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http://dx.doi.org/10.3961/jpmph.19.150

Contextual and Individual Determinants of Mental Health: A Cross-sectional Multilevel Study in Tehran, Iran  

Sajjadi, Homeira (Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences)
Harouni, Gholamreza Ghaedamini (Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences)
Rafiey, Hassan (Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences)
Vaez-Mahdavi, Mohammadreza (Department of Physiology, Shahed University)
Vamegh, Meroe (Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences)
Kamal, Seyed Hossein Mohaqeqi (Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences)
Publication Information
Journal of Preventive Medicine and Public Health / v.53, no.3, 2020 , pp. 189-197 More about this Journal
Abstract
Objectives: Our aim was to answer the following questions: (1) Can mental health variance be partitioned to individual and higher levels (e.g., neighborhood and district); (2) How much (as a percentage) do individual-level determinants explain the variability of mental health at the individual-level; and (3) How much do determinants at the neighborhood- or district-level explain the variability of mental health at the neighborhood- or district-level? Methods: We used raw data from the second round of the Urban Health Equity Assessment and Response Tool in Tehran (in 2012-2013, n=34 700 samples nested in 368 neighborhoods nested in 22 districts) and the results of the official report of Tehran's Center of Studies and Planning (in 2012-2013, n=22 districts). Multilevel linear regression models were used to answer the study questions. Results: Approximately 40% of Tehran residents provided responses suggestive of having mental health disorders (30-52%). According to estimates of residual variance, 7% of mental health variance was determined to be at the neighborhood-level and 93% at the individual-level. Approximately 21% of mental health variance at the individual-level and 49% of the remaining mental health variance at the neighborhood-level were determined by determinants at the individual-level and neighborhood-level, respectively. Conclusions: If we want to make the most effective decisions about the determinants of mental health, in addition to considering the therapeutic perspective, we should have a systemic or contextual view of the determinants of mental health.
Keywords
Mental health; Individual level; Neighborhood level; Determinants; Multilevel analysis; Tehran;
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