Vol 15 No 4 (2020)
Relationship between Serum Homocysteine and Metabolic Syndrome among Patients with Schizophrenia and Bipolar Disorder: A Cross Sectional Study
Objective: This study aimed to compare the prevalence of metabolic syndrome and hyperhomocysteinemia and to specify predictors of the metabolic syndrome among patients with schizophrenia and bipolar disorder.
Method: This cross sectional study was conducted on 100 patients with schizophrenia and 100 patients with bipolar disorder. The participants' metabolic syndrome was determined according to the criteria set by Third Report of the National Cholesterol Education Program–Adult Treatment Panel III. Hyperhomocysteinemia was considered as homocysteine levels higher than 15 µmol/L. Chi-square test, Fisher's exact test, student t test, Mann-Whitney test, and logistic regression were used for data analysis.
Results: The prevalence of metabolic syndrome was not significantly different (P = 0.07) between patients with schizophrenia (27%) and bipolar disorder (39%). No statistically significant difference (P = 0.17) was observed between patients with schizophrenia (82%) and bipolar disorder (74%) in the prevalence of hyperhomocysteinemia. The results of multivariable logistic regression model showed a significant association of smoking and BMI with metabolic syndrome in patients with schizophrenia (OR = 3.69, 95% CI: 1.13-12.05, and OR = 1.38, 95% CI: 1.20-1.60, respectively). In patients with bipolar disorder, BMI was a significant predictor of developing metabolic syndrome (OR = 1.29, 95% CI: 1.14-1.47). Metabolic syndrome was more prevalent in women than in men in both diagnostic groups (P < 0.05). No significant difference was observed in hyperhomocysteinemia prevalence between male and female patients with schizophrenia (P = 1.00). However, hyperhomocysteinemia was more prevalent in males than in females among patients with bipolar disorder (P = 0.001).
Conclusion: Findings showed a high prevalence of metabolic syndrome and hyperhomocysteinemia among patients with schizophrenia and bipolar disorder. To deal with this problem, regular monitoring and conducting early interventions are recommended to determine the metabolic risk profile and to prevent the cardiovascular diseases.
How to Assess Perceived Risks and Safety Behaviors Related to Pandemics; Developing the Pandemic Risk and Reaction Scale during the Covid-19 Outbreak
Objective: The aim of the present study was to develop a self-report questionnaire to assess the level of perceived risks and safety behaviors during pandemics.
Method: We went through recommended phases and their corresponding steps to create a valid and reliable scale: (a) item development (including 1. domain identification and item generation, 2. content validity), (b) scale development (including 1. pretesting questions, 2. sampling and survey administration, 3. item reduction, and 4. extraction of factors), and (c) scale evaluation (including 1. tests of dimensionality, 2. tests of reliability, and 3. tests of validity).
Results: We found four factors with eigenvalues greater than 1 that were accounted for 0.63 of the total variance. The 4-factor solution showed all items had factor loading greater than 0.4 and each belonged to one factor. The fit indices indicated the 4-factor solution model was fitted to our data.
Conclusion: In sum, the Pandemic Risk and Reaction Scale (PRRS) is a valid and reliable self-reported scale to assess the level of perceived risk and safety behaviors during pandemics.
Impact of Proliferator-Activated Receptor γ Gene Polymorphisms on Risk of Schizophrenia: A Case-Control Study and Computational Analyses
Objective: Schizophrenia (SCZ) is a common psychiatric disorder characterized by a complex mode of inheritance. Peroxisome proliferator-activated receptor-γ (PPARG) mainly regulates lipid and glucose metabolisms while it is constitutively expressed in rat primary microglial cultures. This preliminary study was aimed to investigate the relationship of two polymorphisms in the PPARG gene, rs1801282 C/G, and rs3856806 C/T, to the risk of SCZ in the southeast Iranian population.
Method: A total of 300 participants (150 patients with SCZ and 150 healthy controls) were enrolled. Genotyping was done using the amplification refractory mutation system polymerase chain reaction (ARMS–PCR) technique. Computational analyses were carried out to predict the potential effects of the studied polymorphisms.
Results: A significant link was found between genotypes of rs1801282 and SCZ susceptibility. The G allele of rs1801282 in CG and GG form of the codominant model increased the risk of SCZ by 2.49 and 2.64 folds, respectively. With regards to rs3856806, enhanced risk of SCZ was also observed under different inheritance models except for the overdominant model. Also, the T allele of rs3856806 enhanced the risk of SCZ by 3.19 fold. Computational analyses predicted that rs1801282 polymorphism might alter the secondary structure of PPARG-mRNA and protein function. At the same time, the other variant created the binding sites for some enhancer and silencer motifs.
Conclusion: Our findings showed that PPARG rs1821282 and rs3856806 polymorphisms associate with SCZ susceptibility. Replication studies in different ethnicities with a larger population are needed to validate our findings.
The Mediating Role of Positive and Negative Affect in the Association of Perceptions of Parenting Styles with Resilience among Adolescents with Addicted Parents
Objective: This study aimed to investigate the mediating role of positive and negative affect in the association of perceptions of parental involvement, autonomy support, and warmth with resilience among Adolescents with Addicted Parents.
Method: In this descriptive-correlational study, 63 Adolescents of Addicted Parents studying in Zahak and Hirman, located in Sistan and Baluchestan Province in Iran, were selected using convenience sampling method. The participants completed the questionnaires on perceptions of parenting styles, resilience, and positive and negative affect. Data were analyzed via the correlation coefficient and path analysis.
Results: The results showed that the adolescents’ perceived parenting styles were directly and significantly related to positive affect and resilience (P < 0.01). Moreover, the results of the path analysis indicated that mediated by positive affect, the adolescents’ perceived parenting styles predicted resilience indirectly (P < 0.01).
Conclusion: Given the results of this study, perceived parenting styles can directly and indirectly predict resilience. It can be concluded that adolescents’ perceived parenting styles can enhance resilience among them through promoting positive affect.Adolescent
Objective: Suicide is a preventable social harm in the field of health. The present study aimed to design a prediction model for suicide incidence based on Box-Jenkins model in Ilam province.
Method: Using a retrospective method all completed and attempted suicide data were collected during 1993-2013. Then, using the autoregressive integrated moving average (ARIMA) model, the time series analysis of the Box-Jenkins model was conducted to predict suicide status in the coming years (2014-2015).
Results: According to the actual results obtained from the suicide data in 2014, a total of 1078 suicides were recorded and compared to the predicted results, according to the fitted model of the time series, which showed the selected model predicted 931 suicide cases, showing 86% accuracy of prediction. The series’ prediction indicated 931 suicides in 2014 with a negative growth rate of 25.3% compared to 2013 and 969 suicide cases in 2015 with a positive growth rate of 3.93% compared to 2014.
Conclusion: The results of this study showed the designed model provides a high diagnostic value to predict suicide rates. These types of models can help to predict suicide in future and plan to control and prevent suicide attempts.
Driving Behaviors in Iran: Comparison of Impulsivity, Attentional Bias, and Decision-Making Styles in Safe and High-Risk Drivers
Objective: Road traffic injuries are leading cause of death and economic losses, particularly in developing countries such as Iran. Thus, increased understanding of the causes of traffic accidents can help solve this problem. The primary goal of this study was to examine attentional bias, decision-making styles, and impulsiveness in drivers with safe or risky driving behaviors. The secondary purpose was to determine the variance of each variable among 2 groups of drivers.
Method: This was a cross sectional design study, in which 120 male drivers aged 20-30 years (60 males with risky driving behaviors and 60 with safe driving behaviors) were recruited from Tehran using sampling technique. Barratt Impulsiveness Scale (BIS), Decision-Making Style Scale (DMSQ), Manchester Driver Behavior Questionnaire (MDBQ), Self-Assessment Manikin Scale (SAM), and Dot Probe Task were used. The analyses were performed using IBM SPSS version 22.
Results: The mean age of participants was 26 years. Significant differences were found between impulsiveness (attentional, motor, and non planning impulsiveness) and decision-making styles (spontaneous and avoidant) between the 2 groups. Also, based on the results of discriminant function analysis (DFS), the subscales of impulsiveness and 2 decision-making styles explained 25% of the variance in the 2 groups of risky and safe drivers.
Conclusion: Findings of this study indicated that impulsiveness and 2 decision-making styles were predominant factors. Therefore, not only is there a need for research to reduce traffic accidents, but studies can also be helpful in issuing driving licenses to individuals.
Impact of an Existential-Spiritual Intervention Compared with a Cognitive-Behavioral Therapy on Quality of Life and Meaning in Life among Women with Multiple Sclerosis
Objective: Multiple sclerosis (MS) is a chronic neurological disease that could aggressively affect patients’ quality of life in most instances. This study aimed to compare the effectiveness of an existential-spiritual psychotherapy with a cognitive-behavioral therapy on quality of life and meaning in life in women with multiple sclerosis.
Method: A convenience sample of 43 women with multiple sclerosis participated in this quasi-experimental study. They were randomly assigned into 3 groups: an existential-spiritual intervention, a cognitive-behavioral intervention, and the control group. Participants were assessed for outcome measures (quality of life and meaning in life) at 3 points in time: pretest, posttest, and 5-months follow-up. The Multiple Sclerosis Quality of Life-54 (MSQOL-54) and the Meaning in Life Questionnaires (MLQ) were used as outcome measures. To compare outcomes among the study groups, repeated measures analysis of variance was performed.
Results: The results showed that while no difference was observed for the control group, scores for meaning in life improved significantly for existential-spiritual intervention and cognitive-behavioral therapy (p = 0.027, p = 0.039). Also, both mental (p < 0.001, p = 0.014) and physical (p = 0.001, p = 0.013) health dimensions of quality of life increased significantly in the 2 intervention groups. However, the results indicated that women in the existential-spiritual intervention group showed greater improvement in some aspects of meaning in life (search for meaning) and quality of life (role physical and role emotional, pain and energy) compared to women in the cognitive-behavioral intervention group. However, the latter group showed better improvements on 2 subscales (physical function and health distress).
Conclusion: Both existential-spiritual and cognitive-behavioral interventions can improve quality of life and meaning in life among women with multiple sclerosis. However, the findings suggest that although both interventions were effective, the existential-spiritual intervention resulted in more positive improvements in some aspects of meaning in life and quality of life.
Psychometric Properties of the Farsi Version of Eyberg Child Behavior Inventory (F-ECBI) in Iranian Population
Objective: Eyberg Child Behavior Inventory (ECBI) is one of the most frequently used tools for measuring behavioral problems; however, no research has been done to evaluate its psychometric properties in Iran.
Method: The present study sought for exploring the factor structure and psychometric properties of the F-ECBI in an Iranian sample. A total of 495 mothers (mean age = 33.83 years; SD = 4.78) who reported behavioral problems in their children aged 3 to 12 years (mean age = 6.36 years; SD = 2.66) were selected via convenience sampling in 2018-2019. The psychometric properties of F-ECBI, including reliability (Cronbach’s alpha) and validity (exploratory and confirmatory factor analysis, and convergent validity) were assessed using SPSS version 25 and LISREL 8.80.
Results: By performing EFA on the first sample part (n = 360), the examination of scree plot supported a 3-factor or 4-factor solution, and pattern matrix resulted in a 3-factor structure. The factors were called as “behavioral problems related to oppositional defiant”, “behavioral problems related to inattentive”, and “behavioral problems related to conduct”, according to their content and the research. CFA was performed on the second part of the sample (n = 135) to test the fitness of the 3-factor solution. According to CFI (0.91), NFI (0.91), NNFI (0.90), IFI (0.91), PNFI (0.77), GFI (0.75) AGFI (0.70), PGFI (0.62) and chi-square (540.31) indexes, the model had acceptable fitness. Cronbach's alpha was employed to measure the internal consistency and it revealed to be at a good to excellent level (behavioral problems related to oppositional defiant = 0.88; behavioral problems related to inattentive = 0.84; behavioral problems related to conduct = 0.74). The 3-factors subscales were associated with total difficulties, internalizing and externalizing SDQ, indicating the good convergent validity of F-ECBI.
Conclusion: The F-ECBI has good psychometric properties in Iran and can be employed as a useful instrument for measuring children's behavioral problems.
Prevalence and Associated Factors of Posttraumatic Stress Symptoms and Stigma among Health Care Workers in Contact with COVID-19 Patients
Objective: The global spread of COVID-19 has caused great psychological stress in health care workers (HCWs). This study aims to assess the prevalence and associated factors of posttraumatic stress symptoms (PTSS) and stigma among health care workers (HCWs) who are involved in treating COVID-19 patients. This study was conducted as part of studies related to assessing the mental health status of HCWs in Iran during the COVID-19 pandemic.
Method: Overall, in this cross sectional study, 894 HCWs working in 9 general hospitals in Alborz province, Iran, in the field of diagnostic and treatment care of patients with COVID-19 were selected using multistage sampling method. PTSS and its subscales, including intrusion, avoidance, and hyper vigilance were obtained based on the Posttraumatic Stress Disorder-8 Item validated questionnaire. Information on Stigma's perception among HCWs was also obtained based on a questionnaire adopted from the HIV Stigma Scale. Predictors of PTSS and Stigma's perception among HCWs were assessed using multivariate logistic regression analysis.
Results: Overall, 71.4% of the participants were women and 46.9% were front line staff. The prevalence of intrusion, avoidance, and hyper vigilance symptoms was 44.2% (95% CI: 40.8-47.6), 31. 8% (95% CI: 28.8-35.0), and 37.7% (95% CI: 34.5-41.0), respectively. A strong and positive significant correlation was found between stigma score with PTSD total score (coefficient: 0.83) and its components. In multivariate logistic regression model, female gender was associated with intrusion (OR: 1.46, 95% CI: 1.03-2.06) and avoidance (OR: 1.66, 95% CI: 1.147-2.417) and working in frontline increased the odds of intrusion (OR: 1.45, 95% CI: 1.06-1.97) and hyper vigilance (OR: 1.41, 95% CI: 1.03-1.91).
Conclusion: The prevalence of PTSS is high among HCWs during COVID-19 pandemic and it is associated with some demographic characteristics of HCWs. This situation should be considered by health policymakers so that while trying to control the disease, the mental health status of this group of personnel should be given much attention.
Logical Framework Approach a Platform for Integrating the Mental Health and Nutritional Care for Controlling the Covid-19 Pandemic
Coronavirus infection (COVID-19) is spreading rapidly in the world beyond the health care capacity. The World Health Organization (WHO) has announced an emergency state that needs quick and effective actions. In the lack of specific medicine and vaccine, integration of mental health and nutritional care in the platform of a powerful managerial technique named the “Logical Framework Approach” (LFA) could be helpful for successful control of this pandemic. The strengths of the LFA for coronavirus management program are stakeholders’ involvement, integrative teamwork in research and medical procedures, as well as Inter-sectoral cooperation. The related organizations like WHO and ministries of health of every country could easily adopt this approach and act more efficiently to manage this pandemic.
Prevalence of Posttraumatic Stress Disorder among Firefighters in Iran: A Systematic Review and Meta-Analysis
Objective: Firefighters are exposed to many different chemicals and physical hazards and experience a significant number of accidents and injuries. They are exposed to high-risk of posttraumatic stress disorder (PTSD). The purpose of this study was to determine the prevalence of PTSD among Iranian firefighters.
Method: This was a systematic review and meta-analysis. Valid Persian and English keywords were searched in data resources, including SID, Magiran, Irandoc, Google Scholar, PubMed, Scopus, and Web of Science to retrieve articles on the prevalence of PTSD among Iranian firefighters. The STROBE checklist was used to assess the quality of the articles. Heterogeneity among the studies was assessed by I2 index. The data were analyzed using Stata14 software.
Results: Of the 316 articles selected in the initial search, 3 articles the inclusion criteria and were used for the meta-analysis. A total of 274 firefighters were studied. The prevalence of PTSD was 23.17% among Iranian firefighters (I2 = 92.4%, 95% CI = 6.71-39.62, p < 0.001).
Conclusion: The prevalence of PTSD is among Iranian firefighters relatively high and has been on the rise over the recent years.
Introduction: Childbirth can be a normal and nonintervention process, but sometimes the process gets out of normal and requires immediate medical intervention. Thus, home delivery cannot be considered safe without coordination with the treatment staff. Sometimes fear of Covid-19 epidemic prevents mothers to go to the hospital for childbirth and they decide to do it in an unsafe condition, which puts the health of the mother and the neonate at risk.
Presentation Case: Our case was a pregnant woman with a negative blood group (A-) who did not come to the hospital because of fear of contracting Covid-19 from the hospital and decided to give birth at home without medical and midwifery support. After giving birth at home, she called the midwife who was taking care of her pregnancy. But she was still afraid to go to the medical center for postpartum care. The midwife informed the mother and her husband that they would be transferred to the midwifery clinic for further care and follow-up, with the necessary counseling and assurance of protective care to control Covid 19 transmission.
Conclusion: Counseling and training of protective methods during pregnancy can reduce the concerns of pregnant women. It is also recommended that pregnant women avoid unnecessary travel, public places, use of public transportation and contact with sick people, and most importantly, observe personal and public health issues. Some pregnant women may experience severe anxiety and depression during epidemics such as Covid 19, which require educational psychological counseling and continuous psychological support to prevent unintended consequences.
The Relationship between Depression Symptoms and Severity of Coronary Artery Disease in Patients Undergoing Angiography
Objective: Cardiovascular diseases are the main cause of mortality worldwide. Depression is one of the effective factors in the incidence of cardiovascular diseases like coronary artery stenosis. This study aimed to investigate the relationship between depression symptoms and severity of coronary artery disease (CAD) in patients scheduled for angiography.
Method: This prospective, cross sectional research was conducted on as many as 401 patients scheduled to undergo angiography at Dr. Heshmat heart hospital as the referral center in the north of Iran in 2016. Before cardiac catheterization, patients' demographic information (age, gender, level of education, and place of residence) and patients’ medical history (history of diabetes mellitus, hypertension, and family history of cardiac disease) were obtained. Also, Beck Depression Questionnaire 2 (BDI II) was completed by a psychologist before angiography. After collecting the data, SPSS v.21 and statistical tests such as Spearman correlation, and Mann-Whitney U regression were used to analyze the data.
Results: After controlling for age, sex, and having history of diabetes mellitus, no relation was found between having depression symptoms and more frequency of vessel involvement (OR = 1.35, 95% CI: 0.92 to 1.98, P =0.130) or higher severity of CAD (OR = 1.47, 95% CI: 0.95 to 2.28, P = 0.087). The results were similar for the relation between severity of depression symptoms and CAD extent or CAD severity.
Conclusion: The results of this study showed that in patients undergoing angiography, depression symptoms were not related to CAD severity and number of involved vessels. Depression was associated with angina, independently of CAD severity. Our study found no significant correlation between CAD severity and severity of depression. The reason may be that measuring depression at a single time point cannot accurately reveal the impact of this problem on the trend of atherosclerosis over time.