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

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.

Pasteur Institute of Iran--an evaluation model

Background: Pasteur Institute of Iran was established in 1919 with the aim to produce vaccines and prevent communicable diseases in Iran. Over time, their activities extended into areas of research, education and services. Naturally, such a vast development begs establishment of a comprehensive management and monitoring system. With this outlook, the present study was carried out with the aim to design a performance assessment model for Pasteur Institute of Iran that, in addition to determining evaluation indicators, it could prepare the necessary grounds for providing a unified assessment model for the global network of the Pasteur Institutes. Method: This study was designed and performed in 4 stages: first; design of indicators and determining their scores. Second; editing indicators according to the outcome of discussions and debates held with members of Research Council of Pasteur Institute of Iran. Third; implementation of a pilot model based on the Institute’s activities in 2011. Fourth; providing the pilot model feedback to the stakeholders and finalizing the model according to an opinion survey. Results: Based on the results obtained, the developed indicators for Pasteur Institute of Iran evaluation were designed in 10 axes and 18 sub-axes, which included 101 major and 58 minor indicators. The axes included governance and leadership, resources and facilities, capacity building, knowledge production and collaborations, reference services, economic value of products and services, participation in industrial exhibitions, status of the institute, satisfaction and institute’s role in health promotion. Conclusion: The indicators presented in this article have been prepared based on the balance in the Institute’s four missions, to provide the basis for assessment of the Institute’s activities in consecutive years, and possibility of comparison with other institutes worldwide.

Physical Activity Pattern and Personal-Social Factors of Mothers During Pregnancy And Infant Birth Weight Based On MET Scale: A Case-Control Study

Background

Low birth weight is one of the most important public health issues in developing and developed countries and identifying its etiology is important for prevention.

Objectives

Considering the unknown impact of physical activity on low birth weight, this research was conducted to investigate the relationship between physical activity and low birth weight.

Patients and Methods

This research was conducted using a case-control design. The control group was made of 500 women with normal birth weight infants and the case group included 250 women with low birth weight infants from the selected hospitals in city of Tehran. The information was gathered using a researcher-made questionnaire which was prepared for determining the relationship between mothers’ lifestyle during pregnancy and infants' low birth weight using social determinants of health approach. In this questionnaire, scope of physical activity was investigated in three groups of athletic activities, activities at home and leisure activities. Activity intensity was determined using MET scale and the data were analyzed in SPSS software using independent t-test, Chi-square and logistic regression.

Results

In the present research, based on the results of multiple logistic regression test, an increase in the time spent on sport activities (OR = 2.20) and home activities (OR =1.44) (P = 0.003) was accompanied by increased chance of giving birth to low birth weight infants; in contrast, one hour increase of leisure activities decreased the probability of low birth weight infants by 0.32 (P = 0.008).

Conclusions

An increase in the time spent on sport and home activities, even after considering other influential factors, was related to low birth weight.

Psychosocial needs assessment among Earthquake survivors in Lorestan province with an emphasis on the vulnerable groups

Introduction:

Iran is one of the ten most earthquake prone countries in the world. Earthquakes not only cause new psychological needs among the population but particularly so when one considers vulnerable groups. This in - depth study was conducted with the aim of assessing psychosocial needs six months after an earthquake happened in the west of the county in Lorestan province.

Methods:

This is a qualitative study using focus group discussion that focuses mainly on the vulnerable groups (women, children, elderly and disabled people) after an earthquake in Boz-azna; a village in Lorestan province in western part of Iran.

Findings:

Results of the psychosocial assessment indicated feelings of anxiety and worries in four vulnerable groups. Horror, hyper-excitement, avoidance and disturbing thoughts were observed in all groups with the exception of the elderly. Educational failures, loneliness and isolation were highlighted in children. All groups encountered socio-economic needs that included loss of assets and sense of insecurity and also reproductive problems were reported in women's group.

Discussion and Conclusion:

Modification of a protocol on psychosocial support considering the context of the rural and urban areas with emphasis on the specific needs of the vulnerable groups is an appropriate strategy in crisis management. It seems that appropriate public awareness regarding assistance programs can be effective in reducing stress and needs of disaster survivors.

The main advantages of community based participatory health programs: an experience from the islamic republic of iran

Introduction:

Community based participatory program is an approach that emphasize on community empowerment as an important tool in health promotion especially in low and middle income countries. The aim of this study is in-depth understanding the strengths point of active community based participatory programs in Iran in order to develop a scientific foundation and basis for future policy and decision making.

Methods:

This study was a qualitative study using focus group discussions. Thirteen community based programs related to health that were active for last five years were selected and assessed. Data analysis was based on deductive-inductive content analysis approach considering the predetermined structure according to study questions.

Results:

In this study, strengths points of community participatory health programs based on the locality of the implementation of the programs; governmental organization and nongovernmental organizations (NGO’s) were evaluated. The main strengths of these programs were the presence of the spirit of empathy and high motivation in working for community, absorbing the community assistance, community empowerment, presence of female volunteers, using local volunteers, creation of social prestige and evidence based decision making for community problem solving.

Conclusion:

Capacity building of the community, NGOs and policymakers plays key role in participation mechanisms, partnership, team working and mobilizing of necessary resources in the promotion of participatory community based health programs.