions: PHEM personnel suffer from significant levels of depression, anxiety, and stress during the Covid-19 pandemic. Therefore, in order to improve the mental condition, it is recommended that the work schedule and services provided to these people be designed in such a way that they have more time for rest and communication with their family members. The personnel should also have easier access to the expert team in the fields of counseling and psychiatry. [ABSTRACT FROM AUTHOR]

The present study examines the moderating role of religiosity in the association between death anxiety and depression among Iranian community-dwelling older adults. This study recruited 340 participants using a cluster sampling method. The data were collected using the Templer Death Anxiety Scale, Goldberg Depression Questionnaire, and Allport-Ross Intrinsic/Extrinsic Religious Orientation Scale. The moderating role of intrinsic (death anxiety × intrinsic: β = -.048, p =.388) and extrinsic (death anxiety × extrinsic: β = -.011, p =.831) religiosity in the relationship between death anxiety and depression was not confirmed. The findings did not support the moderating role of religiosity in the relationship between death anxiety and depression. Further studies are recommended to confirm these results. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spiritual well-being is very important in adaptation and peace of mind, especially in certain periods of life. Middle age is associated with many biological, psychological, and social changes and problems such depression and hopelessness. This study aims to investigate the relationship between spiritual well-being, depression, and hope in middleaged women in Qom, Iran. Methods: This is a descriptive-analytical study with cross-sectional design that was conducted on 100 middle-aged women referred to community health centers in Qom city, who were selected by a convenience sampling method. Data were collected by three questionnaires including Paloutzian and Ellison's spiritual well-being scale (SWBS), Beck' depression inventory (BDI), adult hope scale (AHS), which were completed through interview. Data were analyzed in SPSS version 21 software using regression analysis. Results: The Mean±SD total scores of SWBS, BDI, and AHS were 73.43±1.25, 31.10±0.91, and 16.26±0.34, respectively. There was a significant relationship between spiritual well-being and depression and between spiritual health and hope (P=0.001). Moreover, spiritual well-being and hope had a significant relationship with depression (P=0.001). Conclusion: Middle-aged women with high spiritual well-being have less depression and more hope. It is recommended to pay more attention to spiritual well-being of these women to maintain their mental health and increase their hope. [ABSTRACT FROM AUTHOR]

One in eight adults in Iran is estimated to have major depressive disorder (MDD) - a leading cause of disability in the country. Many remain undiagnosed, and some receive only partial treatment. An estimated 60% of those with MDD were reported to have received no treatment during the past year. In this paper, we have critically reviewed the current health-care structure in the country along with prevailing patterns of health-care service utilization. We have addressed the role of psychiatrists, general practitioners (GPs), psychologists, and other health-care personnel in the treatment and care of patients with MDD, with an emphasis on the quality of service provision. In addition, the strengths and weaknesses of primary healthcare (PHC), the health insurance system, and inpatient care have been discussed. We have paid attention to the contextual issues such as mental health literacy, stigma, and healthcare inequity where relevant. Finally, practical recommendations have been provided to improve the quality of care for patients with MDD in Iran. [ABSTRACT FROM AUTHOR]

By exposing individuals to trauma, wars can cause a host of psychiatric disorders. This study aimed to collect and compare the studies conducted to estimate the prevalence of depression among veterans, former prisoners of war (POWs) and military personnel in the Iran–Iraq war (1980–1988). In this systematic review, a search was conducted using relevant keywords in major national and international databases, personal archives and national academic libraries. We screened 135 records using their abstracts and selected a total of 56 studies for full‐text review. Eventually, 19 studies were included in our systematic review and meta‐analysis. The estimated pooled prevalence of depression among Iranian veterans and POWs was 22.4% (95% confidence interval = 15.0–32.0). Although the results indicated disparities in the prevalence of depression among veterans and POWs, the aggregate estimated prevalence was much higher than what has been reported for military personnel. Effective policies and strategies are required for prevention and treatment of depression and related psychiatric complications among veterans and former POWs. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine prevalence of anxiety and depression and associated factors in the general population of Iran during the COVID-19 pandemic. Method: We conducted this web-based cross-sectional study on 5328 individuals in Iran between 17th and 29th of April 2020. Data were collected using the convenience sampling method through an anonymous online questionnaire via social media like WhatsApp and Telegram. The online survey collected data on demographic variables, COVID-19- related variables, and symptoms of anxiety and depression. Anxiety and depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. Simple and multiple logistic regression analyses were performed to determine independent predictors of anxiety and depression. Results: The mean GAD-7 and PHQ-9 total scores were 7.17 (SD = 5.42) and 7.80 (SD = 6.68), respectively. Prevalence of anxiety, depression, and comorbid anxiety-depression were 30.1%, 33.4%, and 22.1%, respectively. According to the adjusted analysis, anxiety was significantly associated with female gender, being young and middleaged, being unemployed or a housewife, having chronic diseases, spending considerable time thinking about COVID-19, having family members, friends, and/or relatives infected with COVID-19, and death of family members, relatives or friends due to COVID-19. Same results were also found for depression. Furthermore, depression was associated with being single, being resident in urban area, and having high risk individual in family. Conclusion: Prevalence of anxiety and depression were considerably higher in the general population of Iran during the COVID-19 pandemic. In addition, the findings suggest that more attention needs to be paid to vulnerable groups such as women, young/middle-aged adults, the unemployed, and people with chronic disease. [ABSTRACT FROM AUTHOR]

Objectives: Children's Depression Inventory (CDI) is a self-report tool for measuring depression in children and adolescents. In this study, the psychometric properties of the Persian version of CDI were investigated in an Iranian adolescent population. Methods: This study was conducted on a sample of 480 adolescent boys and girls in the age range of 12-18 years. The results showed that 23.6% of the study population were 11-13 years old, 62.1% were 14-16 years old, and 14.3% were 17-18 years old. Also, 48.5% of the sample were girls, and 51.5% were boys. To investigate the convergent and divergent validity, Beck's Depression Inventory-Second Edition (BDI-II) and Teenage Inventory of Social Skills were used, respectively. Results: The reliability coefficient of CDI, based on Cronbach's alpha, indicated the relatively high internal consistency of the items (0.907). The results of the exploratory factor analysis showed that CDI has a saturated factor, explaining 50.11% of the variance in the data. Also, goodness-of-fit indices of confirmatory factor analysis showed that the model is well suited for explaining depression. The present results also showed a negative correlation between children's depression and the social skills subscale and a positive correlation between children's depression and BDI-II score. Conclusions: The construct validity of the questionnaire was confirmed. It can be concluded that the Persian version of CDI has adequate reliability and validity. Therefore, it can be used as a useful tool for early screening of depression in adolescents due to its easy use and specific design for children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Plant-based dietary pattern, a new scoring system, has had a favorable relationship with the risk of chronic diseases, however, the associations with mental health are long disputed. Thus, we examined the association between an overall plant-based diet (PDI), healthy plant-based diet (hPDI), and unhealthy plant-based diet (uPDI) and psychological disorders in adult Iranian patients.Methods: In this large cross-sectional study, 3,362 Iranian men and women were recruited. Dietary data were gathered using a validated and reliable Willett format food frequency questionnaire (FFQ). Plant-based dietary pattern scores were calculated based on the method of Satija et al. Psychological profile assessment was done using the validated hospital anxiety and depression scale (HADS) and the general health questionnaire (GHQ).Results: A total number of 943, 448, and 760 participants who suffered from depression, anxiety, and psychological distress, respectively, were identified. In the multivariable-adjusted analysis, participants in the highest category of PDI and hPDI scores had lower odds of having depression and anxiety than those in the lowest category. This association was also found between hPDI and psychological distress (OR: 0.51, 95% CI: 0.38-0.68). In contrast, higher scores of uPDI was associated with increased odds of anxiety (OR: 1.60, 95% CI: 1.06-2.42) and psychological distress (OR: 1.38, 95% CI: 1.01-1.90).Limitation: The cross-sectional study design.Conclusion: Our results indicated that greater adherence to the overall plant-based diet and healthy plant-based diet was inversely associated with psychological disorders, while following unhealthy plant-based diet increased the risk of anxiety and psychological distress. [ABSTRACT FROM AUTHOR]