Iranian Journal of Psychiatry
Volume:2 Issue: 3, Summer 2007

The objective of the present study was to perform a systematic review of studies that investigated the prevalence of anxiety and depression in medical inpatients. A search was conducted in Pubmed Medline, ISI Web of Science, PsychINFO, CINAHL, EMBASE, Irandoc, IranPsych, IranMedex, and dissertations. In the next step, the original studies which reported the prevalence of anxiety and/or depression in medical inpatients were included and then evaluated. These evaluations included two parts. The first part was the qualitative evaluation of the articles, which was carried out using a checklist. The second part was data extraction, performed with two researchers for each document. Thirty nine studies (13 articles and 26 dissertations) were finally included. Only in seven studies, diagnostic interview was used to diagnose patients with anxiety and depression. Results of the qualitative evaluation of articles showed that a high percentage of them lacked the appropriate methodology. The maximum and minimum prevalence of depression in the reviewed studies was 91.7% and 17% respectively. The maximum and minimum prevalence of anxiety in the reviewed articles was 78.33% and 6% respectively. The prevalence of depression and anxiety in all studies which had reported prevalence according to sex was higher in females. Meta-analysis with Random effect model indicates the heterogeneity of studies, so we just perform meta- analysis in two groups of patients, chronic renal failure patients and patients with ischemic heart disease. The combined estimation of the prevalence of depression and anxiety in patients with chronic renal failure according to this meta-analysis was 55.91 (confidence interval=37.14-74.69) and 46.72 (confidence interval=20.31-73.13) respectively. The combined estimation of the prevalence of depression and anxiety in patients with ischemic heart disease was 52.54 (confidence interval=42.82-62.26) and 30.92 (confidence interval=1.21-60.64) respectively. The presence of heterogeneity in prevalence of anxiety and depression can be due to the nature of observational studies, which could result in diverse results from different aspects Some of these differences include the difference in instruments and their cutting points, difference in populations under study, dissimilar and non-standard methods, difference in clinical signs and symptoms, and difference in the times of evaluations. Many of the mentioned factors are also responsible for disparities in prevalence in the present study, with the difference in the somatic illnesses being among the most important reasons. However, in subgroups with similar somatic illnesses such as ischemic heart disease and chronic renal failure this difference is also observed. Considering the low quality of articles with regard to methodology, there is a possibility that this factor could have had a more decisive role in the differences observed in similar subgroups.

In contrast to traditional reviews, systematic reviews explore theliterature on a specific topic comprehensively using a well-defined protocol and recruit the findings of eligible studies after the assessment of their qualities, using a clear and reproducible method. Checking the assumptions, we may merge the findings of recruited studies in a systematic review and use metaanalysis techniques not only to estimate the pooled effect but also to assess the possible sources of heterogeneity and the extend of heterogeneity in the findings. Generally, randomized clinical trials are the most common type of studies which are recruiting in systematic reviews and meta-analyses. However, we couldnt ignore the importance of observational studies particularly in sensitivity topics with ethical limitations against interventional studies. Although we are usually faced with wide variations in the methodology of observational studies even in narrow topics, systematic review and meta-analysis of their results can generatevaluable findings. They are particularly useful for explaining the source of heterogeneity in the results of primary observational studies. In this paper, we review the basic concepts of the systematic review and metaanalysis and their main applications in summarizing the findings of observational studies with respect to their advantages and limitations.

Taking the diversity of the methodologies applied in prevalence studies of psychiatric disorders in Iran and their heterogeneous results into consideration, there seems to be need for a systematic review in order to compile the findings and seek appropriate recommendations for future studies. This study aims at systematically identifying studies conducted in Iran describing the prevalence of psychiatric disorders in general population, and to summarize the findings of these studies. To identify the relevant studies, several databases including Pubmed Medline, ISI Web of Science, PsychINFO, CINAHL, EMBASE, Irandoc, IranPsych, IranMedex, Scientific Information Database as well as reference lists of the accessed documents, unpublished reports, conference proceedings and dissertations were searched. In the next step, the original studies which contained an estimation of prevalence of "any psychiatric disorder" (overall prevalence) among a sample of general population in the country were selected. This was followed by data extraction, presentation of the results, quality assessment and quantitative pooling of estimated rates of prevalence of psychiatric disorders. A total number of 35 studies were included. Estimations provided for prevalence rates in different groups illustrate diversity and heterogeneity; the rates varied in the range of 1.9-58.8%. Most of the studies had assessed the point prevalence of the disorders conducted using screening instruments. The median point prevalence has been reported to be 28.70% in screening studies, and 18.60% in studies using diagnostic interviews. Pooled estimates obtained through meta-analysis for screening and diagnostic studies were 29.1% and 21.9%,respectively. The results of the studies which have used diagnostic interviews as their data collection tool showed less heterogeneity than the ones using screening instruments. In quality assessment of the studies, only one third proved to be of high quality. Even though the pooled rates for prevalence of psychiatric disorders are comparable to the rates in many other countries, the most important finding of this study is the diversity of the prevalence rates among different communities in Iran. This diversity does not seem to be attributed solely to the different time frames and geographical locations of the studies. It might also have resulted from differences in methodologies (e.g., using different tools), study procedures and study quality.

Self- inflicted burn is one of the prevalent and grievous methods of suicide in Iran and encompasses different underlying reasons. Although several studies have been conducted to determine the prevalence and the underlying causes of self- inflicted burn in Iran, a large number of strong and weak points can be pointed out in these studies. As a consequence, there seems to be a need for a systematic review to determine the existing gaps and highlight the recommendations for any future studies. This study aims at determining the prevalence of self- inflicted burn and its underlying reasons among the population over 15 years old in Iran through a systematic review. Electronic and manual search methods were applied in order to search the resources. Eventually, only 24 out of 64 abstracts accessed fulfilled the inclusion criteria which were included in the systematic review. The results of the studies showed that self- inflicted burn lied among the main ways of suicide in Iran, and was responsible for 30- 70 percent of suicide mortality. Among all locations where studies were conducted, the highest rates of self- inflicted burn was reported in Masjed Soleiman district. Self- inflicted burn was more prevalent among individuals in the age range of 24.9- 27.2. Most of the attempters were female; these were mainly married housewives with low educational levels. Marital and family conflicts were the most frequently reported stressors. Inadequate information resources, the existing gaps in the conducted studies, and inconsistencies among the reported self- inflicted burn statistics can be noted as limitations of this study. On the other hand, most of the studies have been performed in the western part of the country where self- inflicted burn has a higher rate, a fact that reminds us that their results can not be generalized. To date, the reasons for the higher prevalence of this method of suicide in this part of the country has remained unclear.

The aim of the present study is to perform a systematic review of studies that have investigated the prevalence of sexual disorders in Iran. A broad search was conducted in Pubmed Medline, ISI web of Science, PsychINFO, CINAHL, EMBASE, and three Iranian databases, including IranPsych, IranMedex, and Scientific Information Database (SID). To cover those studies that were not published, we did a hand searching of all theses, reports and congresses abstract booklets which were available in IranPsych and universities'' libraries. Then we included original studies which reported the prevalence of sexual disorders and data extraction was performed with two researchers for each document. five studies were finally included, one in men and the others in women. There was a great heterogeneity between studies and performing metaanalysis was impossible. Prevalence rates of mental disorders were reported in a wide range in different studies. More high quality studies with standard instruments are necessary in this field.

The mean age of cigarette smoking has decreased along with an increase in its prevalence, in developing countries. The aim of this systematic review is to determine the prevalence of lifetime, current and daily smoking among middle school students in Iran. Various search methods have been used in this study including searching different international databanks such as Pubmed, ISI web of Science, PsychInfo, CINAHL, Embase, as well as domestic databanks including IranPsych and IranMedex. All original studies and researches in Persian or English, which had described any kind of use including lifetime, current and daily use of cigarette, hookah, and pipe among middle school students, were included in the study with no restriction on date of publication, and were qualitatively assessed. Subsequent to data extraction, heterogeneity test was carried out on indicators for which more than two studies were found, and meta-analysis was done using random effects model. The combined prevalence of lifetime, current and daily cigarette smoking were calculated as 14.2% (95% CI: 6.6-21.7), 2.7% (95% CI: 0.5- 5.9) and 1.1% (95% CI: 0.6-2.8), respectively. The combined prevalence of "current tobacco use of all kinds" was 15% (95% CI: 10.4-19.5), as well. The prevalence of smoking in this age range is lower in Iran compared to other countries. However, a conclusion cannot be made about the changes in the prevalence of smoking in recent years. Moreover, studies carried out to the present have several qualitative limitations, which points to the necessity of high quality repeated surveys

This study aims at conducting a systematic review of the researches performed to determine case finding rates throughout the integration of Mental Health Services into PHC over recent twenty years. Through electronic search, major national and international databases including Pubmed, PsychInfo, and EMBase were investigated. All original studies and researches in Persian or English, which had described psychiatric case finding in the PHC, classified as severe and mild mental disorders,epilepsy, mental retardation, and other disorders, were included in the study and were qualitatively assessed. Subsequent to data extraction, heterogeneity test was carried out on all of the studies and each subgroup. Meta-analysis was not applicable as a result of the wide range and heterogeneity of the reported results. Overall, ten studies were included. Case finding rate ranged from 0.07 to 2.04 per thousand for severe mental disorders, 0.5 to 7.6 per thousand for mild mental disorders, 0.5 to 3.9 per thousand for epilepsy, and 0.64 to 3.94 per thousand for mental retardation. Case finding rates reported in the selected studies are highly different from the prevalence of the disorders throughout the ountry. It seems that the program has been functioning more effectively in case of some of the disorders such as mental retardation, while it has been less efficient in finding mild mental disorder cases. These results reflect the fact that despite its partial achievements in the field of case finding, the integration program is still far from the desirable rates and there is need for revision of its content of the integration program especially screening and diagnostic tools, training contents, and implementation methods.