Iranian Journal of Psychiatry

The Profile of Self-Harm and Suicide in Iran Considering Gender Differences: A Multicenter Study Affiliated with the National Trauma Registry of Iran

Zahra Ramezani — 2024-06-11

Objective: The main objective of this study was to determine various characteristics and outcomes of self-harm and suicide in men and women with data obtained from the National Trauma Registry of Iran (NTRI).
Method: This retrospective multicenter study using data from the NTRI included all patients who went to the emergency department (ED) due to self-harm and suicide, considering the NTRI's specific inclusion criteria, from September 2016 to January 2023. We evaluated patients regarding demographics and clinical characteristics, various outcomes, and factors influencing in-hospital death. Statistical analyses were conducted using the STATA software version 15.0. The chi-square test was used to compare the distribution of variables between men and women. Also, the logistic regression models were applied to assess the predictors of in-hospital death.
Results: Self-harm and suicide cases were gathered from eleven geographically diverse hospitals across the country, and our study included 511 men and 347 women out of 50,661 registered trauma cases. Among them, 443 men (86.7%) and 267 women (76.9%) were between 18 and 49 years old (P < 0.001). Single women constituted 130 (37.3%) of the female cases, while single men were 313 (61.6%) of the male cases (P < 0.001). The three most common methods among our patients were poisoning with 234 (45.8%) of men and 245 (70.6%) of women cases, stab/cut with 208 (40.7%) of men and 54 (15.6%) of women cases, and fall with 16 (3.1%) of men and 26 (7.5%) of women cases (P < 0.001). The risk of death in patients with a Glasgow Coma Scale (GCS) score of 3 to 8 was 46.22 (95% CI = 18.66 to 114.45) times more than patients with a GCS score of 13 to 15.
Conclusion: Data on self-harm and suicide traumatology were gathered from eleven hospitals in Iran. Our findings indicated differences in the distribution of age and marital status between genders. Moreover, both genders used similar methods for self-harm and suicide, and gender did not affect the outcome.

Psychometric Properties of a Persian Version of the Columbia Suicide Severity Rating Scale (C-SSRS) in Iranian Soldiers

Amirhossein Jafari — 2024-06-11

Objective: Suicide is an important health issue nearly all over the world. The Columbia Suicide Severity Rating Scale (C-SSRS) is a well-known instrument for suicide risk assessment. Our purpose in this study is to provide a Persian version of the C-SSRS and evaluate its psychometric properties in the Iranian military population, particularly suicide risk leveling characteristic of the C-SSRS.
Method: For linguistic adaptation, we gathered opinions of an expert panel consisting of 23 professionals in mental health sciences. Furthermore, this version was administered to two groups of soldiers, one representing a sample of normal population (N = 338), while the other group comprised a sample of clinical population from a referral psychiatric hospital (N = 348) in Tehran, capital of Iran, from July 2021 until one year later. Besides the C-SSRS, the Beck Scale for Suicidal Ideation (BSSI), Beck Hopelessness Scale (BSS), and General Health Questionnaire 28 (GHQ28) were obtained from the participants. Correlation coefficients, internal consistency, and factor analysis were evaluated using the Statistical Package for the Social Sciences (version 23) software.
Results: All items of the Persian version of the C-SSRS had acceptable content validity and face validity. This tool demonstrated high correlation coefficients with the BSSI (r = 0.73, P < 0.001) and BHS (r = 0.64, P < 0.001), but a low correlation coefficient with the GHQ28 (r = 0.22, P < 0.001). Specifically, the suicide risk level based on the C-SSRS had a high correlation with both the BSSI and BHS. Also, its internal consistency was satisfactory (Cronbach's alpha = 0.89). Furthermore, factor analysis revealed two factors that is consistent with suicidal ideation and suicidal behavior factors.
Conclusion: Our results indicated acceptable validity and reliability for the Persian version of the C-SSRS, demonstrating its capability to classify suicide risk. It can be concluded that the ordinal suicide risk level (as red, orange, yellow and green) is a valid index for the application of the C-SSRS.

Validity and Reliability Assessment of the Complete Persian Version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto Questionnaire in an Iranian Population

Roya Vaziri Harami — 2024-06-11

Objectives: This study aimed to assess the validity and reliability of the complete Persian version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) in an Iranian population.
Materials and Methods: In this descriptive study, the TEMPS-A was first translated to Persian by a bilingual expert and was then back-translated to English by another expert and compared with the original version. The face validity and content validity of the Persian version of the questionnaire were confirmed following assessment by several psychiatrists. The Persian version of the questionnaire was then administered among 30 personnel of Imam Hossein Hospital to be completed. The same questionnaire was administered again among the same personnel after a 2-week interval to assess its reliability.
Results: The Cronbach’s alpha was calculated to be 0.911, indicating excellent reliability of the Persian version of the TEMPS-A. None of the questions required correction or omission. Some questions did not have a good correlation with the general scale but the correlation of the majority of them with the general scale was good. A significant difference was found in the mean scores of the questions (P<0.001), and the mean total score was 1.73.
Conclusion: The present results showed excellent reliability of the complete Persian version of the TEMPS-A (> 0.9). Future studies are required to scrutinize the subscales of this questionnaire.

A Comparison of Effectiveness of Attention Process Training (APT) with Parenting Management Training (PMT) in Reducing Symptoms of Attention Deficit Hyperactivity Disorder

Mehriar Nadermohammadi Moghadam — 2024-06-10

Objective: Child-oriented psychotherapies, such as Attention Process Training (APT), target ADHD symptoms directly, whereas family-oriented interventions, like Parent Management Training (PMT), address its functional impairments. The aim of this study was to compare the effectiveness of APT and PMT in treating ADHD symptoms.
Method: This research was a randomized controlled trial in which 45 children (26 females and 19 males, with a mean age of 8.47 ± 1.66 years) with ADHD were selected conveniently and assigned randomly to one of three groups (PMT = 15, APT = 15, and CTRL = 15). The groups had no significant differences in ADHD severity. The PMT children were managed with parenting techniques. Children in the APT group practiced attention techniques, while children in the control group did not receive any intervention. Ritalin was prescribed to all the children in the three groups. The score on the Conners Parenting Rating Scale-Revised: Short form was the outcome variable.
Results: Both interventions decreased ADHD symptoms severity more than the control group. Howver, the reduction in the APT group was more than in the PMT group (P-value < 0.001). The scores of 40% of the APT group and 80% of the PMT group did not fall below the cut-off point. In the APT group after the intervention, the inattention subscale was significantly lower than the hyperactivity subscale, while in the PMT group, the hyperactivity subscale was lower. The effect sizes of APT and PMT were 2.18 and 2.09, respectively.
Conclusion: For ADHD, psychological interventions are crucial in addition to medication. According to the results of this study, APT is more effective for inattention symptoms, while PMT is more effective for hyperactivity symptoms. When selecting psychotherapy, the subtype of ADHD should be taken into account. Treatment sessions must also be completed according to intervention protocols.

Application of Acceptance and Commitment Therapy (ACT) in Children and Adolescents Psychotherapy: An Umbrella Review

Gooya Tayyebi — 2024-06-05

Objective: Acceptance and Commitment Therapy (ACT) is an evidence-based psychological intervention that has gained increasing attention in recent years. While extensively studied for its effectiveness in adult populations, there has been growing interest in exploring the application of ACT in children and adolescents psychotherapy. This umbrella review aims to provide an overview of the current literature on the use and efficacy of ACT in children and adolescents, as well as to highlight potential considerations and future directions for research.
Method: A comprehensive search was done in scientific databases, including Scopus, PubMed, and Web of Sciences, using keywords related to ACT, children, adolescents, and psychotherapy. Relevant articles were included, with a focus on systematic reviews and meta-analysis.
Results: Our findings indicate consistent effectiveness for ACT and related interventions across various delivery formats, including in-person, group, and internet-based approaches, in reducing symptoms of internalizing and externalizing problems, as well as improving overall quality of life among children and adolescents. However, two articles comparing ACT with traditional cognitive behavioral therapy did not demonstrate superiority. Additionally, when comparing internet-based and in-person delivery modes, the included studies did not show significant differences between the two types.
Conclusion: ACT shows promise as an effective therapeutic approach in children and adolescents psychotherapy. However, more research is warranted to establish its specific techniques and adaptations for different age groups and presenting problems. Additionally, future research should explore the feasibility and effectiveness of delivering ACT in varied settings.