Effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of patients with cancer: a randomized controlled trial

Family caregivers of dying cancer patients may suffer from grief experiences and bereavement complications. Previous studies have proposed some psycho-emotional interventions for the management of these complications. However, little attention has been given to family-based dignity intervention and expressive writing. This study was conducted to examine the effects of family-based dignity intervention and expressive writing, combined and alone, on anticipatory grief in family caregivers of dying cancer patients. This was a randomized controlled trial, in which 200 family caregivers of dying cancer patients were randomly assigned to four intervention groups: family-based dignity intervention (n = 50), expressive writing intervention (n = 50), combined family-based single dignity intervention and expressive writing (n = 50), and control group (n = 50). In three times (baseline, 1 week, and 2 weeks after the interventions), anticipatory grief was assessed by a 13-item anticipatory grief scale (AGS). Finally, we found a significant reducing effect of family-based dignity intervention on AGS (-8.12 ± 1.53 vs. -1.57 ± 1.52, P = 0.01) and its subscales including behavioral (-5.92 ± 0.97 vs. -2.17 ± 0.96, P = 0.04) and emotional (-2.38 ± 0.78 vs. 0.68 ± 0.77, P = 0.03) subscales compared to the control group. However, no significant effect was seen for expressive writing intervention and combined interventions of expressive writing and family-based dignity intervention. In conclusion, family-based dignity intervention may be a safe intervention for relieving anticipatory grief among family caregivers of dying cancer patients. Additional clinical trials are needed to confirm our findings. Registration number: IRCT20210111050010N1. Trial registration date:2021-02-06.

Caregivers' experiences and perspectives of factors associated with relapse in Iranian people living with schizophrenia: A qualitative study

BACKGROUND

Relapse in People Living with Schizophrenia (PLS) has several reasons and recognizing these can increase the effectiveness of treatment interventions. Formal and informal caregivers are an informed source to reduce relapse in PLS.

AIM

This study explores the caregivers' perspective in Iran on the factors affecting relapse in PLS.

METHOD

A total of 28 caregivers (16 formal caregivers and 12 informal caregivers) of PLS were enrolled in our qualitative study. A content analysis was conducted using individual and group, semi-structured in-depth interviews with informal and formal caregivers of PLS. This study was conducted in a hospital, three universities, and a non-governmental organization in Tehran, Iran.

RESULTS

The majority (69%) of the participants were females. About half of the informal caregivers were over 60 years old and about 40% of the formal caregivers were in the age range of 30 to 40 years. The average number of years of work for informal caregivers was 17.6 years and the average of work experience among the formal caregivers was 14.1 years. Seven key dual themes were identified from data: 'awareness-stigma', 'social support-social exclusion', 'treatment adherence-treatment discontinuation', 'holistic approach - one-dimensional approach', 'supported employment-social dysfunction', 'emotional management in family - family with high emotional expression', and 'access to treatment-treatment gap'.

CONCLUSION

The results of this research can help practitioners and policymakers to enable evidence-based practices to reduce relapse in PLS by emphasizing and acting on factors identified in our analyses.

The design and process of a family and community-based intervention for relapse prevention in people living with schizophrenia in Iran

BACKGROUND

People living with schizophrenia (PLS) suffer frequent relapse accompanied by emergency room visits, premature mortality, lower quality of life and a substantial social and economic burden on families and health systems. There is a dearth of community-based relapse prevention interventions (RPIs) in Iran.

AIMS

To determine an ideal model for a community-based RPIs for PLS.

METHODS

A qualitative study with 27 experts in Iran was carried out to understand the ideal RPIs for PLS and the key components of such interventions.

RESULTS

In 16 semi-structured interviews and 8 group-discussions, the participants identified six major stages of family and community-based RPIs including preparation, social mobilization, local team formation, design an RPI, implementing the RPI, participatory monitoring, and evaluation of the RPI.

CONCLUSIONS

Given the suboptimal healthcare systems and lack of professionals and services, PLS in Iran may benefit from family and community-based RPIs. Our findings warrant pilot testing of such initiatives across developing communities like Iran to improve health outcomes of PLS.

Clergy's Viewpoint Change Toward Mental Health and Stigma on Mental Illness: A Short Course Training

BACKGROUND

As stigma is one of the main barriers in promoting the mental health, the present study was designed with the purpose of reviewing clergy's viewpoint regarding the effect of mental health workshops on these barriers.

METHODS

For this study, by order of Iran's Health Ministry, a questionnaire was designed to examine the clergy's viewpoint related to mental illnesses and the consequent stigma. Ten faculty members and psychiatrists confirmed the questionnaire's validity after some modifications. In this research, 30 members of the clergy from the main religious city in Iran's "Qom" Seminary attended the training workshops for 2 days. The data obtained from the clergy's responses were analyzed using the SPSS software (ver.16) and descriptive and analytical tests. Also, the significance level was considered p < 0.05 in all tests. The results exhibited that the mean and standard deviation (Mean ± SD) of the clergy's attitude domain and awareness before the workshop was 1.90 ± 26.30 and 8.31 ± 1.64, respectively. Also, average and standard deviation (Mean ± SD) of their attitude domain and awareness after the workshop was 1.95 ± 29.73 and 1.18 ± 10.70, respectively.

DISCUSSION

The present study, which was designed to examine the clergy's viewpoint toward mental illnesses and the consequent stigma in the most considerable religious base in the country, illustrated that one strategy for reducing mental illness stigma in religious communities can be by holding training sessions to promote the clergy's awareness of and attitude toward mental health.

CONCLUSION

There was a significant statistical difference between their awareness and attitude scores before and after the workshop (p < 0.01). In the present research, the awareness and attitude of clergy toward mental health and stigma due to mental illness was relatively good and significantly increased by holding the workshop.

Effects of family-based dignity intervention and expressive writing on anticipatory grief of family caregivers of patients with cancer: a study protocol for a four-arm randomized controlled trial and a qualitative process evaluation

BACKGROUND

Family caregivers of dying cancer patients are affected by grief experiences and bereavement complications. Several approaches such as psycho-emotional care and an increase in spirituality have been suggested to diminish these complications. However, the knowledge about the effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of dying cancer patients is limited. This is a study protocol describing a hospital-based mixed-methods study on the effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of dying cancer patients.

METHODS

This mixed-methods study will be done in an embedded explanatory design with two quantitative and qualitative phases. In the first phase (quantitative), a randomized clinical trial will be done, in which 200 family caregivers of dying cancer patients will be randomly assigned to one of the four groups: family-based single dignity intervention (group 1), expressive writing intervention (group 2), combined family-based single dignity intervention and expressive writing (group 3), and control (group 4). At baseline, 1 week and 2 weeks after the interventions, anticipatory grief will be assessed by a 13-item anticipatory grief scale. After the quantitative phase, the qualitative phase will be conducted through the conventional content analysis approach of Granheim and Lundman, in which an individual semi-structured interview will be taken from participants in the first phase to collect data on their experiences on interventions. Finally, data from the quantitative and qualitative phases will be analyzed and discussed.

DISCUSSION

Family caregivers of dying cancer patients usually experience depression, anxiety, and psychological distress due to isolation and inadequate social support. Psychological interventions such as dignity and expressive writing interventions may help caregivers to obtain a better understanding of themselves and to increase their abilities to cope with caregiving difficulties. Therefore, there is a need for a comprehensive study confirming the effects of mentioned interventions on family caregivers of dying cancer patients.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials ( www.irct.ir ) identifier: IRCT20210111050010N1. Date of trial registration: Feb 6, 2021. This is the first version of this protocol.

Supporting the victims of domestic violence in Iran: two decades of effort

For years there were no organized supporting system helping victims of domestic violence in Iran. 16 years ago Ministry of Interior started a national survey which led to try legislating bills in order to improve preventive and supporting services. This has inspired many health care professionals, including Ministry of Health, Treatment and Medical Training, to pursue this field for research. Since then, many studies has been done; which were reviewed in this paper. We tried to build a stepping stone for the future researchers and activists, since despite all what has been done, still there is no legislated bill or enough organizations to protect the victims.

Situation Analysis for Promotion of Hot-Lines: An Experience from Iran

Background:

The hot line services were developed in response to the perceived need for 24-hour help services in crises ranging from suicide to unwanted pregnancy. This study is aimed at analyzing the strengths, weaknesses, challenges, and suggestions of improving the performance of the help centers from the perspective of key stakeholders.

Methods:

We conducted a qualitative study to elicit the key informants' opinion regarding the performance of Iranian hot-lines. All the conversations were audio-recorded with the permission of the participants. To reach the saturation limit, the number of interviews was completed in the saturation of data. Data was gathered from 15 individual in-depth interviews. Collecting and analyses of data was based on content analysis through which simultaneously during texts open coding, main concepts were extracted and then in axial coding similar concepts were categorized.

Results:

According to the study results, there is no specific and independent system for assessing the hot- lines. One of the major weaknesses was the lack of standard protocols. Most participants believed that most of these guidelines came from the general principles of counseling and are not standard. As another point, the existence of referral services is one of the main problems of counseling lines. The most important suggestion from the majority of experts were the development of services and modification of their investments.

Conclusions:

The findings, in addition to providing the applied data for policy-making in the health system, will significantly contribute to the creation of scientific, technical, and skillful personnel in the community of researchers.

Who Can Provide Spiritual Counseling? A Qualitative Study from Iran

Background and Aim:

Given the increased prevalence of mental illnesses in recent years, many therapists and researchers use spiritual counseling (SC), which is one of the spiritual interventions. However, unfortunately, the use of this intervention by the therapists is nonscientific because the ambiguities of this issue are high in the mental health field of Iran. The aim of this study is to survey the following most important challenges: what groups are qualified to provide SC, what kind of knowledge should be known by suitable individuals, who can train spiritual counselors, what they should teach, and what teaching methods should be used.

Methods:

The present conventional qualitative content analysis used deep semi-structured interview to collect data from the view of stakeholders. A total of 15 people were selected through purposive sampling. After transcription of the interviews, the data were analyzed based on the Graneheim and Lundman model.

Results:

Results obtained from data analysis covered five main themes including SC candidates, general conditions, sciences required, SC curriculum, and spiritual counselors' training method.

Conclusions:

The present study has answered to the most basic questions in SC scope. Since spiritual services are rooted in our culture and religion, native guidelines should be created for them as soon as possible through conducting similar qualitative researches. Furthermore, it is worth considering teaching and training case in this scope to make spiritual service providers concern about solutions to promote these services.

Developing a Training Course for Spiritual Counselors in Health Care: Evidence from Iran

Background:

Spiritual health can cause mental health promotion and well-being of the people's lives but it is still neglected in practice so that there is no trace of spiritual training in medical education in Iran. This study was conducted to develop a training course for spiritual counselors in the Iranian health-care system.

Methods:

In this qualitative study, senior managers of the Ministry of Health (MOH) and experts in the related fields were purposively selected as the participants. Semi-structured interviews and focused group discussions (FGDs) were conducted to collect the data. After transcription of the interviews and FGDs, the data were analyzed using content analysis.

Results:

In this package, community-based spiritual health services are offered in three forms of spiritual lifestyle education, introducing social facilities, and collaborating with the related organizations. Hospital services are offered in four forms of assessment of the spiritual status and referral, spiritual care, spiritual counseling, and providing a spiritual environment in the hospital.

Conclusion:

According to the results of the study, it is suggested that a strategic committee be established at the MOH level for establishment of these training courses as well as another strategic committee for evaluation, review, and service package promotion, and its training courses should be formed. In addition, a set of skills for spiritual assessment of patients and the related interventions should be designed for clinical skill centers of the country in the form of skill training packages.

Spiritual Psychotherapy for Adolescents with Conduct Disorder: Designing and Piloting a Therapeutic Package

Objective: Spiritual psychotherapy has been conceptualized in the context of love and belief as principles of existence. Spiritual psychotherapy can provide an opportunity to design programs to treat conduct disorder. The aim of this study was to introduce the Spiritual Psychotherapy Package for Adolescents with Conduct Disorder and execute it as a pilot study. Method: The intervention is a manual-guided program conducted over 14 group sessions, using the perspectives of object relations and attachment approach. It was executed for a group of eight adolescent boys with conduct disorder (mean age: 17.01 years) at Tehran reformatory. The Aggression Questionnaire and the Attachment to God Inventory were completed pre- and post-intervention. Results: There were no significant differences in outcome measures from pre- to post- intervention. Cohen's dav was applied to estimate the measure of the effect size in this study. Cohen's dav measures of avoidance and anxious attachment to God showed acceptable effect sizes. However, Cohen's dav measure of verbal aggression indicated a small effect size. Conclusion: We found evidence indicating acceptability of spiritual psychotherapy among adolescents with conduct disorder in attachment to God.

Comparison of the Effects of Religious Cognitive Behavioral Therapy (RCBT), Cognitive Behavioral Therapy (CBT), and Sertraline on Depression and Anxiety in Patients after Coronary Artery Bypass Graft Surgery: Study Protocol for a Randomized Controlled Trial

Objective: The present study aimed at comparing the effects of Religious Cognitive Behavioral Therapy (RCBT), Cognitive Behavioral Therapy (CBT), and sertraline on depression, anxiety, biomarker levels, and quality of life in patients after coronary artery bypass graft (CABG) surgery. Method: This was a randomized controlled trial with parallel groups. A total of 160 patients after CABG surgery will be screened for anxiety and depression according to clinical interviews based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and Hospital Anxiety Depression Scale (HADS) scores (≥ 8). To assess religious attitude, Golriz and Baraheni's Religious Attitude questionnaire will be used. Participants will be randomly allocated to 4 groups of 40 including 3 intervention groups (RCBT, CBT, and sertraline) and 1 control group (usual care). RCBT and CBT programs will consist of 12 one-hour weekly sessions. The participants in the pharmacological intervention group will receive 25-200 mg/d of sertraline for 3 months. The Short Form-36 Health Survey (SF-36) will be administered to assess the patients' quality of life. Blood samples will be taken and biomarker levels will be determined using the enzyme-linked immunosorbent assay (ELISA). The primary outcome will be reduction in anxiety and depression scores after the interventions. The secondary outcomes will be increase in quality of life scores and normalized biomarker levels after the interventions. Discussion: If RCBT is found to be more effective than the other methods; it can be used to improve patients' health status after CABG surgery. Irct ID: IRCT201404122898N5.

Comparison of Religious Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, and Citalopram on Depression and Anxiety among Women with Breast Cancer: A Study Protocol for a Randomized Controlled Trial

There has been evidence supporting the reduction of depression and anxiety by religious psychotherapy in cancer patients, however, there have been scarce randomized controlled trials. Therefore, there is a need for replication in a well-designed study to investigate the efficacy of these interventions among depressed women with breast cancer. A randomized controlled trial is designed to be conducted on 160 women with breast cancer. Participants will be screened for anxiety and depression diagnosed by clinical interview based on the DSM-IV criteria and the Hospital Anxiety Depression Scale. Golriz and Baraheni's Religious Attitude Questionnaire will be used to assess the religious attitude. Individuals meeting the prerequisites will be randomly allocated to four groups, each containing 40 participants, including three intervention groups (RCBT, CBT, and citalopram) and one control group (usual breast cancer treatment). An instrument by the EORTCQLQ-C30 and BR-23 will be used to measure the quality of life. Blood tests will be taken to assess biomarkers with the (ELISA) method. The results will determine whether RCBT is more effective than other treatments. If so, the outcomes of the study will have implications not only for the management of similar problems in cancer patients but also for the management of other chronic diseases.

Comparison of Religious Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, and Citalopram on Depression and Anxiety among Women with Breast Cancer: A Study Protocol for a Randomized Controlled Trial

There has been evidence supporting the reduction of depression and anxiety by religious psychotherapy in cancer patients, however, there have been scarce randomized controlled trials. Therefore, there is a need for replication in a well-designed study to investigate the efficacy of these interventions among depressed women with breast cancer. A randomized controlled trial is designed to be conducted on 160 women with breast cancer. Participants will be screened for anxiety and depression diagnosed by clinical interview based on the DSM-IV criteria and the Hospital Anxiety Depression Scale. Golriz and Baraheni's Religious Attitude Questionnaire will be used to assess the religious attitude. Individuals meeting the prerequisites will be randomly allocated to four groups, each containing 40 participants, including three intervention groups (RCBT, CBT, and citalopram) and one control group (usual breast cancer treatment). An instrument by the EORTCQLQ-C30 and BR-23 will be used to measure the quality of life. Blood tests will be taken to assess biomarkers with the (ELISA) method. The results will determine whether RCBT is more effective than other treatments. If so, the outcomes of the study will have implications not only for the management of similar problems in cancer patients but also for the management of other chronic diseases.

Comparison of Religious Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, and Citalopram on Depression and Anxiety among Women with Breast Cancer: A Study Protocol for a Randomized Controlled Trial

There has been evidence supporting the reduction of depression and anxiety by religious psychotherapy in cancer patients, however, there have been scarce randomized controlled trials. Therefore, there is a need for replication in a well-designed study to investigate the efficacy of these interventions among depressed women with breast cancer. A randomized controlled trial is designed to be conducted on 160 women with breast cancer. Participants will be screened for anxiety and depression diagnosed by clinical interview based on the DSM-IV criteria and the Hospital Anxiety Depression Scale. Golriz and Baraheni's Religious Attitude Questionnaire will be used to assess the religious attitude. Individuals meeting the prerequisites will be randomly allocated to four groups, each containing 40 participants, including three intervention groups (RCBT, CBT, and citalopram) and one control group (usual breast cancer treatment). An instrument by the EORTCQLQ-C30 and BR-23 will be used to measure the quality of life. Blood tests will be taken to assess biomarkers with the (ELISA) method. The results will determine whether RCBT is more effective than other treatments. If so, the outcomes of the study will have implications not only for the management of similar problems in cancer patients but also for the management of other chronic diseases.

Effectiveness of Spiritual Group Therapy on Quality of Life and Spiritual Well-Being among Patients with Breast Cancer

Cancer is deemed the century's major health problem, and its increasing growth during the last decades has made experts concerned more than ever. Of all types of cancer, breast cancer is regarded as the second most common disease among women. The aim of this study was to determine the effectiveness of spiritual group therapy on quality of life and spiritual well-being among patients suffering from breast cancer. The present research was carried out between March and June 2011. The sample consisted of 24 participants randomly assigned to 2 groups: an experimental group (n, 12) and a control group (n, 12). All the subjects completed questionnaires on quality of life and spiritual well-being in pretest and posttest. The experimental group received 12 sessions of spiritual group therapy. The results demonstrated improvement in quality of life and spiritual well-being in the experimental group. In conclusion, spiritual group therapy can be used to improve quality of life and spiritual well-being (religious health and existential health) among patients with breast cancer.

Spiritual Care for Cancer Patients in Iran

BACKGROUND

Studies have shown that a return to spirituality is a major coping response in cancer patients so that therapists can adopt a holistic approach by addressing spirituality in their patient care. The present study was conducted to develop a guideline in the spiritual field for healthcare providers who serve cancer patients in Iran.

MATERIALS AND METHODS

Relevant statements were extracted from scientific documents that through study questions were reviewed and modified by a consensus panel.

RESULTS

The statements were arranged in six areas, including spiritual needs assessment, spiritual care candidates, the main components of spiritual care, spiritual care providers, the settings of spiritual care and the resources and facilities for spiritual care.

CONCLUSIONS

In addition to the development and preparation of these guidelines, health policy-makers should also seek to motivate and train health service providers to offer these services and facilitate their provision and help with widespread implementation.

Integrating a suicide prevention program into the primary health care network: a field trial study in Iran

OBJECTIVE

To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion.

METHODOLOGY

This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases.

RESULTS

We identified a higher prevalence of depressive disorders in the intervention site versus the control site (χ (2) = 14.8, P < 0.001). We also found a reduction in the rate of suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites.

CONCLUSION

Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas.

Risk factors of domestic violence in Iran

OBJECTIVES

In this study, we have evaluated the lifetime and past-year prevalence of exposure to physical violence among married women in the city of Tehran and urban and rural areas of Hashtgerd.

METHODS

The target population were noninstitutionalized female citizens, aged 15 years or older, who have at least one history of marriage and who resided in the capital city of Tehran or Hashtgerd County from the summer of 2008 to fall of 2010. We used a multistage sampling method. Tehran's District Six, a central district in Tehran, was selected as a representative cluster of all municipal districts in Tehran. A total of fifty blocks were randomly selected from this district, from which 1,000 married women aged 15 years or older were interviewed using a cross-sectional design. Data was gathered face-to-face using a structured questionnaire. The lifetime prevalence, past-year prevalence, and related factors of domestic violence were measured. SPSS version 11.5 was used for the analyses.

RESULTS

Figures for lifetime prevalence and past-year prevalence were measured to be 38.7% and 6.6%, respectively. The independent effects of marital status and location and type of residency for women, along with education and smoking habits of their spouses, were statistically significant in multivariate logistic regression analysis.

CONCLUSION

Domestic violence is a public health concern in Iran. Based on our findings, we propose that empowering women through education, and improving their ability to find employment and income, along with increasing public awareness of human rights issues through education could lower the prevalence of domestic violence.

What to do to promote mental health of the society

BACKGROUND

According to the last existing documents, the prevalence rate of mental disorders is about 20% which is considered to be 14% of all country's burden of disease. In the fifth economical, social, and cultural development plan of the country in accordance with the 20 year vision, "healthy human being" and "comprehensive health" approaches and also improving of mental health indicators are emphasized. Aim of study was preparing national policy and interventions for promoting mental health.

METHODS

Using secondary data, analytical review of country's mental health programs, recommendations of WHO, descriptive situation of mental health and its trend during the last decade were drafted and a group of experts and stakeholders was formed following a sound stakeholder's analysis. After three Focus Group Discussions (FGDs), main points of the meetings, influencing factors of present situation, and oncoming strategies were agreed upon.

RESULTS

Based on different studies and the experts' opinions, the prevalence of mental disorders in the last decade has increased. Coverage of mental health programs in two last decades in the best could be equal to rural population. Urban areas have been deprived of these services. Analysis of mental health system of the country shows that internal environment is weak and the external one is concede to be in threat. Eight principal challenges in country's mental health are considered.

CONCLUSION

Improving current situation requires increasing internal capacity of mental health system and developing inter-sectoral cooperation. During next five years, the Ministry of Health, Iran should mainly focus on improving mental health services particularly in urban and peri-urban areas, promoting mental health literacy of different groups and minimizing mental health risk factors.

Repetition of suicide attempts: data from emergency care settings in five culturally different low- and middle-income countries participating in the WHO SUPRE-MISS Study

BACKGROUND

Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings.

AIMS

To evaluate a brief educational intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People's Republic of China) as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS).

METHODS

Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over the 18 months following the index attempt - the secondary outcome measure presented in this paper - were identified by follow-up calls or visits. Subsequent completed suicide - the primary outcome measure - has been reported in a previous paper.

RESULTS

Overall, the proportion of subjects with repeated suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, chi(2) = 0.013; p = .909), but there were differences in rates across the five sites.

CONCLUSIONS

This study from five low- and middle-income countries does not confirm the effectiveness of brief educational intervention and follow-up contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.

Is religiosity a protective factor against attempted suicide: a cross-cultural case-control study

This cross-cultural study investigates whether religiosity assessed in three dimensions has a protective effect against attempted suicide. Community controls (n = 5484) were more likely than suicide attempters (n = 2819) to report religious denomination in Estonia (OR = 0.5) and subjective religiosity in four countries: Brazil (OR = 0.2), Estonia (OR = 0.5), Islamic Republic of Iran (OR = 0.6), and Sri Lanka (OR = 0.4). In South Africa, the effect was exceptional both for religious denomination (OR = 5.9) and subjective religiosity (OR = 2.7). No effects were found in India and Vietnam. Organizational religiosity gave controversial results. In particular, subjective religiosity (considering him/herself as religious person) may serve as a protective factor against non-fatal suicidal behavior in some cultures.

Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries

OBJECTIVE

To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries.

METHODS

Suicide attempters (n = 1867) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, China) participated, from January 2002 to October 2005, in a randomized controlled trial to receive either treatment as usual, or treatment as usual plus brief intervention and contact (BIC), which included patient education and follow-up. Overall, 91% completed the study. The primary study outcome measurement was death from suicide at 18-month follow-up.

FINDINGS

Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group (0.2% versus 2.2%, respectively; chi2 = 13.83, P < 0.001).

CONCLUSION

This low-cost brief intervention may be an important part of suicide prevention programmes for underresourced low- and middle-income countries.

Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries

OBJECTIVE

To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries.

METHODS

Suicide attempters (n = 1867) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, China) participated, from January 2002 to October 2005, in a randomized controlled trial to receive either treatment as usual, or treatment as usual plus brief intervention and contact (BIC), which included patient education and follow-up. Overall, 91% completed the study. The primary study outcome measurement was death from suicide at 18-month follow-up.

FINDINGS

Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group (0.2% versus 2.2%, respectively; chi2 = 13.83, P < 0.001).

CONCLUSION

This low-cost brief intervention may be an important part of suicide prevention programmes for underresourced low- and middle-income countries.

A predictor model for suicide attempt: evidence from a population-based study

BACKGROUND

There is an extreme need for planning to prevent suicide in developing countries. It is necessary to detect the risk factors of this problem and plan to control them. The aim of this study was to determine a predictive model for suicide attempt based on its risk factors in order to give information for planning therapeutic, preventive, and educational interventions in Karaj City.

METHODS

The setting was Karaj City, Tehran Province, Iran and the study design was cross-sectional. In this study, data were collected by using the World Health Organization (WHO) questionnaire of SUPRE-MISS study. The questionnaire included questions about demographic characteristics, personal and family history of suicide behaviors, use of psychotropic drugs, physical and mental disorders, and community stress. All parts of the questionnaire were filled out by interview. A total of 2300 individuals participated in this study having considered the 1.2% prevalence of suicide attempt in the pilot study, and with type one error rate of 5%, the sample size was calculated as 2300.

RESULTS

About 65% of the participants were females. Most of the participants had high-school education (48%) and 57.2% of them were married. Housewives included most of the occupation categories (46%). The mean age of the suicide attempters and nonattempters was 26 (+/-9) and 32 (+/-13) years, respectively. This difference was statistically significant. Younger age, female sex, history of mental disorders, lifelong use of tobacco and alcohol, and unemployment were the independent predictors of suicide attempt.

CONCLUSION

Prevention of suicide is possible by understanding its risk factors and planning to control them.

Community study of suicidal behaviors and risk factors among Iranian adults

The present study is part of the WHO/SUPRE-MISS conducted in Iran. The aim of the study was to determine the lifetime prevalence of suicide behaviors in a community sample of Iranian adults. Five hundred and four families were selected randomly according to electricity bills in Karaj, 45 km from the capital city, represented the catchment area for this investigation. The SUPRE-MISS questionnaires used in this study compromised a variety of aspects of suicidal behaviors. Lifetime prevalence rates for suicidal ideation, planning and attempts were 14%, 6.6%, and 4.1% respectively. Tobacco users and long-term mental and physical disabilities were significantly higher among subjects with a history of suicidal attempts. Younger ages, tobacco abuse, and long-term mental or physical disabilities could be considered risk factors for attempting suicide.

Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey

BACKGROUND

The objectives were to assess thoughts about suicide, plans to commit suicide and suicide attempts in the community, to investigate the use of health services following a suicide attempt, and to describe basic socio-cultural indices of the community.

METHOD

The community survey was one component of the larger WHO multisite intervention study on suicidal behaviours (SUPRE-MISS). In each site, it aimed at randomly selecting and interviewing at least 500 subjects of the general population living in the catchment area of the emergency department where the intervention component of the study was conducted. Communities of eight SUPRE-MISS sites (in Brazil, China, Estonia, India, Iran, South Africa, Sri Lanka, and Viet Nam) participated plus two additional sites from Australia and Sweden conducting similar surveys.

RESULTS

Suicide attempts (0.4-4.2%), plans (1.1-15.6%), and ideation (2.6-25.4%) varied by a factor of 10-14 across sites, but remained mostly within the ranges of previously published data. Depending on the site, the ratios between attempts, plans, and thoughts of suicide differed substantially. Medical attention following a suicide attempt varied between 22% and 88% of the attempts.

CONCLUSIONS

The idea of the suicidal process as a continuous and smooth evolution from thoughts to plans and attempts of suicide needs to be further investigated as it seems to be dependent on the cultural setting. There are indications, that the burden of undetected attempted suicide is high in different cultures; an improved response from the health sector on how to identify and support these individuals is needed.

Responsibility attitude in a sample of Iranian obsessive-compulsive patients

BACKGROUND

The study of distorted beliefs about responsibility attitude and interpretation has become the central theme in Salkovskis' (1985) and Rachman and Hodgson's (1980) models of Obsessive-Compulsive Disorder (OCD).

AIMS

The aim of this research is to assess the responsibility attitude in Iranian OCD patients.

METHODS

Twenty OCD patients were selected through available sampling from the case referred to psychology clinics. Two other patient groups comprised of 20 non-OCD anxiety disorder patients and 20 non-clinical participants were also chosen as comparison groups. All participants completed the Responsibility Attitude Scale (RAS) and Responsibility Interpretation Questionnaire (RIQ).

RESULTS

Analyses revealed statistically significant differences between OCD group and comparison groups on both RAS and RIQ. In addition, both RAS and RIQ scores were associated with the severity of OCD assessed by the Yale-Brown scale.

CONCLUSIONS

These findings suggest that responsibility attitude and interpretations are the prominent features of OCD in Iranian patients and are associated with the severity of illness.

Mental health in the Islamic Republic of Iran: achievements and areas of need

The development of mental health in the Islamic Republic of Iran is described with particular reference to the integration mental health into the primary health care system. The achievements made so far are outlined and the areas of need discussed.