Publications by authors named "Masoumeh Amin-Esmaeili"

54 Publications

Spouse and Child Abuse Associated With Illicit Drug Use in Iran: A Systematic Review and Meta-Analysis.

Trauma Violence Abuse 2021 Mar 11:1524838021998655. Epub 2021 Mar 11.

Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.

Background: There is a high prevalence of substance use disorders, especially among men, in Iran and is associated with a high burden on families. We aimed to systematically review the association between illicit drug use and spouse and child abuse in Iran.

Method: Comprehensive terms were used to search three international databases (ISI, Medline, and Scopus) and a national database of Scientific Information Database up to September 2019. The retrieved citations were screened based on the eligibility criteria and then data were extracted, and the risk of bias was assessed by two independent investigators. Data were analyzed using random-effects model to estimate pooled odds ratios (s) and the heterogeneity of studies.

Results: The search yielded 18 articles that met the inclusion criteria. Illicit substance use in husbands was associated with increased odds of current violence ( = 3.50; 95% CI [2.09, 5.86]), current physical violence ( = 5.41; 95% CI [3.50, 8.35]), current psychological violence ( = 6.20; 95% CI [3.74, 10.30]), and current sexual violence ( = 7.23; 95% CI [4.06, 12.87]) against spouse. In studies on child abuse, the odds of current physical child abuse by parents who used an illicit substance was 3.88 times (95% CI [1.50, 10.01]) higher than parents who did not use any illicit substance.

Conclusion: The results of the current study showed that illicit substance use is associated with an increased risk of spouse and child abuse. This is an important social and health consequence of drug use and should be addressed in all drug control plans.
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http://dx.doi.org/10.1177/1524838021998655DOI Listing
March 2021

Metabolomics reveals biomarkers of opioid use disorder.

Transl Psychiatry 2021 Feb 4;11(1):103. Epub 2021 Feb 4.

Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Opioid use disorder (OUD) is diagnosed using the qualitative criteria defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Diagnostic biomarkers for OUD do not currently exist. Our study focused on developing objective biological markers to differentiate chronic opiate users with OUD from chronic opiate users without OUD. Using biospecimens from the Golestan Cohort Study, we compared the metabolomics profiles of high opium users who were diagnosed as OUD positive with high opium users who were diagnosed as OUD negative. High opium use was defined as maximum weekly opium usage greater than or equal to the median usage (2.4 g per week), and OUD was defined as having 2 or more DSM-5 criteria in any 12-month period. Among the 218 high opium users in this study, 80 were diagnosed as OUD negative, while 138 were diagnosed as OUD positive. Seven hundred and twelve peaks differentiated high opium users diagnosed as OUD positive from high opium users diagnosed as OUD negative. Stepwise logistic regression modeling of subject characteristics data together with the 712 differentiating peaks revealed a signature that is 95% predictive of an OUD positive diagnosis, a significant (p < 0.0001) improvement over a 63% accurate prediction based on subject characteristic data for these samples. These results suggest that a metabolic profile can be used to predict an OUD positive diagnosis.
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http://dx.doi.org/10.1038/s41398-021-01228-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862627PMC
February 2021

Data management in substance use disorder treatment research: Implications from data harmonization of National Institute on Drug Abuse-funded randomized controlled trials.

Clin Trials 2021 Apr 1;18(2):215-225. Epub 2020 Dec 1.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Background: Secondary analysis of data from completed randomized controlled trials is a critical and efficient way to maximize the potential benefits from past research. De-identified primary data from completed randomized controlled trials have been increasingly available in recent years; however, the lack of standardized data products is a major barrier to further use of these valuable data. Pre-statistical harmonization of data structure, variables, and codebooks across randomized controlled trials would facilitate secondary data analysis, including meta-analyses and comparative effectiveness studies. We describe a pre-statistical data harmonization initiative to standardize de-identified primary data from substance use disorder treatment randomized controlled trials funded by the National Institute on Drug Abuse available on the National Institute on Drug Abuse Data Share website.

Methods: Standardized datasets and codebooks with consistent data structures, variable names, labels, and definitions were developed for 36 completed randomized controlled trials. Common data domains were identified to bundle data files from individual randomized controlled trials according to relevant concepts. Variables were harmonized if at least two randomized controlled trials used the same instruments. The structures of the harmonized data were determined based on the feedback from clinical trialists and substance use disorder research experts.

Results: We have created a harmonized database of variables across 36 randomized controlled trials with a build-in label and a brief definition for each variable. Data files from the randomized controlled trials have been consistently categorized into eight domains (enrollment, demographics, adherence, adverse events, physical health measures, mental-behavioral-cognitive health measures, self-reported substance use measures, and biologic substance use measures). Standardized codebooks and concordance tables have also been developed to help identify instruments and variables of interest more easily.

Conclusion: The harmonized data of randomized controlled trials of substance use disorder treatments can potentially promote future secondary data analysis of completed randomized controlled trials, allowing combining data from multiple randomized controlled trials and provide guidance for future randomized controlled trials in substance use disorder treatment research.
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http://dx.doi.org/10.1177/1740774520972687DOI Listing
April 2021

Hepatitis B virus infection among people who use drugs in Iran: a systematic review, meta-analysis, and trend analysis.

Harm Reduct J 2020 10 21;17(1):81. Epub 2020 Oct 21.

Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, No. 486, South Karegar Ave., 1336616357, Tehran, Iran.

Background: People who use drugs (PWUD) are considered as one of the main at-risk populations for Hepatitis B virus (HBV) infection. We conducted a systematic review on the prevalence of HBV infection among PWUD in Iran.

Methods: Consistent with PRISMA guideline, international (Medline, Web of Science, Scopus, and Embase) and national (Scientific Information Database) databases were searched using a comprehensive search strategy up to September 2019. The retrieved records were reviewed, and experts were contacted for unpublished studies. Studies on Iranian PWUD reporting HBV surface Antigen (HBsAg) prevalence among people who inject drugs (PWID) and non-injecting PWUD were included. HBsAg prevalence was pooled for PWID and non-injecting PWUD and for other subgroups using random-effects model meta-analysis. The trend of HBV prevalence over time was investigated using meta-regression analysis.

Results: Overall, 35 studies reported data on HBV infection among PWID (33 studies) and non-injecting PWUD (11 studies). The pooled prevalence of HBsAg among PWID was 4.8% (95% CI 3.7-6.2). The only risk factor significantly associated with the odds of positive HBsAg in PWID was the previous history of imprisonment (OR 1.72, 95% CI 1.29-2.30, p value = 0.000). The pooled estimate of HBsAg among non-injecting PWUD was 2.9% (95% CI 2.5-3.2). Time trend analyses showed significant decrease in HBV prevalence among PWID reaching from 8.2% (95% CI 3.9-16.5) in 2004-2006 to 3.1% (95% CI 2.3-4.1) in 2016 and later (b = -0.07; p value = 0.05). No significant trend was detected for non-injecting PWUD.

Conclusion: The prevalence of HBV infection among non-injecting PWUD and even PWID was not considerably higher than the Iranian general population. This might be the result of extensive harm reduction interventions in Iran. However, it seems that there are subgroups of PWID, who do not adequately benefit from existing harm reduction interventions. Future programs should more specifically target these high-risk groups.
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http://dx.doi.org/10.1186/s12954-020-00424-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579800PMC
October 2020

Validation of Addiction Severity Index (ASI) for Assessment of Psychiatric Comorbidity in Multi-Site Randomized Controlled Trials.

J Dual Diagn 2020 Jul-Sep;16(3):312-321. Epub 2020 Apr 7.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

: This study aimed to assess the validity of the psychiatric problems subscale of the Addiction Severity Index (ASI-psych) to ascertain psychiatric comorbidity among individuals participating in randomized controlled trials (RCTs) of substance use disorder (SUD) treatments.: The ASI-psych score among 1,660 RCT participants of National Institute of Drug Abuse Clinical Trials Network studies was compared against diagnosis of any serious mental disorder based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (SCID) or Mini-International Neuropsychiatric Interview (MINI). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for detecting any serious mental disorders were estimated by the receiver operating characteristic (ROC) analysis.: Based on the overall sample, the AUC score for any serious mental disorder was 0.72 (95% confidence interval [CI], [0.69, 0.75]) with the optimal ASI-psych score of 24.6. There was no statistically significant difference in AUCs based on the SCID and MINI ( = 0.05,  = .82) or by target drugs of RCTs ( =1.33,  = .72).: Results support the utility of the ASI in screening for psychiatric comorbidity among patients receiving SUD treatments in RCT settings.
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http://dx.doi.org/10.1080/15504263.2020.1741755DOI Listing
April 2020

Tramadol use and public health consequences in Iran: a systematic review and meta-analysis.

Addiction 2020 12 25;115(12):2213-2242. Epub 2020 Apr 25.

Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.

Background And Aims: Misuse of tramadol, an opioid prescription analgesic, is known as a public health challenge globally. We aimed to systematically review studies on the prevalence of non-prescribed use, regular tramadol use and dependence, tramadol-induced poisoning and mortality in Iran.

Methods: Consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, international (Medline, Scopus, Web of Science) and Persian (SID) databases were systematically searched up to June 2019. Other relevant data were collected through personal contacts and review of reference lists. Pooled estimates of prevalence of tramadol use in subgroups of males and females, percentage of tramadol poisoning among admitted poisoning cases, tramadol-associated seizures and mortality among tramadol poisonings and percentage of tramadol as a cause of death among fatal drug-poisoning records were estimated through a random-effects model.

Results: A total of 84 records were included. Pooled estimates of last 12-month use of tramadol in the Iranian general population were 4.9% [95% confidence interval (CI) = 4.1-5.9] and 0.8% (95% CI = 0.2-1.8) among males and females, respectively. The estimates for last 12-month use among Iranian male and female university students were 4.8% (95% CI = 1.9-8.9) and 0.7% (95% CI = 0.3-1.1), respectively. Six heterogeneous reports indicated the existence of regular use of tramadol and dependence in Iran. Sixty-two studies provided data on tramadol-induced poisoning, seizures and mortality. The pooled estimate of the percentage of tramadol poisoning among all drug-poisoning patients was 13.1% (95% CI = 5.7-22.9). The overall estimates of seizures and mortality among tramadol-poisoning patients were 34.6% (95% CI = 29.6-39.8) and 0.7% (95% CI = 0.0-1.9), respectively. The pooled percentage of tramadol-related fatalities among drug-poisoned cases was 5.7% (95% CI = 0.5-15.4).

Conclusion: Despite control policies, tramadol use is as prevalent as the use of illicit opioids in Iran. Numerous cases of tramadol abuse, dependence, poisonings, seizures and hundreds of tramadol-related deaths have been reported in recent years.
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http://dx.doi.org/10.1111/add.15059DOI Listing
December 2020

Prevalence of Psychiatric Disorders and Associated Factors among the Youth in Ravansar, Iran.

Arch Iran Med 2019 08 1;22(8):435-442. Epub 2019 Aug 1.

Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Background: Mental disorders contribute significantly to the burden of diseases in Iran. Therefore, the current study aims to assess the prevalence of psychiatric disorders and their associated factors among youth in Kermanshah province of Iran.

Methods: The current study is a part of the first phase of Ravansar Cohort (a part of the PERSIAN Youth Cohort) including 2991 participants aged 15 to 34 from Ravansar district in western Iran. Enrollment and data collection for this phase were performed from end April 2015 to early April 2017. The data were gathered using structured interviews and national and international standard questionnaires. Data analysis was carried out using multinomial logistic regression and chi-square test.

Results: The prevalence of any psychiatric disorder among the selected population was 31.3%. Major depressive disorder (MDD) (21.6%), followed by generalized anxiety disorder (GAD) (6.4%) and dysthymia (1.9%) were the most prevalent disorders among the study individuals. The prevalence of alcohol and opioid/stimulant use disorders was 4.6% and 5.1%, respectively. Moreover, there was significant relationship between location of residence (city or village) and marital status with prevalence of the disorders.

Conclusion: Based on the results of the current study, it can be concluded that the prevalence of mental and psychiatric disorders among the youth in Ravansar district, western Iran is relatively high and needs specific plans and interventions to control it.
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August 2019

HIV prevalence among people who inject drugs (PWID) and related factors in Iran: a systematic review, meta-analysis and trend analysis.

Addiction 2020 04 11;115(4):605-622. Epub 2020 Jan 11.

Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.

Aims: In Iran, injecting drug use has been the major route of human immunodeficiency virus (HIV) transmission. In order to control the HIV epidemic, a harm reduction program was initiated and has been expanded in recent years. The aim of this study was to provide an updated estimate of HIV prevalence among people who inject drugs (PWID) in Iran, investigate prevalence differences over time and assess prevalence correlates.

Design: A comprehensive systematic review was undertaken in the international, regional and national bibliographic databases in November 2018 and extensive contacts with authors were made. For studies conducted before 2005, we used data from a previous published systematic review.

Setting: All studies conducted in Iran were included. Recruitment settings included anywhere except studies conducted in infectious diseases wards or HIV counseling centers.

Participants: PWID with any definition utilized in the studies. Thirty-six studies were included, which were conducted in 24 of 31 provinces with a sample size of 22 160 PWID.

Measurements: We included studies that had performed HIV testing and had a confirmed diagnosis of HIV through repeating the enzyme-linked immunosorbent assay (ELISA) or Western immunoblot assay (WB). Pooled prevalence of HIV was calculated for the total sample and for different subgroups, by available socio-demographic and behavioral factors. For assessing the trend of HIV prevalence over time, a linear meta-regression model was fitted separately for before 2007 and during 2007 and afterwards.

Findings: The pooled prevalences of HIV before 2007 and in 2007 and afterwards were 14.3% [95% confidence interval (CI) = 9.8-18.9] and 9.7% (95% CI = 7.6-11.9), respectively. HIV prevalence increased until 2005-06 and then slowly declined until 2009-10, which was not significant. Prevalence of HIV was significantly higher in PWID above age 25 years, and in those with history of imprisonment and history of needle/syringe-sharing. HIV prevalence was higher in men than in women, but the difference was insignificant.

Conclusion: The prevalence of HIV among people who inject drugs in Iran decreased after 2006 which could, at least in part, be attributed to the development of extensive harm reduction programs in the country.
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http://dx.doi.org/10.1111/add.14853DOI Listing
April 2020

Province-Level Prevalence of Psychiatric Disorders: Application of Small-Area Methodology to the Iranian Mental Health Survey (IranMHS).

Iran J Psychiatry 2019 Jan;14(1):16-32

Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

National surveys revealed a high prevalence of psychiatric disorders in Iran. Province-level estimates are needed to manage the resources and focus on preventive efforts more efficiently. The objective of this study was to provide province-level estimates of psychiatric disorders. In this study, Iranian Mental Health Survey (IranMHS) data (n = 7886) was used to produce province-level prevalence estimates of any psychiatric disorders among 15-64 year old males and females. Psychiatric disorders were diagnosed based on structured diagnostic interview of the Persian version of Composite International Diagnostic Interview (CIDI, version, 2.1). The Hierarchical Bayesian (HB) random effect model was used to calculate the estimates. The mental health status of half of the participants was also measured using a 28-item general health questionnaire (GHQ). A wide variation in the prevalence of psychiatric disorders was found among 31 provinces of Iran. The direct estimates ranged from 3.6% to 62.6%, while the HB estimates ranged from 12.6% to 36.5%. The provincial prevalence among men ranged from 11.9% to 34.5%, while it ranged from 18.4% to 38.8% among women. The Pearson correlation coefficient between HB estimates and GHQ scores was 0.73. The Bayesian small area estimation provides estimation with improved precision at local levels. Detecting high-priority communities with small-area approach could lead to a better distribution of limited facilities and more effective mental health interventions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505053PMC
January 2019

Misuse of prescribed opioids in the United States.

Pharmacoepidemiol Drug Saf 2019 03 5;28(3):345-353. Epub 2019 Feb 5.

Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA.

Purpose: To assess the prevalence and correlates of self-reported misuse of prescribed-opioid medications in the US general population.

Method: In 31 068 adult participants of the National Survey on Drug Use and Health (NSDUH) 2015 and 2016 who reported using opioids in the past year, we assessed the prevalence and correlates of self-reported misuse of prescribed opioids, defined as using a larger dose, more frequently, or longer than prescribed. Multivariable logistic-regression models and the machine-learning method of boosted regression were used to identify the correlates of misuse.

Results: On the basis of weighted NSDUH estimates, of more than 89 million US adults who used prescription opioids every year, close to 3.9 million (4.4%) reported misused the prescribed medications. Prescribed-opioid misuse was most strongly associated with co-occurring misuse of opioids without a prescription, misuse of benzodiazepines, other drug-use disorders, history of illegal activity, and psychological distress. Misuse of prescribed opioids was also strongly associated with prescription opioid-use disorder, especially among those who misused more potent opioids or started misusing opioids before the current year.

Conclusions: Misuse of prescribed opioids is associated with other high-risk behaviors and adverse health outcomes. The findings call for better monitoring of opioid prescription in clinical practice.
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http://dx.doi.org/10.1002/pds.4743DOI Listing
March 2019

Prevalence and Costs of Complementary and Alternative Medicine among Traumatic Patients in Iran: A Nationwide Population-based Study.

Iran J Public Health 2018 Oct;47(10):1558-1566

Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: This study was aimed to determine the prevalence, predictors and cost of CAM practitioner use among traumatic patients in Iran.

Methods: This cross-sectional household survey of a nationally representative sample of Iranians 15 to 64 yr old was conducted in 2011, using a three-stage cluster sampling. Short Form Injury Questionnaire 7 (SFIQ7) was utilized through face-to-face interviews and data on demographics, history of injuries, mechanism, site and type of injury, type and place of the treatment were attained. Via telephone calls, service use and costs of treatment were also collected.

Results: The prevalence of CAM practitioner use in injured people and victims seeking medical care was 0.7% and 4.1%, respectively in 3-month interval in 2011. There were no significant sociodemographic differences between victims who seek unconventional settings and those who seek conventional treatment. The most common injury description treated by CAM providers was as follows: fracture (type of injury), upper limb (site of injury), fall (mechanism of injury) and cast, splint, and physiotherapy (type of treatment). The average medical cost of CAM practitioner was US$14.7 while this amount in the conventional setting was US$195.5.

Conclusion: Use of CAM is not very common among injured people in Iran. However, due to lack of formal training, CAM usage has possible side effects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277723PMC
October 2018

Cluster analysis of psychiatric profile, its correlates, and using mental health services among the young people aged 15-34: findings from the first phase of Iranian youth cohort in Ravansar.

Soc Psychiatry Psychiatr Epidemiol 2018 Dec 25;53(12):1339-1348. Epub 2018 Aug 25.

Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Purposes: (1) Cluster analysis of psychiatric disorders and partitioning the youth; (2) determining socio-demographic correlates and parental histories for each one of the clusters; and (3) comparing clusters based on the extent and type of using psychotherapeutic services.

Methods: The current cross-sectional study is a part of the first phase of PERSIAN Youth Cohort. The sample of the study includes 2991 participants aged 15-34 (27 ± 5.1 years, 55.6% female) from Ravansar district in western Iran. Enrollment and data collection for this phase were performed from October, 2014 to January, 2017. The data were collected through structured interviews, including the Composite International Diagnostic Interview (CIDI; version 2.1), mental health-related Sheehan Disability Scale, and Service Use Questionnaire. The obtained data were analyzed using two-step cluster analysis, multinomial logistic regression, and Chi-square test.

Results: Our model proposed three clusters: a clinical cluster with significant mental disability; a healthy cluster with significant disability; and a healthy cluster with mild disability. There is a direct relationship between widow/divorced marital status and psychiatric maternal history with the clinical cluster (P < 0.05). Clinical and non-clinical clusters with medium to severe disability used services for mental health more often that the healthy cluster with mild functional disability (P < 0.05).

Conclusions: The results of the study show that 28.7% of the youth in the general population of western Iran are suffering from psychiatric disorders and nearly two-thirds of the total population reported a medium-severe functional disability. Considering the wide range of mental disorders and the functional disability levels created by these disorders, cluster analysis could provide invaluable information regarding the partitioning of the youth population.
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http://dx.doi.org/10.1007/s00127-018-1580-4DOI Listing
December 2018

Bipolar features in major depressive disorder: Results from the Iranian mental health survey (IranMHS).

J Affect Disord 2018 12 8;241:319-324. Epub 2018 Aug 8.

Consultant Psychiatrist, Eastern Health, Melbourne, VIC, Australia.

Background: Past research suggests that individuals suffering from depressive disorders with bipolar features might have different clinical outcomes resembling bipolar disorders. The objectives of this study are to determine the prevalence of bipolar features among individuals meeting the criteria for 12-month major depressive disorder (MDD) in the Iranian population and to examine the demographic and clinical characteristics associated with these features.

Methods: Data were drawn from the Iranian Mental Health Survey (IranMHS), a representative household survey of the Iranian population aged 15-64 years. The study sample consisted of all individuals with a 12-month MDD (n = 1014) ascertained by the Composite International Diagnostic Interview (CIDI 2.1) without a lifetime history of bipolar I or II disorders. Mood Disorder Questionnaire (MDQ) was used to screen for the lifetime history of bipolar features among participants with MDD.

Results: Among participants meeting the 12-month MDD criteria, 22.1% (95% CI: 19.6-24.7) had a lifetime history of bipolar features. Compared with those without these features, participants with bipolar features had higher odds of endorsing suicidal ideations and suicide attempts, comorbid anxiety and substance use disorders, severe impairment, history of psychotic symptoms, some features of atypical depression and fewer depressive symptoms. Associations with comorbid anxiety disorders [Odds Ratio (OR) = 1.43; 95% confidence interval (CI): 1.00-2.03] and history of psychotic symptoms (OR = 2.63 95% CI: 1.81-3.81) persisted in multivariable models.

Limitation: Relying on self-reports of lifetime bipolar symptoms which is open to recall bias, and cross-sectional study design which limits interpretation of outcome and course of MDD are two major limitations of this study.

Conclusion: The presence of bipolar features is associated with a distinct demographic and clinical profile in MDD. Identifying these cases would enhance the homogeneity of the depressive disorder phenotype in general population surveys. Identifying MDD patients with these features has potential clinical implications.
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http://dx.doi.org/10.1016/j.jad.2018.08.014DOI Listing
December 2018

Major anxiety disorders in Iran: prevalence, sociodemographic correlates and service utilization.

BMC Psychiatry 2018 08 20;18(1):261. Epub 2018 Aug 20.

Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.

Background: It has been shown in the past two decades that anxiety disorders are the most common mental disorders in general population across the world. This study sought to assess the prevalence of major anxiety disorders, their sociodemographic correlates and mental health service utilization as part of the Iranian Mental Health Survey (IranMHS).

Methods: A national household face-to-face survey was carried out on a representative sample of Iranian adults from January to June 2011 using Composite International Diagnostic Interview (CIDI 2.1). A total of 7886 subjects between 15 and 64 years who can understand Persian language were included. The 12-month prevalence of anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), their socio-demographic correlates, health service use and days out of role were measured in this study.

Results: The 12-month prevalence of anxiety disorders (not including specific phobias) was 15.6%. The prevalence was 12.0% in males and 19.4% in females. The three most prevalent anxiety disorders were generalized anxiety disorder (5.2%), obsessive-compulsive disorder (5.1%) and social phobia (3.2%), respectively. Factors found to be significantly associated with anxiety disorders were: female gender (OR = 1.16, 95% CI: 1.09-1.23), middle (OR = 1.23, 95%CI: 1.01-1.50) or low (OR = 1.66, 95%CI: 1.31-2.10) socioeconomic status, unemployment (OR = 1.98, 95%CI: 1.49-2.62), and urban residence (OR = 1.31, 95%CI: 1.10-1.57). Comorbidity with non-anxiety disorders significantly increased service utilization. In all subgroups, service utilization was higher among females while the number of days out of role was higher among males.

Conclusions: Anxiety disorders are common conditions with a higher prevalence among the female gender, unemployed individuals, and people with low socioeconomic conditions living in urban areas. Comorbidity of anxiety disorders with other psychological disorders aggravates the disability and significantly increases the number of days out of role.
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http://dx.doi.org/10.1186/s12888-018-1828-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6102821PMC
August 2018

Methods for calculation of per capita alcohol consumption in a Muslim majority country with a very low drinking level: Findings from the 2011 Iranian mental health survey.

Drug Alcohol Rev 2018 11 19;37(7):874-878. Epub 2018 Jul 19.

Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.

Introduction And Aims: There is a paucity of data on volume of alcohol use from Muslim majority countries. We aimed to present estimation methods for alcohol consumption with the use of survey data for these societies and provide an estimation for age 15+ per capita consumption of pure alcohol for Iran.

Design And Methods: The Iranian Mental Health Survey was a nationally representative household survey on individuals aged 15-64 years, with a multistage, cluster sampling design. We used the 'Last Week' method and 'Quantity-Frequency' methods for gathering data on alcohol consumption and combined these to provide more complete estimates.

Results: The response rate was 85.7%. From the total of 7840 respondents, 5.7% and 1% reported past 12 months and past week alcohol use, respectively. The highest estimation for age 15+ per capita consumption of pure alcohol was yielded by the 'combination method' (0.108 L ethanol/person/year) followed by the Quantity-Frequency method (0.079 L). The 'Last Week' method provided the lowest estimate (0.059 L).

Discussion And Conclusions: Unlike in surveys of non-Muslim countries, frequency of drinking from recent recall (last week) was much lower than from recall of usual drinking in the last year. We conclude that 0.108 L (SE = 0.03) is the best survey-based estimate of age 15+ per capita consumption, which translates to about 5 750 000 L of national consumption per year in Iran. However, this method is still likely to under-estimate per capita consumption due to evidence of under-reporting in the survey.
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http://dx.doi.org/10.1111/dar.12847DOI Listing
November 2018

Ambiguities in existing Iranian national policies addressing excessive gaming.

J Behav Addict 2018 09 19;7(3):540-542. Epub 2018 Jul 19.

1 Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences , Tehran, Iran.

Considering the scarcity of available science and controversies around effective policies addressing gaming disorder and its health-related consequences, Király et al. have conducted a systematic review on current evidence regarding this issue. We, a group of researchers in this field, would like to express our perspective from Iran. With rapid growth of gaming, Iran seems to be facing some specific policy issues and challenges, which are going to be reviewed in this short commentary.
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http://dx.doi.org/10.1556/2006.7.2018.63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426390PMC
September 2018

Explaining socioeconomic inequalities in illicit drug use disorders in Iran.

Med J Islam Repub Iran 2017 18;31:108. Epub 2017 Dec 18.

Research Center for Addiction and Risky Behaviors (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran.

Drug use disorders are one of the major health problems in societies, which cause physical, psychological, and social damages to individuals. Socioeconomic status is often inversely associated with drug use disorders. The present study aimed at determining the effect of socioeconomic inequality on the prevalence of drug use disorders and identifying its determinants in Iran. Data of 7886 individuals aged 15 to 64 years were collected from Iran Mental Health Survey (IranMHS). Initially, the socioeconomic status of the participants was determined by principal component analysis. Later, socioeconomic inequality was measured using the concentration index, and the factors influencing the gap between the high and low socioeconomic groups were identified using the Oaxaca-Blinder Decomposition. The concentration index for drug use disorders in Iran was -0.29 (standard error= 0.06). The results of decomposition technique revealed that 1.14% and 2.7% of the participants with high and low socioeconomic status were affected by drug use disorders, respectively. In addition, the gap between these 2 groups was found to be 1.65%. Among the studied variables, occupation, marital status, and gender accounted for the highest contribution to inequality, respectively. There is inequality in the prevalence of drug use disorders in Iran; these disorders are more common in lower socioeconomic group. Based on the findings, it is suggested that improvement in the socioeconomic status of the households, especially for males, the divorced or widowed individuals, and the unemployed may lead to a reduction in inequality in drug use disorders.
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http://dx.doi.org/10.14196/mjiri.31.108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014806PMC
December 2017

Pharmacological therapies for management of opium withdrawal.

Cochrane Database Syst Rev 2018 06 21;6:CD007522. Epub 2018 Jun 21.

Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, No. 486, South Karegar Ave., Tehran, Tehran, Iran, 1336616357.

Background: Pharmacologic therapies for management of heroin withdrawal have been studied and reviewed widely. Opium dependence is generally associated with less severe dependence and milder withdrawal symptoms than heroin. The evidence on withdrawal management of heroin might therefore not be exactly applicable for opium.

Objectives: To assess the effectiveness and safety of various pharmacologic therapies for the management of the acute phase of opium withdrawal.

Search Methods: We searched the following sources up to September 2017: CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, regional and national databases (IMEMR, Iranmedex, and IranPsych), main electronic sources of ongoing trials, and reference lists of all relevant papers. In addition, we contacted known investigators to obtain missing data or incomplete trials.

Selection Criteria: Controlled clinical trials and randomised controlled trials on pharmacological therapies, compared with no intervention, placebo, other pharmacologic treatments, different doses of the same drug, and psychosocial intervention, to manage acute withdrawal from opium in a maximum duration of 30 days.

Data Collection And Analysis: We used the standard methodological procedures expected by Cochrane.

Main Results: We included 13 trials involving 1096 participants. No pooled analysis was possible. Studies were carried out in three countries, Iran, India, and Thailand, in outpatient and inpatient settings. The quality of the evidence was generally very low.When the mean of withdrawal symptoms was provided for several days, we mainly focused on day 3. The reason for this was that the highest severity of opium withdrawal is in the second to fourth day.Comparing different pharmacological treatments with each other, clonidine was twice as good as methadone for completion of treatment (risk ratio (RR) 2.01, 95% confidence interval (CI) 1.69 to 2.38; 361 participants, 1 study, low-quality evidence). All the other results showed no differences between the considered drugs: baclofen versus clonidine (RR 1.06, 95% CI 0.63 to 1.80; 66 participants, 1 study, very low-quality evidence); clonidine versus clonidine plus amantadine (RR 1.03, 95% CI 0.86 to 1.24; 69 participants, 1 study); clonidine versus buprenorphine in an inpatient setting (RR 1.04, 95% CI 0.90 to 1.20; 1 study, 35 participants, very low-quality evidence); methadone versus tramadol (RR 0.95, 95% CI 0.65 to 1.37; 1 study, 72 participants, very low-quality evidence); methadone versus methadone plus gabapentin (RR 1.17, 95% CI 0.96 to 1.43; 1 study, 40 participants, low-quality evidence), and tincture of opium versus methadone (1 study, 74 participants, low-quality evidence).Comparing different pharmacological treatments with each other, adding amantadine to clonidine decreased withdrawal scores rated at day 3 (mean difference (MD) -3.56, 95% CI -5.97 to -1.15; 1 study, 60 participants, very low-quality evidence). Comparing clonidine with buprenorphine in an inpatient setting, we found no difference in withdrawal symptoms rated by a physician (MD -1.40, 95% CI -2.93 to 0.13; 1 study, 34 participants, very low-quality evidence), and results in favour of buprenorpine when rated by participants (MD -11.80, 95% CI -15.56 to -8.04). Buprenorphine was superior to clonidine in controlling severe withdrawal symptoms in an outpatient setting (RR 0.35, 95% CI 0.19 to 0.64; 1 study, 76 participants). We found no difference in the comparison of methadone versus tramadol (MD 0.04, 95% CI -2.68 to 2.76; 1 study, 72 participants) and in the comparison of methadone versus methadone plus gabapentin (MD -2.20, 95% CI -6.72 to 2.32; 1 study, 40 participants).Comparing clonidine versus buprenorphine in an outpatient setting, more adverse effects were reported in the clonidine group (1 study, 76 participants). Higher numbers of participants in the clonidine group experienced hypotension at days 5 to 8, headache at days 1 to 8, sedation at days 5 to 8, dizziness and dry mouth at days 1 to 10, and nausea at days 1 to 9. Sweating was reported in a significantly higher number of participants in the buprenorphine group at days 1 to 10. We found no difference between groups for all the other comparisons considering this outcome.Comparing different dosages of the same pharmacological detoxification treatment, a high dose of clonidine (1 to 1.2 mg/day) did not differ from a low dose of clonidine (0.5 to 0.6 mg/day) in completion of treatment in an inpatient setting (RR 1.00, 95% CI 0.84 to 1.19; 1 study, 68 participants), however a higher number of participants with hypotension was reported in the high-dose group (RR 3.25, 95% CI 1.77 to 5.98). Gradual reduction of methadone was associated with more adverse effects than abrupt withdrawal of methadone (RR 2.25, 95% CI 1.02 to 4.94; 1 study, 20 participants, very low-quality evidence).

Authors' Conclusions: Results did not support using any specific pharmacological approach for the management of opium withdrawal due to generally very low-quality evidence and small or no differences between treatments. However, it seems that opium withdrawal symptoms are significant, especially at days 2 to 4 after discontinuation of opium. All of the assessed medications might be useful in alleviating symptoms. Those who receive clonidine might experience hypotension.
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http://dx.doi.org/10.1002/14651858.CD007522.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513031PMC
June 2018

Adaptation and validation of short scales for assessment of psychological distress in Iran: The Persian K10 and K6.

Int J Methods Psychiatr Res 2018 09 11;27(3):e1726. Epub 2018 Jun 11.

Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland.

Objectives: The aims of the study were to translate into Persian and culturally adapt the Kessler Psychological Distress Scales, K10 and K6, and to assess their reliability and validity.

Method: The sample was recruited from primary health care (PHC) settings by quota nonprobability sampling, stratified by sex and age. Validity was assessed against the Composite International Diagnostic Interview (v2.1). The psychometric properties of K6 and K10 were also compared with the 12-item General Health Questionnaire (GHQ-12).

Results: A total of 818 participants completed the questionnaire. Cronbach's alpha were 0.92 and 0.87 for K6 and K10, respectively. Optimal cutoff scores for detecting any mood or anxiety disorder in the past 30 days were 15 for K10 and 10 for K6. At these cutoff points, the measures had sensitivities of 0.77 and 0.73, specificities of 0.74 and 0.78, and positive predictive values of 0.48 and 0.52, respectively. Psychometric properties of K10 and K6 were similar to GHQ-12.

Conclusion: Persian K10 and K6 have acceptable psychometric properties as screening instruments for common mental health conditions. Given its brevity and similar psychometric properties to the longer instruments, the Persian K6 appears to be a suitable scale for use in PHC settings and, possibly, epidemiologic studies in Iran.
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http://dx.doi.org/10.1002/mpr.1726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877187PMC
September 2018

Psychiatric disorders among people living with HIV/AIDS in IRAN: Prevalence, severity, service utilization and unmet mental health needs.

J Psychosom Res 2018 07 27;110:24-31. Epub 2018 Apr 27.

Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: HIV and psychiatric disorders are closely correlated and are accompanied by some similar risk factors.

Objective: The aim of this study was to assess psychiatric comorbidity and health service utilization for mental problems among people living with HIV/AIDS in Iran.

Methods: A total of 250 cases were randomly selected from a large referral center for HIV treatment and care in Tehran, Iran. Psychiatric disorders in the past 12 months including mood, anxiety, and substance use disorders were assessed through face-to-face interview, using a validated Persian translation of the Composite International Diagnostic Interview (CIDI v2.1). Severity of psychiatric disorders, social support, socio-economic status, service utilization and HIV-related indicators were assessed.

Results: Participants consisted of 147 men and 103 women. Psychiatric disorders were found in 50.2% (95% confidence interval: 43.8-56.6) of the participants. Major depressive disorder was the most prevalent diagnosis (32.1%), followed by substance use disorders (17.1%). In bivariate analysis, psychiatric disorders were significantly higher among male gender, single and unemployed individuals and those with lower social support. In multivariate regression analysis, only social support was independently associated with psychiatric disorders. Among those with a psychiatric diagnosis, 41.1% had used a health service for mental problems and 53% had received minimally adequate treatment.

Conclusion: The findings of the study highlight the importance of mental health services in the treatment of people living with HIV/AIDS.
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http://dx.doi.org/10.1016/j.jpsychores.2018.04.012DOI Listing
July 2018

Global Scientific Production on Illicit Drug Addiction: A Two-Decade Analysis.

Eur Addict Res 2018 6;24(2):60-70. Epub 2018 Apr 6.

Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.

Aims: Addiction science has made great progress in the past decades. We conducted a scientometric study in order to quantify the number of publications and the growth rate globally, regionally, and at country levels.

Methods: In October 2015, we searched the Scopus database using the general keywords of addiction or drug-use disorders combined with specific terms regarding 4 groups of illicit drugs - cannabis, opioids, cocaine, and other stimulants or hallucinogens. All documents published during the 20-year period from 1995 to 2014 were included.

Results: A total of 95,398 documents were retrieved. The highest number of documents were on opioids, both globally (60.1%) and in each of 5 continents. However, studies on cannabis showed a higher growth rate in the last 5-year period of the study (2010-2014). The United States, the United Kingdom, Germany, Canada, Australia, France, Spain, Italy, China, and Japan - almost all studies were from high-income countries - occupied the top 10 positions and produced 81.4% of the global science on drug addiction.

Conclusion: As there are important socio-cultural differences in the epidemiology and optimal clinical care of addictive disorders, it is suggested that low- and more affected middle-income countries increase their capacity to conduct research and disseminate the knowledge in this field.
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http://dx.doi.org/10.1159/000487590DOI Listing
October 2018

The PERSIAN Cohort: Providing the Evidence Needed for Healthcare Reform.

Arch Iran Med 2017 Nov 1;20(11):691-695. Epub 2017 Nov 1.

Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

In the past, communicable diseases caused the highest mortality in Iran. Improvements in socioeconomic status and living standards including access to safe drinking water, along with the inception of Health Houses in the 1980s, have changed disease patterns, decreasing the spread of and deaths from infectious and communicable diseases. The incidence and prevalence of non-communicable diseases (NCD), however, have now increased in Iran, accounting for nearly 80% of deaths and disabilities. Without interventions, NCD are predicted to impose a substantial human and economic burden in the next 2 decades. However, Iran's health system is not equipped with the necessary policies to combat this growth and must refocus and reform. Therefore, in the year 2013, the Ministry of Health and Medical Education funded a well-designed nationwide cohort study-Prospective Epidemiological Research Studies in IrAN (PERSIAN)-in order to assess the burden of NCD and investigate the risk factors associated with them in the different ethnicities and geographical areas of Iran. The PERSIAN Cohort, which aims to include 200000 participants, has 4 components: Adult (main), Birth, Youth and Elderly, which are being carried out in 22 different regions of Iran. Having an enormous dataset along with a biobank of blood, urine, hair and nail samples, the PERSIAN Cohort will serve as an important infrastructure for future implementation research and will provide the evidence needed for new healthcare policies in order to better control, manage and prevent NCD.
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November 2017

Inclusion of gaming disorder in the diagnostic classifications and promotion of public health response.

J Behav Addict 2017 09 17;6(3):310-312. Epub 2017 Aug 17.

1 Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences , Tehran, Iran.

There are ongoing controversies regarding the upcoming ICD-11 concept of gaming disorder. Recently, Aarseth et al. have put this diagnostic entity into scrutiny. Although we, a group of Iranian researchers and clinicians, acknowledge some of Aarseth et al.'s concerns, believe that the inclusion of gaming disorder in the upcoming ICD-11 would facilitate necessary steps to raise public awareness, enhance development of proper diagnostic approaches and treatment interventions, and improve health and non-health policies.
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http://dx.doi.org/10.1556/2006.6.2017.048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700723PMC
September 2017

Alcohol use disorders in Iran: Prevalence, symptoms, correlates, and comorbidity.

Drug Alcohol Depend 2017 07 10;176:48-54. Epub 2017 May 10.

Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Background: For nearly four decades, alcohol production and consumption has been banned in the Islamic country of Iran. However, little is known about the extent of alcohol use and associated problems in the country. The paper aims to present findings on the 12-month prevalence, symptoms, severity, correlates, and comorbidity of alcohol use disorders in the Iranian population.

Methods: This report is based on the 2011 Iranian household Mental Health survey (IranMHS), a nationally representative face-to-face household survey with a multi-stage, cluster sampling design. A total of 7840 individuals aged 15-64 responded to the alcohol section. We assessed 12-month alcohol use disorders according to DSM-IV and DSM-5 criteria and harmful use according to the ICD-10 criteria.

Results: Weighted prevalence of using alcohol at least once in the past 12 months was 5.7%. The prevalence of 12-month alcohol use disorders was 1% according to DSM-IV criteria and 1.3% according to DSM-5. Harmful use was reported in 0.6%. Alcohol use disorders were markedly more common in men than women with an odds ratio (OR) of 13.3. It was also more prevalent in never-married versus married individuals (OR=2.5) and in those living in urban versus rural areas (OR=2.4). Among those with alcohol use disorders, 46.3% had a concurrent mood or anxiety disorder. Aggressive behaviors and injuries were more likely in those with alcohol use disorders.

Conclusion: Although Iran has a low level of alcohol use, its adverse consequences including use disorders, aggression, and injuries are moderately common and raise serious public health concerns.
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http://dx.doi.org/10.1016/j.drugalcdep.2017.02.018DOI Listing
July 2017

Use of amphetamine-type stimulants in the Islamic Republic of Iran, 2004-2015: a review.

East Mediterr Health J 2017 May 1;23(3):245-256. Epub 2017 May 1.

Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

Amphetamine-type stimulants (ATS) are the second most commonly used illicit drugs in the world, after cannabis. The production of ATS has increased worldwide, including in the Middle East. This review aims to assess ATS use in the Islamic Republic of Iran. PubMed, Scientific Information Database (a national database) and Iranian Center for Addiction Studies were searched. The review included studies on the general population, university and high school students, other specific populations, and drug users. The result show that self-reported methamphetamine and ecstasy use in 2016 was < 1% in the general population and university and high-school students, but the prevalence was higher in certain groups. There has also been an increase in the proportion of ATS users among clients of drug treatment centres. The findings highlight the need for high quality epidemiological studies and closer monitoring of stimulant use in different populations.
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http://dx.doi.org/10.26719/2017.23.3.245DOI Listing
May 2017

Drop-out from a drug treatment clinic and associated reasons.

East Mediterr Health J 2017 May 1;23(3):173-181. Epub 2017 May 1.

Iranian National Center for Addiction Studies (INCAS), Iranian Institute for Reduction of High-Risk Behaviour, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

The aim of this study was to assess drop-out rates and associated reasons among patients at the Iranian National Center for Addiction Studies (INCAS) clinic. In a one-year period (April 2014 to March 2015), all patients with drug dependence who had been referred for treatment and attended for a first assessment were included in this study (N=242). Those who received treatment were followed until March 2016. Survival analysis showed that 70.2% had dropped out from treatment. Log rank test showed that treatment drop-out rates differed between the different approaches used (P < 0.001), with the lowest slope inbuprenorphine maintenance treatment and the highest in the detoxification programme. Drop-out rates within the first three months was 62% (SE= 0.05) and 82.4% (SE=0.03) for opioids and stimulants dependence, respectively. Analyses were performed using SPSS (Version 21.0) and STATA software, (version 13.0). From the patients' perspective, motivational inconsistencies were considered as the main reason for not starting or leaving treatment. The findings of this study could give service providers a better grasp of drop-out rates and the associated reasons.
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http://dx.doi.org/10.26719/2017.23.3.173DOI Listing
May 2017

Out-of-pocket cost of drug abuse consequences: results from Iranian National Mental Health Survey.

East Mediterr Health J 2017 May 1;23(3):150-160. Epub 2017 May 1.

Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran.

Drug abuse has significant cost to the individual, the family and the society. This study aimed to assess out of-pocket costs of consequences of drug use disorder. Data were drawn from the Iranian Mental Health Survey (IranMHS) through face-to-face interviews with 7841 respondents aged 15-64 years. We used a bottom-up cost-ofillness method for economic analysis. Out-of-pocket costs for treatment of mental and drug problems, treatment of medical illnesses, as well as costs of crimes were assessed. The average of total annual expense was US$ 2120.6 for those with drug use disorder, which was 23.5% of annual income of an average Iranian family in the year 2011. The average of total out-of-pocket cost was US$ 674.6 for those with other mental disorder and US$ 421.9 for those with no mental disorder. Catastrophic payment was reported in 47.6% of the patients with drug use disorder and 14.4% of those with other mental disorder. Thus, considerable amount of family resources are spent on the consequences of drug use.
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http://dx.doi.org/10.26719/2017.23.3.150DOI Listing
May 2017

Incidence and cost of non-fatal burns in Iran: a nationwide population-based study.

Int J Inj Contr Saf Promot 2018 Mar 7;25(1):23-30. Epub 2017 Apr 7.

a Sina Trauma and Surgery Research Center , Tehran University of Medical Sciences (TUMS) , Tehran , Iran.

To determine the incidence and cost of non-fatal burns in Iran; this cross-sectional household survey of a nationally representative sample of 15-64 years old was conducted. Through face-to-face interviews and telephone calls, the data on the demographics, history and cost of burns were collected. The annual incidence rate of burns was estimated 129.85 per 1000 population. Burns occurred higher in younger age, female gender and urban residency. The most common burn description was as follows: unpaid work (activity during burn), home (place of burn), heat and hot substances (mechanism of burn) and upper limb (site of burn). The average total cost of burn includes victims seeking medical care was US$124 per case. The main findings of this study suggest that burns are a major public health concern in Iran. To stop this important health issue, a national program for burn prevention and education must be developed.
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http://dx.doi.org/10.1080/17457300.2017.1310739DOI Listing
March 2018

Profile of People Who Inject Drugs in Tehran, Iran.

Acta Med Iran 2016 Dec;54(12):793-805

Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

The marked shift in the patterns of drug use in Iran, from opium smoking to injecting drug use, has led to serious health-related outcomes. This study was designed to explore characteristics of people who inject drugs (PWID) in Tehran, Iran. Nine hundred and four PWID were recruited from treatment and harm reduction facilities, as well as drug user hangouts in public areas in Tehran. Participants were interviewed using the Persian version of the World Health Organization Drug Injecting Study Phase II questionnaire. The median age at the time of the first illegal drug use, at the time of the first injection and current age was 20, 24 and 32, respectively. In more than 80% of the cases, the first drug used was opium. The transition from the first drug use to the first drug injection occurred after an average of 6.6 and 2.7 years for those who had started drug use with opium and heroin, respectively. Two-thirds of the participants shared injecting equipment within the last 6 months. Difficulty in obtaining sterile needles and thehigh cost of syringes were reported as the major reasons for needle/syringe sharing. Approximately 80% of community-recruited PWID reported difficulties in using treatment or harm reduction services. Self-detoxification and forced detoxification were the most common types of drug abuse treatment in alifetime. Despite a dramatic shift in drug policy in Iran during the past few years, wider coverage of harm reduction services, improvement of the quality of services, and education about such services are still necessary.
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December 2016

Direct and indirect costs of nonfatal road traffic injuries in Iran: A population-based study.

Traffic Inj Prev 2017 05 30;18(4):393-397. Epub 2016 Aug 30.

a Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences (TUMS) , Tehran , Iran.

Objectives: The objective of this study was to assess the incidence rate as well as direct and indirect costs of nonfatal road traffic injuries (RTIs) in Iran in 2011.

Methods: Data from the 2011 national household survey were used. In this survey, data on demographics, history, and costs of injury were obtained in 2 steps: first, direct face-to-face interview and second, telephone calls. We estimated the incidence rate of nonfatal RTIs in this year. The direct costs included medical care as well as nonmedical costs paid by the patient or insurance services. The indirect costs were estimated by considering the cost of absence from work or education. We also used logistic regression analyses to investigate risk factors of nonfatal RTIs.

Results: We found 76 nonfatal RTI cases (0.96%) out of 7,886 whole reference study cases. These 76 injured patients had a history of RTI in the preceding 3 months. The annual incidence of RTIs was estimated at 3.84%. The mean age of RTI cases was 28.5 ± 10.6 and 88.16% of them were male. Male gender was a major risk factor (odds ratio [OR] = 9.64, 95% confidence interval [CI], 4.79-19.41) and marriage was a protective factor (OR = 0.44, 95% CI, 0.28-0.70) for RTI. The medians of direct, indirect, and total costs were US$214, US$163, and US$387, respectively. The total cost of nonfatal RTIs in Iran was estimated at 1.29% of the gross domestic product (GDP) in 2011.

Conclusions: In Iran, nonfatal RTIs imposed a total cost of almost US$7 billion to the country for one year. Extension and more serious implementation of preventive measurements seem necessary to decrease this notable burden of RTIs.
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http://dx.doi.org/10.1080/15389588.2016.1211272DOI Listing
May 2017