Iranian Journal of Psychiatry

Psycho-Spiritual Pathways to Well-Being after Adversity: An Umbrella Review

Zahra Asgari — 2026-06-10

Objective: This umbrella review synthesizes findings from existing systematic, scoping, and narrative reviews on psycho-spiritual processes and interventions that influence well-being following trauma and adversity.

Method: Following umbrella review methodology, we searched major databases (PsycINFO, PubMed, CINAHL, etc.) for reviews published between 2015 and 2025. Methodological quality was assessed using the AMSTAR-2 tool. Only reviews scoring above the predefined threshold of > 8/16 were included. All 18 included reviews scored 14–16 out of 16, indicating high methodological quality. Eighteen reviews met the inclusion criteria, encompassing diverse populations including veterans, cancer survivors, disaster victims, and survivors of abuse.

Results: The synthesis reveals three core psycho-spiritual pathways: 1) The Meaning-Making Pathway, where spirituality facilitates posttraumatic growth (PTG), identity reconstruction, and spiritual well-being (SWB); 2) The Pathway of Spiritual Struggle, where existential conflict, moral injury, and a loss of meaning exacerbate psychological distress; and 3) The intervention Pathway, where psycho-spiritually integrated therapies showed positive effects. However, effect sizes, confidence intervals, and heterogeneity were inconsistently reported across the 18 included reviews, precluding a single pooled estimate. Effect sizes from meta‑analyses ranged from small to moderate: for depression (Cohen’s d = 0.42, 95% CI [0.21, 0.63]), for anxiety (SMD = 0.31–0.58), and for spiritual well‑being (SMD = 0.47, 95% CI [0.29, 0.65]). Heterogeneity was moderate to high (I² = 54–72%). Key facilitators include person-centered, trauma-informed care that validates spiritual concerns, while a primary barrier is the clinician's lack of training in addressing existential and spiritual dimensions.

Conclusion: Psycho-SWB is a pivotal, multifaceted outcome of trauma recovery. Effective support requires a nuanced approach that acknowledges both the potential for growth and the reality of existential pain. Clinical practice must integrate evidence-based psycho-spiritual interventions, while research should prioritize longitudinal designs, diverse populations, and standardized measures of psycho-spiritual constructs.

Toward Responsible Suicide Reporting in Iran: Media Practices, Social Media Challenges, and WHO Recommendations

Mohammadreza Shalbafan — 2026-06-09

Effects of Vitamin B12 and Folic Acid Supplementation on Negative Symptoms as the Primary Outcome and Positive and Cognitive Symptoms as Secondary Outcomes in Schizophrenia: A Randomized Controlled Trial

Mahnaz Shah Ali — 2026-06-07

Objective: Persistent negative symptoms in chronic schizophrenia often show limited responsiveness to antipsychotic therapy. The present study evaluated whether supplementation with vitamin B12 and folic acid improves negative symptoms as the primary endpoint, while also examining effects on positive symptoms and global cognitive functioning as secondary outcomes.

Method: In this randomized, double-blind, placebo-controlled trial, 88 inpatients with chronic schizophrenia receiving stable risperidone therapy were assigned to one of four groups: vitamin B12 (1 mg/day), folic acid (1 mg/day), combined vitamin B12 plus folic acid (1 mg/day each), and placebo for eight weeks. Negative symptoms were measured using the Scale for the Assessment of Negative Symptoms (SANS), positive symptoms using the Scale for the Assessment of Positive Symptoms (SAPS), and cognitive function using the Mini-Mental State Examination (MMSE). Serum concentrations of vitamin B12 and folate were assessed at baseline and after the intervention.

Results: Supplementation with vitamin B12 and/or folic acid led to significant increases in serum concentrations of the corresponding vitamins (P < 0.001). All supplementation groups demonstrated significant and clinically meaningful reductions in negative symptom severity compared with placebo, with large effect sizes. In contrast, no significant changes were detected in positive symptoms or global cognitive performance.

Conclusion: Adjunctive vitamin B12 and folic acid supplementation significantly reduced negative symptom severity in chronic schizophrenia, without affecting positive symptoms or global cognition. Targeted correction of vitamin deficiencies may represent a valuable adjunctive approach for persistent negative symptoms.

Sociocultural Factors Influencing Prolonged Grief Disorder: A Scoping Review

Narges Ensan — 2026-05-20

Objective: Grief is a response to significant loss that may become prolonged and develop into prolonged grief disorder (PGD). Sociocultural factors can influence this process. This scoping review examined studies on sociocultural determinants of PGD.

Method: Databases searched included PubMed, Web of Science, Scopus, PsycINFO, and ProQuest. Studies published between January 2012 and December 2025 were screened in accordance with PRISMA-ScR guidelines and analyzed descriptively.

Results: From 877 identified papers, 19 met the inclusion criteria. Four key sociocultural factors emerged: religious beliefs, mourning customs, cultural beliefs, and social support. Religious beliefs functioned as both risk and protective factors depending on the context and coping style. Mourning customs promoted healing when upheld and intensified grief when disrupted; moreover, in some contexts, rituals may also maintain grief. Cultural beliefs shaped grief expression and understanding, sometimes conflicting with diagnostic criteria. Social support, especially when culturally congruent, moderated grief outcomes, while social withdrawal or isolation also emerged as an important predictor of prolonged grief (PG) symptoms.

Conclusion: The findings underscore the importance of culturally sensitive interventions in PGD. Understanding these sociocultural dynamics is essential for developing culturally tailored prevention and treatment strategies for PGD.

Effectiveness of Internet-Based Psychoeducation in Reducing Caregiver Burden in Dementia: A Clinical Trial

Jalal Mirabdollah — 2026-05-12

Objective: This study aimed to assess the impact of online psychoeducational training on reducing the psychological burden of caregivers of patients with moderate to severe dementia. Caring for such patients, especially by non-professional caregivers, poses significant mental and physical challenges. Internet-based interventions offer a practical and innovative solution to help alleviate this burden.

Method: This clinical trial was conducted in 2023 in Kashan, Iran, with 84 caregivers of patients with moderate to severe dementia. Participants were divided into two groups: an intervention group (n = 42) and a control group (n = 42). The intervention group received a 20-session online psychoeducational program over eight weeks, while the control group received routine care. Caregiver burden was measured using the Zarit Burden Interview (ZBI) before, immediately after, and three months after the intervention. Data analysis included independent t-tests and repeated measures ANOVA.

Results: Baseline characteristics of caregivers in both groups were homogeneous in most variables, except for education level, which differed significantly (P = 0.006). Repeated measures of the general linear model (GLM) analysis revealed a significant reduction in caregiver burden in the intervention group (P = 0.014). Within-group analysis showed that the burden significantly decreased immediately after the training. Although a slight increase was observed at the three-month follow-up, it remained lower than the baseline (P < 0.001).

Conclusion: Online psychoeducational training significantly reduces the psychological burden of dementia patient caregivers, with sustained effectiveness over a three-month follow-up. These findings support the integration of digital psychoeducation as a viable alternative or complement to traditional interventions, particularly in resource-limited or high-need settings.