Iranian Journal of Psychiatry and Behavioral Sciences
Year:2018 | Volume:12 | Issue:2|Papers Count:30

Background: Methamphetamine dependence is a health concern in Iran. The matrix model and cognitive-behavior therapy are the two treatment programs for this problem. Objectives: The current study aimed at exploring the problems associated with delivering these two treatments for methamphetamine dependence among patients dependent on methadone in four cities of Iran (Tehran, Shiraz, Isfahan, and Karaj). Methods: A total of 3000 subjects (2200 males and 800 females) participated in the study from December 2012 to December 2016. Fifteen psychologists participated in the study. Participants were recruited from 179 outpatient psychiatric and psychological centers as well as methadone treatment clinics. Results: Females, compared with males, were more likely to state long duration of treatment (70. 8% vs. 48. 5%, P = 0. 01), high costs (57. 1% vs. 44. 8%, P = 0. 01), and boredom associated with the treatments (54. 3% vs. 42. 4%, P = 0. 01). Males, compared with females, were more likely to state the necessity of professional training of psychologists for treatment delivery (46. 4% vs. 29. 3%, P = 0. 01), interference of the treatments with job and life (46. 3% vs. 15. 7%, P = 0. 01) and the intensiveness of the treatments (45. 4% vs. 15. 7%, P = 0. 01). Interviewing psychologists also stated that long duration of the two treatments led to a high attrition rate (52%) among the patients. All of them (100%) stated that intensive and long-term professional training of psychologists was needed. Almost 60% of the psychologists stated that both treatments were intensive, which led to poor patient engagement. Conclusions: The problems associated with delivering these two treatments should be managed in methadone withdrawal centers in Iran. Lower costs and brief interventions should be provided for such patients.

Background: Suicide is a worldwide public health problem with over a million deaths each year. Overall, the suicide rates among Muslim countries is reported at as low, however, there is growing evidence that it is increasing. Suicide is one of the greatest sins in Islam and is strictly forbidden. Therefore, data on the national incidence and prevalence of suicide in Muslim countries may be under-reported. Objectives: The current study aimed at describing the frequency and pattern of deaths due to suicide based on medicolegal autopsy records. Methods: In the current retrospective study, data were collected on all suicide deaths underwent a medicolegal forensic investigation from 01 January, 2013, to 31 December, 2015, in the Isfahan province, Iran. Results: During the study period 576 suicides were identified. Hanging was the most frequent method comprising 335 cases, followed by poisoning and burning with 98 and 87 cases, respectively. Males hanged themselves (68. 79%), while females used burning (41. 2%). Among the victims, 307 were married and 261 were unmarried. Death due to burning was 3. 3 times more frequent among the married cases compared with that of the single ones (P < 0. 001). Education status did not significantly contribute to explain differences in the methods of suicide (P value = 0. 123). Discussion: The current study results showed that self-burning was a method mostly used by housewives. Due to the heavy influence of Islam on this region, there was a high probability that the true number of suicides is significantly underreported and more detailed investigations are required.

Context: Breast cancer in women can cause sexual dissatisfaction and hinder sexual function as a result of treatment processes. Several studies have been conducted on the impact of therapeutic-supportive interventions on sexual satisfaction and performance; nonetheless, contradictory results have been reported. The aim of this systematic review and meta-analysis was to review the effects of therapeutic-supportive interventions on sexual satisfaction and function in patients with breast cancer. In this study, a quality assessment of published articles was also conducted. Evidence Acquisition: In this systematic review, electronic databases, including Google Scholar, Web of Sciences, Science Direct, Cochrane Library, ProQuest, Scopus, and PubMed (including Medline), were searched to retrieve articles published between 1990 and 2016. The articles were screened with regard to breast cancer in 4 stages. Articles, which focused on therapeutic-supportive interventions and sexual satisfaction and function of patients with breast cancer, were included in the study. According to the heterogeneity index between articles (Cochran’ s Q and I square tests), the random effects model, inverse variance weighting method, and standardized Cohen’ s statistics were applied to estimate the mean differences in sexual function and satisfaction. Results: Six articles studied the effects of therapeutic-supportive interventions on sexual satisfaction, while 8 articles assessed the effects of these interventions on sexual function in patients with breast cancer. The standardized mean difference of sexual satisfaction between the intervention and control groups was-0. 03 (95% CI,-0. 55-0. 49). In addition, the standardized mean difference of sexual function between the intervention and control groups was 0. 14 (95% CI,-0. 28-0. 57). Conclusions: The results showed that therapeutic-supportive interventions had no impact on the sexual satisfaction and function of patients with breast cancer.

Background: Methamphetamine dependence on a stable methadone dose is a health problem in Iran (i. e. the most populated Persian Gulf country). However, many Iranian patients are not motivated to enter treatment. Objectives: The studyaimed to assess the efficacy of motivational interviewing for entry to matrix treatment formethamphetamine dependence. Methods: A study was conducted on 275 Persian male and female methadone patients who were methamphetamine-dependent, however they reported unwillingness to receive the matrix model. The study was conducted in 20 methadone services in Karaj, Iran during 2014. Addiction severity index was used to collect data on demographics and illicit drug use. Psychological well-being and social functioning were assessed using the Persian versions of the general health questionnaire-28 and the social functioning subscale of the opiate treatment index. Results: The study indicated that 5 sessions of motivational interviewing were significantly efficacious in increasing attendance in the Matrix Model in the treatment group (P < 0. 001). Attendance in motivational interviewing was significantly accompanied with increased psychological well-being (P < 0. 001) and social functioning (P < 0. 001). Conclusions: Motivational interviewing should be provided for those participants who are methamphetamine dependent but are not motivated for change. Conducting randomized controlled trials is suggested.

Background: Job stress is one of the major threats of health and mental health in the workplace and is affected by intangible elements, such as social capital and organizational commitment in organizations. Objectives: The present study aimed at assessing job stress (JS) in staff of Kermanshah University of Medical Sciences, Iran, using organizational social capital (OSC) and organizational commitment (OC) questionnaires. Methods: This cross-sectional study was done in summer of 2014. From 311 distributed questionnaires, 302 persons who were selected by multi-stage stratified sampling, filled the questionnaires of Organizational Social Capital, Organizational Commitment and Job Stress (HSE). Data were analyzed using SPSS-18 (Pearson correlation and regression tests) and Amos18 (structural equation model (SEM)). Results: The mean score of JS, OCand OSC, was 90. 51 14. 45, 50. 26 9. 74, and 105. 00 14. 57, respectively. Based on Pearson correlation results, there was a significant reverse correlation between JS with OSC (r =-0. 504) and OC (r =-0. 317), and a positive correlation betweenOSCandOC(r=0. 374) (P< 0. 001). Also, SEMresults revealed that the indirect relationship betweenOCandJSwassignificant by mediating OSC ( =-0. 37, P = 0. 001). Conclusions: Organizational commitments can reduce job stress more when social capital increases.

Context: Depression is a major health problem in geriatric population and has many adverse consequences. The aim of this study was to review the existing literature on psychosocial factors that protect against depression in later life. Evidence Acquisition: A MEDLINE systematic search was done via Pubmed and Sciencedirect web pages to gather the published articles on psychosocial factors of late life depression First, the titles and abstracts reviewed and relevant articles were selected according to the inclusion criteria. Then full texts of the selected articles obtained, read, and data were extracted and categorized. Results: There were 204 articles on psychosocial factors of late life depression in community dwelling older adults and among them 29 articles included protective factors. Reading them carefully, protective factors were extracted and organized into 5 main categories: Demographic factors, psychological factors, social factors, health related factors and also spiritual factors. Conclusion: Psychosocial factors protecting older adults against depression are diverse. Identification of the modifiable ones and provision of appropriate interventions to enhance them, can be helpful in preventing geriatric depression.

Background: Methamphetamine (MA) dependence is a health concern in Iran (Persia). One main impacted group is female methadone patients. Objectives: The aim of this paper was to briefly report the prevalence of MA dependence among female methadone patients in 3 large cities of Iran. The other aim was to report the status of psychological well-being and social functioning among MA-dependent and non-MA dependent participants. Methods: In the first survey of Iran, 570 females were recruited from 38 main methadone clinics in Mashhad, Karaj, and Isfahan. A researcher-designed questionnaire was used to collect baseline demographics, details of MA use, and treatment history. Results: Of them, 266 females were MA-dependent. In other words, the prevalence of MA dependence among females was 46. 6%. The length of MA dependence was 5 years. The adverse health impacts of high doses of methadone use were the main self-reported reasons for MA dependence. These adverse health impacts included depression (n = 118, 44. 36%), oversleeping (n = 88, 33. 08%), and low physical energy to do the housework (n = 60, 22. 55%). However, lifetime MA treatment was only 25%. The prevalence of MA dependence was significantly associated with poor psychological well-being (P < 0. 01) and social dysfunction (P < 0. 01) among MA dependent females compared with non-MA dependent females. Conclusions: Methamphetamine dependence was common and associated with serious health problems. Special treatment services should be provided for these females.

Background: Although depression is recognized as the most common psychiatric disorder in hemodialysis patients with a significant negative impact on management and prognosis, we didn’ t find any previous data regarding its prevalence in Jordanian patients. Objectives: We conducted this study to determine the prevalence of depression in Jordanian hemodialysis patients, the factors that may influence it, and to boost the awareness of its detrimental consequences. Methods: In a descriptive cross-sectional study, patients on hemodialysis at the University of Jordan hospital in July 2015 participated in this survey utilizing a validated Arabic translation of the patient health questionnaire 9 (PHQ-9). The patients answered the questionnaire on the same day of dialysis, specifically, a few hours post dialysis when the effects of indistinguishable uremic symptoms are minimal. Results: From the 49 patients that completed the survey, we found 29% to have depression, though significantly higher than the general population, however, considerably lower than similar studies. This finding may be due to the critical timing of questionnaire answering that had been ignored in other studies and led to an overestimation of the diagnosis of depression in hemodialysis patients. Interestingly, most patients were unaware of the diagnosis and refused therapeutic intervention. Although the adequacy of hemodialysis correlated with depression, it didn’ t reach statistical significance. Also, several relevant factors didn’ t correlate with depression, which may imply an independent endogenous origin of the disorder in hemodialysis patients. Conclusions: Depression is highly prevalent and under diagnosed among hemodialysis patients in Jordan, which is ironic with patient’ s negative attitude towards the diagnosis and its treatment. Hence, we recommend a policy of routine assessment of depression accompanied by an educational program to emphasize the importance of treatment in improving the quality of life and the overall outcome of hemodialysis therapy.

Background: Borderline personality disorder (BPD) might be conceptualized as belonging to the bipolar disorder spectrum. For this purpose, we compared these disorders’ attachment styles, intimate relationship, and anger experience. Objectives: Objectives of the current research were investigating of attachment style, quality of intimate relationship, and anger experience in patients with porderline personality and bipolar-II disorders and comparing these variables in these groups. Methods: The method of research was comparative. The sample consisted of 37 BPD and 41 BP-II outpatients that were selected through convenience sampling method. They were requested to answer “ Attachment Style Questionnaire” , “ Quality of relationship inventory” and “ Multidimensional Anger Inventory” . Results: The t-test showed that there wasnosignificant difference betweenBPDand bipolar disorder Type II (BP-II) groups in anxious and secure attachment styles. However, BPD patients showed higher levels of avoidant attachment styles compared to the BD-II patients. In addition, there was no significant difference between the 2 groups in the quality of intimate relationship and anger experience in general. However, BPD and BD-II patients had a significant difference in “ conflict with friends” , “ conflict with partner” , and “ anger arousal” subscales, in a way that BPD patients had higher scores on these subscales. Conclusions: The results of our study suggest that insecure attachment style is the common underlying psychopathology of both BPD and Bipolar disorders that leads to similar intimate relationships and anger experience. These findings support the re-conceptualization of BPD in the Bipolar spectrum.

Background: Dysfunctional cognitions and attitudes about sleep are considered as one of the most important factors underlying insomnia. Objectives: The current study aimed at investigating the validity and reliability of the dysfunctional beliefs and attitudes about sleep scale-10 (DBAS-10) in an Iranian clinical population. Methods: The clinical sample consisted of 120 patients with insomnia disorder referred to the sleep disorders clinic at Baharloo hospital in Tehran in 2015. The control group (n = 120) included a community sample volunteered to participate in the study. Sleep Diary, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Pre-Sleep Arousal Scale, and Depression, Anxiety, Stress Sacle-21, were used to assess concurrent validity. Test-retest and Cronbach’ alpha were conducted to examine the reliability of the scale. Construct validity of the scale was investigated via confirmatory factor analysis. Results: The current study findings indicated that DBAS-10 had appropriate test-retest reliability (r = 0. 83) and internal consistency (Cronbach’ alpha = 0. 82). Total score of DBAS-10 was significantly associated with PSQI (r = 0. 34), ISI (r = 0. 45), the cognitive subscale of PSAS (r = 0. 36), and depression (0. 34), anxiety (r = 0. 34) and stress (r = 0. 39) subscales of DASS-21. Factor analysis indicated that the Espie et al. (2000) model had significantly better fitness in comparison with the Edinger andWohlgemuth (2001) model. The cutoff point, sensitivity, and specificity of the scale were 6. 7%, 74. 17% and 87. 50%, respectively. Conclusions: The Persian version of DBAS-10 had proper psychometric properties for Iranian clinical population.

Background: Autism spectrum disorders (ASD) are early onset conditions characterized by significant impairment in social interaction and communication. Objectives: The purpose of this study was the assessment of Atomoxetine effectiveness and tolerability in the treatment of autistic features in patients with ASD. Methods: A total of 44 children, aged 6 to 17 years, diagnosed with ASD, enrolled in a 8 week randomized clinical trial. The study conducted at the outpatient clinic of Ibne-sina hospital and Dr. Sheikh hospital affiliated to the Mashhad Medical University in Iran, between August 2015 to September 2016. Subjects were randomly allocated to Atomoxetine (0. 5 to 1. 2 mg/kg/day) plus risperidone or Placebo plus risperidone. The primary outcome was assessed by the childhood autism rating scale (CARS) and clinical global impression (CGI). Patients were evaluated at baseline, 4 weeks and 8 weeks after the administration of the drug. Mixed ANOVA test is used for the outcome of evaluation. The clinical trial registration number is: IRCT2016022826802N1. Results: Atomoxetine augmentation comparison to placebo augmentation showed significant improvement in global impression and severity index in CGI, and also in total score of CARS and 7 subscales of CARS including relationship to people, emotional response, body use, listening response, fear and nervousness, nonverbal communication, and activity level (all P value  0. 05). The most common adverse effects of Atomoxetine were mood change, irritability, and GI disturbance. Conclusions: The results showed that Atomoxetine add-on therapy may be effective in symptoms of ASD while adverse effects tend to subside. The authors suggest further studies for clarifying this conclusion.

Background: Depression is a mental health disorder, which affects all the communities around the world. One of the major components of depression is hopelessness. There is evidence that depression is accompanied by increased reactive oxygen species, which contribute to DNA damage. Objectives: This study aimed at evaluating whether depression and hopelessness are associated with markers of DNA damage, proliferative potential, and cell death. Methods: The sample included 59 healthy females from Fars province, southern Iran. Depression and hopelessness scores were measured using Beck’ s depression inventory and Beck’ s hopelessness scales, respectively. Smears were taken from the buccal mucosa of participants, and using micronucleus assay, they were analyzed for various cell population and genome damage markers, including cytokinetic defects (binucleated cells), proliferative potential (basal cell frequency), cell death (condensed chromatin, karyorrhectic, pyknotic, and karyolitic cells), and biomarkers of DNA damage (micronuclei and nuclear buds). Results: None of the micronucleus (MN) assay parameters had an association with depression scores. There was a significant negative correlation between the frequency of basal cells and hopelessness scores (r =-0. 323, P = 0. 012). Other parameters of MN assay showed no association with hopelessness scores. Conclusions: As the basal cells are biomarkers of proliferative potential, the results suggest that cellular regeneration is decreased in buccal mucosa of people with high level of hopelessness. However, more studies with larger sample sizes are required to verify this conclusion.

Background: Along with growth of attention to spirituality in workplace, this question “ what is the meaning and effects of spirituality in workplace” came up. Objectives: To investigate the relationship between spirituality in a workplace, organizational commitment, and professional ethics among girl senior high school teachers in Neka city-Iran. Methods: A sample of 90 teachers who had 5 years of experience of teaching participated in a descriptive-relational study. Data gathering process was done using spirituality in workplace, organizational commitment, and professional ethic questionnaires. Pearson Correlation Coefficient tests were used for data analysis. Results: There was a significant relationship between spirituality in workplace and dimensions of organizational commitment and professional ethics [(r = 0. 556, 0. 482, 0. 328 n = 90, P = 0. 000), (r = 0. 570, 0. 375, 0. 318, 0. 356 n = 90, P = 0. 000) respectively]. Also, therewasa significant correlation between spirituality in workplace, organizationalcommitmentandprofessional ethics (r=0. 466, 0. 449, n = 90, P = 0. 000). Conclusion: The more spirituality in the work place among teachers would cause a growth in organizational commitment and professional ethics and vice versa. Accordingly, educational organizations need to pay attention to teachers’ mental and spiritual needs, so they can do their jobs with perseverance, commitment, and seriousness.

Dear Editor, In recent years, technology-based interventions have been used for treating methamphetamine dependence in western countries (1). These treatments are believed to be more cost-effective and time-saving than therapistassisted therapies (2). Technology-based interventions include computer-based interventions, internet-based interventions, text messaging, and smart phone or mobilebased treatments (1-3).

Background: Methamphetamine (MA) use remains a major public health concern around the world. Recent findings suggest that buprenorphine may be helpful for cocaine use reduction. Moreover, animal studies described reduced dopamine peak effect following MA use, due to the administration of low dose buprenorphine. Objectives: This study examined the effectiveness of buprenorphine with brief cognitive behavioral therapy on MA use disorder. Methods: The study was conducted in an outpatient substance abuse treatment center in Qazvin, Iran. Nineteen MA users received buprenorphine for 24 weeks combined with brief cognitive behavioral therapy in an outpatient substance abuse treatment program, three times per week, as a before and after non-randomization study. Clinical outcomes included treatment retention, MA use, degree of MA dependency and craving, quality of life, cognitive abilities questionnaire, addiction severity and also adverse events. Data was analyzed by performing repeated measures analysis and the Friedman test for nonparametric variables. Results: Fifteen participants completed the study during six months and frequency of MA use was significantly decreased at 24 weeks (P < 0. 001). There were also significant reductions in craving (P < 0. 001), degree of MA dependence (P < 0. 001), and improvements in quality of life, cognitive ability, and some subscales of addiction severity. Conclusions: The results of this preliminary clinical study demonstrated that buprenorphine could potentially attenuateMAcraving and alternate rewarding effects of MAand had promising effects on cognitive impairment. Furthermore, buprenorphine can be considered as a harm reduction intervention in some communities, in which the people, as a result of cultural beliefs, do not accept a therapy, which only consists of counseling and no medications.

Background: Anxiety disorders are the most common groups of mental disorders. Based on the world health organization reports 7. 4% of global DALYs are caused by disorders, which are in the mental and behavioral category. One of the problems of these patients is the length of stay in the hospital, which can be studied in various aspects. Objectives: The objective of this study was to determine the effects of related factors on the duration of hospitalization in patients with anxiety disorders. Methods: A historical cohort of patients placed in the psychiatric center in Sari, northern Iran, were studied from April 2007 to March 2012. Statistical analysis usingWeibull regression and stata. 12 was performed at the significant level of 0. 05. Results: A total of 427 persons were studied. The median length of hospital stay was 17 (inter quartile range 10-29 day). The results showed age was associated with the length of stay (P = 0. 036). Also, patients with previous hospitalization and patientswhoreceived electro convulsive therapy and occupational therapy had a longer stay in the hospital (P < 0. 001). Conclusions: The overall results showed that the type of treatment is effective in reducing the duration of hospitalization. Aging has a subtractive effect on the length of hospital stay. It seems that additional research concerning mental health care services may be required to identify more factors affecting the length of stay.

Background: Little is known on the correlation between categories of the misperception of body weight and depression. Objectives: The study aimed to investigate the association between body weight, weight misperception categories, and depressive symptoms in ASEAN University students. Methods: In a cross-sectional survey, 5, 337 undergraduate university students from 8 ASEAN countries responded to a selfadministered questionnaire and anthropometric measurements were taken in 2014 to 2015. Results: In logistic regression analyses adjusted for confounding variables, overweight female university students tended to report more depressive symptoms than female students with normal body mass index (OR = 1. 52, CI = 1. 11, 2. 05), and male university students with self-perceived overweight tended to report more depressive symptoms (OR = 1. 63, CI = 1. 12, 2. 35) than male students with normal body weight perception. Overweight male university students with normal body weight perception tended to experience less depressive symptomatology (OR = 0. 33, CI = 0. 15, 0. 72) than male students who had accurate perceptions of their body weight, and underweight male university students who self-perceived their body weight as overweight tended to display more depressive symptoms (OR = 5. 63, CI = 1. 91, 16. 62). Conclusions: Female university students who were overweight and male students with perceived overweight were having a higher prevalence of depression than students that had normal (perceived) weight. Male university students who underestimated their normal or overweight tended to have less depressive symptoms and male students that overestimated their underweight tended to report more depressive symptoms than male students who perceived their weight accurately.

Background: Cognitive impairment is one of the complications experienced by older adults with diabetes. Objectives: This study was conducted to assess the association of cognitive function with the glycemic condition of the elderly population. Methods: This analytic cross-sectional study was conducted on individuals 60 years and over in Babol, Northern Iran, during 2014 and 2015. Sociodemographic characteristics, history of other chronic diseases, medications, physical examination, fasting blood glucose, and serum lipid profile were used for data collection. MMSE was used to assess cognitive function and GDS for depressive symptoms. Results: A total of 1, 503 individuals participated in the study. The mean age of the participants was 69. 07  7. 28 years; of them, 1, 038 (69. 1%) were normoglycemic (non-diabetic) and 465 had (31. 9%) diabetes mellitus. There were significant differences in weight, BMI, systolic blood pressure, serum TG, LDL, and past medical history of MI or angina pectoris between diabetic and non-diabetic patients (P< 0. 05). Of the elderly, 1, 042 (69. 3%) had normal cognition and 461 (30. 7%) showed impaired cognition according toMMSE cut values. The mean of MMSE score in non-diabetic and diabetic patients was 25. 51  3. 40 (25. 30-25. 72) and 25. 02  3. 86 (24. 63-25. 46), respectively (P = 0. 018). A significant difference was observed in the severity of cognitive impairment between the two groups (P = 0. 048). Conclusions: Older adults with diabetes mellitushave poorer cognitive functions, therefore, health care providersandfamily physicians should pay more attention to the identification of any cognitive decline in the initial stages of diabetes mellitus.

Background: An understanding of the relationships between mental health literacy and health promotion behaviours is essential for the development of community-based interventions in the prevention of mental disorder. Objectives: The aim of this study was to examine the relationships between mental health literacy and health-promoting behaviours and to assess the contributions of mental health literacy through mediation to demographic characteristic in healthpromoting behaviours. Methods: This cross-sectional study was performed on 378 participants by convenience method in public places of Bushehr city from January to March 2016. The data collection tool included demographic variables section, mental health literacy scale, and health-promoting lifestyle profile. Assessment of the potential mediation effect of MHL was assessed using the three criteria. The association of the demographic characteristic with the MHL must be significant, the association of the demographic characteristic with health-promoting behaviours must be significant, and MHL must be significantly associated with the health-promoting behaviours controlling the demographic characteristics. The analysis was done by SPSS software version 20. 0. Results: Findings indicated that there is a significant association between the education level (P < 0. 001) and history of mental disorder (P = 0. 004) withMHLscore. There is a significant association between education (P< 0. 001), employment status (P = 0. 028), marital status (P = 0. 013), and history of mental disorder (P = 0. 035) with HPLP score. The hierarchical multiple regression analysis indicated that the education tended to have both direct and indirect effect in HPLP. Conclusions: MHL is a significant predictor and mediator to all the health-promoting behaviours. MHL is predictor of healthrelated behaviours, and, it also mediates the effect of the academic education on these behaviours.

Background: Planning to decrease mental health problems in children requires knowledge of the extent and type of behavioral problems in this age group. Given that children comprise a large proportion of the population in the outskirt areas of cities, evaluation of the prevalence of behavioral problems in children in outskirt areas could be effective in the prevention and treatment of mental disorders. Objectives: The aim of this study, performed during year 2015, was to detect the prevalence of behavioral problems in children in the outskirt areas of Mashhad city, Iran. Methods: This was a descriptive study. The study sample that was selected by the accessible sampling method consisted of 450 males, who were in the first to fifth grade. The instrument used to measure behavioral problems was the Achenbach child behavior checklist, which was completed by parents. The findings were analyzed by the SPSS 19 software using descriptive statistics. Results: The prevalence of behavioral problems on elementary school males was 36. 44% on outskirts of Mashhad. The most common behavioral problem was defiant behavioral problems with 23. 11% prevalence and social problems with the lowest prevalence of 7. 33%. On scholastic grades, the students of the second grade most commonly had behavioral problems with a prevalence of 25. 6% and the students of the fifth grade least frequently had behavioral problems with a prevalence of 13. 4%. Conclusions: The prevalence of childhood behavioral problems in outskirts of Mashhad was large. These results suggest that more attention to children of outskirt areas and precise planning for reducing their behavioral problems is necessary.

Background: Today, improving the quality of life for the elderly is of great importance. In addition, creating a favorable environment for the elderly has become a common concern worldwide. Objectives: The aim of this study was to assess the psychometric properties of the Persian version of quality of life (CASP-19) in older people. Methods: The study included 200 participants. The CASP-19 quality of life instrument for older people was adapted to Persian language through a translation and translation-back procedure. Afterwards, the reliability (internal consistency and test-retest) and validity (including face validity, content validity, factor analysis, known groups, and criterion validity), through assessing the correlation between the Persian version of the CASP-19 and the SF-36, were measured. Results: Based on internal consistency (Cronbach > s  ), the reliability for CASP-19 was 0. 97 and for the four subscales varied from 0. 93 to 0. 97. Test-retest reliability (Pearson’ s correlation coefficient) for the Farsi version of the CASP-19 ranged from 0. 87 to 0. 94. Evaluation of discriminant validity indicated the discriminant power of the CASP-19 in terms of the presence or absence of curtailment of personal autonomy. Criterion validity indicated a significant correlation between many dimensions of the CASP-19 and the SF-36. Conclusions: This study confirmed the validity of the CASP-19 in terms of construct, convergent, known groups, and face validity. Besides, it showed an acceptable internal consistency. The CASP-19 is valid for investigating the needs of the Iranian elderly.

Background: Premature infants experiencemany problems during their stay in the neonatal intensive care unit (NICU). Premature birth creates a sense of loss in family members, especially mothers, and causes tension and stress. Moreover, inefficient coping strategies increase stress, incompatibility, and mental problems. Objectives: In the current study, we aimed to evaluate the effectiveness of an empowerment program of stress coping strategies for mothers of preterm infants, admitted to the NICU. Methods: This clinical trial was performed on 70 mothers of premature infants, divided into the intervention and control groups. The empowerment program included 4 stages of behavioral training: first stage, 2-4 days after the infant’ s hospitalization; second stage, 2-4 days after the first stage; third stage, 1-3 days before the infant’ s discharge; and fourth stage, 1 week after discharge. At each stage, the mothers listened to an audio file related to the corresponding stage. The control group received information and routine care according to the hospital policies. To assess the stress-coping strategies, mothers completed a questionnaire once before the program and once before the infant’ s discharge. To analyze the data, Chi square test, t test, and paired t test were used in SPSS version 16. Results: The results showed a significant difference between the groups in terms of the mean score of problem-focused coping (P < 0. 2), emotion-focused coping (P < 0. 003), and inefficient coping (P < 0. 1) after the implementation of the empowerment program. This led to the increased use of problem-focused coping strategies and reduced use of emotion-focused and inefficient strategies in the empowerment group, although no significant difference was observed versus the controls (P > 0. 05). Conclusion: Implementation of the empowerment program for mothers of premature infants increased the use of problemfocused coping and reduced the use of emotion-focused and inefficient coping strategies.

Background: Cognitive-behavioral therapy has been suggested as a treatment program for methamphetamine dependence. Objectives: The current brief report aimed to assess the effectiveness of 16 sessions of this treatment for abstinence from methamphetamine and improvement of psychological well-being among methadone-maintained patients. Methods: Overall, 200 male and female methadone patients who were on stable methadone doses were assigned to either an interventiongroup( n=100) or a controlgroup(n=100). Thestudywaspart of arandomizedcontrolled trial conducted in fivemethadone services in Shiraz, near the Persian Gulf of Iran. All methamphetamine-dependent participants were assessed using two questionnaires at baseline, post-test (the end of the 16th cognitive-behavioral therapy or control session), and a three-month follow-up that was conducted90days after the endof the 16th session. Urinalyses were also conducted to detectmethamphetamineuse at thesame assessment points. The control group was in a wait-list control condition. There was no participant attrition during the assessment procedures. Results: Overall, 30 participants in the treatment group became abstinent at post-test and remained abstinent at follow-up. 16 sessions of cognitive-behavioral therapy led to a significant reduction in methamphetamine use (P < 0. 001) and improved psychological well-being (P < 0. 001) in the treatment group while there was no significant change in the control group. Conclusions: Cognitive-behavioral therapy can be an efficacious option for methamphetamine problem in methadone treatment although further studies are suggested on long-term abstinence.

Background: Spirituality and its effect on people’ s health are attendedmorethan before. The current study was conducted to determine the relationship between spiritual well-being, hopelessness, and self-efficacy component in the students of Isfahan University of Medical Sciences. Objectives: The current study aimed at Investigate the relationship between spiritual health and hopelessness to Self-efficacy in students of Isfahan University of Medical Sciences. Methods: The current descriptive-correlational study was conducted in 2014 on 175 students selected from Isfahan University of Medical Sciences. The data were collected via demographic characteristics, spirituality well-being, hopelessness, and self-efficacy questionnaires; the significant level was considered < 0. 05. Results: A total of 175 students including 75 males and 100 females participated in the study. There was a significant and revers relationship between spiritual well-being and hopelessness among the subjects (R =-0. 632; P < 0. 0001). Conclusions: In the current study, spiritual well-being had a direct relationship with self-efficacy and revers relationship with hopelessness. It is offered to make arrangement in order to promote self-efficacy and reduce hopelessness in students.

Background: Providing care for an old person with a psychiatric disorder is a long-term and stressful process exerting negative outcomes on the caregivers’ physical, psychological, and social health. Objectives: The aim of the study was to determine the burden among family caregivers of psychiatric elderly and its related factors. Methods: This descriptive study was conducted on 200 elderly psychiatric patients via convenient sampling, referring to the zare teaching psychiatric hospital of Sari, Iran. The sampling lasted from June tomid-November, 2015. Twoquestionnaires of demographics (the elderly and caregivers) and Zarit Burden Interview were used to collect the data. The data was analyzed using descriptive and inferential statistics, such as independent t-test, Analysis of Variance (ANOVA) and Scheffe Post Hoc test. Results: The results indicated that the mean of the caregivers’ age was 51. 24  12. 16. Ninety-four percent of the caregivers were married, and 49% had higher diploma education. Sixty-seven percent reported average economic status. The findings showed 68% of caregivers came up with mild to severe burden. According to the demographics, the hours of care per week (P = 0. 001) and having other psychiatric patients in the family (P = 0. 006) were related to the burden. Conclusions: Significantly high caregivers’ burden can overshadow the risk of low quality of care the psychiatric elderly patients and expose their caregivers’ psychological health to danger. Thus, it seems that community-oriented interventions are required to reduce the burden and boost long-term quality of care by informal caregivers, such as patients’ families.

Context: Moral distress is acommonphenomenonin the nursing profession. This study was aimed to determine themeanintensity and frequency of moral distress among Iranian Nurses. Evidence Acquisition: This systematic review and meta-analysis was based on PRISMA guideline and searching in National databases as SID, Magiran, Irandoc, Noormag, IranMedex, and Medlib as well as International databases as Madlib and Web of Sciences, Scopus, PubMed, Direct-Science, Cochrane, Embase, Springer, Online Library Wiley, Ebsco, CEBM, CINHAL, SAGE, and Google Scholar were published by 2016. Researched keywords were in Persian and their English equivalents in accordance with their Mesh: “ Moral” , “ Morale” , “ Distress” , “ Iran” , “ Frequency” , “ intensity” , “ Ethics” , “ Nurse” , and all possible combinations. The obtained documents were analyzed based on appropriate checklist through a random effects model by using Review Manager Software ver: 5. 3. 5. Results: According to 12 (3. 08%) selected documents out of 389, 2655 Iranian nurses with a mean age of 32. 3 15. 265 years entered to meta-analysis. Mean intensity of moral distress was calculated 2. 2329 [CI95%: 1. 7651, 2. 5230] out of 4, 2. 9566 [CI95%: 2. 4362, 3. 4769] out of 5, and 3. 4328 [CI95%: 3. 3200, 3. 5455] out of 6. Furthermore, its frequency was calculated 1. 9237 [CI95%: 1. 5533, 2. 2941] out of 4, 3. 0278 [CI95%: 2. 4533, 3. 6024] out of 5, and 2. 6261 [CI95%: 2. 5210, 2. 7312] out of 6. Which the range of both has been reported in moderate to intense Conclusions: According to the results, the intensity and frequency of moral distress have been reported in the range of moderate to intense. Due to the most harmful effects of moral distress in nursing, management and prevention protocols of moral distress should be developed and done by nurses.

Background: Methamphetamine (MA) abuse is a health concern among drug abuse patients in Iran. Objectives: This study aimed at determining the prevalence of MA dependence among a group of female methadone users and investigating the current psychological well-being, high risk sexual and criminality behaviors, and the status of receiving MA treatment. Methods: This study was a cross-sectional survey conducted in Iran. The study was conducted at 5 central female-only methadone services in Tehran and Karaj, during years 2011 to 2013. A questionnaire was devised to collect baseline data. The general health questionnaire-28 and the Opiate Treatment Index were used to assess psychological well-being, and criminality and high-risk sexual behaviors. Results: Overall, 245 females were registered at these sites. Of them, 201 females (82%) were dependent on MA while on treatment. Duration of MAdependence was 6 years. However, only 14. 3% of the participants reported lifetimeMAtreatment. Noparticipant was on MA treatment. Participants reported high rates of MA-related depression (76. 4%), anxiety (68. 4%), social dysfunction (41. 2%), and somatic symptoms (38. 2%), respectively. Untreated MA dependence in methadone treatment was associated with engagement in high-risk sexual behaviors (43. 8%) and criminality (28. 7%). Only 10% of the participants reported receiving a lifetime matrix model. All of them reported that the Matrix model was long and it was not easily available in methadone services. Conclusions: The study showed that the high prevalence for MA dependence and its adverse health impacts while receiving MA treatment remained the same. Effective psychosocial treatments should be delivered forMAdependenceamong female methadone users.

Background: Due to low adherence to treatment and side effects of pharmacotherapy, using new brain stimulation, such as transcranial direct current stimulation (tDCS) in patients with anxiety disorders are available. Objectives: The present researchwasperformed to evaluate theefficacyof tDCSandcompareit with pharmacotherapyonreduction of worry, depression, and anxiety in a group of Iranian patients with generalized anxiety disorder (GAD). Methods: This study was a quasi-experimental research. A total of 18 patients (46% females and 64% males) withGADwere randomly assigned either to tDCS, pharmacotherapy or sham conditions. Stimulation was delivered over the contralateral deltoid at 2 m/A during 20 minutes in 10 sessions of 4 weeks. Symptoms were assessed by a 7-item GAD scale, HARS, HDRS, and PSWQ in pre-test, post-test and follow up assessment (2 months later). Analysis of variance with repeated measure was used to analyze the data. Results: The results showed that both tDCS and pharmacotherapy were effective in reducing worry symptoms, also the pharmacotherapy group compared with the tDCS group and sham condition was more effective in treating of worry. Anxiety symptoms were reduced by both tDCS and pharmacotherapy and the difference between the 2 methods was not significant. Finally, the effectiveness of tDCS therapy on reducing depressive symptoms was more significant than pharmacotherapy. Conclusions: The tDCS is a promising treatment for generalized anxiety disorder, especially in depressive and worry symptoms.

Background: Patients with methadone abuse are the main group with methamphetamine dependence in the Iranian context. However, there are only a few studies on this group. Objectives: This study aimed at determining the prevalence of methamphetamine dependence among methadone patients on stable methadone doses. Methods: This cross-sectional study was conducted on 140 methadone services in Tehran, Karaj, and Qazvin. Fifty percent of methadone services were located in middle class areas and provided methadone maintenance treatment and counselling. Overall, 105 centres were selected from Tehran. Twenty centres were selected from Karaj and 15 centres were selected form Qazvin. A researcher-designed questionnaire was used to collect data. Overall, 2645 males and 304 females participated in the study during years 2011 to 2013. Results: The prevalence of methamphetamine dependence was 26% among males and 45% among females. Females were more likely to self-report depression (53% versus 22%, P < 0. 05) and psychiatric hospitalisation (28% versus 16%, P < 0. 05) than males while males were more likely to self-report criminality (43% versus 24%, P < 0. 05) and poor concentration (39% versus 13%, P < 0. 05) than females. Conclusions: Special educational, preventative, and treatment programs should be provided to reduce methamphetamine dependence among this group in Iran. Further studies in other parts of Iran are required.

Background: Modification of nutritional behaviors in adolescents is of high importance and can prevent nutrition-related diseases in adulthood. Objectives: The current study aimed at determining the effect of a social cognitive theory (SCT)-based intervention on fast food consumption among students. Methods: The current quasi-experimental study was carried out on 92 students randomly divided into the intervention and control groups. Data gathering tool consisted of food frequency questionnaire (FFQ) and SCT questionnaire filled out using self-reporting method at 2 times (before and after the intervention). Intervention was performed based on SCT in 4 sessions. SPSS version 20 was used to analyze the data (independent t test and paired samples t test). A 2-tailed P-value, lower than 0. 05, was considered statistically significant. Results: In the intervention group, the mean scores of fast food consumption before and after intervention were 16. 1 8. 9 and 9. 4  7. 5, respectively. There was a significant difference in the scores obtained in 2 times (P < 0. 001) in the intervention group. There was a significant difference in the mean scores of self-efficacy and value expectation aspects before and after the intervention in the intervention group; however, no significant changes were observed in the control group. Conclusions: Based on the obtained results, the SCT-based intervention can be effective in decreasing students’ fast food consumption.