1. Introduction
Mental problems represent a significant explanation for incapacity internationally (1). Of the assorted indicators of psychological problems, despair, anxiousness, and stress are essentially the most outstanding (2) with despair being essentially the most prevalent and chargeable for a big proportion of the burden of psychological sickness globally (3, 4). According to the World Health Organization, an estimated 5% of adults worldwide undergo from despair, and one in 4 people expertise a psychological well being situation in some unspecified time in the future throughout their lifetime (5). Recent analysis means that the worldwide prevalence of psychological problems ranges between 11% and 23.8%, with adults being affected at a fee of 12.6% to 48.6% (6, 7). Furthermore, the one-year prevalence of psychological problems varies between 3.4% and 26.4%, with the Eastern Mediterranean areas exhibiting the very best prevalence charges of 15.6% to 35.5% (3).
The prevalence of psychological problems in Iran is in step with the worldwide pattern, with despair and anxiousness being essentially the most generally recognized situations (8, 9) and their burden on the inhabitants can be growing (10). Studies point out that roughly 7 million individuals in Iran are affected by some type of psychological dysfunction, with roughly 15%–20% of the inhabitants experiencing signs of despair starting from gentle to extreme. These traits are attributed to heightened stress ranges brought on by social and environmental adjustments, in addition to an increase in particular bodily illnesses (11, 12).
The outcomes of a examine in Iran confirmed that 31.03% of the inhabitants is affected by psychological problems (13). The survey by Hajebi et al. confirmed the prevalence of hysteria in individuals 15–64 years. Old was 15.6% (14). Another examine with a considerable pattern dimension reviews that 11% of Iranians have some type of psychological dysfunction (9). Najafipour et al. (15) and Mohammadi et al. (16) confirmed that 25.4 and 59.5% of residents in southeast Iran suffered from anxiousness and despair, respectively. Further research in Kashan (17) and Iran (18, 19), discovered the prevalence of psychological problems to be between 23%–39.6%. However, there have been few research of residents of western Iran. According to Shirzadi et al. (20), the prevalence of despair and anxiousness problems in Kermanshah was 8.3% and 4.7%, respectively. Finally, in response to Veisani et al. (21), 26.1% of Ilamian individuals had a number of psychological problems.
Mental problems can happen in complicated interactions between social, psychological, and organic components. The danger of growing psychological problems will increase with poverty, unemployment, childhood adversity, life occasions such because the dying of relations, bodily sickness, and alcohol and drug abuse (22). Previous analysis has recognized a number of key variables that affect psychological well being, together with age, gender, revenue, entry to healthcare providers, bodily and social atmosphere, training and literacy ranges, private hygiene habits, and coping abilities (23–25).
Due to its distinct geographical options, poor welfare and growth infrastructure, excessive unemployment fee, and the consequences of the imposed battle, Ilam province has a larger frequency of psychological problems (23). As a outcome, the suicide fee in Ilam is increased than the common for the world and has been rising just lately (26). Mental problems result in a lower in a single’s high quality of life and have detrimental results on human well being, efficiency, and effectivity, and their impacts may be long-term and have an effect on an individual’s capability to perform and stay a wholesome life. Therefore, it’s essential to pay particular consideration to the psychological well being state of the group. The want for complete details about psychological well being with the intention to plan and make insurance policies led us to conduct a examine with the goal of figuring out the prevalence of stress, anxiousness and despair within the inhabitants of Ilam.
2. Methods
2.1. Study inhabitants
Figure 1. Geographical location of Ilam metropolis.
According to the examine by Montazeri et al. (27), the prevalence of despair in Iran ranges from 6% to 73%. Considering the prevalence of despair being equal to 30%, a confidence stage of 95%, and the precision = 1/10 of the prevalence, based mostly on the next system, a minimal pattern dimension of 896 was estimated.
n
=
z
2
p
q
d
2
=
1.96
2
∗
0.3
∗
0.7
0.03
2
=
896
According to the kind of sampling, contemplating the design impact equal to 1.5 pattern dimension, 1,344 individuals had been estimated, and at last, 1,350 individuals had been thought of because the minimal remaining pattern dimension (28). Multi-stage stratified cluster random sampling with a proportion-to-size strategy was used to pick out the individuals. For this function, town of Ilam was divided into 10 areas based mostly on 10 group well being facilities, and the inhabitants coated by every area was obtained. Then, in response to the inhabitants of every area, the proportion of the pattern dimension that ought to be chosen from every area was decided. After figuring out the pattern dimension in every area, cluster sampling was applied.
The pattern dimension in every cluster was thought of to be 20 individuals so the clustered map was ready individually for every area and the clusters had been chosen in response to the pattern dimension in every middle. After figuring out every cluster, the sampling group was positioned on the southwest aspect of this cluster by referring to the handle of the cluster. The group then began to pattern the households counter-clockwise and this course of continued till the pattern dimension of every cluster was exhausted. It ought to be famous that each one relations over 15 years of age had been included within the examine.
After explaining the targets of the examine and acquiring knowledgeable consent, the pattern group collected the examine info by questionnaire. This questionnaire has two elements. The first half consists of demographic info (age, gender, race, training, family dimensions, occupation, and insurance coverage protection), financial standing (which included 15 questions on belongings and was created utilizing the precept element evaluation methodology of financial variables), and different info (co-morbidities, historical past of psychological dysfunction, historical past of dying of relations, historical past of job loss and one’s hope for the long run).
The second half included the Depression-Anxiety-Stress-Scales (DASS) questionnaire (21-question model), which incorporates three domains and every area has seven questions. The scoring of every query was on a Likert scale (0 to three) and the ultimate rating of every was obtained by way of the sum of the scores of the associated questions. The validity and reliability of this instrument had been beforehand confirmed by Sahebi et al. (29) (Cronbach’s alpha for despair, anxiousness, and stress had been 77, 79, and 78%, respectively).
2.2. Statistical evaluation
To estimate the age- and sex-standardized prevalence, the pattern taken was weighted based mostly on the Ilam metropolis inhabitants. Then, the age- and sex-standardized prevalence of despair, anxiousness, and stress was estimated with a 95% confidence interval. First, the chi-squared take a look at and t-test had been used to examine the affiliation between the studied outcomes and demographic variables. Then, a number of ordinal logistic regression was used for mannequin constructing and checking the simultaneous impact of the examine variables on the outcomes.
It ought to be famous that the factors for getting into the variables into the a number of ordinal logistic regression mannequin was a significance stage of lower than 0.2, and the cluster impact was thought of with the intention to right the sampling error. The standardized coefficients had been used to find out a very powerful efficient variables within the mannequin. All analyses had been carried out by utilizing Stata model 12 and a significance stage of 0.05 was thought of.
3. Results
The knowledge of 1,431 individuals had been analyzed. Table 1 reveals the distribution of demographic and different variables within the current examine. The imply age (SD) of the individuals was 40.43 (15.51), 50.38% (47.79 to 52.98) of the individuals had been feminine, 94.34% (93.14 to 95.54) had been of Kurdish ethnicity, 61.29% (58.76 to 63.81) had been married, 35.64% (33.16 to 38.12) had an training stage of greater than a bachelor’s diploma, and 30.75% (28.35 to 33.14) had been categorized as a excessive financial group. In complete, 8.03% (6.62 to 9.45) of the individuals had a historical past of psychological dysfunction and simply 57.02% (54.45 to 59.59) of individuals had hope for the long run.
Table 1. Distribution of demographic variables in examine inhabitants.
As proven in Table 1, the age- and sex-standardized prevalence of extreme despair, anxiousness, and stress signs was 19.90% (17.64 to 22.16), 25.95% (23.48 to twenty-eight.43), and 15.75% (13.69 to 17.81), respectively. The age-sex standardized prevalence of reasonable despair, anxiousness, and stress signs was 27.03% (24.52 to 29.54), 19.90% (17.64 to 22.16), and 20.15% (17.88 to 22.42), respectively.
Table 2 reveals the affiliation between the psychological problems and totally different variables. As proven in Table 2, the prevalence of extreme despair signs in females (25%) was considerably greater than in males (17.33%) (p < 0.003). This sample was noticed for anxiousness signs (31.15% vs. 23.30%; p < 0.001) and stress signs (18.64% vs. 13.64%; p < 0.012). Furthermore, these of Kurdish ethnicity had been extra prone to have extreme despair signs (p < 0.045) or anxiousness signs (p < 0.049). The individuals who had academic ranges decrease than a diploma had been extra prone to have extreme despair (p < 0.003), anxiousness (p < 0.016), and stress signs (p < 0.023). Other variables together with working as a housekeeper or being unemployed (28.32%; p < 0.001), lack of insurance coverage protection (27.60% vs. 19.15%; p < 0.006), low financial standing (29.28%; p < 0.001); historical past of job dropping (28.68% vs. 19.29%; p < 0.001); historical past of psychological problems (43.12% vs. 19.14%; p < 0.001); hopelessness for the long run (39.63% vs. 8.24%; p < 0.001), and historical past of different illnesses (30.16% vs. 16.53%; p < 0.001) had a constructive impact on the severity of despair signs. Age, BMI, and marital standing had no affiliation with despair signs.
Table 2. Association between the psychological problems with totally different variables based mostly on the chi-squared take a look at.
The affiliation of talked about variables with anxiousness signs was additionally the identical, in order that individuals who skilled job loss (33.21% vs. 25.69%; p < 0.001), lack of relations (30.32% vs. 24.34%; p < 0.038), psychological dysfunction historical past (51.82% vs. 24.96%; p < 0.001), hopelessness to future (43.20% vs. 16.17%; p < 0.001) and historical past of different illnesses (41.69% vs. 19.65%; p < 0.001), had a excessive stage of hysteria signs. The affiliation between stress signs with demographic variables is also proven in Table 2.
Table 3 confirmed the affiliation between psychological problems with examine variables utilizing a a number of ordinal logistic regression mannequin. As proven in Table 3, there was a constructive affiliation between feminine intercourse and despair signs (OR with 95% CI: 1.52; 1.16 to 1.98), anxiousness signs (OR with 95% CI: 1.72; 1.32 to 2.25), and stress signs (OR with 95% CI: 1.71; 1.31 to 2.22), adjusted for different variables. Furthermore, the likelihood of despair signs (OR with 95% CI: 2.15; 1.28 to three.61), and anxiousness signs (OR with 95% CI: 2.08; 1.26 to three.44) in these of Kurdish ethnicity was greater than different ethnicities. Although training stage had a big affiliation with anxiousness signs and stress signs within the easy evaluation, this affiliation was not noticed within the a number of evaluation. The affiliation between training and despair signs remained vital because the likelihood of despair signs was increased in individuals with diplomas and affiliate levels than in these with a decrease diploma (OR with 95% CI: 1.37; 1.03 to 1.83).
Table 3. Association between the psychological problems with totally different variables a number of ordinal logistic regression.
Moreover, the results of the evaluation confirmed that increased financial standing had a unfavourable affiliation with despair signs because the likelihood of getting reasonable or extreme despair signs was 0.7 (95% CI: 0.52 to 0.93) in individuals with excessive financial standing, compared to these with a decrease financial standing. This sample for anxiousness signs and stress signs was proven just for center financial standing. In different phrases, in individuals with center financial standing, the likelihood of getting reasonable or extreme anxiousness and stress signs was 0.70 (95% CI: 0.53 to 0.92) and 0.71 (95% CI: 0.54 to 0.94), respectively, compared to decrease financial standing.
Our evaluation additionally confirmed {that a} historical past of dropping a job (OR with 95% CI: 1.64; 1.24 to 2.18), historical past of psychological problems (OR with 95% CI: 2.17; 1.47 to three.21), hopelessness for the long run (OR with 95% CI: 5.38; 4.25 to six.81), and historical past of different illnesses (OR with 95% CI: 1.67; 1.30 to 2.15) result in will increase within the likelihood of despair signs. An analogous sample was seen for anxiousness signs. Seen collectively, job loss historical past (OR with 95% CI: 1.53; 1.16 to 2.02), psychological problems historical past (OR with 95% CI: 2.11; 1.42 to three.14), hopelessness for the long run (OR with 95% CI: 3.33; 2.65 to 4.18) and historical past of different illnesses (OR with 95% CI: 1.97; 1.54 to 2.53) had a constructive affiliation with anxiousness symptom ranges. For stress signs, along with the talked about variables, the lack of relations was additionally related to an elevated likelihood of stress signs (OR with 95% CI: 1.97; 1.53 to 2.52).
The standardized coefficient was estimated to find out the best variables in every mannequin. As proven in Table 4, the best variables for despair signs had been hopelessness for the long run (−0.668) and a historical past of different illnesses (0.668). Furthermore, the best variable for anxiousness signs and stress signs was a historical past of different illnesses (0.745 and 0.765, respectively).
Table 4. Standardized coefficients to find out the best variables on the outcomes.
4. Discussion
According to the outcomes, lower than 50% of the examine inhabitants have skilled totally different ranges of despair, anxiousness, and stress signs. The prevalence of psychological problems estimated on this examine is in step with the findings of earlier nationwide psychological well being surveys performed in Iran in 2001, 2002, and 2012, which reported the incidence of psychological problems to be 17, 21, and 26.3%, respectively.
It ought to be famous that as a result of the usage of numerous measurement instruments, inhabitants teams, and diagnostic methods, the prevalence of psychological problems could vary considerably between numerous geographic areas. The outcomes of this examine had been, nevertheless, nearly similar to these of the nationwide psychological well being surveys, and the small variation within the estimated prevalence may be attributed to the various statistical inhabitants and numerous estimation strategies (9, 19, 26). Moreover, a meta-analysis of 46 analysis research discovered that despair was prevalent in 34.26% of individuals, which is comparable with the findings of the current examine (30).
The present examine discovered that the prevalence of despair, anxiousness, and stress signs was considerably increased in ladies in comparison with males, with the prevalence of despair at 25% and 17.3%, anxiousness at 31.15% and 23.3%, and stress at 18.6% and 13.6%, respectively. This discovering is in step with earlier analysis performed globally (31–33) and in Iran (34–36), which has urged that ladies have a better prevalence of psychological problems as a result of numerous components reminiscent of social limitations, environmental stress, physiological components, and hormonal variations (37–39).
As could be anticipated, there’s an affiliation between training stage and stress, anxiousness, and despair signs, such that increased charges of those problems had been related to decrease ranges of training. This is in step with different research (26, 40). Higher ranges of training are related to higher communication abilities, entry to useful assets, and a extra favorable social and financial scenario that allow individuals to handle life’s challenges. People with decrease ranges of training have a better prevalence of despair as a result of socio-cultural limitations and the shortcoming to handle these feelings successfully (10, 35). Our findings, nevertheless, weren’t in step with Chegini’s et al. examine (41), which can be defined by the truth that in addition they thought of paranoid and temper problems along with stress, anxiousness, and despair (41).
There is an affiliation between Kurdish ethnicity and decrease ranges of despair signs and anxiousness signs. It seems that in societies with numerous ethnicities, the bulk ethnicity has larger social assist, main to higher coping mechanisms for coping with environmental stress and psychological well being points (42). This discovering is aligned with the outcomes of a earlier examine (43).
According to the findings of earlier research (44, 45), there was an inverse affiliation between despair signs and excessive financial standing within the current examine. The excessive prevalence of psychological problems in these with low financial standing could also be as a result of a lot of components, together with not having sufficient revenue to satisfy even essentially the most fundamental wants, the necessity for leisure, the monotony of life, and an absence of hope for the long run (40, 44, 45).
In line with different research (10, 44, 45), the present examine’s findings confirmed a constructive affiliation amongst despair and anxiousness signs and a historical past of job loss, psychological sickness, feeling hopeless in regards to the future, and having different medical situations. The strongest affiliation on this space was with feeling hopeless in regards to the future; those that felt hopeless in regards to the future had been 5.38 and three.33 instances extra prone to expertise despair and anxiousness signs, respectively. In the subsequent stage, a historical past of psychological problems has the strongest affiliation because the likelihood of despair and anxiousness signs in individuals with a historical past of psychological problems was 2.17 and a pair of.11 increased, respectively than in those who didn’t have a historical past.
The current examine doesn’t present any affiliation between age, physique mass index, and marital standing with despair signs. Although this discovering is in step with Mirzaei’s examine (10), it’s not in step with different research (40, 41, 44). Possible causes for the inconsistency could possibly be as a result of the usage of totally different instruments or totally different populations.
4.1. Limitations
4.2. Conclusion
The outcomes of the examine confirmed that hopelessness in regards to the future, historical past of affected by different illnesses, historical past of psychological problems, job loss, low economic-social standing, low training, ethnicity, and feminine intercourse are components affecting psychological problems. Among these, hopelessness in regards to the future and a historical past of different illnesses had been the strongest components affecting psychological problems. Increasing individuals’s consciousness, establishing counseling facilities, particularly phone counseling, and bettering leisure and sports activities amenities are crucial, and psychological well being policymakers ought to pay particular consideration to them.
4.3. Implications for follow
The present examine’s findings are relevant to native well being policymakers by way of the reform and redesign of psychological well being packages in society. They ought to pay extra consideration to features that contribute to psychological illnesses, reminiscent of hopelessness in regards to the future, by implementing revolutionary initiatives that may rework society’s angle. Arranging happiness packages, spending extra time on social media to orient social views into the long run, growing infrastructure, and coping with impoverishment are efficient methods for reducing the prevalence of psychological problems. Furthermore, if researchers are conscious of the appreciable impact of hopelessness in regards to the future on psychological problems, they may analyze this variable impact and which variables contribute to this affiliation.
Data availability assertion
Ethics assertion
The research involving human individuals had been reviewed and accredited by This undertaking has been accredited by Ilam University of Medical Sciences with ethics code (IR.MEDILAM.REC.1401.031). Informed consent was obtained from all particular person individuals included within the examine. Written knowledgeable consent to take part on this examine was offered by the individuals’ authorized guardian/subsequent of kin.
Author contributions
Acknowledgments
Conflict of curiosity
Publisher’s word
Supplementary materials
The Supplementary materials for this text may be discovered on-line at: https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1166692/full#supplementary-material
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