| 1. |
- Dejman, Masoumeh
(författare)
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Cultural explanatory model of depression among Iranian women in three ethnic groups (Fars, Kurds and Turks)
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: As one of the most prevalent diseases globally and as an important cause of disability, depressive disorders are responsible for as many as one in every five visits to primary care. However, the true figures are unknown, as many do not seek help or know how to access help. Women suffer more than men according to surveys in Iran and other countries. Cultural variations in clinical presentation sometimes make it difficult to recognize the disorder, resulting in patients not being diagnosed and not receiving appropriate treatment and follow up. Purpose: This thesis explores how women s depression is conceptualized among Iranian people in three cities located in north-west (Tabriz), west (Ilam) and central (Tehran, capital city) Iran, representative of three major ethnic groups (Fars, Kurds, and Turks) and how this conceptualization may contribute to the help-seeking behaviour of depressed women. Methods: The thesis consists of four exploratory papers employing qualitative methods including individual interviews and focus group discussions (FGDs). Paper 1 reports a pilot study using a case vignette and explanatory interview guides on Iranian people (including depressed women, clinicians and lay people). Forty three adults participated in three focus group discussions (25 participants) and 18 individual interviews in the three ethnic groups. Paper II presents an explanatory model of the community (lay people) in the three ethnic groups in Iran concerning women's depression. Thirty eight men and thirty eight women from the general population, classified by level of education participated in twelve FGDs in the aforementioned cities by using a case vignette describing a woman with major depression without psychotic features. Paper III reports interview results (25 depressed women and 14 relatives) regarding how these women and their families conceptualize the patients conditions and how their conceptualization shaped the patients help-seeking process. Paper IV reports individual interview results from 24 clinicians (six general practitioners [using case vignette], 14 psychiatrists and four psychologists [interview guide, both]) exploring the explanatory model of depressed women. Results: There were more similarities than differences in the models proposed by Iranian people in the three ethnic groups. Among most of the study participants depressive symptoms were perceived as a transient reaction to external stressors. Most participants named the depressive symptoms as distress of nerve/ soul narahati asabi/narahati rohi , problem of nerve/soul moshkel asabi/rohi, sadness and depression afsordegi . Other names were darikhma (deep sadness with anxiety, Turkish participants only), and tarjoman (sadness and nerve problems due to external events, Kurdish participants only). All connected the illness with an external stressor caused by loss (death of relatives, job loss, etc.), environmental causes (including family conflict), gender-linked stressors and internal factors caused by emotional factors, cognition distortion and hormonal factors. Coping mechanisms involved two strategies: (1) solving problems by seeking help from family and friends, especially ones husband and neighbours, religious practice, and engaging in pleasurable activities, and (2) seeking professional support mostly from general practitioners, psychologists, family counsellors, and traditional support from herbalists and amulets (written prayer notes). The choice of medical treatment depended on the type of somatic or psychological complaints. The important barriers to seeking help from professional (psychiatrists or psychologists) were stigma and fear of dependency on medication. Conclusion and implications: Rather than having a biological model, in this study participants tended to have a psychosocial explanatory model linked with preferred seeking help from informal healers (family and friends, religious practices and traditional healers) as the first treatment step. The inter-ethnic similarities could stem from common cultural and social elements, such as a common official language, legal, structural, educational and political structures, mass media, and religion in the three major ethnic groups in Iran. This finding could be useful for integrating a gender approach to health service delivery and linking gender and culture sensitivity to training of health workers, and also for education society to reduction of the stigma related to depression.
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| 2. |
- Dejman, Masoumeh, et al.
(författare)
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Explanatory model of help-seeking and coping mechanisms among depressed women in three ethnic groups of Fars, Kurdish, and Turkish in Iran.
- 2008
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Ingår i: Arch Iran Med. - 1029-2977. ; 11:4, s. 397-406
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Tidskriftsartikel (refereegranskat)abstract
- Explanatory model of help-seeking and coping mechanisms among depressed women in three ethnic groups of Fars, Kurdish, and Turkish in Iran.Dejman M, Ekblad S, Forouzan AS, Baradaran-Eftekhari M, Malekafzali H.Department of Psychiatry, Welfare and Rehabilitation University, Tehran, Iran. dejmanms@hbi.ir.BACKGROUND: As one of the most prevalent diseases globally and as an important cause of disability, depressive disorders are responsible for as many as one in every five visits to primary care doctors. Cultural variations in clinical presentation, sometimes make it difficult to recognize the disorder resulting in patients not being diagnosed and not receiving appropriate treatment. To address this issue, we conducted a qualitative pilot study on three ethnic groups including Fars, Kurdish, and Turkish in Iran to test the use of qualitative methods in exploring the explanatory models of help-seeking and coping with depression (without psychotic feature) among Iranian women. METHODS: A qualitative study design was used based on an explanatory model of illness framework. Individual interviews were conducted with key informant (n=6), and depressed female patients (n=6). A hypothetical case vignette was also used in focus group discussions and individual interviews with lay people (three focus groups including 25 participants and six individual interviews; n=31). RESULTS: There were a few differences regarding help-seeking and coping mechanisms among the three ethnic groups studied. The most striking differences were in the area of treatment. Non-psychotic depressive disorder in all ethnicities was related to an external stressor, and symptoms of illness were viewed as a response to an event in the social world. Coping mechanisms involved two strategies: (1) solving problems by seeking social support from family and neighbors, religious practice, and engaging in pleasurable activities, and (2) seeking medical support from psychologists and family counselors. The Fars group was far more likely to recommend professional treatment and visiting psychiatrists whereas the other two ethnic groups (i.e., Turks and Kurds) preferred to consult family counselors, psychologists or other alternative care providers, and traditional healers. CONCLUSION: The study has educational and clinical implications. Cultural reframing of the patient's and family's perceptions about mental illness and depression may require community education. Family counseling, family therapy, and also religious practices can be used to empower the patient.
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| 3. |
- Dejman, Masoumeh, et al.
(författare)
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Psychometric Study Using Item Response Theory of an Instrument Developed for Assessment of Iranian Mental Health Problems
- 2022
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Ingår i: Iranian Journal of Psychiatry and Behavioral Sciences. - : Brieflands. - 1735-8639 .- 1735-9287. ; 16:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Currently, in addition to the undeniable impact of cultural factors on mental health problems’ diagnosis and treatment methods, the use of rapid, short, and intervention-based instruments can be effective in the accurate diagnosis of mental health problems, especially in the health system of developing countries.Objectives: This study aimed to validate an instrument developed for screening patients with common mental health problems using item response theory (IRT).Methods: The study was conducted in Semnan province (with Persian ethnicity), Iran, from August 2017 to February 2018. A 101-item tool consisted of district common mental health problems (i.e., depression, anxiety, and obsession), along with a functional checklist. The development of the instrument involved a pilot study and psychometric testing. The IRT-based analysis was used as the item-reduction method to evaluate the shortened tool as an appropriate screening tool. The participants were healthy individuals and patients with depression, anxiety, and obsessive-compulsive disorder (OCD). The data were analyzed using Stata software (version 15.1).Results: The study participants were 160 individuals (58.2% male) with a mean age of 36.3 ± 11.2 years. All item impact factors were within the range of 1.8-5. The mean values of clarity, simplicity, relevance, and scale-level content validity index/averaging calcu-lation method of the instrument were 96.73 ± 0.70, 97.64 ± 0.61, 98.2 ± 1.9, and 97.09 ± 0.63, respectively. Cronbach’s alpha and internal consistency coefficient were 0.88 and 0.7. Moreover, 13, 5, and 12 items were excluded using IRT from depression, anxiety, and OCD dimensions based on the threshold criteria, respectively.Conclusions: Iranian screening tools for mental health problems can provide qualified information with the least error and the most precision in appropriate early diagnosis and decrease the burden of mental health problems in the national healthcare system.
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| 4. |
- Falahat, Katayoun, et al.
(författare)
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Determining the effectiveness of cognitive behavioral therapy interventions based on the transdiagnostic approach in the treatment of common mental health problems : Presenting an experience from the Islamic Republic of Iran
- 2022
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Ingår i: Brain and Behavior. - : John Wiley & Sons. - 2162-3279 .- 2162-3279. ; 12:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: There is growing support to develop transdiagnostic approaches that provide new insights into mental health problems and cut across the existing traditional diagnostic boundaries all over the world. The present study was conducted to test the transdiagnostic cognitive behavioral therapy (TCBT) approach in treating patients with common mental health problems and evaluate its effectiveness compared to the current treatment settings of the healthcare system.Methods: A randomized controlled trial was conducted in Semnan Province, north of Iran. The study took pace in urban health centers. A sample of 520 Iranian adults, tested as positive on the Kessler Psychological Distress Scale, were enrolled. Participants who received a score above the cut-off point in any of the three mental health disorders (depression, anxiety, or obsessive compulsive disorder [OCD]) based on the locally validated study instrument were randomly allocated to the study. The intervention group received TCBT during eight sessions provided by trained general health service providers without previous mental health training; the standby control group received Mental Health Services as Usual (MHSU). The post-test interviews were conducted using the study instrument after the completion of both group treatments.Results: A total of 459 individuals (87.8% female) ultimately entered the study. The withdrawal rate was 24% (53 participants in the TCBT and 56 in the MHSU). Reduction in depression, anxiety, and OCD symptoms was significant within each group and when comparing TCBT and MHSU (mean difference).Conclusion: This trial recommends that the transdiagnostic CBT approach can be effective in improving common mental health problems and functions among individuals by trained general healthcare providers in the primary healthcare system. The results can be more useful in decision making when defining the process of providing mental healthcare in the National Primary Healthcare System.
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| 5. |
- Forouzan, Ameneh S, et al.
(författare)
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Reliability and validity of a Mental Health System Responsiveness Questionnaire in Iran
- 2014
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 7, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background:The Health System Responsiveness Questionnaire is an instrument designed by the World Health Organization (WHO) in 2000 to assess the experience of patients when interacting with the health care system. This investigation aimed to adapt a Mental Health System Responsiveness Questionnaire (MHSRQ) based on the WHO concept and evaluate its validity and reliability to the mental health care system in Iran.Design: In accordance with the WHO health system responsiveness questionnaire and the findings of a qualitative study, a Farsi version of the MHSRQ was tailored to suit the mental health system in Iran. This version was tested in a cross-sectional study at nine public mental health clinics in Tehran. A sample of 500 mental health services patients was recruited and subsequently completed the questionnaire. Item missing rate was used to check the feasibility while the reliability of the scale was determined by assessing the Cronbach's alpha and item total correlations. The factor structure of the questionnaire was investigated by performing confirmatory factor analysis (CFA).Results: The results showed a satisfactory feasibility since the item missing value was lower than 5.2%. With the exception of access domain, reliability of different domains of the questionnaire was within a desirable range. The factor loading showed an acceptable unidimentionality of the scale despite the fact that three items related to access did not perform well. The CFA also indicated good fit indices for the model (CFI = 0.99, GFI = 0.97, IFI = 0.99, AGFI = 0.97).Conclusions: In general, the findings suggest that the Farsi version of the MHSRQ is a feasible, reliable, and valid measure of the mental health system responsiveness in Iran. Changes to the questions related to the access domain should be considered in order to improve the psychometric properties of the measure.
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| 6. |
- Forouzan, Ameneh Setareh, et al.
(författare)
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Service users and providers expectations of mental health care in Iran : a qualitative study
- 2013
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Ingår i: Iranian Journal of Public Health. - 2251-6085. ; 42:10, s. 1106-1116
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mental disorders are known to be an important cause of disabilities worldwide. Despite their importance, about two thirds of mentally ill people do not seek treatment, probably because of the mental health system's inability to decrease the negative side effects of the interaction with the mental health services. The World Health Organization has suggested the concept of responsiveness as a way to better understand the active interaction between the health system and the population. This study aimed to explore the expectations of mental health service users and providers.Methods: Six focus group discussions were carried in Tehran, the capital of Iran. In total, seventy-four participants comprising twenty-one health providers and fifty-three users of mental health system were interviewed. Interviews were analyzed through content analysis. The coding was synchronized between the researchers through two discussion sessions to ensure the credibility of the findings. The results were then discussed with two senior researchers to strengthen plausibility.Results: Five common domains among all groups were identified: accessibility, quality of interpersonal relationships, adequate infrastructure, participation in decisions, and continuity of care. The importance of cultural appropriateness of care was only raised by service users as an expectation of an ideal mental health service.Conclusions: Both users and providers identified the most relevant expectations from the mental health care system in Iran. More flexible community mental health services which are responsive to users? experiences may contribute to improving the process of care for mental health patients.
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| 7. |
- Forouzan, Ameneh Setareh, et al.
(författare)
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Testing the WHO responsiveness concept in the Iranian mental healthcare system : a qualitative study of service users
- 2011
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Individuals' experience of interacting with the healthcare system has significant impact on their overall health and well-being. To relate patients' experiences to a common set of standards, the World Health Organization (WHO) developed the concept of health system responsiveness. This study aimed to assess if the WHO responsiveness concept reflected the non-medical expectations of mental healthcare users in Teheran.Methods In this qualitative study, four mixed focus group discussions were formed, comprising 53 mental health service users in Tehran, Iran, in 2010. Content analysis was performed for data analysis. Responses were examined in relation to the eight domains of the WHO's responsiveness model.Results There were many commonalities between the findings of this study and the eight domains of the WHO responsiveness model, although some variations were found. Effective care was a new domain generated from our findings. In addition, the domain of prompt attention was included in two new labelled domains: attention and access to care. Participants could not differentiate autonomy from choice of healthcare provider, believing that free choice is part of autonomy. Therefore these domains were unified under the name of autonomy. The domains of quality of basic amenities, access to social support, dignity and confidentiality were considered to be important for the responsiveness concept. Some differences regarding how these domains should be defined were observed, however.Conclusions The results showed that the concept of responsiveness developed by the WHO is applicable to mental health services in Iran. These findings might help policy-makers' better understanding of what is useful for the improvement of mental health services.
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| 8. |
- Forouzan, Setareh, et al.
(författare)
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Measuring the mental health care system responsiveness : results of an outpatient survey in Tehran
- 2016
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Ingår i: Frontiers In Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- As explained by the World Health Organization (WHO) in 2000, the concept of health system responsiveness is one of the core goals of health systems. Since 2000, further efforts have been made to measure health system responsiveness and the factors affecting responsiveness, yet few studies have applied responsiveness concepts to the evaluation of mental health systems. The present study aims to measure responsiveness and its related domains in the mental health-care system of Tehran. Utilizing the same method used by the WHO for its responsiveness survey, responsiveness for outpatient mental health care was evaluated using a validated Farsi questionnaire. A sample of 500 public mental health service users in Tehran participated and subsequently completed the questionnaire. On average, 47% of participants reported experiencing poor responsiveness. Among responsiveness domains, confidentiality and dignity were the best performing factors while autonomy, access to care, and quality of basic amenities were the worst performing. Respondents who reported their social status as low were more likely to experience poor responsiveness overall. Attention and access to care were responsiveness dimensions that performed poorly but were considered to be highly important by study participants. In summary, the study suggests that measuring responsiveness could provide guidance for further development of mental health-care systems to become more patient orientated and provide patients with more respect.
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