Original Article

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents


Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels.
Method: A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL).
Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father).
Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services.

1. Wittchen H-U. Continued needs for epidemiological studies of mental disorders in the community. Psychotherapy and psychosomatics. 2004;73(4):197-206.
2. MacMahon B, Pugh TF. Epidemiology: principles and methods. Epidemiology: principles and methods. London UK: 1970.
3. Smelser NJ, Baltes PB. International encyclopedia of the social & behavioral sciences. Kidlington, UK: Elsevier Amsterdam; 2001.
4. Wittchen HU. Epidemiological research in mental disorders: Lessons for the next decade of research—The NAPE Lecture 1999. Acta Psychiatr Scand. 2000;101(1):2-10.
5. Bobevski I, Rosen A, Meadows G. Mental health service use and need for care of Australians without diagnoses of mental disorders: findings from a large epidemiological survey. Epidemiol Psychiatr Sci. 2017;26(6):596-606.
6. Shanfi V, Mojtabai R, Shahnvar Z, Alaghband-Rad J, Zarafshan H, Wissow L. Child and Adolescent Mental Health Care in Iran: Current Status and Future Directions. Arch Iran Med. 2016;19(11):797-804.
7. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual Research Review: A meta‐analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345-65.
8. Fombonne E. The Chartres study: I. Prevalence of psychiatric disorders among French school-aged children. Br J Psychiatry. 1994;164(1):69-79.
9. Kroes M, Kalff AC, Kessels AG, Steyaert J, Feron FJ, Van Someren AJ, et al. Child psychiatric diagnoses in a population of Dutch schoolchildren aged 6 to 8 years. Journal of the American Academy of Child & Adolescent Psychiatry. 2001;40(12):1401-9.
10. Angold A, Erkanli A, Farmer EM, Fairbank JA, Burns BJ, Keeler G, et al. Psychiatric disorder, impairment, and service use in rural African American and white youth. Arch Gen Psychiatry. 2002;59(10):893-901.
11. Canino G, Shrout PE, Rubio-Stipec M, Bird HR, Bravo M, Ramirez R, et al. The dsm-iv rates of child and adolescent disordersin puerto rico: prevalence, correlates, service use, and the effects of impairment. Arch Gen Psychiatry. 2004;61(1):85-93.
12. Fleitlich-Bilyk B, Goodman R. Prevalence of child and adolescent psychiatric disorders in southeast Brazil. J Am Acad Child Adolesc Psychiatry. 2004;43(6):727-34.
13. Petersen DJ, Bilenberg N, Hoerder K, Gillberg C. The population prevalence of child psychiatric disorders in Danish 8–to 9–year–old children. Eur Child Adolesc Psychiatry. 2006;15(2):71-8.
14. Lynch F, Mills C, Daly I, Fitzpatrick C. Challenging times: prevalence of psychiatric disorders and suicidal behaviours in Irish adolescents. J Adolesc. 2006;29(4):555-73.
15. Leung PW, Hung S-f, Ho T-p, Lee C-c, Liu W-s, Tang C-p, et al. Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion. Eur Child Adolesc Psychiatry. 2008;17(7):452-61.
16. Pillai A, Patel V, Cardozo P, Goodman R, Weiss HA, Andrew G. Non-traditional lifestyles and prevalence of mental disorders in adolescents in Goa, India. Br J Psychiatry. 2008;192(1):45-51.
17. Heiervang E, Stormark KM, Lundervold AJ, Heimann M, Goodman R, Posserud M-B, et al. Psychiatric disorders in Norwegian 8-to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use. J Am Acad Child Adolesc Psychiatry. 2007;46(4):438-47.
18. Frigerio A, Rucci P, Goodman R, Ammaniti M, Carlet O, Cavolina P, et al. Prevalence and correlates of mental disorders among adolescents in Italy: the PrISMA study. Eur Child Adolesc Psychiatry. 2009;18(4):217-26.
19. Merikangas KR, Nakamura EF, Kessler RC. Epidemiology of mental disorders in children and adolescents. Dialogues Clin Neurosci. 2009;11(1):7-20.
20. Goodman R, Slobodskaya H, Knyazev G. Russian child mental health a cross-sectional study of prevalence and risk factors. Eur Child Adolesc Psychiatry. 2005;14(1):28-33.
21. Anselmi L, Fleitlich-Bilyk B, Menezes AMB, Araújo CL, Rohde LA. Prevalence of psychiatric disorders in a Brazilian birth cohort of 11-year-olds. Soc Psychiatry Psychiatr Epidemiol. 2010;45(1):135-42.
22. Benjet C, Borges G, Medina‐Mora ME, Zambrano J, Aguilar‐Gaxiola S. Youth mental health in a populous city of the developing world: results from the Mexican Adolescent Mental Health Survey. J J Child Psychol Psychiatry. 2009;50(4):386-95.
23. Kessler RC, Avenevoli S, Costello EJ, Georgiades K, Green JG, Gruber MJ, et al. Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry. 2012;69(4):372-80.
24. Ford T, Goodman R, Meltzer H. The British child and adolescent mental health survey 1999: the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry. 2003;42(10):1203-11.
25. Vicente B, Saldivia S, de la Barra F, Kohn R, Pihan R, Valdivia M, et al. Prevalence of child and adolescent mental disorders in Chile: a community epidemiological study. J Child Psychol Psychiatry. 2012;53(10):1026-35.
26. Abolfotouh MA. Behaviour disorders among urban schoolboys in south-western Saudi Arabia. 1997.
27. Al-Kuwaiti MA, Hossain MM, Absood GH. Behaviour disorders in primary school children in Al Ain, United Arab Emirates. Annals of tropical paediatrics. 1995;15(1):97-104.
28. Swadi H. Screening for psychiatric morbidity among a community sample of Arab children in the United Arab Emirates. Emirates Medical Journal. 1998;16:99-104.
29. Mousa Thabet A, Vostanis P. Epidemiology of child mental health problems in Gaza Strip. 2001.
30. Eapen V, Jakka ME, Abou-Saleh MT. Children with psychiatric disorders: The Al Ain community psychiatric survey. Can J Psychiatry. 2003;48(6):402-7.
31. Alyahri A, Goodman R. The prevalence of DSM-IV psychiatric disorders among 7–10 year old Yemeni schoolchildren. Soc Psychiatry Psychiatr Epidemiol. 2008;43(3):224-30.
32. Mohammadi MR, Ahmadi N, Salmanian M, Asadian-Koohestani F, Ghanizadeh A, Alavi A, et al. Psychiatric disorders in Iranian children and adolescents. Iran J Psychiatry. 2016;11(2):87-98.
33. https://www.amar.org.ir/Portals/0/census/1395/results/ch_nsonvm_95.pdf.
34. Sepanlou SG, Parsaeian M, Krohn KJ, Afshin A, Farzadfar F, Roshandel G, et al. Disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE) in iran and its neighboring countries, 1990â 2015: Findings from global burden of disease study 2015. Archives of Iranian medicine. 2017;20(7):403-18.
35. Mohammadi MR, Ahmadi N, Kamali K, Khaleghi A, Ahmadi A. Epidemiology of Psychiatric Disorders in Iranian Children and Adolescents (IRCAP) and Its Relationship with Social Capital, Life Style and Parents' Personality Disorders: Study Protocol. Iran J Psychiatry. 2017;12(1):66.
36. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36(7):980-8.
37. Ghanizadeh A, Mohammadi MR, Yazdanshenas A. Psychometric properties of the Farsi translation of the kiddie schedule for affective disorders and schizophrenia-present and lifetime version. BMC psychiatry. 2006;6(1):10.
38. Wittchen H-U, Nelson CB, Lachner G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med. 1998;28(1):109-26.
39. Zarafshan H, Mohammadi M-R, Salmanian M. Prevalence of anxiety disorders among children and adolescents in Iran: a systematic review. Iran J Psychiatry. 2015;10(1):1-7.
40. Qin P, Agerbo E, Mortensen PB. Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register–based study of all suicides in Denmark, 1981–1997. Am J Psychiatry. 2003;160(4):765-72.
41. Vega WA, Kolody B, Aguilar-Gaxiola S, Alderete E, Catalano R, Caraveo-Anduaga J. Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Arch Gen Psychiatry. 1998;55(9):771-8.
42. La Maison C, Munhoz TN, Santos IS, Anselmi L, Barros FC, Matijasevich A. Prevalence and risk factors of psychiatric disorders in early adolescence: 2004 Pelotas (Brazil) birth cohort. Soc Psychiatry Psychiatr Epidemiol. 2018;53(7):685-697.
43. Kandemir G, Hesapcioglu ST, Kurt ANC. What Are the Psychosocial Factors Associated With Migraine in the Child? Comorbid Psychiatric Disorders, Family Functioning, Parenting Style, or Mom’s Psychiatric Symptoms? Journal of child neurology. 2018;33(2):174-81.
44. Tonna M, Amerio A, Stubbs B, Odone A, Ghaemi SN. Comorbid bipolar disorder and obsessive-compulsive disorder: A child and adolescent perspective. Aust N Z J Psychiatry. 2015;49(11):1066-7.
45. Deepmala, Coffey B. Challenges in Psychopharmacological Management of a Young Child with Multiple Comorbid Disorders, History of Trauma, and Early-Onset Mood Disorder: The Role of Lithium. J Child Adolesc Psychopharmacol. 2014;24(9):519-24.
46. Dilsaver SC, Akiskal HS, Akiskal KK, Benazzi F. Dose–response relationship between number of comorbid anxiety disorders in adolescent bipolar/unipolar disorders, and psychosis, suicidality, substance abuse and familiality. J Affect Disord. 2006;96(3):249-58.
47. Moss HB, Lynch KG. Comorbid disruptive behavior disorder symptoms and their relationship to adolescent alcohol use disorders. Drug Alcohol Depend. 2001;64(1):75-83.
48. Tuisku V, Pelkonen M, Kiviruusu O, Karlsson L, Marttunen M. Alcohol use and psychiatric comorbid disorders predict deliberate self-harm behaviour and other suicidality among depressed adolescent outpatients in 1-year follow-up. Nord J Psychiatry. 2012;66(4):268-75.
49. Moaddab M, Mangone E, Ray MH, McDannald MA. Adolescent alcohol drinking renders adult drinking BLA-dependent: BLA hyper-activity as contributor to comorbid alcohol use disorder and anxiety disorders. Brain sciences. 2017;7(11):151.
50. Brand-Gothelf A, Leor S, Apter A, Fennig S. The impact of comorbid depressive and anxiety disorders on severity of anorexia nervosa in adolescent girls. J Nerv Ment Dis. 2014;202(10):759-62.
51. Noterdaeme M, Schlamp D, Linder M, Kischel K-H. Analyse der komorbiden psychiatrischen Diagnosen anhand der Basisdokumentation der Kinder-und Jugendpsychiatrie. Psychiat Prax. 2004; 31:126-8.
IssueVol 14 No 1 (2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v14i1.418
Comorbidity Child and Adolescent Epidemiology Psychiatric Disorders Risk Factors

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Mohammadi M, Ahmadi N, Khaleghi A, Kamali K, Mostafavi SA, Rahgozar M, Ahmadi A, Hooshyari Z, Alavi SS, Molavi P, Sarraf N, Hojjat SK, Mohammadzadeh S, Amiri S, Arman S, Ghanizadeh A, Ahmadipour A, Ostova R, Nazari H, Hosseini SH, Golbon A, Derakhshanpour F, Delpisheh A, Riahi F, Talepasand S, Mojahed A, Hajian Motlagh N, Heydari Yazdi AS, Ahmadpanah M, Dastjerdi R, Amirian H, Armani A, Safavi P, Kousha M, Alaghmand A, Eslami Shahrbabaki M, Kiani A, Mahmoudi Gharaei J, Shakiba A, Zarafshan H, Salmanian M, Taylor E, Fombonne E. Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents. Iran J Psychiatry. 2018;14(1):1-15.