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Studies on mental health in Kurdistan - Iran
Umeå University, Faculty of Medicine, Clinical Sciences, Psychiatry.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to carry out an epidemiological study on mental health related issues in the Kurdish population of Iran. This part of Iran suffered directly during the Iran-Iraq war 1980-1988. Iran is an Islamic republic with strict adherence to Islamic traditions, which has implications for the way of life and gender issues. Suicide is prohibited according to Islamic teaching, but still there is a rather high suicide incidence especially among young women, who burn themselves to death. This thesis deals with mental health in general, the prevalence of post traumatic stress disorder and issues related to suicide.

In a cross- sectional study in Sanandaj, the capital of the province of Iranian Kurdistan, 1000 households were approached. One member of each household was asked to respond to the following internationally well-known questionnaires; General Health Questionnaire (GHQ12), Posttraumatic Stress Disorder Checklist (PCL), Life Events Check List (LEC), Beck Depression Inventory (BDI-II) and Attitude Toward Suicide (ATTS). PCL and LEC were translated to Farsi and their psychometric properties were studied. The other instruments have already been translated and used by other researchers in Iran.

About 27% of the subjects were found to suffer from mental distress according to GHQ-12.

No gender differences were found. Unmarried and unemployed belong to the most afflicted.

The participants in the investigation reported, not surprisingly, a low level of personal experiences of suicidal behaviour in their family. Females were more prone to believe that suicide is preventable compared to males.

A low number reported suicide attempts during the last year. Being married seemed to have a protective effect against suicide attempts for males but not for females. Suicide behaviour was not substantially related to PTSD, but to severe depression.

The idea that there is a continuity of suicidal behaviour from suicidal thoughts to suicide attempts was supported. Younger individuals more often reported thoughts of life weariness and those who reported suicide attempts were younger than individuals with no suicidal attempts. Females reported more death wishes than males during the last year and married women more often reported suicide attempts than men.

The prevalence of posttraumatic stress disorder was 10, 9% which is higher than reported in other countries, but still lower than expected. Women suffered significantly more often from PTSD than men. Women reported also more often re-experiencing and more arousal symptoms than men. The finding supported a good construct validity of PCL.

One major limitation of these studies is the fact that the sample was drawn from the population of the capital city of the province. So the finding cannot probably be generalized to Iranian Kurds from rural areas.

The sample also had a rather high educational level compared to the population of Sanandaj. To this should be added the fact that the instruments used are developed in the western culture, which might influence the way questions are perceived. So, the result should be interpreted with some caution.

The results, however, give indications that there are mental health problems of a magnitude that should be taken seriously. 

Place, publisher, year, edition, pages
2009. , 42 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1272
Keyword [en]
Kurdistan, Psychiatric epidemiology, General mental health, PTSD, Suicide
Identifiers
URN: urn:nbn:se:umu:diva-22581ISBN: 978-91-7264-807-4 (print)OAI: oai:DiVA.org:umu-22581DiVA: diva2:217180
Public defence
2009-06-04, Sal A, By 23.NUS, Pchiatric department, Psychatric clinic, 13:00 (English)
Opponent
Supervisors
Available from: 2009-05-19 Created: 2009-05-13 Last updated: 2009-05-20Bibliographically approved
List of papers
1. General mental health, quality of life and suicide related attitudes among kurdish people in Iran
Open this publication in new window or tab >>General mental health, quality of life and suicide related attitudes among kurdish people in Iran
Show others...
2008 (Swedish)In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 54, no 5, 457-468 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate (1) general mental health, (2) quality of life and (3) suicide-related attitudes in Kurds living in Iranian Kurdistan.

Methods: Cross-sectional investigation; cluster random sampling procedure; 1,000 Kurds were randomly selected from 1,000 of 68,000 households in Sannandaj City, Iran; General Health Questionnaire (GHQ-12); Questionnaire on Attitudes Towards Suicide (ATTS).

Results: About 27% of the subjects had to be regarded as probably suffering from a psychological disturbance. There was no gender difference regarding the number of `cases'. These possible `cases' were younger than `non-cases'. The most `cases' occurred among the unemployed. An increasing number of experiences related to suicide and the increasing emotional closeness of those experiences was found to be related to an increased probability that the individual would be classified as a `case' according to the GHQ-12 total score. Unmarried individuals more often evaluated their overall quality of life as `moderate' or `bad' compared to married individuals. Unemployed people, self-employed people and housewives formed the groups who most often reported a `very bad' or `bad' quality of life.

Conclusions: Kurdish people in Iran are in need of facilities and interventional programmes aiming to improve general mental health.

Place, publisher, year, edition, pages
SAGE Publications, 2008
Keyword
general mental health, general population, Iranian Kurds, quality of life, suicidal attitudes
National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychiatry
Research subject
Social Medicine; Psychiatry
Identifiers
urn:nbn:se:umu:diva-9577 (URN)10.1177/0020764008091663 (DOI)18786907 (PubMedID)
Available from: 2008-11-18 Created: 2008-11-18 Last updated: 2011-06-22Bibliographically approved
2. Post traumatic stress disorder in Kurdish Iranians
Open this publication in new window or tab >>Post traumatic stress disorder in Kurdish Iranians
(English)Manuscript (Other academic)
Keyword
PTSD, general mental health, life events, Kurdish iranian, general population
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-22569 (URN)
Available from: 2009-05-13 Created: 2009-05-13 Last updated: 2010-09-21Bibliographically approved
3. Attitudes towards suicide among Kurdish people in Iran
Open this publication in new window or tab >>Attitudes towards suicide among Kurdish people in Iran
2008 (English)In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 43, no 4, 291-298 p.Article in journal (Refereed) Published
Abstract [en]

Background Attitudes towards suicide represent a key stage in the pathway leading to suicide. A deeper understanding of the social, psychological and treatment-related factors influencing the development of attitudes towards suicide could guide suicide prevention strategies especially in a neglected population like Kurds.

Methods In a cross-sectional study in Iranian Kurdistan, 1,000 households participated in the investigation from April to May 2006 selected by a cluster random sampling process. A questionnaire on attitudes towards suicide (ATTS) was used to measure suicide related attitudes and thoughts.

Results Suicide related experiences were more often reported from the wider social network (relative, friends, acquaintances) than from family members. There is a significant accumulation of suicide related experiences when a related event was reported in the close family. The level of suicide related attitudes is related to age, gender, marital status, level of education and employment status.

Discussion Openness towards the topic of suicide as well as abilities to communicate about it should be improved by educating the public and additionally be promoted by changing conservative value systems.

Keyword
attitudes towards suicide, suicide attempts, Iranian Kurds, cross-sectional study
National Category
Sociology Public Health, Global Health, Social Medicine and Epidemiology Psychiatry
Research subject
Psychiatry; Social Medicine; Sociology
Identifiers
urn:nbn:se:umu:diva-9573 (URN)10.1007/s00127-007-0296-7 (DOI)18157515 (PubMedID)
Available from: 2008-04-28 Created: 2008-04-28 Last updated: 2011-06-22Bibliographically approved
4. Continuity from suicidal ideations to suicide attempts in Iranian Kurds?
Open this publication in new window or tab >>Continuity from suicidal ideations to suicide attempts in Iranian Kurds?
(English)Manuscript (Other academic)
Abstract [en]

Background. Suicidal ideation is a critical point for the identification of individuals at risk of committing suicide/attempting suicide. Whilst existing studies provide valuable data from Western countries, more research is needed to determine the applicability of these findings outside of the context of Western culture.

Method. In a cross–sectional study in Sanandaj, capital of Iranian Kurdistan, 1,000 randomly selected individuals were investigated by means of the Attitudes towards Suicide questionnaire which includes items concerning various suicidal thoughts.

Results. The Iranian Kurds reported very few suicide attempts, whereas the prevalence of reported suicidal thoughts was found to be very high. The assumption of a continuum of suicidal behaviour is supported by our data; but, this did not include self-reported suicide attempts. The various suicidal thoughts showed very low sensitivity and low predictive power in relation to suicide attempts. The reported frequency of suicidal thoughts and the number of suicide attempts during the last year was significantly higher than that from earlier in life. Age was determined to be a substantial moderator variable related to the occurrence of suicidal thoughts and suicide attempts with increasing impact with increasing severity of suicidal behaviour. Gender, cohabitation status and employment situation were largely only weakly associated with the occurrence of suicidal behaviours.

Conclusions. Culture seems to be of low impact upon the relationship between socio-demographical variables and suicidal behaviour. The reported frequency of suicidal thoughts and suicide attempts seems to be highly dependent on applied response categories and the considered timeframe, which has to be considered thoroughly when interpreting related results, and when comparing with findings from other investigations.

Identifiers
urn:nbn:se:umu:diva-22575 (URN)
Available from: 2009-05-13 Created: 2009-05-13 Last updated: 2010-09-21Bibliographically approved
5. How about the relationships between PTSD, depressivity and suicide related thoughts in Iranian Kurds?
Open this publication in new window or tab >>How about the relationships between PTSD, depressivity and suicide related thoughts in Iranian Kurds?
(English)Manuscript (Other academic)
Abstract [en]

Our primary aim was to explore the relationships between PTSD, depressivity and suicide in Iranian Kurds (a relative homogeneous minority population in Iran) in order to contribute to the understanding of suicide in Muslim populations. A random sample of 1,000 individuals from the general population was investigated by means of questionnaires in a cross-sectional study. Only a very few of the Iranian Kurds reported suicide attempts; and suicide related variables were substantially more closely related to severe depressivity than to PTSD, resulting in direct paths from PTSD and depressivity to attitudes towards suicide only in contrast to results from Western countries.

Keyword
PTSD, suicide, suicidal ideation, depression, Muslim population
Identifiers
urn:nbn:se:umu:diva-22577 (URN)
Available from: 2009-05-13 Created: 2009-05-13 Last updated: 2010-09-21Bibliographically approved

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