Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 21 2 2026 03 15 222 233 Sadegh Jafarzadeh Department of Audiology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran. Arash Ziaee Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Khajedaluee Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mahdi Gholian-Aval Department of Health Education and Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran AND Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 12 02 2026 02 14 Objective: Positive mental health is a distinct dimension of population health. Despite the validation of the Persian Mental Health Continuum–Short Form (MHC-SF), population-based estimates for adult municipal surveillance in Iran are limited. To describe MHC-SF score distributions, internal consistency, and demographic gradients among adults in Mashhad. Method: A population-based cross-sectional survey (May 2024–March 2025) used stratified cluster sampling across five health districts (50 clusters; Kish-grid household selection). Adults aged ≥ 18 years completed the 14-item Persian MHC-SF indexing emotional well-being (EWB), social well-being (SWB), and psychological well-being (PWB). Results: Among 2,066 adults (57.6% women), the overall mean (SD; median) MHC-SF score was 61.55 (13.21; 63), with domain scores of 28.99 (6.19; 30) for PWB, 19.01 (5.63; 19) for SWB, and 13.54 (4.11; 14) for EWB. Men scored slightly higher than women on the total scale, EWB, and PWB (all P < 0.001; small effect sizes), while the SWB difference was not statistically significant (p = 0.075). Age showed weak positive associations with total, EWB, and SWB scores (ρ = 0.060–0.069; P ≤ 0.006), but not PWB (ρ = 0.018; P = 0.408). Item-level contrasts suggested higher male endorsement of agency/meaning indicators and higher female endorsement of benevolence/collective optimism; both sexes reported high levels of warm, trusting relationships. In a multivariable linear regression adjusting for age and sex simultaneously, demographic predictors accounted for < 1% of outcome variance, with male sex independently associated with higher total, EWB, and PWB scores, and age independently associated with slightly higher total, EWB, and SWB scores. Conclusion: In this representative urban population-based study, positive mental health was moderately high; PWB ranked highest, while SWB lagged. Demographic gradients were small: men slightly exceeded women, and older adults reported marginally higher EWB and SWB. For surveillance, the MHC-SF total score appears suitable as a summary indicator, while the SWB profile may help identify community-level levers (e.g., social capital and trust) to strengthen social connectedness in Mashhad, Iran. https://ijps.tums.ac.ir/index.php/ijps/article/view/4498 https://ijps.tums.ac.ir/index.php/ijps/article/download/4498/1332