Academic Journal
Psychological distress in urban Iran: a multilevel analysis of socioeconomic position and context.
| Title: | Psychological distress in urban Iran: a multilevel analysis of socioeconomic position and context. |
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| Authors: | Alipour F; Department of Social Work, Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran., Rafiey H; Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran., Salimi Y; Department of Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran., Ahmadi S; Health in Emergency and Disaster Research center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran., Paykani T; Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran. Paykani.t@gmu.ac.ir. |
| Source: | BMC psychology [BMC Psychol] 2026 Jul 16; Vol. 14 (1). Date of Electronic Publication: 2026 Jul 16. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 101627676 Publication Model: Electronic Cited Medium: Internet ISSN: 2050-7283 (Electronic) Linking ISSN: 20507283 NLM ISO Abbreviation: BMC Psychol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : BioMed Central, [2013]- |
| MeSH Terms: | Urban Population*/statistics & numerical data , Stress, Psychological*/epidemiology , Psychological Distress* , Social Class*, Iran/epidemiology ; Humans ; Female ; Adult ; Cross-Sectional Studies ; Male ; Middle Aged ; Socioeconomic Factors ; Multilevel Analysis ; Young Adult ; Adolescent ; Socioeconomic Disparities in Health |
| Abstract: | Background: Mental health disorders significantly contribute to the global burden of disease, both as non-communicable diseases (NCDs) and as risk factors for other health conditions. They represent a major public health concern in low- and middle-income countries (LMICs). This study aims to investigate associations between psychological distress, socioeconomic factors, and corruption-related factors among Iranian adults in urban settings using multilevel analysis. Methods: This cross-sectional analysis uses data from a survey conducted in 2025 among urban adults across all 31 provinces of Iran, employing a proportional, stratified cluster sampling design with probability proportional to size (PPS). Psychological distress among adults aged 18 years and above was assessed using the 12-item General Health Questionnaire (GHQ-12), with a binary threshold of ≥ 4. Multilevel logistic regression models were used to examine associations between psychological distress and socioeconomic factors, perceived corruption, and experience of paying bribes. Models adjusted for health status and included random effects at the province and county levels. Sensitivity analyses were conducted using alternative GHQ-12 thresholds (≥ 3 and ≥ 5) to assess the robustness of findings to the choice of cut-off. Results: The proportion of participants scoring above the GHQ-12 threshold of ≥ 4 for psychological distress was 41.2% (mean = 3.46, SD = 3.54). Psychological distress showed clustering at both province and county levels. In the fully adjusted model, compared with married participants, single (OR = 1.32, 95% CI: 1.21-1.44) and divorced/separated participants (OR = 1.48, 95% CI: 1.26-1.74) reported higher odds of psychological distress, whereas widowed participants (OR = 1.18, 95% CI: 0.96-1.43) showed no statistically significant difference. Higher education (OR = 0.80, 95% CI: 0.72-0.89) and better subjective socioeconomic status (OR = 0.30, 95% CI: 0.25-0.37 for highest vs. lowest category) were associated with lower odds. Compared with unemployment, all employment categories were associated with lower odds of psychological distress (ORs = 0.65-0.70, all p < 0.001). Poorer health status showed a graded association with higher odds of distress (ORs = 1.30-1.70). After adjustment for socioeconomic and health factors, perceived corruption was weakly but positively associated with psychological distress (OR = 1.024, 95% CI: 1.019-1.028), and experience of paying bribes was associated with higher odds of psychological distress (OR = 1.38, 95% CI: 1.27-1.51). Conclusions: The findings indicate that participants' psychological distress is associated with socioeconomic factors, perceived corruption, and experience of paying bribes, with variation across provinces and counties in urban Iran. These results underscore the relevance of socioeconomic disadvantage, corruption-related conditions in public services, and area-level contextual variation as important factors in understanding psychological well-being. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: This study used data from a social health survey in Iran, which was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Code: IR.USWR.REC.1402.068). The participants provided verbal consent. All methods/study procedures were carried out in accordance the 2024 Declaration of Helsinki. All participants were informed about the purpose of the study, assured of confidentiality, and provided verbal consent prior to participation. Participation was voluntary, and respondents could withdraw at any time without consequence. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. |
| References: | Baxter AJ, Charlson FJ, Somerville AJ, Whiteford HA. Mental disorders as risk factors: assessing the evidence for the Global Burden of Disease Study. BMC Med. 2011;9(1):134. (PMID: 10.1186/1741-7015-9-134221767053305628) Fan Y, Fan A, Yang Z, Fan D. Global burden of mental disorders in 204 countries and territories, 1990–2021: results from the global burden of disease study 2021. BMC Psychiatry. 2025;25(1):486. (PMID: 10.1186/s12888-025-06932-y4037517412080068) Dragioti E, Radua J, Solmi M, Gosling CJ, Oliver D, Lascialfari F, et al. Impact of mental disorders on clinical outcomes of physical diseases: an umbrella review assessing population attributable fraction and generalized impact fraction. World Psychiatry. 2023;22(1):86–104. (PMID: 10.1002/wps.21068366404149840513) WHO. Promoting mental health: concepts, emerging evidence, practice : summary report / a report from the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation (VicHealth) and the University of Melbourne.; 2004. UN, Goal. 3. Ensure healthy lives and promote well-being for all at all ages Available from: https://sdgs.un.org/2030agenda . Lund C, Brooke-Sumner C, Baingana F, Baron EC, Breuer E, Chandra P, et al. Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. lancet psychiatry. 2018;5(4):357–69. (PMID: 10.1016/S2215-0366(18)30060-929580610) ZHU H, JIANG H, ZHU Z. YAO Z. International disparity of mental disorders burden: New trends of global mental health disparity. 2022. Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, et al. The social determinants of mental health and disorder: evidence, prevention and recommendations. World psychiatry. 2024;23(1):58–90. (PMID: 10.1002/wps.211603821461510786006) Solar O, Irwin A. A conceptual framework for action on the social determinants of health. WHO Document Production Services; 2010. Danaei G, Farzadfar F, Kelishadi R, Rashidian A, Rouhani OM, Ahmadnia S, et al. Iran in transition. Lancet. 2019;393(10184):1984–2005. (PMID: 10.1016/S0140-6736(18)33197-031043324) Farzadfar F, Yousefi M, Jafari-Khounigh A, Khorrami Z, Haghdoost A, Shadmani FK. Trend and projection of non-communicable diseases risk factors in Iran from 2001 to 2030. Sci Rep. 2024;14(1):8092. (PMID: 10.1038/s41598-024-58629-z3858293110998837) Ghalichi L, Shariat SV, Naserbakht M, Taban M, Abbasi-Kangevari M, Afrashteh F, et al. National and subnational burden of mental disorders in Iran (1990–2019): findings of the Global Burden of Disease 2019 study. Lancet Global Health. 2024;12(12):e1984–92. (PMID: 10.1016/S2214-109X(24)00342-5) Rahimi-Movaghar A. National Mental Health Survey (2021–2022). 2022. Noorbala AA, Faghihzadeh S, Kamali K, Yazdi SAB, Hajebi A, Mousavi MT, et al. Mental health survey of the Iranian adult population in 2015. Arch Iran Med. 2017;20(3):0. Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A. The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health Qual Life Outcomes. 2003;1(1):66. (PMID: 10.1186/1477-7525-1-6614614778280704) Motamed N, Edalatian Zakeri S, Rabiee B, Maadi M, Khonsari MR, Keyvani H, et al. The factor structure of the twelve items general health questionnaire (GHQ-12): a population based study. Appl Res Qual Life. 2018;13(2):303–16. (PMID: 10.1007/s11482-017-9522-y) Goldberg D, Oldehinkel T, Ormel J. Why GHQ threshold varies from one place to another. Psychol Med. 1998;28(4):915–21. (PMID: 10.1017/S00332917980068749723146) Adler N. The MacArthur scale of subjective social status. MacArthur research network on SES & health; 2007. Blair J, Czaja RF, Blair EA. Designing surveys: A guide to decisions and procedures. Sage; 2013. Vehovar V, Toepoel V, Steinmetz S. Non-probability sampling: The Sage handbook of survey methods; 2016. Lindström M, Ali SM, Rosvall M. Socioeconomic status, labour market connection, and self-rated psychological health: The role of social capital and economic stress. Scand J Public Health. 2012;40(1):51–60. (PMID: 10.1177/140349481142182521983194) Linander I, Hammarström A, Johansson K. Which socio-economic measures are associated with psychological distress for men and women? A cohort analysis. Eur J Public Health. 2015;25(2):231–6. (PMID: 10.1093/eurpub/cku13725172836) Muñoz IG, Santos-Lozada AR. Educational attainment and psychological distress among working-age adults in the United States. SSM-Mental Health. 2021;1:100003. (PMID: 10.1016/j.ssmmh.2021.1000033857157610989279) Mirzaei-Alavijeh M, Najafi F, Veis RG, Moradinazar M, Farasati F, Jalilian F. Psychological distress and its association with gender, socioeconomic status, education and health conditions. Sci Rep. 2025;15(1):29142. (PMID: 10.1038/s41598-025-14848-64078364212335555) Islam S, Jaffee SR. Social mobility and mental health: A systematic review and meta-analysis. Soc Sci Med. 2024;340:116340. (PMID: 10.1016/j.socscimed.2023.11634038006845) Yang YC, Gerken K, Schorpp K, Boen C, Harris KM. Early-life socioeconomic status and adult physiological functioning: A life course examination of biosocial mechanisms. Biodemography social biology. 2017;63(2):87–103. (PMID: 10.1080/19485565.2017.1279536285216245439296) Barch DM, Donohue MR, Elsayed NM, Gilbert K, Harms MP, Hennefield L, et al. Early childhood socioeconomic status and cognitive and adaptive outcomes at the transition to adulthood: the mediating role of gray matter development across five scan waves. Biol psychiatry: Cogn Neurosci neuroimaging. 2022;7(1):34–44. (PMID: 34273554) Kivimäki M, Batty GD, Pentti J, Shipley MJ, Sipilä PN, Nyberg ST, et al. Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study. Lancet Public Health. 2020;5(3):e140–9. (PMID: 10.1016/S2468-2667(19)30248-832007134) Stringhini S, Carmeli C, Jokela M, Avendaño M, Muennig P, Guida F, et al. Socioeconomic status and the 25× 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1· 7 million men and women. Lancet. 2017;389(10075):1229–37. (PMID: 10.1016/S0140-6736(16)32380-7281593915368415) Salem M, Robenson J. The Impact of Socioeconomic Factors on Mental Health: A Conceptual Framework. Cureus. 2025;17(7):e88244. https://doi.org/10.7759/cureus.88244 . PMID: 40827172; PMCID: PMC12358166. Renzi C, Provencal N, Bassil KC, Evers K, Kihlbom U, Radford EJ, et al. From epigenetic associations to biological and psychosocial explanations in mental health. Prog Mol Biol Transl Sci. 2018;158:299–323. (PMID: 10.1016/bs.pmbts.2018.04.01130072059) Ungar M, Theron L. Resilience and mental health: How multisystemic processes contribute to positive outcomes. Lancet Psychiatry. 2020;7(5):441–8. (PMID: 10.1016/S2215-0366(19)30434-131806473) Hsiao A, Vogt V, Quentin W. Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa. PLoS ONE. 2019;14(8):e0220583. (PMID: 10.1371/journal.pone.0220583314338216703670) Sharma S, Singhal S, Tarp F. Corruption and mental health: Evidence from Vietnam. J Econ Behav Organ. 2021;185:125–37. (PMID: 10.1016/j.jebo.2021.02.008) Sulemana I, Iddrisu AM, Kyoore JE. A micro-level study of the relationship between experienced corruption and subjective wellbeing in Africa. J Dev Stud. 2017;53(1):138–55. (PMID: 10.1080/00220388.2016.1187721) Van Deurzen I. And justice for all: Examining corruption as a contextual source of mental illness. Soc Sci Med. 2017;173:26–34. (PMID: 10.1016/j.socscimed.2016.11.03327914315) Ribanszki R, Taylor S, Scheutzow K, et al. Welfare systems and mental health in OECD and EEA countries: a scoping review. Humanit Soc Sci Commun. 2022;9:431. https://doi.org/10.1057/s41599-022-01391-2 . Wilkinson R, Pickett K. The inner level: How more equal societies reduce stress. restore sanity and improve everyone’s well-being: Penguin; 2020. De France K, Evans GW. Expanding context in the role of emotion regulation in mental health: How socioeconomic status (SES) and developmental stage matter. Emotion. 2021;21(4):772. (PMID: 10.1037/emo000074332191088) Keynejad RC, Dua T, Barbui C, Thornicroft G. WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries. BMJ Ment Health. 2018;21(1):30–4. Podsakoff PM, MacKenzie SB, Lee J-Y, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. 2003;88(5):879. (PMID: 10.1037/0021-9010.88.5.87914516251) |
| Contributed Indexing: | Keywords: Corruption; Iran; Mental health; Psychological distress; Social determinants of health |
| Entry Date(s): | Date Created: 20260717 Date Completed: 20260731 Latest Revision: 20260801 |
| Update Code: | 20260801 |
| PubMed Central ID: | PMC13422113 |
| DOI: | 10.1186/s40359-026-05194-x |
| PMID: | 42464387 |
| Database: | MEDLINE |
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