University of Social Welfare and Rehabilitation Sciences

Background Static stretching is a treatment that reduces spasticity by elongating the muscle fibers. Dry needling is also a novel intervention that reduces spasticity by destroying dysfunctional endplates. Plantar flexor spasticity can cause gait disturbances and impaired balance in patients who have had a stroke. Therefore, reducing the spasticity of these muscles can improve the patient’s independence and overall function. This study reported the additional effects of dry needling on static stretching in reducing spasticity and function in a chronic stroke patient. Case presentation The patient was a 47-year-old Iranian woman with a past-7-month history of stroke and plantar flexor muscle spasticity. In this study, interventions were conducted for 5 days. In the treatment session, first dry needling (60 seconds × 3 days/week for 1 week total) was applied on the gastrocnemius, and then, an orthosis was used for static stretching (20 minutes × 5 days/week for 1 week total). The outcome measures were the Modified Modified Ashworth Scale, active and passive range of motion, the timed up and go test, and the European Quality of Life questionnaire . The patient was assessed at baseline (T0), immediately following treatment (T1), and at 1-week follow-up (T2). The results were reported as follows: The Modified Modified Ashworth Scale score decreased from 2 at T0 to 1 at T1 and remained 1 at T2. Active range of motion increased from 10° at T0 to 25° at T1 and decreased again to 15° at T2. Passive range of motion increased from 40° at T0 to 50° at T1 and decreased again to 45° at T2. The timed up and go test decreased from 50 seconds at T0 to 40 seconds at T1 and increased again to 42 seconds at T2. Her European Quality of Life questionnaire score increased from 0.25 at T0 to 0.39 at T1 and remained unchanged at 0.39 at T2. Conclusion This case study reported a patient with post-stroke spasticity. After dry needling in combination with static stretching, spasticity and overall function improved. It would be beneficial to conduct a randomized clinical trial study with a control group to comprehend the additional impact of dry needling on static stretching. Trial registration IRCT20230719058844N1, Registered 7 August 2023, https://irct.behdasht.gov.ir/trial/71395.

Objective The increasing demographic shift toward an aging population in Iran highlights the urgent need to understand how socioeconomic inequalities affect the ability of older individuals to access essential resources and services. This study examined socioeconomic inequalities in meeting the needs of older people in Hamadan, Iran. Method This cross-sectional study was conducted on the 501 elderly people living in western Iran. Data collection was carried out from December 1, 2022 to March 31, 2023, among elderly individuals who were registered in the SIB (Unified Health System). system. Elderly were selected by stratified random sampling among 17 comprehensive urban health centers (CURHCs) in Hamadan province. The data collection process consisted of four sections, including: A demographic information questionnaire, the Abbreviated Mental Test (AMT) questionnaire to determine the absence of dementia, cognitive impairment and the Barthel Index questionnaire to measure functional independence status and 4) Camberwell Assessment of Need for the Elderly. Socio-economic inequalities were assessed using the concentration index and a decomposition approach, determining the contribution of each factor to the socio-economic inequality at 95% CI. Results The concentration index for met needs was 0.15 (95% CI: 0.12, 0.19), indicating a concentration of met needs among the elderly with higher economic status. Subgroup analysis (with statistically significant results) revealed that the lowest levels of met needs were observed among illiterate people (53.09% vs. 92.11% (p < 0.001)) and those with dyslipidemia (55.86% vs. 65.98, p = 0.050). Education (60.38%) and economic status (25.32%) were the primary contributors to inequality in elderly individuals’ met needs. Conclusion The findings reveal significant disparities in meeting the needs of the elderly, particularly among the wealthy, the illiterate, and those with dyslipidemia. To address these issues, public health initiatives should focus on expanding education and providing economic support to disadvantaged older adults. In addition, personalized health care for those with chronic conditions is essential. Proposed solutions include training health care workers in geriatric care, developing community-based programs with home care, and creating economic support packages for low-income seniors.

Suicide is a complex public health issue that necessitates a comprehensive approach to prevention. This paper adopts an ecological perspective, emphasizing the interplay of factors across individual, interpersonal, community, and societal levels that contribute to suicidal behavior. By integrating theoretical frameworks such as Bronfenbrenner's Ecological Systems Theory and the Social-Ecological Model, we provide a robust structure for understanding the multifaceted nature of suicidal behaviors. Our analysis highlights the need for policies and interventions that address both immediate and long-term influences on suicidal behavior, with the ultimate goal of reducing suicide rates across diverse populations.

Background Family participation in patient care is critical for delivering quality care, and many interventions in the healthcare system have been dedicated to improving this complex process. There is no agreement about what this participation means and how it should be conducted. The current study aims to clarify the concept of family participation in hospitalized patient care. Materials and Methods This study used a hybrid model and a three-step concept analysis. In the theoretical phase, credential databases were searched to retrieve studies published from 1990 to 2022. In the fieldwork phase, semistructured interviews were conducted with six patients, six family members, and five healthcare workers. In the last phase, data from these steps were analyzed using conventional content analysis based on the Graneheim and Lundman approach. Results According to the final analysis, ‘family participation in hospitalized patient care’ is a centric-process multidimensional phenomenon that includes involvement in comprehensive patient care and healthcare decision-making. This partnership is based on “interactions”, “information exchange”, “collaboration between families and healthcare teams”, and “support from the healthcare system”. If it is implemented in a planned and coordinated manner, family participation can lead to positive consequences for the healthcare system and favorable outcomes for hospitalized patients. Conclusions This study provides insights into the concept of family participation as well as its features and factors affecting its correct implementation. Healthcare providers need to boost their knowledge regarding this type of care and improve clinical practice in this area.

Recovery is an important component in the treatment of addiction-related policy making. Although there have been many studies on addiction in West Asia, the meaning of addiction recovery from the substance users’ point of view has not been explored. In this study, we assessed Iranian drug users’ perspectives on recovery from addiction. A qualitative content analysis study design was utilized where 31 substance users from 5 major Iranian provinces were recruited via purposeful and convenient sampling. Sampling was terminated when data saturation occurred. Semi-structured interviews were conducted for data collection. All interviews were tape-recorded and transcribed verbatim and the text was open-coded. Evolving concepts were regrouped to form abstract categories and these were sorted, compared, and contrasted systematically. Finally, the findings were compared with the original tapes, and equality between texts, extracted categories, and themes was ensured. Twenty men and eleven women participated in the study (age range of 19 to 60 years). All the participants had repeatedly experienced drug withdrawal. The research participants believed “Total abstinence” and “Sustained behavior change” were two main conditions of recovery. They described recovery as a “Voluntary process” and emphasized that “Social acceptance” of drug users is essential for recovery. According to Iranian drug users, recovery is a process of voluntary total abstinence, without replacing the previous substance with another along with positive, sustainable, and visible changes in a person’s behaviors. Practitioners in Iran and neighboring regions can use these findings to help recovering addicts and inform policymaking initiatives on the treatment of substance use disorders.

Background Clinical reasoning (CR) skills are among the most important nursing competencies for providing safe and effective care in critical care units. Development of CR skills in nursing needs a well-designed interactive process for change to effectively support clinical competence promotion. The aim of this study was to develop CR skills among coronary care nurses through an action plan. Methods This participatory action research study was conducted in 2021 based on the framework of Hart and Bond (1995). Study setting was the coronary care unit of a leading heart center in Rasht, Iran. An action plan was designed and implemented with three main components, namely efficiency of nursing education, effective nursing management, and personal professional development. The results of the plan were provided to participants and strategies for improving the plan were determined. Quantitative outcome assessment was performed using the Nurses’ Clinical Reasoning Skills Checklist and the Nurses’ Clinical Reasoning Scale and data were analyzed through the Wilcoxon’s test. Qualitative outcome assessment was performed through focus group discussions and data were analyzed through conventional content analysis. Results The mean scores of CR skills significantly increased after the action plan and participants were satisfied with the plan. The four main categories of the outcomes of the plan were improvement of the thinking process, improvement of professional commitment, improvement of professional competence, and improvement of interprofessional communications. The challenges of the plan were limited efficiency of educational courses on the nursing process, incoherence in nursing documentation, mentors’ inadequate supervision and instructions, and mentors’ role pressure. Conclusions The CR skills action plan can improve coronary care nurses’ CR skills and their competency in making sound clinical decisions and providing safe and quality care services.

Objective The rising prevalence of substance use amongst young people (ages 18–25) is a critical global health issue, especially in non‐Western contexts where cultural factors impact mental health. This study explores the role of uncertainty mentalizing—understanding ambiguous social situations—in individuals with borderline personality traits and its link to substance use, a relationship that remains underexplored amongst young Iranian people. It further examines the mediating role of borderline personality traits in the relationship between uncertainty mentalizing, emotion dysregulation and substance use severity. Method The study included 185 people who use substances aged 18–25 years who completed questionnaires related to the research variables. Results Analysis Revealed Significant Positive Associations Amongst all Variables ( p < 0.001). Borderline Personality Traits ( β = 0.19, p < 0.05) and Uncertainty Mentalizing ( β = 0.45, p < 0.001) Directly Influenced Substance Use Severity. Uncertainty Mentalizing Also Indirectly Affected Substance Use Severity Through Borderline Personality Traits (Indirect Effect = 0.093, p < 0.05) and Notably Impacted Borderline Personality Traits ( β = 0.49, p < 0.001). However, Emotion Dysregulation Did Not Show Significant Direct or Indirect Effects. Discussion These results highlight the critical role of uncertainty mentalizing in substance use severity, both directly and through its influence on borderline personality traits, suggesting that interventions aimed at enhancing uncertainty mentalizing may effectively address co‐occurring issues related to substance use and borderline personality traits.

BACKGROUND During the COVID-19 pandemic, nursing care was very complicated and confusing due to the special conditions of this time period and due to the lack of objective evidence to provide evidence-based nursing care. The purpose of this study was to post-COVID-19 investigate nurses’ lived experiences of evidence-based care in Iran. MATERIALS AND METHODS This research was conducted through a qualitative approach using Husserli’s descriptive phenomenological method. The participants included nurses working in the wards of COVID-19. Sampling in this study was conducted using a targeted method. People were selected based on inclusion and exclusion criteria. A code of ethics and necessary permits were received. Data collection was performed using unstructured interviews. The time of the interviews varied between 30 and 60 minutes. All interviews were recorded and then transcribed. The method proposed by Colaizzi was used for data analysis. Lincoln and Guba’s criteria were used for the accuracy and robustness of the data. Also, MAXQDA software was used for data management. RESULTS The main themes and sub-themes in this study include barriers (lack of mastery in searching for evidence, lack of prioritization of evidence-based care, lack of availability of sufficient evidence, and the complexity of the condition of the COVID-19 disease) and facilitators (need for new evidence, a different care context, the need for extensive training, and the need to improve the nursing care). CONCLUSION The findings of this research showed that based on the experiences of nurses, there are still barriers to patient care after the COVID-19 pandemic, and in addition, there are facilitators that are effective in the development of evidence-based care. We recommend that based on examining barriers and facilitators in this study, necessary planning should be performed to conduct applied research, develop clinical regulations, and better manage patients in the future.

BACKGROUND Reproductive health (RH) is a critical human right that requires safeguarding in all contexts, including during disaster situations. Nevertheless, RH services frequently face neglect in disasters. In view of the issue’s importance and the notable gap in scientific documentation, this research was conducted to examine the underlying factors that lead to the neglect of RH in post-disaster settings in Iran. MATERIALS AND METHODS A qualitative study was conducted using the method of content analysis, by performing in-depth semi-structured interviews in 2021–2022. Interviews were continued until the point of data saturation. The selection of participants involved a purposive sampling approach, drawing from various stakeholders, including recipients and providers of RH services, key health system and risk management officials, faculty members, relief personnel, and non-governmental organization members. The study’s setting encompassed the health system, disaster risk management organization, and the Kermanshah earthquake-affected areas. To ensure the reliability and robustness of the data, Lincoln and Goba criteria were used, and Granheim and Lundman methods were further utilized for their analysis. RESULTS Data saturation was achieved after conducting 23 interviews. The findings of this study identified several key factors contributing to the neglect of RH in post-disaster scenarios: 1) RH: A neglected priority, irrespective of critical conditions; 2) the decline of RH in the shadow of multiple needs; and 3) lack of attention to the differences in women’s needs. CONCLUSION The health system should prioritize RH in both normal and disaster situations. This requires promoting awareness among the general population and experts. It is recommended to develop comprehensive education programs, covering topics related to RH. Advocacy for RSH rights is recommended. Post-disaster needs and access to RH services should be prioritized in planning and resource allocation. Education on gender differences and vulnerabilities is important for officials and responders involved in risk management and post-disaster efforts.

The new managerial approach demands the profound examination of capacities, resources, and facilities in social institutions and organizations and optimum and systemic utilization of capacities such as individuals’ abilities, expertise, and skills within the framework of social institutions. This approach will thus empower the community, which is the most appropriate platform for sustainable development, and improve systemic and integrated management. The study is designed systematically to identify the capacities of social institutions to empower the existing capacities and plan management and educational programs in a better manner to use these capacities within communities. This systematic review study is conducted until February 15, 2024. The PRISMA system was used to track the review process and findings. Databases were searched for relevant articles, and the STROBE checklist was used to evaluate the quality of the articles. The community-based social organizations will still face budgetary challenges and costs in their capacity-building efforts. As such, advanced management techniques such as teamwork, collaboration and coordination between departments, innovative thinking, brainstorming, or even the use of program evaluation and analytical actions can help reduce possible challenges. This calls for the availability of exact management models and planners in both government systems and people-centered systems to coordinate such capacities. This will seek to shed more light on the important role of social institutions and hence serve to give a clearer understanding of challenges, opportunities, and supportive actions for such institutions to contribute to better government system management.

Background Hypertension, commonly known as the silent killer, is one of the most prevalent cardiovascular disorders among older adults and represents a significant burden on healthcare systems worldwide. Spiritual well-being appears to play a critical role in fostering resilience and facilitating the adoption of a health-promoting lifestyle in older hypertensive patients. Consequently, this study was undertaken in southern Iran to investigate the associations among spiritual well-being, resilience, and a health-promoting lifestyle in this population. Methods In this descriptive-analytical, cross-sectional study, 230 older adult hypertensive patients attending the Fasa Cardiac Clinic in southern Iran were recruited using convenience sampling. Data were collected via a demographic information form and three self-report questionnaires: The Health Promoting Lifestyle Profile, the Paloutzian and Ellison Spiritual Health Scale, and the Connor-Davidson Resilience Scale. Statistical analyses were performed using SPSS version 25, employing descriptive statistics, Pearson correlation coefficients, and linear regression analyses, with significance determined at p < 0.05. Results The mean age of the participants was 64.36 ± 6.06 years, with the majority being male (66.90%) and residing in urban areas (94.80%). Among the participants, 70.44% were married and 41.74% were employed in government positions. The mean scores for the health-promoting lifestyle, spiritual well-being, and resilience measures were 127.70 ± 17.30, 83.30 ± 18.40, and 62.50 ± 14.10, respectively. Furthermore, significant direct correlations were observed between spiritual well-being and resilience (r = 0.37, p < 0.001) and between spiritual well-being and a health-promoting lifestyle (r = 0.47, p < 0.001). Additionally, a robust positive correlation emerged between health-promoting lifestyle and resilience (r = 0.52, p < 0.001), with spiritual well-being proving to be a significant predictor of both a health-promoting lifestyle and resilience in this cohort. Conclusion In light of the demonstrated predictive role of spiritual well-being in enhancing both resilience and the adoption of health-promoting behaviors, interventions aimed at bolstering spiritual well-being may serve as a valuable resource. This approach holds promise for improving the overall health of older adults and potentially reducing the incidence of chronic diseases often linked to unhealthy lifestyle choices.

Background Iran’s demographic trends indicate significant aging, with intensive caregiving linked to mental health issues among caregivers, especially during the Covid-19 pandemic. This study aimed to evaluate the impact of Mehrpishegan’s web-based intervention on depression, anxiety, and stress levels among informal primary caregivers of older adults in Iran. Methods This study was a parallel-group, superiority, single-blinded randomized controlled trial conducted in Tehran. Eligible participants were informal caregivers with primary caregiving responsibility, access to the internet and a smart device, at least one month of caregiving experience, and the ability to use a web-based intervention. The primary outcomes were measured at baseline, 3 months, and 6 months using DASS-21. Participants with mild and moderate levels at baseline were randomized into intervention (n = 83) and control (n = 80) groups. The intervention group accessed the website, which provided structured educational content and chatrooms(psychologist-led for three months, then peer-led). Engagement was measured via session attendance, forum participation, and educational material usage. Data were analyzed using repeated measures ANOVA based on the intention-to-treat (ITT) and per-protocol approaches. Results Of the participants, 128 completed the final assessment at six months, resulting in an attrition rate of 20%. The intervention group showed a small decrease in depression (10.23 ± 0.80 vs. 10.48 ± 0.75, diff = 0.253; 95% CI = -0.24, 1.94), anxiety (6.70 ± 0.64 vs. 7.86 ± 0.60, diff = 1.17; 95% CI = -2.93, 0.59), and stress (13.94 ± 0.78 vs. 15.16 ± 0.74, diff = 1.22; 95% CI = -3.37, 0.92), but none of these differences were statistically significant (p > 0.05). Effect size calculations indicated small reductions in anxiety (d = -0.30) and depression (d = -0.28) at three months, though these remained below the threshold for clinical significance (|d| < 0.5). Conclusions Although the web-based intervention showed some improvements in caregivers’ mental health outcomes, the changes were not significantly different from those in the control group. Several challenges, including internet disruptions, voluntary participation, and the impact of the COVID-19 pandemic, may have influenced these outcomes. To enhance the effectiveness of web-based support programs, future interventions must overcome technological barriers, strengthen caregivers’ digital competencies, tailor content to individual needs, and address key mental health risk factors. A more personalized and accessible approach could improve engagement and long-term benefits for caregivers. Trial registration The protocol of this research was registered in the Iran Randomized Clinical Trial Center with registration number IRCT2 02010 12,048 999N1 on 25 December 2020.

Woodhouse-Sakati syndrome (WSS) is a rare autosomal recessive neuroendocrine disorder characterized by a variety of endocrine and neurological involvement, including extrapyramidal symptoms and intellectual disability. This report presents five Iranian patients with WSS with their genetic characterizations, also reporting the first Iranian patient to undergo Deep Brain Stimulation (DBS). We highlight five Iranian patients with mutations in DCAF17 gene presenting with variable features of WSS, with symptom onset in early adolescence. Whole exome sequencing identified four homozygous variants (c.436delC, c.982-2A>G, c.580C>T, and c.838+1G>A) within the DCAF17 gene in the probands. Patients had variable responses to common therapies, and one patient achieved significant improvement following DBS. We expand the clinical and genetic heterogeneity among Iranian patients and suggest the c.436delC variant as a founder mutation in the region. We highlight the importance of considering WSS in patients with both neurological and endocrine symptoms and suggest DBS as a potential treatment option.

Background: To assess the 10-item Spine Functional Index (SFI-10) clinimetric properties in a general musculoskeletal disorder (MSD) spine population. Ascertain the psychometric characteristics' consistency with the developmental study findings for structural and criterion validity, internal consistency, and floor/ceiling effect; establish the longitudinal characteristics for test-retest reliability, responsiveness, construct validity, and error scores; and clarify practical characteristics of readability, missing responses, and time/errors for completion/scoring related to administrative burden. Methods: A longitudinal study of deidentified spine MSD patients (n = 1317, 53.4% female, age = 18-91yrs, av = 49.5 ± 16.4yrs; neck = 36.5%, mid-back = 8.4%, low back = 56.0%, multi-site = 0.3%) who completed the SFI-10, the Patient Specific Functional Scale (PSFS), and Numerical Rating Scales for Global-function (G-NRS) and Pain (P-NRS). Structural validity used factor analysis, exploratory (EFA) and confirmatory (CFA), plus Rasch analysis. Criterion validity used Spearman's correlation coefficient (r) between the SFI-10 and criteria (PSFS, G-NRS and P-PRS) scores, and construct validity (n = 91, known-groups independent t-test). Internal consistency used Cronbach's alpha (α) and floor/ceiling effects were determined. Subgroups determined reliability (n = 104, intraclass correlation coefficient, ICC2.1); error (n = 171) through the standard error of measurement (SEM) and minimum detectable change (MDC90). Responsiveness (n = 171) was calculated using effect-size (ES), standard response mean (SRM), and area under the curve (AUC); and interpretability through the minimal clinically important difference (MCID). Practicality (n = 16) clarified missing responses, readability, and time/errors for completion/scoring. Results: The SFI-10's structural validity was unequivocally one-dimensional from EFA and verified by CFA with acceptable fit-indices (chi-square/df = 2.88, CFI = 0.981, TLI = 0.975, RMSEA = 0.061), and supported by Rasch analysis (PSR = 0.79, Infit = 0.678-1.216, Outfit = 0.604-1.279, Item-difficulties = -1,215-2.488). Criterion validity varied from high (G-NRS, r = 0.60) and moderate (PSFS, r = 0.43) to low-inverse (P-NRS, r = -0.24). Internal consistency was strong (α = 0.84) and no floor/ceiling effects were present. Reliability was excellent (ICC2.1 = 0.97), responsiveness substantial (ES = 1.54; SRM = 1.64; AUC = 0.89), and measurement error robust (SEM = 3.84; MDC90 = 8.98%, MDIC = 10.4%), with construct validity confirmed (p < 0.001). Practicality showed no missing responses, completion/scoring errors < 1%, excellent readability (Grade = 5.1, Ease = 74.1%), short completion (39.2 ± 10.3 s) and scoring times (8.5 ± 1.8 s). Conclusions: The SFI-10 demonstrates sound measurement properties in a general physiotherapy outpatient MSD spine population for both psychometric and practical characteristics. Further investigation in culturally diverse settings that include both inpatients and community settings with whole-spine and regional-spine criteria is required.

Background Orthopedic injuries can negatively impact both the physical and mental health of patients. Ensuring patient satisfaction with their recovery is crucial for meeting patient-centered goals and enhancing overall health outcomes. Objective We aimed to investigate whether satisfaction with recovery can be predicted based on demographic information and baseline characteristics in people with non-catastrophic musculoskeletal trauma. Methods Participants with acute musculoskeletal injuries were recruited. The Satisfaction and Recovery Index (SRI) was used to assess the patient’s satisfaction with their recovery. A multivariable linear regression model was created to determine factors that are associated with SRI scores. Results A total of 100 patients participated, with a mean age of 32 years and 82% male. The majority had a high school education or lower, were employed, and sustained left-side injuries. Injuries were most often fractures/dislocations caused by motor vehicle collisions. The results of the multivariable linear regression analysis indicated no significant factors predicting satisfaction with recovery. Conclusions The studied demographic variables and baseline characteristics are not associated with the level of satisfaction with recovery among patients with non-catastrophic musculoskeletal trauma. Clinicians can use these findings to rule out these variables as contributors to low (or high) satisfaction with recovery. Future studies must assess the contribution of other probable and relevant psychological and social characteristics.

Background Schizophrenia is characterised by pervasive cognitive deficits that significantly impair daily functioning and quality of life. Pharmacological treatments have limited efficacy in addressing these deficits, highlighting the need for adjunctive interventions like computerised cognitive training (CCT). Aims This study aimed to evaluate the effects of a 30-session CCT programme on mental well-being and cognitive performance in individuals with schizophrenia. Additionally, it assessed the usability and acceptability of CCT in this population. Methods A double-blind, randomised clinical trial was conducted with 54 participants assigned to intervention and control groups. Cognitive and mental health outcomes were assessed using validated tools such as the Depression Anxiety Stress Scale 21, the Warwick-Edinburgh Mental Wellbeing Scale and the Cambridge Neuropsychological Test Automated Battery. Usability was measured with the System Usability Scale (SUS). Assessments were conducted at baseline, post-intervention and 3 months post-follow-up. Results The CCT intervention significantly improved mental well-being, reduced stress and enhanced working memory (paired associate learning, spatial working memory and spatial span) compared with controls. However, no significant effects were observed for anxiety, depression or executive function. Usability scores were high (SUS=83.51), and compliance rates were strong (92.7%), indicating favourable participant engagement. Conclusion CCT demonstrated potential as an adjunctive treatment for schizophrenia, with significant improvements in targeted cognitive and mental health domains. The high usability and compliance rates support its feasibility for broader implementation. Further research is needed to optimise protocols and explore long-term benefits. CCT offers a promising approach to addressing mental health and cognitive challenges in schizophrenia, particularly for stress and working memory. Its usability and acceptability suggest it could be seamlessly integrated into clinical practice.

Objective This study aimed to examine the experiences of psychiatric trainees and early career psychiatrists in Iran with Electroconvulsive Therapy (ECT). Methods A cross-sectional survey, employing a 36-item questionnaire was conducted in Iran from March to November 2023. The survey targeted psychiatric trainees and early career psychiatrists, assessing ECT availability, training experiences, knowledge and attitudes. Results 173 responses were received. The majority of respondents were female (79.2%) and had experience in inpatient settings. About 63.0% reported ECT availability in their institutions, with 89.0% confirming the presence of specialised ECT centers within 100 km. Training in ECT was widely reported (96.5%), with 77.4% administering ECT to 10 or more patients during psychiatry training. However, only 55.5% were familiar with national ECT guidelines, and even fewer knew about international recommendations. Attitudes toward ECT were largely positive, with 86.2% agreeing on its effectiveness and 77.5% willing to recommend it to patients. ECT services were less frequently available in institutions where ECPs were employed compared to institutions where trainees were undergoing their psychiatry training. Confidence in ECT knowledge varied, with 52.6% feeling confident in their understanding, and 75.7% expressed interest in additional training. Conclusions The study highlights a gap between ECT training and confidence among Iranian psychiatrists. Positive attitudes toward ECT and a high level of interest in further training underscore the need for enhanced educational programs and the standardisation of guidelines. Addressing stigma and policy gaps is crucial for improving ECT access and utilisation.

Background: Substance abuse, as a major global issue, not only affects individuals but also impacts family members, particularly women. Meanwhile, post-traumatic growth and resilience are important factors in the recovery process for these women. Therefore, the aim of this study was to investigate the effectiveness of a resilience-based intervention in facilitating post-traumatic growth among women with addicted spouses. Methods: A randomized clinical trial was conducted involving women with addicted partners (n=30) in Qom during the years 2021 and 2022. Participants were randomly allocated to the two groups of intervention and control. A demographic information form, post-traumatic growth questionnaire, resilience scale, perceived stress scale, and the Connor-Davidson coping skills questionnaire, were used to collect data at pre-test, post-test, and follow-up (three months later). Data analysis was conducted using SPSS software (version 22.0), with a significance level of P<0.05. Findings: The findings demonstrated a significant increase in scores of resilience (η²=0.015), post-traumatic growth (η²=0.185), emotion-focused coping skills (η²=0.253), and problem-focused coping skills (η²=0.131) in the intervention group between pre-test, post-test, and follow-up stages (P<0.001). However, the intervention did not influence perceived stress (η²=0.017) (P=0.473). No significant changes were observed in these variables in the control group. Conclusion: The findings showed that the resilience intervention resulted in enhanced post-traumatic growth, coping abilities, and resilience in women with addicted spouses. Implementing this intervention in mental health centers and addiction recovery programs not only enhances the mental well-being of these women but also contributes to the psychological well-being of their families.