Iranian Journal of Psychiatry and Behavioral Sciences
Volume:19 Issue: 2, Jun 2025

 Non-suicidal self-injury (NSSI) is an intentional behavior without suicidal intent, recently recognized as an independent diagnostic entity in the diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Various studies indicate that NSSI is prevalent worldwide, but there are no reports on its prevalence among the Iranian population. 

A systematic review of the literature was conducted using databases such as Scopus, PubMed/Medline, Web of Science, IMBIS, Google Scholar, Cochrane, and PsycInfo. Domestic databases, including Iran Medex, Mogiran, and SID, were also utilized. All available data until the end of June 2024 were reviewed. Data extraction was performed by two researchers, and study quality was assessed using the Newcastle-Ottawa Scale (NOS). Studies on NSSI in the general population of Iran that reported prevalence rates and accurate sample sizes were included. The heterogeneity of the studies was evaluated using the Cochran test and I2 statistics. Additionally, a meta-regression analysis was conducted based on the year of study.

A total of 2,180 articles were reviewed, with 17 articles ultimately selected and included in the study. The random-effects model estimated the pooled prevalence of NSSI in the general population at 16.51% (95% CI, 13.59 - 19.43). The prevalence of NSSI in women and men was 19.27% (95% CI, 13.31 - 25.24) and 14.74% (95% CI, 10.53 - 18.94), respectively. A correlation was found between the number of years since the study was conducted and the prevalence of NSSI (Reg Coef = 0.01, 95% CI: 0.003 to 0.020, P = 0.011); newer studies reported higher prevalence rates.

The present study revealed a high prevalence of NSSI in the general population, particularly in certain provinces and among women, indicating the need for specific prevention and treatment programs.

Electroencephalographic (EEG) neurofeedback training provides an effective alternative treatment for generalized anxiety disorder (GAD) through various protocols.

The purpose of this study was to compare the alpha-theta (AT) increase protocol with the sensorimotor rhythm (SMR) protocol in individuals with GAD.

A randomized two-arm trial assessed two single-electrode EEG neurofeedback protocols based on operant conditioning. Forty university students receiving treatment for GAD at Taleghani Hospital, Tehran, were randomly assigned to 15 sessions of either AT training at Pz or sensory motor rhythm training at Cz (three sessions per week for five weeks). Assessments at pretest, posttest, and two-month follow-up included the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Beck Anxiety Inventory (BAI). Data were analyzed using repeated measures and mixed ANOVA in SPSS 26.

Analysis indicated that both protocols led to a significant reduction in anxiety symptoms. A significant time × group interaction was observed for state anxiety (P = 0.01), with the SMR group demonstrating a slightly greater immediate reduction at the post-test. Both protocols effectively reduced trait anxiety over time, with no significant differences between groups.

These results suggest that EEG neurofeedback can be an effective non-pharmacological intervention for anxiety reduction, with potential for long-term benefits. Personalized neurofeedback protocols may enhance treatment outcomes by targeting specific brain regions involved in emotional regulation. However, given the sample characteristics and study design, caution is warranted when generalizing these findings to broader and more diverse populations, underscoring the need for future research to confirm their applicability.

Recent studies have shown an increase in the prevalence of individuals with gender dysphoria (GD). However, there is limited research on the epidemiology of GD in Iran.

This study aimed to determine the prevalence and demographic characteristics of GD among individuals referred to the Forensic Medicine Organization (FMO) in Mazandaran, Iran, from 2016 to 2021.

This descriptive study involved reviewing medical records of individuals with confirmed GD who were referred to the FMO of Mazandaran province for permission to undergo sex reassignment surgery (SRS). Data were analyzed using the Mann-Whitney U test and chi-square test.

The prevalence of GD was 123 per 100,000 people. From 2016 to 2022, 71 individuals with GD were referred to the FMO in Mazandaran province. Of these, 27 (38%) were male-to-female (MTF) and 44 (62%) were female-to-male (FTM), showing a significant difference (χ2 = 4.07, P = 0.05). The average age was 26.9 ± 5.91 years. One individual (1.4%) was married, 65 (91.5%) were single, and five (7%) were divorced. Twenty-one (28.2%) were undergoing hormone therapy before referral to forensic medicine. Fifty-five participants (77.5%) wore clothing of the opposite sex in public places.

From 2016 to 2022, the age of individuals with GD referring to forensic medicine decreased, possibly due to increased awareness and reduced stigma associated with GD.

The Short Index of Self-Actualization (SISA) is a self-report measure used to evaluate an individual’s degree of self-actualization tendencies.

This study aimed to investigate the psychometric properties of Jones and Crandall’s SISA within an Iranian population.

A sample of 466 individuals was selected using a convenience random sampling method. Participants completed the SISA, Ambiguity Tolerance Scale, Rosenberg Self-Esteem Scale, and Rational Behavior Inventory (RBI). Internal consistency coefficients, along with exploratory and confirmatory factor analyses, were employed to examine the data. Analyses were conducted using SPSS 25 and AMOS software.

The findings indicated that the internal consistency coefficient for this questionnaire across all components exceeded 0.70, suggesting the appropriateness of the tool. Exploratory factor analysis (EFA) accounted for 0.47% of the variance. Confirmatory factor analysis (CFA) supported the five-factor structure of the SISA, which includes autonomy or self-direction, self-acceptance and self-esteem, avoidance of unpleasant experiences, trust and responsibility in interpersonal relations, and acceptance of emotions, in the Iranian sample [root mean square error of approximation (RMSEA) = 0.062, CFI = 0.919, NFI = 0.94]. The correlation coefficient results indicated a significant negative relationship between elements of ambiguity tolerance, while a significant positive relationship was found between aspects of rational behavior and self-esteem with self-actualization (P < 0.0001).

The Persian version of the SISA is a reliable and valid instrument for assessing self-actualization in the Iranian population, providing researchers and practitioners with a useful self-assessment scale.

Among various types of rumination, relational rumination is distinct, defined as repetitive thoughts concerning the security of past or current romantic relationships. Although relational rumination is a promising area for further exploration, a comprehensive questionnaire to measure it was previously unavailable. The Relational Rumination Questionnaire (RelRQ) has emerged as a promising instrument for measuring this construct.

The present study investigated the factorial structure, psychometric characteristics, and measurement invariance of the RelRQ in an Iranian sample.

A sample of 604 residents of Zanjan, aged 18 - 50 years, participated in this study. The RelRQ, following translation and back-translation, underwent assessment of construct validity via confirmatory factor analysis (CFA), including examination of measurement invariance and criterion validity. Internal consistency reliability was determined. Data analysis was conducted using SPSS version 27 and AMOS version 24.

The CFA demonstrated that the 16-item Persian RelRQ, with three factors — relationship uncertainty rumination (RU), romantic preoccupation rumination (RP), and break-up rumination (BU) — exhibited a good fit similar to the original version. These findings provide compelling evidence for the robust psychometric properties of the Persian RelRQ, including strong validity, reliability (α = 0.90), and measurement invariance across genders.

This comprehensive assessment underscores the suitability of the instrument as a valuable research tool for investigating relational rumination in non-English-speaking populations.

Identifying factors leading to couple burnout is crucial, especially considering the high prevalence of sexual dysfunction within the first year postpartum. This study addresses the relationship between couple burnout and sexual function.

The present study aimed to examine the association between couple burnout domains and female sexual function domains within one year after childbirth using structural equation model analysis.

This cross-sectional study utilized a structural equation model for analysis. A total of 352 primiparous mothers, with infants aged two to twelve months, participated. Health centers affiliated with Iran University of Medical Sciences, Tehran, Iran were listed, and 14 centers were randomly selected as recruitment sites. Sampling was conducted through convenience sampling. Data collection included a demographic characteristics form, the Pines Couple Burnout Measure (comprising physical, emotional, and mental exhaustion domains), and the Rosen Female Sexual Function Index (comprising desire, arousal, vaginal lubrication, orgasm, satisfaction, and pain domains). Descriptive analysis, including mean, standard deviation, frequency, and percentage, was performed using SPSS 16. Inferential statistics were conducted using Smart PLS version 8, employing confirmatory factor analysis with a significance level set at 0.05.

A significant inverse correlation was observed between arousal and physical (β = -2.13, P = 0.03) and emotional exhaustion (β = -0.16, P = 0.003), but no correlation was found with mental exhaustion. Additionally, a significant correlation was found between pain and emotional (β = 0.26, P < 0.001), mental (β = 0.31, P < 0.001), and physical exhaustion (β = 0.27, P < 0.001). Desire, lubrication, satisfaction, and orgasm were not associated with any domains of couple burnout.

Two sexual function domains, pain and arousal, emerged as predictors of couple burnout during the first two to twelve months postpartum in primiparous mothers. Pain during sexual intercourse was associated with emotional, physical, and mental exhaustion. Low arousal following sexual contact led to high physical and emotional exhaustion. Healthcare providers should prioritize assessing and addressing women’s sexual well-being postpartum.

Individuals who experience acute coronary syndrome (ACS) are at an increased risk of depression and anxiety.

This research was conducted to investigate the relationship between depression, anxiety, and quality of life (QOL) with cardiac functional class in patients with ACS.

This cross-sectional study was carried out among adult inpatients with newly diagnosed ACS during 2022 - 2023 in a state hospital in northern Iran. The patients were included through convenience sampling. The Hospital Anxiety and Depression Scale (HADS), the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF), plasma concentration of troponin, left ventricular ejection fraction (LVEF), and the New York Heart Association (NYHA) functional class were examined as the main research variables at baseline and follow-up visits.

In total, 139 patients with a mean age of 63.82 ± 12.58 years were included. Multivariate linear regression models to explore the effect of research variables, including the baseline QOL score, different NYHA classes, levels of LVEF, and positive serum troponin on the total QOL score during the follow-up period, revealed that baseline QOL (P < 0.001) and NYHA class 4 (P < 0.001). Significantly reduced the QOL score at the follow-up examination. Additionally, in the model where the effect of age was adjusted, an LVEF level of 40 - 50 significantly reduced the overall QOL score at the follow-up assessment (P = 0.008).

A significant association was found between LVEF and baseline QOL with anxiety, depression, and the QOL score at the follow-up assessment. Proper screening and early intervention are recommended for patients with ACS who have depressive or anxiety symptoms and a low QOL at the baseline examination.

Previous studies have shown that adolescent girls are more frequently affected by social anxiety disorder compared to boys. Various factors contribute to this condition, including challenges in emotion regulation, depressive symptoms, and low self-esteem. A significant factor influencing social anxiety among adolescent girls is their physical development, which can adversely affect their social relationships. Although research has established the crucial role of physical appearance in social avoidance among adolescent girls, the underlying reasons remain unclear.

The present study aimed to explore the mediating roles of self-worth and body image concern in the relationship between self-objectification and social anxiety in adolescent girls.

This cross-sectional study utilized a multi-stage cluster sampling technique to select and examine 384 adolescent girls in Isfahan city during the 2022 - 2023 academic years. Data were collected using the Social Anxiety Scale for Adolescents (SAS-A), the Contingencies of Self-worth Scale (CSWS), the Self-objectification Questionnaire (SOQ), and the Body Image Concern Inventory (BICI). Data analysis was conducted using Pearson correlation coefficients and structural equation modeling (SEM).

The findings indicated that self-objectification and body image concern were significantly positively associated with social anxiety (P < 0.01), while self-worth demonstrated significant negative relationships with all three variables (P < 0.05). The findings indicated that self-worth mediates the relationship between self-objectification and social anxiety.

These results suggest that mental health professionals can develop targeted interventions to address the interplay between self-objectification, body image concern, and social anxiety in adolescent girls. Such interventions could potentially mitigate the development of social anxiety and its associated challenges in this population.

Attitudes towards childbearing are influenced by various biological, psychological, and social factors.

This study aims to investigate the impact of social determinants of health on attitudes towards childbearing, mediated by social support among women of reproductive age.

This descriptive-analytical study was conducted on 500 women who were referred to health centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran, using a multistage random sampling method in 2022 - 2023. Data were collected using Soderberg's Attitudes Toward Fertility and Childbearing Scale, the Demographic and Midwifery Questionnaire, Ghodratnama's Socio-economic Status Questionnaire, the Multidimensional Scale of Perceived Social Support, the Depression-Anxiety-Stress Scale (DASS)-21 Scale, Spanier's Marital Compatibility Questionnaire, and the Fear of Childbirth Scale. The data were analyzed using SPSS 26 and LISREL 8.8, applying the statistical method of path analysis. Stepwise regression tests were used to examine the relationship between independent variables (demographic variables) and dependent variables while controlling for contextual and confounding variables.

Based on the results of the path analysis, the levels of depression, anxiety, and stress as measured by the DASS-21 had only a direct effect (β = -0.25); fear of childbirth (β = -0.06), socio-economic status (β = 0.057), and social support (β = 0.19) had only an indirect effect; and marital compatibility (β = 0.257), education (β = -0.16), and women's employment (β = -0.13) had both direct and indirect effects on attitudes towards childbearing. Notably, marital compatibility (β = 0.257) had the most substantial positive influence on attitudes towards childbearing. The model proposed in the study showed a good fit (P-value = 0.001; GFI = 0.99; RMSEA = 0.033).

Based on the findings, social support plays a significant role as a mediating factor in improving attitudes towards childbearing. Therefore, relevant organizations should recognize their responsibility in implementing laws and policies aimed at enhancing social support, particularly for employed women.

Buprenorphine is a partial agonist of the μ-opioid receptor and one of the main drugs used for maintenance treatment of opioid use disorder. The widespread misuse of buprenorphine, particularly via non-sublingual routes, poses significant health risks.

This paper presents a detailed case study of a 39-year-old male with a history of polydrug use, focusing on the respiratory complications arising from intranasal buprenorphine use, which he had been snorting for the past three years.

It appears that buprenorphine snorting can lead to serious and irreversible injuries and complications, including congestion and erythema of the nasal mucosa, deviation and perforation of the middle nasal septum, chronic sinusitis, and reduced sleep quality.

This study examined the factorial structure and measurement invariance of the Mindfulness in Teaching Scale (MTS) among 735 Iranian teachers, comprising 370 primary and 365 secondary school teachers, aged 24 to 55.

To evaluate the psychometric attributes and validity of the MTS within educational settings, employing confirmatory factor analysis (CFA) alongside the LMS to ascertain convergent validity and scrutinize measurement invariance across varying educational levels and age groups, thereby ensuring that the scale uniformly quantifies mindfulness among diverse populations.

Using multi-group confirmatory factor analysis (CFA) with AMOS-24, the study validated the MTS’s dual-factor model, which includes intrapersonal and interpersonal mindfulness, across the entire sample, as well as various educational levels and age groups.

The model fit indices demonstrated satisfactory alignment for the aggregate sample and across different educational levels and age classifications, meeting established criteria including Comparative Fit Index (CFI) (0.90), root mean square error of approximation (RMSEA) (< 0.08), and χ2/df ratios (< 3.0). All factor loadings exceeded 0.30 (P < 0.05), affirming the scale’s structure and consistency with its original design. The reliability of the MTS and its subscales was acceptable, ranging from 0.68 to 0.85. Additionally, the MTS showed metric and scalar invariance for age groups [Δχ2 values of 19.25 (Δdf = 12; P > 0.05) and 7.33 (Δdf = 5; P > 0.05)], and for educational levels, the metric and scalar invariance models [Δχ2 of 6.75 (Δdf = 12; P > 0.05) and Δχ2 of 22.36 (Δdf = 14; P > 0.05)], supporting consistent measurement across subgroups. Furthermore, a positive correlation (r = 0.23, P < 0.05) with the Langer Mindfulness Scale (LMS) supported its validity.

The study suggests that the MTS is a reliable and valid tool for assessing mindfulness among primary and secondary school teachers in Iran.

 This study aimed to identify and describe research on interventions based on emotion-focused therapy (EFT) for children and adolescents. 

We conducted a comprehensive search across six databases: Scopus, Web of Science (core collection), PubMed/Medline, Embase, Google Scholar, and PsycInfo (via EBSCO). The search strategy was tailored to each database, and studies published up to December 2024 were included.

In the initial search, 2,803 articles were identified, from which 217 duplicate articles were removed. After screening, 14 studies remained for review based on our inclusion criteria. The types of studies varied and included clinical trials, descriptive studies, qualitative research, and mixed-methods approaches. The interventions addressed various components of EFT and employed diverse implementation strategies such as family therapy, group therapy, sessions for parents and caregivers, and workshops for parents and caregivers. The primary outcomes studied were eating disorders, along with a range of mental health issues and behavioral-emotional problems in children and adolescents. Overall, these interventions demonstrated positive effects on mental health outcomes in the target population.

The findings suggest that EFT has been effectively utilized in various formats with children and adolescents — primarily through family therapy. These interventions warrant further investigation across different populations of children and adolescents to enhance understanding and application.