Child Psychiatry in Iran
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Child Psychiatry in Iran
By Dr Hadi Shaker Naeeni, MD MRCPsych , Child and Adolescent Specialist Registrar
Declaration of Interest: none
Country Profile
Iran has a population of 75 million peopleaccording to census 2011, more than half
of which is under 35 years old [21millions under 18, UNICEF], and is located in the
Middle East. Iran’s neighbours to the East and North-East are: Afghanistan, Pakistan
and Turkmenistan and to the West and North-West are: Iraq, Turkey, Armenia and
Azerbaijan.
Iran is a party to the Convention on the Rights of the Child (CRC). On the basis of
Article 24 CRC, which contains an elaborate and comprehensive provision on the
right to health of children, Iran is obliged to ensure that children have access to
health services that are accessible and of good quality. In order to implement World
Health Organisation’s programme on “Primary Health Care” (PHC), Iran created a
system of PHC, Financed by the public budget. PHC is a delivery system provided
by the Ministry of Health and Education (MOHME) and is a primary source of access
to health and health care.
There is a coordinating body to oversee education and public awareness campaigns
on mental health and mental disorders. Government agencies, NGOs, professional
associations, private trusts and foundations, international agencies have promoted
education and public awareness.These campaigns have targeted many groups
including children, adolescents, as well as health care providers, teachers, social
services staff, leaders and politicians, and other professional groups linked to the
health sector [WHO].
In terms of support for child and adolescent health, about one tenth of primary and
secondary schools have either a part-time or full-time counsellor and about a quarter
of primary and secondary schools have school-based activities to promote mental
health and prevent mental disorders. In addition to legislative and financial support,
there are formal collaborations with the Departments/agencies responsible for Child
and adolescent health, child protection, Education, welfare [WHO].
Training and Research
There are currently about 1,000 psychiatrists practicing throughout the country, of
whom about 70 are child psychiatrists (Ministry of Health and Medical Education,
2003; National Research Centre of Medical Sciences).
Child Psychiatry in Iran
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Among the six sub-specialties in psychiatry, the only sub–specialty training is a twoyear child and adolescent psychiatry course; all general psychiatry trainees have
also a rotation placement in child psychiatry.
During the 1970s,Tehran University of Medical Sciences saw the founding of the first
program in child psychiatry, but this remained incomplete until early 1990s, when the
health minister at the time invited Dr Mohammad Valli Sahamito start training of
subspecialty residents with an orientation in family therapy. Roozbeh Hospital, which
was founded in 1946 as the first modern psychiatric teaching hospital in Iran,
becamethe main hub for this training. At the moment, the postgraduate psychiatry
training is offered at 12 university centres across the country.Dr Sahami also
established Parent Training Programme based on Webster-Stratton approach with
some adjustments to Iranian culture.
In 2001, Iranian Academy of Child and Adolescent Psychiatry (IACAP) was
established by the effort of pioneers in child and adolescent psychiatry in Iran and
has now about fifty members. Later on, some academic members of IACAP in
collaboration with Queensland University in Australia implemented the positive
parenting program (Triple-P) in Iran.
Psychiatry and Psychology Research Centre(PPRC), at Roozbeh Hospital hasa
leading role in psychiatry research in Iran. In addition, The Institute for Cognitive
Science Studies (ICSS)was founded in 1997 as a non-governmental institution in
Tehran, committed to providing a research and educational environment that brings
together the various disciplines that contribute to cognitive sciences.
There is a national database of published research in mental health and related
fields as IranPsych (http://iranpsych.tums.ac.ir). This database gathers about 7800
scientific papers on psychiatry, psychology, and neuroscience published in both
national and international journals.
Of a total of 3113 Iranian mental health articles published in the 30-year period 19732002, the topic of child and adolescent mental health constituted 883 (28%) articles.
Among these articles 81 (9%) appeared in international journals and the remaining
were published in domestic journals (no international indexing).
Epidemiology
According to previous epidemiological studies, anxiety disorder, mood disorder and
ADHD are among the most prevalent child and adolescent psychiatric disorder in the
western countries [Nikapota Ad].
Child Psychiatry in Iran
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There has been no published national epidemiological survey for child and
adolescent mental disorders in Iran, but according to the unpublished work of
Alaghband-rad et al. (2000) on more than 12000 children and adolescents in all
regions of Iran by means of K-SADS (Ref) and also World Health Organization
(WHO) case studies done in a number of countries (Egypt, Nigeria, India, Indonesia,
Thailand and Sri Lanka), the rate of child and adolescent mental disorders
approximates very closely to rates of disturbances reported in studies in developed
countries [Nejatisafa et al]. Mental retardation is part of the child psychiatry case load
in developing countries. In the region, prevalence rate is 8–12 per 1000 children
aged between three and ten years [Nikapota Ad].
The frequency of psychiatric disorders among children and adolescents in Tehran's
urban areas was comparable to the reports from other countries. The most prevalent
psychiatric disorders were attention-deficit/hyperactivity disorder (ADHD),
oppositional defiant disorder, depressive disorders and separation anxiety disorder
[Mohammadi et al 2008] [ Alavi et al 2010].
Mental Health Services
The percentage of users that are children or adolescents varies substantially from
facility to facility. The proportion of child/adolescent users is highest in outpatient
facilities and lowest in mental hospitals and residential facilities.
In Iran, payment takes place at all levels of health care. Patients pay 25% of the fee
for a clinic consultation, laboratory investigations or medicines obtained from
pharmacies. For hospital in-patient treatments, including investigations and
medicines, a payment of 10% is required from the patient. All emergencies, however,
are treated immediately without prior payment. Children are not exempt from
payments for medication, and fees in Iran do not vary across age ranges.
There are 855 outpatient mental health facilities available in the country, of which
40 are for children and adolescents only. These facilities treat 640,000 users (948
per 100,000) general populations. Of all users treated in mental health outpatient
facilities, 25% are children or adolescents. There are 31 day treatment facilities
available in the country, of which none is for children and adolescents only. There
are 46 community-based psychiatric inpatient units providing 1,366 beds (2.02
per 100,000 population). About 3% of these beds in community-based inpatient units
are reserved for children and adolescents only, and in the year of assessment, there
were 22,150 admissions in community based inpatient units, 20% of which were
children/adolescents.
Child Psychiatry in Iran
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There are 75 community residential facilities available in the country for a total of
3,600 beds/places (5.3 per 100,000 populations) but no children or adolescents are
cared for in these facilities. There are 33 mental hospitals available in the country
for a total of 5,350 beds (7.9 per 100,000 population). All of these facilities are
organizationally integrated with mental health outpatient facilities. Only 3.4% of these
beds in mental hospitals are reserved for children and adolescents. The number of
patients in mental hospitals is 88,000 (130 per 100,000), of whom 4% are children
and adolescents. These facilities have a 93% occupancy rate [WHO].
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Frequency of Psychological Disorders amongst Children in Urban Areas of
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Iran’s Contribution to Child and Adolescent Mental Health Research (1973–2002):
A Scientometric Analysis, Ali-Akbar Nejatisafa et al, Iran J Psychiatry 2006; 1: 9397
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