{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T21:58:10Z","timestamp":1787090290778,"version":"build-2736575974"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T00:00:00Z","timestamp":1686614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine the age- and sex-standardized prevalence and risk factors of depression, anxiety, and stress symptoms in the city of Ilam.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>In this population-based cross-sectional study, 1,350 people were invited using a multi-stage stratified cluster random sampling method. Depression, anxiety, and stress symptoms were measured using the DASS-21 standard questionnaire. For data analysis, multiple ordinal logistic regression was used in Stata version 12 software. A significance level of 5% was considered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The data of 1,431 people were analyzed. The age- and sex-standardized prevalence (95% CI) of severe depression, anxiety, and stress symptoms was 19.90% (17.64 to 22.16), 25.95% (23.48 to 28.43), and 15.75% (13.69 to 17.81), respectively. There was a positive association among depression symptoms with female sex (OR: 1.52; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.003), Kurdish ethnicity (OR: 2.15; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.004), low educational level (OR: 1.37; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.031), job losing history (OR: 1.64; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), mental disorders history (OR: 2.17; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), hopelessness for the future (OR: 5.38; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), and history of other diseases (OR: 1.67; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). There was a positive association among anxiety symptoms with female sex (OR: 1.72; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), job losing history (OR: 1.53; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.003), mental disorders history (OR: 2.11; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), hopelessness to future (OR: 3.33; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) and history of other diseases (OR: 1.97; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Hopelessness for the future and a history of other diseases were the most effective variables for anxiety symptoms and stress symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A significant proportion of Ilam\u2019s urban population suffers from mental disorders. Increasing people\u2019s awareness, establishing counseling centers, and improving infrastructure should be considered by mental health policymakers who work in the province.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2023.1166692","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T04:15:56Z","timestamp":1686629756000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["High prevalence of mental disorders: a population-based cross-sectional study in the city of Ilam, Iran"],"prefix":"10.3389","volume":"14","author":[{"given":"Hojatollah","family":"Kakaei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farajolah","family":"Maleki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azam","family":"Biderafsh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Valizadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Ali","family":"Mansournia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iraj","family":"Pakzad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Pakzad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11920-019-0997-0","article-title":"Global burden of disease and the impact of mental and addictive disorders","volume":"21","author":"Rehm","year":"2019","journal-title":"Curr Psychiatry Rep"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e22817","DOI":"10.2196\/22817","article-title":"Investigating mental health of US college students during the COVID-19 pandemic: cross-sectional survey study","volume":"22","author":"Wang","year":"2020","journal-title":"J Med Internet Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e0169575","DOI":"10.1371\/journal.pone.0169575","article-title":"The burden of mental disorders in the eastern Mediterranean region, 1990\u20132013","volume":"12","author":"Charara","year":"2017","journal-title":"PLoS One"},{"key":"ref4","first-page":"15","article-title":"Depression as a predictor of academic performance in male and female university students","volume":"12","author":"Khanam","year":"2015","journal-title":"J Pak Psychiatr Soc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e20160340","DOI":"10.1542\/peds.2016-0340","article-title":"Mediators and adverse effects of child poverty in the United States","volume":"137","author":"Pascoe","year":"2016","journal-title":"Pediatrics"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2581","DOI":"10.1001\/jama.291.21.2581","article-title":"Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization world mental health surveys","volume":"291","author":"Demyttenaere","year":"2004","journal-title":"JAMA"},{"key":"ref7","volume-title":"mhGAP: mental health gap action programme: scaling up care for mental, neurological and substance use disorders","year":"2008"},{"key":"ref8","first-page":"100","article-title":"Importance of general hospital in the development of mental health care","volume":"2","author":"Mendis","year":"2003","journal-title":"World Psychiatry"},{"key":"ref9","first-page":"76","article-title":"Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian mental health survey, 2011","volume":"18","author":"Sharifi","year":"2015","journal-title":"Arch Iran Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"137","DOI":"10.18502\/ijps.v14i2.993","article-title":"Prevalence of depression, anxiety and stress among adult population: results of Yazd health 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mental health (2010\u20132011)","author":"Amin-Esmaeili","year":"2013"},{"key":"ref19","first-page":"136","article-title":"Prevalence of psychiatric disorders in Iran: a systematic review","volume":"2","author":"Farhoudian","year":"2007","journal-title":"Iran J Psychiatry"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.ajp.2019.04.004","article-title":"An epidemiological survey of psychiatric disorders in Iran: Kermanshah","volume":"43","author":"Shirzadi","year":"2019","journal-title":"Asian J Psychiatr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e2017031","DOI":"10.4178\/epih.e2017031","article-title":"Prevalence and comorbidity of common mental disorders and associations with suicidal ideation in the adult population","volume":"39","author":"Veisani","year":"2017","journal-title":"Epidemiol Health"},{"key":"ref22","volume-title":"The world health report 2002: reducing risks, promoting healthy life","year":"2002"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1111\/j.1525-1446.1996.tb00227.x","article-title":"Health promotion needs of students in a college environment","volume":"13","author":"Fish","year":"1996","journal-title":"Public Health Nurs"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1007\/s40615-019-00692-8","article-title":"Race\/ethnicity, gender, and trajectories of depressive symptoms across early-and mid-life among the add health cohort","volume":"7","author":"Hargrove","year":"2020","journal-title":"J Racial Ethn Health Disparities"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/healthcare6010006","article-title":"Age and gender differences in psychological distress among African Americans and whites: findings from the 2016 National Health Interview 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Psychol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1111\/j.1532-5415.2011.03448.x","article-title":"A roadmap of aging in Russia: the prevalence of frailty in community-dwelling older adults in the St. Petersburg district\u2014the \u201ccrystal\u201d","volume":"59","author":"Gurina","year":"2011","journal-title":"Study"},{"key":"ref34","first-page":"42","article-title":"Investigation of psychological disorders profile (anxiety, depression and psychological distress) in adult population of Isfahan province","volume":"3","author":"Alizade","year":"2016","journal-title":"J Torbat HeydariyehUniv Medical Sci"},{"key":"ref35","first-page":"212","article-title":"Prevalence of psychiatric disorders in Tehran city","volume":"2","author":"Noorbala","year":"1998","journal-title":"Hakim"},{"key":"ref36","first-page":"479","article-title":"Mental health status of individuals fifteen years and older in Tehran-Iran (2009)","volume":"16","author":"Noorbala","year":"2011","journal-title":"Iran J Psychiatry Clin Psychol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.psyneuen.2005.07.002","article-title":"The effects of sex and hormonal status on the physiological response to acute psychosocial stress","volume":"31","author":"Kajantie","year":"2006","journal-title":"Psychoneuroendocrinology"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.biopsycho.2004.11.009","article-title":"Sex differences in HPA axis responses to stress: a review","volume":"69","author":"Kudielka","year":"2005","journal-title":"Biol Psychol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.psyneuen.2004.06.002","article-title":"A meta-analysis of cortisol response to challenge in human aging: importance of gender","volume":"30","author":"Otte","year":"2005","journal-title":"Psychoneuroendocrinology"},{"key":"ref40","first-page":"1","article-title":"Evaluation of mental disorders incidence trend in Iran","volume":"22","author":"Noorbala","year":"2014","journal-title":"Daneshvar Med"},{"key":"ref41","first-page":"44","article-title":"Epidemiology of mental disorders in Qom, 2000","volume":"4","author":"Chegini","year":"2002","journal-title":"J Babol Univ Medical Sci"},{"key":"ref42","first-page":"46","article-title":"Racial differences in the salience of social support for mental health an intersectional approach","volume":"34","author":"Roxburgh","year":"2020","journal-title":"Mich Sociol Rev"},{"key":"ref43","first-page":"375","article-title":"Socio-economic inequality and mental health in Tehran","volume":"16","author":"Hosseini Shokouh","year":"2021","journal-title":"Iran"},{"key":"ref44","first-page":"422","article-title":"The prevalence of psychiatric disorders and the related 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