Prevalence of Mental Disorders among High-School Students in Iran: A Systematic Review

Objective: The aim of the present study is to perform a systematic review of studies that investigated the prevalence of any kind of mental disorders in high school students in Iran. Method: A broad search was conducted in MEDLINE/PubMed, ISI web of Science, PsychINFO, CINAHL, EMBASE, and three Iranian databases, including IranPsych, IranMedex, and Scientific Information Database (SID). To cover studies not published, we did a hand searching of all theses, reports and congresses' abstract booklets which were available in IranPsych. Then, we included the original studies which reported the prevalence of any kind of mental disorders in high school students; data extraction was performed with two researchers for each document. Results: Sixteen studies were finally included, representing 19 estimates of mental disorders in high school students, using diagnostic or screening instruments. The prevalence rate of any mental disorder reported by two studies using diagnostic instruments was equal to 16.6% and 4.34%. The median of prevalence rates of mental disorders reported in studies using screening instruments was 34.4%. There was a significant heterogeneity between the studies. Conclusion: Prevalence rates of mental disorders were reported in a wide range in high school students of Iran. More studies with improved quality are needed in this field. Keywords: Iran, Mental health, Meta-Analysis, Prevalence, Psychiatry, Review, School, Students Iran J Psychiatry 2009; 4: 1-6 Mental disorders are among the most common health problems all over the world. Global burden of disease estimates placed mental illness at the top three causes of years lost due to disability (1). Considering early age of onset and the chronic course of these disorders compared with other highly burdensome diseases such as cardiovascular illnesses, more emphasis on mental health of children and adolescents is needed. Prevention, detection, and treatment of childhood and adolescent mental disorders are important not only to relieve current distress but also to improve adult functioning and to prevent the perpetuation of this disadvantage into the next generation (2). For developing any kind of mental health improvement policy, understanding the prevalence of mental disorders is a crucial step (3). Studies investigating the prevalence of mental disorders in Iran reported a wide range of percentages from 1.9% (4) to 58.8% in adult general population (5). Several factors may contribute to explain these differences such as temporal and geographical characteristics, use of different instruments, small sample sizes or methodological biases. Even two national studies with large sample size differ a lot in their estimations with 10.8% (6) and 21% (7). Lack of a reliable knowledge of the prevalence of mental disorders in Iran is more prominent in the field of child psychiatry. It seems that there is a need for systematic reviews of the literature addressing prevalence of mental disorders in Iran to build a reliable ground for future studies. Like other fields of medical research, reviews should be based on data that are as complete and as rigorous as possible. Meta-analysis is a tool for extracting and synthesizing new data by means of pooling the data and providing a final value. Even the orderly sorting of data using meta-analytic techniques can provide useful insights into the structure of relevant studies (8). Trying to have a clear definition of prevalence, in this study, it is defined as the proportion of individuals who manifest a disorder at a specified time, or during a specified period. There are several ways to find out the proportion of people who are affected by a specific mental disorder. However, in this study we reviewed those studies which investigated the prevalence of any kind of mental disorder, not a particular type. The aim of the present study is to perform a systematic review of studies that have investigated the prevalence of any kind of mental disorders in high school students in Iran. …