[Show abstract][Hide abstract] ABSTRACT: Alcohol use and its disorders are associated with increased risk of suicidal behaviors Research has shown that 6-8% of those who use alcohol have a history of suicide attempt. Given the prohibition of alcohol use legally, the increased alcohol consumption, and the lack of strong evidence in favor of its use associated with suicide in Iran, this study was conducted to determine the link between suicide attempt and alcohol abuse. The case-crossover method was used in this research. Out of 305 referrals to the emergency room due to a suicide attempt, 100 reported drinking alcohol up to six hours before their attempt. Paired Matching and Usual Frequency were employed to analyze the data with STATA 12.0. The probability of attempting suicide up to six hours after drinking alcohol appeared increased by 27 times (95% CI: 8.1-60.4). Separate analysis for each of these hours from the first to the sixth hour after alcohol use was also performed. Fifty percent of attempted suicides happened one hour after alcohol use. Relative risk for the first and second hour was 10% and 5% respectively. Alcohol use is a strong proximal risk factor for attempted suicide among Iranian subjects. Prevention of alcohol use should be considered in setting up of the national Suicide attempt prevention program.
Global journal of health science 11/2015; 8(7):58. DOI:10.5539/gjhs.v8n7p58
[Show abstract][Hide abstract] ABSTRACT: Previous suicide attempt is the most important predictor of death by suicide. Thus preventive interventions after attempting to suicide is essential to prevent reattempts. This paper attempts to determine whether phone preventive interventions or other vehicles (postal cards, email and case management) are effective in reattempt prevention and health promotion after discharge by providing an overview of studies on suicide reattempts. The research investigated in this review conducted from 1995 to 2014. A total of 26 cases related to the aim of this research were derived from 36 English articles with the aforementioned keywords Research shows that providing comprehensive aids, social support, and follow-up after discharge can significantly prevent suicide reattempts. Several studies showed that follow-up support (phone calls, crisis cards, mails, postal cards.) after discharge can significantly decrease the risk of suicide. More randomized controlled trials (RCT) are required to determine what factors of follow-up are more effective than other methods.
Global journal of health science 09/2015; 8(5):145. DOI:10.5539/gjhs.v8n5p145
[Show abstract][Hide abstract] ABSTRACT: Implementing community-based psychiatric services is one of the priorities of the WHO/EMRO mental health programs. This study presents an aftercare service, as a community based-service, for patients with severe mental illness (SMIs).
In this randomized controlled clinical trial design, 176 patients, who attended selective hospitals with SMI, were allocated into three groups: clinical case managers provided by general practitioners, nurses and the control group (usual treatment). The clients and their caregivers received monthly home visits (education and treatment supervision). The effectiveness of the intervention was measured by indicators of psychopathology such as scores of YOUNG, caregivers' knowledge and satisfaction with the services. Health-related quality of life (SF-36) was considered as the primary outcome variable. Data were collected at baseline and at 12 months follow-up. Direct and indirect medical costs were obtained through a periodic completion of questionnaires and interviews by caregivers. Cost effectiveness ratio was estimated as cost per QALY gained in each group. SPSS 16.0 was used in this survey and statistical methods were chi-square, ANOVA, Scheffe as post-Hoc test and paired sample t-test with 95% confidence interval and 0.05 significance level.
The results of our study revealed that the score of YOUNG, caregivers' knowledge and satisfaction with service were improved in both intervention groups after 12 months. Improvement in health-related quality of life was observed in the general practitioner and nurse group. The incremental cost effectiveness ratio was 5740807 IRR and 5048459 IRR per QALYs gained in the general practitioner and nurse groups, respectively.
The model of aftercare services provided by trained nurses is the most cost- effective and feasible model for Iran's socio-economic conditions with low resource allocations.
Medical journal of the Islamic Republic of Iran 07/2015; 29:196.
[Show abstract][Hide abstract] ABSTRACT: Suicide prevention is one of the priorities in policies of Iranian Ministry of Health and Medical Education (MHME). The suicide prevention program had two main parts of identifying and treatment of the depressed and suicide high risk individuals by Primary Health Care (PHC) network. The main aim of this study was to evaluate the results of integration of the program into PHC network in two cities with moderate to high rate of suicide with diverse socio-cultural backgrounds.
This work as a field trial study was conducted in Nahavand and Savojbolagh from April 2010 to March 2011 (12 months). A screening tool was designed. Required capacities such as treatment, referral and registration system were provided six months before the main study. The intervention phase (for one year) including the treatment process and five consultation sessions was conducted to identify depressed people and individuals with high risk of suicide. The data were analyzed by Chi square test.
After one year of intervention, the rate of committing suicide became 4.98 and 3.36 per one hundred thousand population in Nahavand and Savojbolagh, respectively (16 and 1.6 per 100,000 in the year of before intervention respectively, 2009-2010). The female: male ratio of committing suicide was 2:1 in Nahavand and 1:1 in Savojbolagh. The most common method of committing suicide was drug intoxication in both cities. The identified cases by health workers at rural setting were 33 to 44 per 1000, in which 1.3 cases per 1000 population had been approved by general physicians.
This study approved the feasibility and efficacy of integration of suicide prevention program into PHC. The increased rate of suicide in Savojbolagh could be related to low rate of screening and lack of treatment facilities (hospitalization and electroconvulsive therapy (ECT), and part-time psychiatrist. Increasing the PHC capacities could improve the health network efficiency to identify and manage depressed and at risk of suicide individuals. Screening tool/s and method have to be improved to provide better results.
Medical journal of the Islamic Republic of Iran 07/2015; 29:208.
[Show abstract][Hide abstract] ABSTRACT: This systematic review aimed to help better to understand the epidemiology of suicidal behaviors among Eastern Mediterranean Region (EMR) countries. The PubMed, EMR medex, Scopus, PsychInfo, ISI, and IMEMR were searched with no language limitation for papers on the epidemiology of suicidal behaviors in the general population, published up to August 2013. A total of 13 articles were reviewed. The incidence (per 100.000) of committed suicide ranged from 0.55 to 5.4. The lifelong prevalence of attempted suicide, suicidal plan and thoughts were 0.72-4.2%, 6.2-6.7%, and 2.9-14.1%, respectively. The figures for suicide are higher than those officially reported. Suicide behaviors' statistics is susceptible to underestimation presumably due to the socio-cultural, religious and legal barriers, not to mention the lack of well-organized registries and methodologically sound community-based surveys.
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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.
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.
BioMed Research International 01/2015; 2015:193729. DOI:10.1155/2015/193729 · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
Zolpidem is a non-benzodiazepine hypnotic drug for treatment of insomnia. It has been introduced as a lower potential agent for dependency and abusive effects.
In this study, the reported case was a 62 years old female patient suffering simultaneously with Major Depressive Disorder and Opium Dependency. After abrupt discontinuation of zolpidem, 570 mg per day, she exhibited severe withdrawal symptoms, led her to be admitted to emergency department.
Zolpidem has a potency to be abused with high risk of dependency and withdrawal syndromes particularly among elderly patients with comorbid anxiety/depressive symptoms/disorders.
[Show abstract][Hide abstract] ABSTRACT: Objective: Providing treatment and educational services for consumers and their caregivers is more effective if those services are implemented based on their characteristics and differences. To partly address this objective, the present study aimed to describe and compare characteristics and differences of chronic hospitalized and household maintained consumers and their caregivers who were regular users of educational and rehabilitation programs of the Iranian Society Supporting Individuals with Schizophrenia (ISSIS) in Tehran, Iran.
Methods: Two hundred and thirty one consumers were evaluated based on demographics, and clinical and symptom-related characteristics. Their caregivers (n = 231) were independently evaluated based on their knowledge on schizophrenia, family function, burden, and availability of social services and support for them. Data were analyzed by performing independent sample t-test and Mann-Whitney U.
Results: The study findings revealed hospitalized consumers were older, had longer length of illness, greater severity of positive and negative symptoms and lower efficacy in basic life skills in comparison with household maintained consumers. The caregivers of the hospitalized consumers had greater objective and subjective burdens and lower knowledge on schizophrenia in comparison with caregivers of household maintained consumers. While household maintained consumers had more access to medical insurance, their caregivers had more access to the supportive organizations, more availability of substitute caregiver and assistant caregiver compared with caregivers of hospitalized consumers.
Conclusion: Our findings suggest the need to promote specific interventions and treatment programs for Iranian consumers and their caregivers based on their characteristics and differences due to schizophrenia.
Declaration of interest: None.
Iranian Journal of Psychiatry and Behavioral Sciences 07/2014; 8(1):5-12.
[Show abstract][Hide abstract] ABSTRACT: Abstract
Background and Objectives: Previous suicide attempt is the most important
predictor of death by suicide. Therefore preventive interventions after attempting to
suicide is essential to prevent reattempts. This study to answer the question that
“whether phone preventive interventions or other reminders (e.g. postal cards, email,
case management, etc.) are effective in reattempts after discharge” by providing an
overview of studies related to suicide reattempts.
Methods: This is a comprehensive review of the studies using the main scientific
Results: The research investigated in this review has been conducted from 1995 to
2014. A total of 23 cases related to the objective of this research were derived from
33 English articles with the aforementioned keywords. In summation, research shows
that providing comprehensive aids, social support and follow-up after discharge can
significantly prevent suicide reattempts.
Interpretation and Conclusions: Most patients surviving one suicide attempt
reattempt particularly a short time after discharge. Most suicides occur during the
first month after discharge with a sudden increase during the first week. This rate is
more than a hundred times in public population. Therefore it is essential to persist and
maintain follow-up treatments. Several studies have shown that follow-up support
(phone calls, crisis cards, mails, postal cards, etc.) after discharge can significantly
decrease the risk of suicide. More random controlled trials (RCT) are required to
determine what factors of follow-up are more effective than other methods.
Keywords: fallow up, suicide attempt, telephone contact
[Show abstract][Hide abstract] ABSTRACT: Background: Major depression is a common disorder with great social and individual burdens. Transcranial sonography (TCS) is a useful and noninvasive measure for assessment of normal and impaired brain parenchyma. The brainstem raphe nuclei are in close association with dorsocaudal limbic system and plays an important role in depression. In this study we compared the echogenicity of the raphe nuclei in patients with major depressive disorder and the control group.
Methods: Thirty patients suffering from depression, diagnosed by a psychiatrist, and 30 cases of similar age and sex were entered into the case and control groups respectively. Semi-structural clinical conversation was done according to the DSM IV-TR in order to confirm the depression by the psychiatrist member of the group. Echogenicity of the brainstem raphe nuclei was assessed by a trained neurologist using TCS. To compare the mean echogenicity between the two groups independent sample t-test was used. In order to assess the strength of association between the disease and the echogenicity, odds ratio was also calculated.
Results: The echogenicity of the brainstem raphe nuclei was significantly decreased in depressed patients (36.7%) in comparison with the control group (10% ) (p= 0.015, OR= 5.21).
Conclusion: Echogenicity of the brainstem raphe nuclei in patients with depression is significantly lower than normal population. To confirm the results, we recommend a meta analysis considering previous articles' results.
Medical journal of the Islamic Republic of Iran 02/2014; 28:9.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to determine the frequency of various methods of suicide in Eastern Mediterranean Region by a systematic review and meta-analysis. All published articles in international database were systematically searched before September 2011. In order to analyze the data we used STATA, ver.10 software. We reported proportions with standard errors (SE) for single studies and pooled estimates for proportions of different suicidal methods based on random model meta-analysis. We included 19 articles in the final analysis. The pooled proportion of hanging, self-immolation, and poisoning were 39.7% (95% CI: 26.8%-52.7%), 17.4% (95% CI: 10%-24.8%), and 20.3% (95% CI: 14%-26.5%) respectively. Self-immolation and poisoning were gender dependent and hanging was country dependent in the meta-regression method. We found out that the 3 most common methods of suicide in EMR are hanging, poisoning, and self-immolation. These methods are estimated to account for 77.4% of all methods of suicide in EMR.
Archives of suicide research: official journal of the International Academy for Suicide Research 10/2013; 17(4):335-44. DOI:10.1080/13811118.2013.801811
[Show abstract][Hide abstract] ABSTRACT: Introduction
Parkinson's disease is one of the most disabling diseases which by electrode implantation and stimulation of subthalamic nucleus (STN), much progress has been made in the treatment of drug resistant patient. This new method of neurosurgery may have some neuropsychological side effects on the patients. The main aim of this study is to evaluate the effects of this kind of treatment on the different neuropsychological aspect of patients.
The case-control study designed for comparing two groups of patients with Parkinson's disease. Thirty patients, who underwent electrode implantation and Deep Brain Stimulation (DBS), compare with 60 patients treated with antiparkinson's drugs. These two groups matched in age, sex, Parkinson's disease duration and Parkinson's severity scores. Measurements: the UPDR scale was used to assess the severity of the Parkinson's severity. Beck Depression Inventory questionnaire (BDI) and Hamilton Anxiety Rating Scale questionnaire (HARS) were used to evaluate the depression and anxiety consequences of DBS.
Mini Mental Status Examination (MMSE) and Clock Drawing Test (CDT) were used to evaluate the cognitive and executive function of the study subjects.
Patients with STN stimulation showed lower level of anxiety and depression, however, the cognitive status were more deteriorated in study subjects than control group.
Patient with DBS surgery have to be followed up for neuropsychiatric symptoms particularly for the cognitive deterioration in long term period.
[Show abstract][Hide abstract] ABSTRACT: Severe mental illness is responsible for a significant proportion of burden of diseases in Iranian population. People with severe mental illnesses are more likely to have high rates of non-attendance at follow-up visits, and lack of an active follow-up system, particularly in the country's urban areas that has resulted in the revolving door phenomenon of rehospitalizations. Therefore, there is an increasing need for implementation of effective and cost-effective aftercare services.Method/DesignThis is a randomized control trial with the primary hypothesis that aftercare services delivered to patients with severe mental illnesses in outpatient department and patient's home by a community care team would be more effective when compared to treatment as usual (TAU) in reducing length of hospital stay and any psychiatric hospitalization. Patients were recruited from three psychiatric hospitals in Iran. After obtaining informed written consent, they were randomly allocated into aftercare intervention and control (TAU) groups. Aftercare services included treatment follow-up (through either home care or telephone follow-up prompts for outpatient attendance), family psychoeducation, and patient social skills training that were provided by community mental health teams. Patients were followed for 12 months after discharge. The primary outcome measures were length of hospital stay and any hospitalization in the 12 month follow-up. Secondary outcome measures included patients' clinical global impression, global functioning, quality of life, and patient's satisfaction. The trial also allowed an assessment of direct cost-effectiveness of the aftercare services.
This paper presents a protocol for an RCT of aftercare services delivered to patients with severe mental illnesses within patients' home or outpatient department. The findings of this study can influence policy and program planning for people with severe mental illnesses in Iran.Trial registrationIRCT201009052557N2.
[Show abstract][Hide abstract] ABSTRACT: Premenstrual syndrome (PMS) refers to a cyclic appearance of somatic and psychiatric symptoms that affect some women. Finding an effective and safe method for the treatment of PMS has always been a serious concern, because approximately 40% of women report PMS, and in 2-10% of cases it is severe enough to affect their life style and job.
The purpose of the present study is to evaluate the effect of omega-3 fatty acids on the treatment of PMS.
A randomized double blind controlled trial was performed on 184 eligible women. The eligible women were randomly assigned into two groups. The number of women who have finalized the study with us was 124. In the case group (omega-3 group=group A, n=70), omega-3 in an amount of 2g was prescribed for a one per day basis on a single dosage (two 1g pearls), and in the control group (placebo group=group B, n=69) 2 placebo soft gel, which were completely similar to omega-3 soft gels, were prescribed. The severity and duration of each of the symptoms were compared in both groups 1.5 and 3months after the beginning of treatment.
There were no significant differences between the two groups according to age, BMI, level of education, and the severity and duration of primary symptoms. After 45days from starting omega-3, the mean severity of depression (P=0.03), anxiety (P=0.02), lack of concentration (P=0.03) and bloating (P=0.02) in the case group, were all significantly lower than in the control group. The duration of depression (P=0.04) and bloating (P=0.031) in the case group were less than in the control group. After 90days from starting the treatment, the mean severity of depression (P=0.007), anxiety (P=0.004), lack of concentration (P=0.009), bloating (P=0.004), nervousness (P=0.01) and the duration of depression (P=0.01), nervousness (P=0.02), anxiety (P=0.03), lack of concentration (P=0.02), bloating (P=0.004), headache (P=0.04) and breast tenderness (P=0.02) were all lower in the case group.
It appears that omega-3 fatty acids may reduce the psychiatric symptoms of PMS including depression, nervousness, anxiety, and lack of concentration and may also reduce the somatic symptoms of PMS including bloating, headache and breast tenderness. These effects increased by longer duration of treatment.
Complementary therapies in medicine 06/2013; 21(3):141-6. DOI:10.1016/j.ctim.2012.12.008 · 1.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Psychiatric hospitalization of patients imposes heavy burdens on caregivers, but little is known about this issue in Iran. The present cross-sectional study aimed to investigate the risk factors associated with psychiatric hospitalization of patients with schizophrenia who were the regular clients for the educational programs of The Iranian Society for Supporting Individuals with Schizophrenia (ISSIS) in Tehran, Iran.
Methods: 231 male and female study subjects and 231 of their caregivers participated in the study. The study subjects were independently assessed in demographics, clinical and symptom-related characteristics and basic life skills domains. Their caregivers were assessed in domains of knowledge on schizophrenia, burden, social support, family function, and the patterns of relationships with their patients and the role of health and supportive services. Data were analyzed by performing logistic regression model.
Results: Old age, low level of education, unemployment, greater severity of positive and negative symptoms, poor basic life skills among subjects, and objective family burden, inadequate knowledge on schizophrenia, low perceived social support and lack of medical insurance among caregivers were the most important factors associated with psychiatric hospitalization among the clients.
Conclusions: Some factors originated in Iranian patients and their caregivers could cause patients’ pathways to psychiatric hospitalization. Although the study results did not establish causation, based on the findings, psychoeducational interventions may reduce schizophrenia referral and lower the rate of need to inpatient services in Iran.
Declaration of interest: None.
[Show abstract][Hide abstract] ABSTRACT: Comorbidity of chronic tinnitus and mental disorders may result in more disability.
This research provides an evaluation about the effects of medically treated comorbid mental disorder on chronic tinnitus.
Fifty-five patients diagnosed with chronic tinnitus and mental disorders were randomly requited by producing a before-after design. They underwent three months of drug therapy for comorbid mental disorders by psychiatrists. Study instruments are Tinnitus Handicap Inventory, Tinnitus Questionnaire, Loudness Match Tinnitus, Hamilton Depression Rating Scale, Beck Anxiety Inventory, The Structured Clinical Interview and Symptom Check List -90.
Three months medical treatment puts forward the argument that among mental disorders, anxiety and major depressive disorder demonstrate a significant reduction. Pearson Correlation coefficient ostensibly reveals that there is no significant relationship between mental disorders and tinnitus severity. The statistics lend support to profound effect of major depressive disorder as a key factor on tinnitus disability exacerbation. Medical treatment also touches on issue such as tinnitus severity, its disabling effects and TQ subscales that statistics shows significant trends in their reduction.
Findings lay emphasis on tinnitus severity reduction and connection might be established between alleviated mental disorders comorbidity and the improvement of quality of life.
The international tinnitus journal 12/2012; 17(2):163-168. DOI:10.5935/0946-5448.20120029
[Show abstract][Hide abstract] ABSTRACT: This study aims to demonstrate the sexual functioning of elderly Iranian retirees who reside in Tehran, Iran. The participants' sexual interests are also reviewed in association with their physical and mental health status. The authors recruited 390 elders (199 men, 191 women) by convenient sampling from 4 retirement organizations in Tehran from April 2007 to October 2008. Tools for evaluation included use of a demographic questionnaire, modified Brief Index of Sexual Functioning for Women, Brief Sexual Function Inventory for Men, and the General Health Questionnaire. Sexual activity was "important/very important" in 56.6% and 17.0% of men and women, respectively (p < .005), but their satisfaction from sexual life was similar. Sexual desire and activities were more common among men than among women (p < .05). Impotency and ejaculatory problems were 40% and 33%, respectively, among the male study participants. This study indicated that having a sexual partner was the most important variable for sexual activities. This study provides a profile of sexual behaviors among elderly people in Iran and shows that although sexual decline and dysfunction are seen in both genders, both groups express satisfaction with their sexual affairs when they have a partner available.
Journal of Sex and Marital Therapy 07/2012; 38(4):365-77. DOI:10.1080/0092623X.2011.628438 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to validate the Farsi version of Neuropsychiatric Inventory (F-NPI), with the aim of promoting clinical assessment and local research on evaluation of neuropsychiatric symptom profiles of individuals with dementia in Iran.
In this cross-sectional, psychometric study, 100 patients with dementia in the age range of 60–90 years participated. Two trained psychiatrists interviewed the study subjects. Positive and Negative Symptoms Scale (PANSS) and Geriatric Depression Scale (GDS) were used to determine the concurrent validity. Testretest,inter-rater reliability and internal consistency were calculated. Discrimination validity was determined,using a matched control group consisting of 49 participants without dementia. Cronbach’s α and Pearson’ scorrelation coefficients were used to analyze the data.
The internal consistency (Cronbach’s α = 0.9) was excellent. The inter-rater reliability varied between 0.6 and 0.98 for frequency, severity and total scale of the F-NPI, and test-retest reliability was between 0.4 and 0.96. Concurrent validity varied between 0.3 and 0.9 (P < 0.05). The most prevalent symptom was “apathy” and the least prevalent was “euphoria”.
The Farsi version of NPI has satisfactory psychometric indexes and is applicable for clinical and study works in Iranian community.
International Psychogeriatrics 02/2012; 24(2):223-30. DOI:10.1017/S1041610211001797 · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Complaining of psychiatric symptoms is more common among individuals suffering from tinnitus. The aim of this study is to determine the psychiatric diagnosis and symptoms of patients with chronic tinnitus. Materials and Methods: Four hundred patients with chronic tinnitus from the registry of Otorhinolaryngology Research Center of Rasoul General Hospital, Tehran, Iran were enrolled. The study instruments were Structured Clinical Interview for DSM-III-R, axis I psychiatric disorders, Tinnitus Handicap Index (THI) and Symptom Check List-90-Revised. Results: The lifetime and current psychiatric disorders among patients with chronic tinnitus were 60% and 55% respectively. Depressive and anxiety disorders were the most common type. Females with severe THI were 75.6% versus 63.9% in men. Discussion: The comorbidity of chronic tinnitus with depressive and anxiety disorders is more common. This may have treatment implication to alleviate the stress and dysfunction resulted from chronic tinnitus.
The international tinnitus journal 01/2011; 1616(16):118-22.
[Show abstract][Hide abstract] ABSTRACT: In the last 30 years, ever since the PHC network in Iran has been established, the job duties of Behvarzes (Mental Health Workers in rural areas) have been constantly increasing. The aim of this study was to determine the burnout level, mental health status and the severity of occupational stress among Behvarzes.
All Behvarzes (227) working in areas covered by Iran University of Medical Sciences were considered for participation in the study. Maslach Burnout Inventory, GHQ-12, and Stainmentz questionnaires were used.
The completed questionnaires were returned by 93% of the subjects. The mean score of job stress was in the first percentile (42.8 ± 27.16). 17.6% of the study subjects had moderate to severe level of burnout; 12.3%, 5.3% and 43% of the subjects had abnormal scores on emotional exhaustion, depersonalization and personal subscales respectively; and 28.3% of the cases were suspected to have mental disorders by GHQ.
In spite of increasing assigned jobs to Behvarzes, job stress and burnout are not seriously distressful. Providing more desirable personal accomplishment for Behvarzes by reducing job ambiguity/ conflict, participating in planning new programs, and improving interaction with health authorities may help them to overcome their job related pressure and increasing workload.