Journal of School of Public Health and

---

Approximately 21% of children and adolescents experience signs and symptoms of aDSM-1V disorder during the course of a school year, yet fewer than 20% of those needingmental health services actually receive any. Research suggests that schools and teacherscan help promote mental health, delect children at risk, and refer them for psychiatricassistance. This study aims to determine the effects of an educational intervention onteachers' knowledge, attitude, self-reliance and practice.This study was carried out in 24 State-run elementary schools in the city of Khorramabadin Lorestan province. Iran, during the academic years 2001 - 3.Of the 64 teachers initially selected, 57 agreed to participate in the study 27 of these wereplaced in the intervention group and the remaining 30 in the control group.The intervention group attended a 3-day workshop. Self- administered questionnaireswere filled before and after the workshop, and at the end of the project data were collectedfrom teachers and students. Statistical analysis was done by the SPSS package, usingmainly nonparametric tests.49% of the participants were men, 42% had a high school diploma and others haduniversity degrees. Findings showed significant improvements in teachers' knowledge.attitude, and practice in the intervention group. Nosuchimprovement was observed incontrols. Teachers in the intervention group were able to identify and refer 106 suspectedcases, of whom 79 had a mental disorder confirmed by a psychiatrist. Within the sameperiod, only 2 cases had been referred by the control group. Students' knowledge, themain criteria of teachers' practice in mental health education, had significantly improvedin the intervention but not in the control group. Results suggest that female teachers hadhigher KAP levels than their male colleagues.The study confirms that trained teachers have the capabilities required for participating inSchool - Based Mental Health Services. It also appears that schools are indeed a crucialplace for helping children in need of mental health services.

---

Natural disasters cause millions of death and disability and major financial losses world wide every year. The major concern of our health system has already been to reduce physical mortality and morbidity. While such events may be a considerable source of stress for the survivors and cause serious and long-lasting psychiatric complications. The purpose of this study was to assess the function of rescuers in mental health service delivery to survivors of Bam earthquake in four steps Rescuing, Emergency services, Transportation of the injured survivors and Treatment in the first 2 weeks after the earthquake. For reaching the purpose 4 groups of the survivors were selected: first group was the healthy survivors (>15 years) living in Bam after the earthquake, the second group was healthy survivors (<15 years) living in Bam after the earthquake, the third group was the injured survivors admitted in Kerman and Tehran hospitals and the last group was the Relatives who accompanied the injured survivors. 2 weeks after the earthquake a questionnaire including questions about, demographic data, function of rescuers in rescuing and emergency services steps, informing the survivors of their relatives condition and Condoling with the survivors and mental health services delivery was filled for each of the cases. In all groups, more than 85% of the cases who needed help and rescued from the load of the earthquake were rescued by their relatives and rescuers of the Red Crescent Society or other governmental organization just had a little portion (5%)in this field. Only 25%of the cases who needed help and rescuing from the load of the earthquake were rescued in the first hour after the earthquake. Only 40% of the cases were sympathized by their rescuers. About 65% of the cases had enough information about their relatives. 40% of the cases were prevented from crying by rescuers. Only 30% of the cases said that they knew addict individuals who were hot given alternative materials. 30/% of the children had played during 2 weeks after earthquake and 42/% of them had facilities for playing. Regarding to all studied groups rescue activities, primary care services and transfers have been performed by relatives and domestic people , therefore general training and organizing CBO (community Based organization) for providing services in disasters especially in regions which are at high risk of earthquake will be useful for reducing the injuries. According to this research rescuers are in serious need of training in mental health services and that major areas of education need are: using counseling techniques, providing the necessary information for the survivors and stress management techniques.

---

Background and Aim: Hospitals are among the most important health and medical institutions responsible for promoting health, and provision of appropriate health services requires a healthy, hygienic and safe environment. This research was done with the aim of assessing the environmental health situation Qom hospitals in 2005.

Materials and Methods: This research is an applied descriptive - analytic study on hospitals in QOM Province. Data were gathered using survey and observation methods and a two-part questionnaire. The first part of the questionnaire consisted of 45 items covering demographic data on hospitals and hospital managers. The second part comprised 363 questions about the environmental health situation as well as diagnostic, treating and support services. The questionnaires were filled after validity and reliability tests in eight hospitals in Qom Province. For statistical analysis, we performed Mann-Whitney and Kruskal-Wallis tests and calculated Spearman's coefficient, using the software package SPSS.

Results: Poor environmental health was observed in 25% of the radiology wards, kitchens and laundries. The situation was assessed as "appropriate" in 12.5% of laboratories and central sterilization (CSR), 25% of emergency services, 50% of ICU wards and 71% of surgery and recovery rooms, and it was intermediate of the other wards. Overall, the level of compliance with the principles of environmental health was average, i.e. about 72.5 percent. Further analysis of data showed that the situation was better in private, non-teaching hospitals compared to government-run and teaching hospitals. However, environmental health was found to improve with an increase in the number of active hospital beds and the managers' experience in their current job. It declined with increasing hospital age and increasing age of the hospital managers.

Conclusion: Overall, the environmental health situation in Qom hospitals was found to be at an intermediate level. Hence, these hospitals have a long way to go before they can achieve the appropriate level of environmental health

---

Background and Aim: There are no occupational health data concerning the prevalence of mental disorders in Iranian hospital nurses. Such information may be a prerequisite for efficient occupational mental health interventions. The aim of this study was to determine mental health status among shift work hospital nurses.

Materials and Methods: This paper reports the findings of a cross-sectional survey that was part of a larger quasi-experimental study. We selected and evaluated 1195 nurses in 12 general hospitals in Shiraz (capital of Fars Province), using the 28-item version of the General Health Questionnaire (GHQ). We used structured observations in accordance with an occupational health checklist to assess working environment during the work period.

Results: Results indicated that 28.7% of nurses were in poor mental health. Mental disease was more common among females than males (p<0.05). Prevalence rates for anxiety and somatic symptoms were 42.2% and 35.5% respectively. The prevalence of depression was 11.9% and social dysfunction, 79.5%. There was a significant relationship between shift work and anxiety as well as sleep disorders (p< 0.05). Associations were also found between marital status and depression and between gender and social dysfunction (p< 0.001).

Conclusion: Prevalence figures for mental disorders are similar to those from nationwide surveys but it seems that social dysfunction and anxiety disorders are more common in nurses compared to the general population aged 15 and over. More attention must be paid to the health of shift work nurses (especially female staff). This can take the form of shift work health education programs, occupational health counseling, and periodic examinations.

---

Background and Aim: Environmental health impact assessment of industrial estates will help greatly in better planning for sustainable development and reducing disease risk in a community. The objective of this study was to assess the positive and negative effects of establishing an industrial estate in Jovein, Sabzevar, Iran in 2006-7 and suggest managerial strategies to reduce undesirable environmental health impacts.

Methods and Materials: A modified Leopold Matrix and Scaling checklist method was used. The existing environmental situation was investigated and then environmental impact assessment alternatives were determined, bearing in mind the amounts and kinds of predicted pollutants in the construction and operational phases . The assessment was made considering the immediate, direct, and indirect impacts in the short and long terms. It was attempted to use a wide range of values of different factors (-5, +5) in order to estimate the impact of all activities on the environmental status.

Results: The results of the study are presented with two alternatives, i.e., "No" (conducting the project with no concern for environmental issues), and "Yes" (performance of the project with application of methods to reduce the environmental harmful impacts), when establishing the industrial estate, in the construction and operation phases. The impact assessment with the "No" alternative scored -791, meaning that execution of the project had to be rejected. However, after reducing the harmful impacts the score rose to +252, indicating that the project would be accepted.

Conclusion: The method of reducing harmful environmental impacts along with environmental management programs introduced are accepted in this study. It is recommended that the Ministry of Health and Medical Education and The Iranian Environmental Protection Agency collaborate closely in the area of environmental health impact assessment of industries and industrial estates.

---

Background and Aim: Educational programs for couples' mental health promotion in marital life are a necessity.  The first step in planning an educational program understands the needs of the target group. This paper reports the mental health educational needs in youth planning to marry.

Materials and Methods: In a descriptive-analytical cross sectional study, 450 individuals taking part in pre-marriage education courses in Tehran were selected by randomized stratified sampling. The data was collected using a questionnaire that measured the educational needs in the area of mental health by the 5-point Likert-type scale. Data analysis was done using the SPSS-15 software, the statistical tests being the independent T-test, one-way analysis of variance (ANOVA), and the chi-square test.

Results: On the whole, the subjects' felt need for mental health education was more than moderate (3 on the Likert scale) women expressed a higher need than men (p=0.001). The main concern of the participants - both men and women - was How to keep romance alive in married life. The extent of need expressed for mental education was not statistically different in different socio-demographic groups of women, while worker men expressed a higher need than self-employed men (P=0.018).                                                                        

Conclusion: Based on the findings of this study, young people planning to marry have a felt need for education in the area of mental health. It is recommended to design and implement educational programs to promote their knowledge in this area with due consideration of priorities stated by them.

---

  Background and Aim: The community assessment is the basis of strategic policies for health professionals and managers. The aim of community assessment is collection of the data that relating to public health problems, data analysis and concludes about necessary capacities for providing the necessary resources to resolve problems.

  Materials and Methods: In this study the databases of Scientific Information Database, MagIran, MEDLINE, Google Scholar, and IranMedex were searched up to April 2014 (farvardin1393). All papers of community assessment in the country according to our standard community assessment model were included in this study.

  Results: Overall 11 studies were evaluated and the common feature of all research is to identify problems of society and local problems. The drug addiction was classified in 3 of the studies as a main problem and in 7 of studies was classified in the ten major problems. Poverty and unemployment are allocated to the next priority, the second priority in 2 studies, the third priority in 3 studies and the fourth priority in 3 studies. Environmental health problems and socio-cultural problems were the next priorities.

  Conclusion: The proposed model can be used to suggest new health services with due consideration of community problems, as well as develop suitable, effective intervention strategies. This type of community study should not be conducted only once. Rather, it should be repeated periodically in any community, results compared and used for policy-making.

---

Background and Aim: Communication is one of the oldest and greatest human achievements underlying our social life. Available literature show factors such as self-esteem, interpersonal skills, establishing desirable communication, goal setting and determining individual values have effective roles in the prevention and reduction of susceptibility to behavioral abnormalities and mental disorders (anxiety, depression, etc.), as well as in the promotion of mental health. The objective of this study was to determine associations between communication skills and mental health in Mashhad University of Medical Sciences (MUMS), Mashhad, Iran.

Methods and Materials: This was a cross-sectional analytical study conducted in 2011. The statistical population was all the MUMS students. A sample of 210 students was selected by stratified sampling and signed an informed consent. Data were collected using Communication Skills and General Health Questionnaires and analyzed using the SPSS 16 software, the statistical tests being Kruskal-Wallis, Mann-Whitney U and Chi-square. In all tests the significance level was 5%. To determine correlations between the variables the Spearman coefficient was used.

Results: The findings showed that 130 of the 210 students (61.9%) were suspected of having a mental disorder. Based on the Spearman correlation coefficient there were no statistically significant relationships between mental health and age (p=0.727) or skills such as listening (p=0.653), understanding verbal and nonverbal messages (p=0.857), awareness of the communication process (p=0.626) and assertiveness (p=0.477). However, a significant correlation was observed between mental health and emotion control skill (p=0.010). Furthermore, the Spearman correlation coefficient indicated no relationships between communication skills and age (p=0.228) or social dysfunction (p=0.074), while significant inverse correlations were found between communication skills and anxiety (p=0.043), physical symptoms (p=0.049) and depression (p=0.049). According to Mann-Whitney test no significant relationships were observed between communication skills and field of study (p=0.806), level of education (p=0.406), sex (p=0.404), place of residence (p=0.277), marital status (p=0.875) or employment status (p=0.274), but significant relationships did exist between mental health and sex (p=0.006), field of study (p=0.036)r and marital status (p<0.001). Finally, no significant correlations were found between mental health and level of education (p=0.080), place of residence (p=0.951) or employment status (p=0.978).

Conclusion: Based on the findings of this study, in an attempt to promote the mental health of the students it is recommended to make psychological assessments of the students, provide consultative services to them, and organize communication skills educational workshops for them.

---

Background and Aim: This study aimed to investigate the association of Internet addiction and self-control with mental health among students of the University of Applied Sciences and Technology (UAST) in Ilam city, Iran.

Materials and Methods: Data collection tools included the Mental Health Goldenberg scale, Tanji Self-control Inventory and Young Internet Addiction questionnaires. The sample consisted of 101 UAST students in Ilam City, Iran.

Results: Analysis of the data showed a statistically significant negative relationship between internet addiction and mental health and a positive association between self-control and mental health in male- and female-students.

Conclusion: It can be concluded that he more a student uses the Internet, the more likely he/she is to be less healthy mentally, while if a student has more self-control, he/she is more likely to be healthier mentally.The use of the Internet among the new generation in the society is spreading, becoming an important part of life. It has been said that teenagers are at a high risk. Hence the responsible authorities should consider mental health as a factor preventing extreme behavior of young people.

---

Background and Aim: Mental health plays a vital role in psycho-social development of an individual in various periods of life, particularly during adolescence. Addressing the mental health problems of adolescents is considered as a global health promotion and disease prevention priority. The aim of this study was to assess the mental health status of adolescent boys and determine the role of contextual factors and life skills in predicting mental health of the students in 2016 and present n appropriate model.
Materials and Methods: This was a cross-sectional study conducted on 550 secondary male school tudents,  selected by  cluster random sampling, in Ray County, Iran. Data were collected using a standard valid General Health Questionnaires (GHQ-28) and a life skills questionnaire and analyzed using the SPSS software 22.0, the statistical tests being Chi-square and logistic regression.
Results: Analysis of the data showed that 46.9% of the students were suspected of having mental health problems, the rest (53.1%) having no disorder. The most common disorder (56%) was in the  social functioning. As regards life skills, the proportions of the students with a low, moderate and high life skills were 35.3%, 32.5% and 32.2%, respectively. Statistically significant correlations were found between mental health and its four dimensions on the one hand and the independent variables, namely, self-awareness, decision-making and age on the other.
Conclusion: The findings indicate a fairly moderate prevalence of mental disorders among the students and demonstrate the role of life skills training in promotimg mental health in adolescents and the youth.

---

Background and Aim: Stress during pregnancy can have a lasting effect on the mental health of women after childbirth. Statistics show that about 18% of pregnant women have major or partial depression during pregnancy, but many have not been screened or treated. Lack of treatment can have serious consequences for the mother and her child. The purpose of this study was to determine the mental health status and marital satisfaction of pregnant mothers in Kashan city, Iran in 2015.
Materials and Methods: This was an analytical cross-sectional study. Using the convenience sampling method 202 pregnant women were selected from four urban health centers in Kashan, Iran and entered the study. Data were collected using a Diagnostic Interview, the General Health-28 Questionnaire and the Golombok Rust Inventory of Marital State. Descriptive statistics was used for data analysis, the statistical tests being one-way ANOVA, chi-square test, Pearson correlation test and logistic regression.
Results: The results showed that 26.7% of the pregnant women were suffering from psychiatric disorders, the most and least serious disorders being related to physical activity and depression, respectively. About 80% of the women expressed very good marital satisfaction. Further analysis of the data showed statistically significant associations between depression and age and anxiety, insomnia and duration of marriage, marital satisfaction and delivery type, and mental health and marital satisfaction. Furthermore, marital satisfaction had a negative association with education. (p<0.05).
Conclusion: It seems that it is essential to develop and implement a therapeutic, psychiatric and health care model for women at risk of psychiatric disorders during pregnancy and after childbirth in the health service delivery system in Iran.

---

Background and Aim: This study investigated the role of teachers' assessment of school environment health in predicting their mental health and happiness.         
Materials and Methods: This was a descriptive-correlational study. The statistical population was a group of 254 primary school teachers in the city of Darab, Iran, from whom a sample of 160 was selected by stratified sampling. Happiness and mental health were measured using the Oxford and Gildberg questionnaires, respectively, and teacher’s assessment of environmental health was determined using a researcher-made questionnaire, all the questionnaires being valid and reliable. 
Results: On the whole, 57.23 %, 37.73% and 5.00% of the teachers judged the school environment health to be desirable, moderate and undesirable, respectively. As regards the teachers’ assessment of the school environmental heath, there were statistically significant differences between male and female teachers, local and nonlocal teachers, their field of study (primary education and other fields), schools for boys and for girls, their previous knowledge of health, type of employment (life tenure versus others), and whether they were teaching in health promoting or ordinary schools (p<0.05). The teachers assessment of school environmental health was significantly correlated with happiness and mental health (p<0.0001); their assessment of environmental health could predict 19.8% of happiness changes and 10.2% of mental health changes.        
Conclusion: Judgment of the school environment health by teachers as unfavorable would affect their happiness and mental health.

---

Background and Aim: The “Package for mental and social health promotion and drug abuse prevention” was developed in response to the importance of, and concerns relate to, the mental and social health in the population. Since any policy and plan needs to be assessed to find its weaknesses, strengths and challenges to ensure its successful implementation, this study aimed to find and explain the executive leadership challenges of this service package from the service provider's perspective.
Materials and Methods: This study was a qualitative research, the data being collected through interviews and reviewing the relevant documents. The research population included experts from Kerman University of Medical Sciences, Kerman, Iran, those in charge of the package implementation, urban community health center officials and health care providers. The interviewees were selected using a targeted sampling method.
Results: Based on the interviews, the findings were categorized into four main themes: low public cooperation, difficulty in communication, missing links in design and implementation of packages, and methods of payment to service providers. In addition, the findings based on reviewing the documents were grouped as objectives, plans, activities, target groups, and interventions related to this service package.
Conclusion: Based on the findings of this study, it can be concluded that the implementation challenges of the mental health care package fall into three categories, namely, policy-making, facilities, and personal challenges. Proper changes and reforms at the public policy-making level, creating individual awareness and providing proper facilities for the implementation of the package can help overcome these challenges.

---

Background and Aim: One of the dimensions of health is mental health that could be affected by the quality of occupational life. The purpose of this study was to determine the effect of job satisfaction on teachers' mental health with due consideration of the moderating role of gender and the subjects taught.
Materials and Methods: This was a quantitative survey using a questionnaire including a sample of 373 teachers, selected by multistage random sampling, from among all (n = 1500) the secondary school first- and second-grade teachers in Najafabad city, Isfahan Province, Iran. Data analysis was done using the software AMOS and SPSS.
Results: The confirmatory factor analysis of the items showed that these items could explain 63.25% of the variance of the mental health construct. In addition, the standard effect of job satisfaction on mental health was found to be 0.37 (p <0.001), explaining 13% of the mental health construct variance. Further analysis of the data showed that the teachers’ mean mental health construct (66.64) and their mean of job satisfaction (73.90) were lower and higher than the means of the respective spectra (p <0.001), respectively.
Conclusion: Job satisfaction, which has been proven to affect the teachers’ mental health, can improve their personal and social life and make them more efficient in education. In this regard, gender and the type of subject taught can have moderating effects on the relationship between job satisfaction and mental health of the teachers. Based on the beta-values (0.55 for the women group and 0.68 for the experimental science teachers group), the gender female and teaching experimental science can have a stronger effect on the teachers’ mental health than gender male and teaching subjects other than experimental science.

---

Background and Aim: The human mental health is a multidimensional and complex issue affected by a wide range of biological, psychological, sociological, economic and cultural factors. Considering the social nature of human life, the purpose of this study was to investigate the relationship between some social variables, e.g., social support, social bond, social trust and social status, and teachers’ mental health.
Materials and Methods: This study was a cross-sectional quantitative survey using a questionnaire to collect. The sample included 373 primary school teachers (first and second grades) in Najafabad, Isfahan, Iran selected in 2020 by multi-stage random sampling.  Data were analyzed using the structural equation modelling technic, with the SPSS-25 and Amos-23 software.
Results: The confirmatory factor analysis of the items showed that they could explain 63.25% of the variance of the teachers' mental health variable, the social support, social status and social trust variables affecting it (0.65, 0.45 and 0.18, respectively), with a confidence interval of 99% and p<0.001. On the whole, the independent variables could explain 76% of the variance of the teachers’ mental health. In addition, moderation analysis showed that in general gender moderates the effects of social variables on the teachers’ mental health, the female gender having stronger effects in these relationships.
Conclusion: The results of this study show that primary school teachers' mental health, which is an individual/private phenomenon, is greatly affected by their quality of social life, some factors such as social support, social status and social trust potentially influencing it. Moreover, this effect is much more pronounced among women than men.        

---

Background and Aim: Among the valuable developments in the primary health care system has been the special attention paid to the issue of mental health and the addition of a self-care program for community mental health education. However, no integrated measures have been taken in relation to the needs of service recipients, educational priorities and the required facilities. This study was conducted to explain the priorities of this program in primary health care centers affiliated to Iran University of Medical Sciences, Tehran, Iran.
Materials and Methods: This was a qualitative study with a content analysis approach. The sample consisted of 12 stakeholders selected by purposive sampling with maximum diversity. Data were collected through in-depth and semi-structured interviews and a modified checklist of the Community Health Needs Assessment Program and analyzed using the Granheim and Landman approach.
Results: Based on data analysis, the needs were grouped into two main categories, namely, the needs of service providers and the needs of service recipients. The service providers’ needs included continuous coordination with non-health sectors, a virtual education and information system and continuous training and educational supervision, as well as appropriate space, facilities and equipment, while the of needs of service recipients were classified based on services needed for age groups, namely, services for children, adolescents and young people, adult and middle-aged, elderly and others.
Conclusion: Identifying needs can lead to the optimal use of limited resources aiming at imparting applied education and training. The results of this research can be an effective step towards expansion based on the needs for mental health education and a great help in achieving the goals of this program in primary health care centers. Based on the results it is recommended to plan personnel training and revise the services based on the identified needs in order to increase the effectiveness of this program.
 

---

Background and Aim: Social health is one of the most basic criteria of social well-being and an effective factor in improving the quality of life of any society. .In Iran, the Office of Mental Health, Social Health and Addiction (OMSHA) is responsible for planning, implementing, monitoring and evaluating social health programs. The purpose of this research was to criticize and assess the contents of the social health component of the primary health care (PHC) system in an attempt to revise the contents.
Materials and Methods: The method used in this study was the deconstruction method. The research environment was all the contents of the social health component provided by OMSHA, and in order to obtain precise data the entire statistical population was taken as the study sample.
Results: In general, data analysis indicated the following: inappropriate screening, cultural adaptation, unidimensionality, role and responsibility adaptation, the preference of treatment to prevention, updating, comprehensiveness and adequacy of basic contents, and comprehensiveness and adequacy of practical suggestions.
Conclusion: It can be concluded that revision of the contents of the social health component of the Office of Mental health, Social Health and Addiction is a necessity in order to improve the delivery of mental health services..
 

---

Background and Aim: The objective of this study was to gain a deep understanding of the importance (expected services) and performance (services provided) of mental health services to determine the priority indicators of mental health to help design higher quality and more effective community mental health interventions.
Materials and Methods: This was a mixed-method study including all the mental health executives and practitioners (n=998) in Iran. In the quantitative part, the Importance-Performance Analysis (IPA) model was used to determine the importance and performance of the current mental health programs in the primary health care (PHC) system, and in the qualitative part complementary explanations were analyzed using the thematic analysis method.
Results: The findings show that there were gaps between the expected services and the services provided in the mental health program. Thus, the following points should be taken into account to be able to improve the mental health services: 1. Strengthening the domestic violence prevention program as regards spouse misbehavior and misbehavior towards children; 2. Continuation of lifestyle skills and parenting programs, 3. Self-care in mental health and drug use programs; 4. psychiatric disorders diagnosis and care and a healthy adolescents program is desirable and necessary, but revising and modifying the suicide prevention program (as regards costs and treatment) are essential. 5. In addition, the psycho-social intervention programs in disasters, addiction harm reduction program, strengthening family foundation and the Competent Family Program are of low importance in formulating a strategy.
Conclusion: Corrective actions based on the prioritizations determined can be included in the working agenda of the managers of mental health care systems at the primary levels to improve the quality of mental health services.