Province-level Prevalence of Psychiatric Disorders: Application of Small-Area Methodology to the Iranian Mental Health Survey (IranMHS)
AbstractObjective: 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. Method: 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). Results: 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. Conclusion: 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.
Steel Z, Marnane C, Iranpour C, Chey T, Jackson JW, Patel V, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014;43(2):476-93.
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet. 2013;382(9904):1575-86.
Naghavi M, Abolhassani F, Pourmalek F, Lakeh M, Jafari N, Vaseghi S, et al. The burden of disease and injury in Iran 2003. Popul Health Metr. 2009;7:9.
Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet.386(9995):743-800.
Charara R, Forouzanfar M, Naghavi M, Moradi-Lakeh M, Afshin A, Vos T, et al. The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013. PloS One. 2017;12(1):e0169575.
Douglas MJ, Conway L, Gorman D, Gavin S, Hanlon P. Achieving better health through health impact assessment. Health Bull (Edinb). 2001;59(5):300-5.
Ha NS, Lahiri P, Parsons V. Methods and results for small area estimation using smoking data from the 2008 National Health Interview Survey. Stat Med. 2014;33(22):3932-45.
Sagar R, Pattanayak RD, Chandrasekaran R, Chaudhury PK, Deswal BS, Lenin Singh RK, et al. Twelve-month prevalence and treatment gap for common mental disorders: Findings from a large-scale epidemiological survey in India. Indian Journal of Psychiatry. 2017;59(1):46-55.
Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, et al. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Arch Iran Med. 2015;18(2):76-84.
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62(6):617-27.
Eaton WW, Martins SS, Nestadt G, Bienvenu OJ, Clarke D, Alexandre P. The burden of mental disorders. Epidemiol Rev. 2008;30:1-14.
Jia H, Muennig P, Borawski E. Comparison of small-area analysis techniques for estimating county-level outcomes. Am J Prev Med. 2004;26(5):453-60.
Rao JNK, Molina I. Small area estimation. Second edition. ed. Hoboken, New Jersey: John Wiley & Sons, Inc.; 2015. xxix, 441 pages p.
Rahimi-Movaghar A, Amin-Esmaeili M, Sharifi V, Hajebi A, Radgoodarzi R, Hefazi M, et al. Iranian mental health survey: design and field proced. Iran J Psychiatry. 2014;9(2):96-109.
Hudson CG. Socioeconomic status and mental illness: tests of the social causation and selection hypotheses. The American Journal of Orthopsychiatry. 2005;75(1):3-18.
Malec D, Sedransk J, Moriarity CL, LeClere FB. Small area inference for binary variables in the National Health Interview Survey. Journal of the American Statistical Association. 1997;92(439):815-26.
Schneider KL, Lapane KL, Clark MA, Rakowski W. Using small-area estimation to describe county-level disparities in mammography. Prev Chronic Dis. 2009;6(4):A125.
Levy PS, French DK. Synthetic estimation of state health characteristics based on the Health Interview Survey. Vital Health Stat 2. 1977(75):1-22.
Holzer C, Jackson DJ, Tweed D. Horizontal synthetic estimation: a strategy for estimating small area health related characteristics. Eval Program Plann. 1981;4(1):29-34.
Hirve S, Vounatsou P, Juvekar S, Blomstedt Y, Wall S, Chatterji S, et al. Self-rated health: small area large area comparisons amongst older adults at the state, district and sub-district level in India. Health Place. 2014;26:31-8.
Green JG, Alegria M, Kessler RC, McLaughlin KA, Gruber MJ, Sampson NA, et al. Neighborhood sociodemographic predictors of Serious Emotional Disturbance (SED) in schools: demonstrating a small area estimation method in the National Comorbidity Survey (NCS-A) Adolescent Supplement. Adm Policy Ment Health. 2015;42(1):111-20.
Noorbala AA, Damari B, Riazi IS. Evaluation of mental disorders incidence trend in Iran. Daneshvar Medicine. 2014;21(112):1-11.
Noorbala AA, Bagheri Yazdi SA, Yasamy MT, Mohammad K. Mental health survey of the adult population in Iran. The British journal of psychiatry : The Journal of Mental Science. 2004;184:70-3.
Mohammadi MR, Davidian H, Noorbala AA, Malekafzali H, Naghavi HR, Pouretemad HR, et al. An epidemiological survey of psychiatric disorders in Iran. Clin Pract Epidemiol Ment Health. 2005;1:16.
Noorbala AA, Faghihzadeh S, Kamali K, Bagheri Yazdi SA, Hajebi A, Mousavi MT, et al. Mental Health Survey of the Iranian Adult Population in 2015. Arch Iran Med. 2017;20(3):128-34.
Yousefi-Nooraie R, Mohammadi MR, Salesian N, Amin-Esmaeeli M, Mansouri N, Mesgarpour B, et al. Prevalence of psychiatric disorders in Iran: A systematic review. Iranian Journal of Psychiatry. 2007;2(4):137-50.
Khosravi A, Najafi F, Rahbar MR, Motlagh ME, Kabir MJ. Health indicator in Islamic republic of Iran. Tehran2009. 439 p.
Ghosh M, Rao J. Small area estimation: an appraisal. Statistical Science. 1994;9(1):55-76.
Pfeffermann D. Small Area Estimation‐New Developments and Directions. International Statistical Review. 2002;70(1):125-43.
Congdon P. Estimating population prevalence of psychiatric conditions by small area with applications to analysing outcome and referral variations. Health Place. 2006;12(4):465-78.
Hudson CG, Soskolne V. Disparities in the geography of serious mental illness in Israel. Health Place. 2012;18(4):898-910.