Academic journal article Iranian Journal of Psychiatry

Mental Health Priorities in Iranian Women: Overview of Social Determinants of Mental Health

Academic journal article Iranian Journal of Psychiatry

Mental Health Priorities in Iranian Women: Overview of Social Determinants of Mental Health

Article excerpt

Mental health is an essential component for positive adaptation that enables people to cope with adversity to achieve their full potential and humanity (1). Mental health is also the key to understanding the impact of inequalities on health (2). The significance of mental health and its role in health outcomes confirms the importance of humans in community, but it does not mean that we should ignore the mental character and power of the individual. Mental disorders are responsible for one third of Years Lived with Disability (YLD) in the world (3). Also, different studies showed that the prevalence of mental disorders in women is more than men (4). In Iran, based on urban HEART study, the prevalence of mental disorder was 38% in Tehran in 2008 (twice in females)(5). Understanding the social determinants of mental health and set their priorities based on community participation are essential to design appropriate interventions for mental health promotion. This process guides the policy makers to design primary prevention plans for mental disorders and provide maximum social welfare (6). In 2007, in the commission on social determinations of health, World Health Organization suggested a five-level priority public health conditions analytical framework that consisted of socioeconomic context and position, differential exposure, vulnerability, health care outcomes and differential consequences to design intervention (7).

The socioeconomic context has a powerful effect on societal distribution of health conditions. In 2004, Bhugra and colleagues investigated the relation between socioeconomic reform and mental disorders and found that rapid changes in the configuration of societies can cause substantial increase in societal burden of mental disorders (8). Differential exposures to risk factors such as stressful life events, social conflict, civil unrest, natural disasters and working environments have strong association with mental health problems (9). In differential vulnerability stage, individual characters such as gender, age, health status, marital status and income affect mental health (10). Chronic physical ill-health, female gender and being a young adult can increase the vulnerability to mental health problems (11).

Lack of mental health literacy and stigma reduce the ability to use health care services (12). Increased financial cost of treatment for mental disorders, loss of job and earning are different consequents of mental health problems (13).

In many studies, different interventions for mental health problems target the five levels of this analytical framework (14, 15). In Iran, there are some interventional programs for the promotion of mental health in different age groups (16, 17), but in the present study, using community participatory research approach, the social determinants of mental disorders were extracted and priority setting for interventional programs according to analytical framework of WHO was implemented.

Material and Methods

This was a community based participatory research(CBPR) conducted for needs assessment and setting priorities for women's mental health in district 22 in western part of Tehran. This method was selected because the CBPR begins with a research topic of importance to community with the aim of combining knowledge and action for a social change to improve the community's health and eliminate health disparities. It is a participatory, cooperative and capacity building process that achieves a balance between research and action.

The district 22 of Tehran has an approximate population of 100 thousand, of which , 49% are women; this district has nine zones and has also special characteristics such as easy access to the community, having active humanitarian organizations and hyper active volunteers that led us to select this district as the venue of our study. In this area, more than 41% of the population has impaired mental health (18).

For needs assessment, we used ENHR approach (8) that has four phases: Stakeholder's analysis, preparatory phase, needs assessment and priority setting. …

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