Razi Journal of Medical Sciences

---

Background and Aims: Psychiatric disorders are typically viewed as neuropsychological and neurobehavioral conditions that impair the ability to comprehend new or complex information. It is estimated that over 450 million people worldwide experience various mental disorders, with major depression anticipated to be the most disabling by 2030. Major depressive disorder (MDD), also known as unipolar disorder, is characterized by prolonged periods of depression across different situations and contexts, low self-esteem, and a lack of interest in activities that are normally enjoyable, lasting for at least two weeks. To diagnose MDD, it is essential to exclude any history of manic or hypomanic episodes. In children and adolescents, MDD may present as irritability. According to the DSM-5, other depressive disorders include persistent depressive disorder (formerly known as dysthymia), disruptive mood dysregulation disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, and depressive disorder due to another medical condition, and unspecified depressive disorder. Depression can impact both mental and physical health. Although the clinical cure rate for MDD is high, the treatment and recurrence rates are less favorable due to patients' lack of understanding and reluctance to adhere to regular treatment.
Globally, major depressive disorder (MDD) is consistently among the most prevalent mental disorders, affecting 322 million people worldwide. The average age of individuals with this disorder is 30.4 years. The prevalence of MDD is twice as high in women compared to men and affects one in six adults over their lifetime. The lifetime prevalence is estimated to be around 10-15%. The World Health Organization predicts that by 2030, MDD will account for 13% of the total global disease burden, surpassing cardiovascular disorders. MDD is a significant cause of suicide and morbidity among adolescents and young adults, making accurate diagnosis and effective care crucial for these age groups.
This disorder can cause significant suffering and poor performance in work, school, and home environments. While antidepressants can treat depression, their effectiveness varies. Most antidepressant medications, which primarily target monoamine pathways, are effective, but over 30% of patients do not achieve remission even after multiple treatment trials. Current interventions for MDD include behavioral activation, Acceptance and Commitment Therapy (ACT), problem-focused therapy, functional analytic psychotherapy, mindfulness-based cognitive therapy, and cognitive-behavioral analytic psychotherapy. Treatment for MDD often requires a combination of antidepressants, antipsychotics, psychotherapy, or electroconvulsive therapy. However, a lack of understanding about MDD or an unwillingness to seek formal treatment can negatively impact recovery rates. The complexity of MDD makes it difficult for most patients to fully understand the disorder.
Major depressive disorder (MDD) is influenced by both hereditary and environmental factors. Genetic contributions to MDD are well-documented through family, twin, and adoption studies. However, high discordance rates in studies of monozygotic twins suggest significant non-genetic influences, such as stressful life events, which can elevate the risk of developing depression. The heritability of MDD is estimated to be between 30% and 50%. The high prevalence, moderate heritability, and polygenic nature of MDD pose significant challenges for genetic mapping compared to other psychiatric disorders.
Environmental factors, such as sexual, physical, or emotional abuse during childhood, are significantly linked to an increased risk of developing MDD. Although no single mechanism can account for all aspects of the disorder, MDD is associated with changes in regional brain volumes, particularly the hippocampus, and functional alterations in brain circuits, including the cognitive control network and the affective-salience network. Additionally, disruptions in key neurobiological stress-responsive systems, such as the hypothalamic-pituitary-adrenal axis and the immune system, are observed in MDD. Treatment primarily involves psychotherapy and pharmacological interventions. For patients with treatment-resistant MDD who do not respond to multiple augmentation or combination therapies, electroconvulsive therapy has the strongest empirical support.
Major depressive disorder (MDD) is a complex, multifactorial disorder likely influenced by numerous individual genetic variations, similar to many other psychiatric disorders. The causes of MDD are intricate and involve a combination of genetic, immune system, and endocrine factors, often triggered by stress-related psychosocial conditions. Acute stress and major depression share similar pathophysiological changes, such as inflammatory states, metabolic alterations, and a prothrombotic state. The roles of genetic and epigenetic factors in the development and progression of MDD have been recognized, with nearly 200 genes associated with the disorder identified so far. By conducting genetic analyses to identify risk types, we can enhance our understanding of MDD's development, potentially leading to better prevention strategies and the creation of newer, more effective treatments.
Psychiatric disorders significantly impact patients' quality of life and impose substantial economic burdens on their families. The considerable phenotypic variability among patients complicates the investigation of their pathogenesis. However, bioinformatics is emerging as a promising tool for diagnosing psychiatric disorders by identifying sensitive biomarkers and exploring related signaling pathways. Bioinformatics studies now facilitate the discovery of key genes associated with diseases like depression. Advances in bioinformatics, coupled with high-throughput assessments of brain and behavior, have provided technologies for rapidly identifying and characterizing the roles of biological systems in behavioral processes. This progress has led to the identification of new molecular targets for research, diagnostics, and therapies. Although much of this research is in its early stages, significant advancements are being made, and practical applications are already emerging. This study utilizes bioinformatics data to investigate the genes contributing to depression. In molecular biology, techniques such as signal processing and 3D imaging generate abundant raw data that can be used for disease diagnosis and treatment. Bioinformatics is also crucial for analyzing gene and protein regulation and expression. By identifying genes that contribute to MDD, rapid and cost-effective computational methods can be employed to diagnose the disorder and develop effective treatment solutions.
Methods: In the present study, microarray was used from the Gene Expression Omnibus (GEO) database on 32 samples, including 10 samples from healthy individuals, 10 samples from patients with MDD and 10 samples from patients diagnosed with MDD but recovered. Data analysis was performed using R software. In addition, inflammation-related genes were extracted from the MSigDB database for further analysis.
Finally, protein-protein interaction (PPI) analysis and hub gene selection were analyzed using Cytoscape software.
Results: In the present study, a total of 1179 genes were identified as DEGs between MDD and healthy subjects, of which 648 were up-regulated and 531 were down-regulated. 18 genes are shared between DEGs and genes related to inflammatory processes, termed inflammation-related DEGs.
This study identified the genes IL-1β (interleukin 1 beta), TLR2 (toll-like receptor 2), IFNAR2 (interferon alpha and beta receptor subunit 1), TLR1 (toll-like receptor 1) and C5AR1 (complement receptor 1 C5a) as key genes in major depressive disorder.
Conclusion: This study had limitations such as lack of access to other databases and the inability to cite some articles. It is suggested that clinical and laboratory studies be carried out to confirm and complete the present study and to use this information for better diagnosis and treatment of this disorder. The key genes obtained by analysing the data in the present study provide important information for revealing the molecular mechanism and targeted treatment of depression disorder, and in the future, with more studies, the aforementioned genes can be used in the diagnosis and correct treatment of this disease. However, depression is still a major public health problem and governments should support the necessary research to develop interventions and better prevention and treatment.

 

---

Introduction: depression is one of the most common psychiatric disorders that its treatment imposes large amount of costs on the individual and consequently the family and society.
Depression is one of the most common psychiatric disorders, which destroys a person's innate capacity to grow and flourish, causing a disorder in a person's mental health [1] and as one of the major health problems, it is predicted that by 2030, it will be the only become the main cause of disease all over the world [2]. This serious mood disorder is accompanied by severe symptoms that affect a person's feelings, thoughts and daily life [3]. The prevalence rate of depression is higher than other mental disorders and is around 17%. In the Iranian population, the prevalence rate of depression varies between 5.69% and 73%, and among women it is reported to be 1.7 times more than men [4]. Depressed patients are part of the group of patients who do not receive adequate treatment and only half of them recover. It seems that the effective management of depression in patients requires more attention to their preferences, treatment needs, and finally the use of more comprehensive treatment packages to maximize patient participation and adequate use of the treatment method[5].
Objective: the study aimed to evaluate effectiveness acceptance and commitment therapy for cognitive flexibility, resilience and perceived stress among depressed women of Andimeshk.
Method: statistical population included all the women referring to psychiatric clinics of Andimeshk from March 2021 to March 2022. According to the inclusion criteria, 30 patients who were willing to participate in the research were randomly assigned into two groups (experiment group and control group, 15 people each). to Morrow’s questionnaire was used; for cognitive flexibility, Dennis and Vander Wal’s questionnaire and for resilience, Connor-Davidson Scale and for perceived stress, Cohen, Kamarck & Mermelstein were applied. To diagnose depression the clinical interview SCID5 was applied. The data were analyzed using analysis of covariance and evaluation of its assumptions.
Findings: the results indicated that acceptance and commitment therapy affected the depressed patients’ cognitive flexibility and perceived stress. Inferential findings showed that the treatment based on acceptance and commitment to reflection, cognitive flexibility, resilience and perceived stress of depressed patients had a significant effect. In order to align the obtained results with the research background, it can be said that the treatment based on acceptance and commitment, relying on its therapeutic principles, including the principle of acceptance, as the most basic principle of treatment, by increasing the patient's psychological acceptance of his thoughts and feelings, has been able to reduce ineffective control actions such as perceived stress are effective. Because during the above treatment method, a person learns to accept them without any internal or external reactions in order to eliminate the above reactions, then the above acceptance by the patient makes him able to act independently of such negative experiences. This has been able to lead to a reduction in and a more logical evaluation of stressful situations by the person, and this is how the perceived stress of patients has decreased. Also, by increasing the psychological and mental acceptance of the person, the above treatment has increased the patient's cognitive flexibility by actively and effectively confronting his thoughts and feelings and avoiding any avoidance.
Conclusion: the results emphasized the efficiency of this therapy for depressed patients and that it can be used as an effective interventional procedure. Treatment based on acceptance and commitment in depressed patients has resulted in their ability to use effective coping strategies. This ability causes people to have a more logical approach to the conditions of different life situations and when problems arise, they deal with them by solving the appropriate problem, and in this way, their resilience has increased. Treatment based on acceptance and commitment instead of changing cognitions increases the psychological connection of a person with his thoughts and feelings. It also increases the capacity to accept psychological experiences and commitment, meaningful, flexible, adaptive activities without considering the content of obvious experiences [60]. By clarifying values and paying them and determining the important goals of life, instead of dealing with symptoms and everyday issues, people including depressed patients learn to deal with values and what is more important in life instead of physical and mental responses. It causes a decrease in the attention and excessive sensitivity of the person to the complications of the disease.
 

---

Background & Aims: Depression is one of the leading causes of disability worldwide and can have a profound effect on an individual's ability to function and lead a productive life. It is also estimated by the WHO (2023) that 5% of the adult population worldwide suffers from this disorder (2). Therefore, the high prevalence of depression has led researchers to look at other related factors, including childhood trauma (3). Childhood is a very important time for our physical, mental, and social development. What we experience and what happens to us during this very sensitive time will be the foundation and root of our physical and mental health as we grow up and enter adulthood. Therefore, through childhood experiences we are building a path with very long term effects (4). Therefore, a trauma during this period can have negative consequences in life. It can cause a person to develop a negative or depressive cognitive style (5). Research shows that people who have experienced childhood trauma are twice as likely to develop depression in adulthood than those who have not been traumatized (6). There are several types of childhood trauma, the most important of which are emotional abuse, sexual abuse, and physical abuse, as well as emotional neglect and physical neglect. While the presence of traumatic events in childhood increases the risk of depression in adulthood, not all people who have such experiences show the same symptoms in adulthood (7). Other factors have also been found to play a mediating role between these two variables; for example, research shows that childhood trauma leads to a decrease in a person's level of mindfulness (8,9). In fact, traumatized people are very sensitive to the threat of danger. They feel that danger can occur at any time. As a result, they become dissociated from their current situation, their mindfulness is disturbed, and they experience negative psychological experiences, including depression (10). Several studies indicate a negative relationship between mindfulness and depression (11 - 14). Based on the definition of Ryan & Brown (2003), mindfulness is defined as a state of aroused attention and awareness of what is happening in the present moment, which allows a person to respond with thought and reflection, rather than reacting to events involuntarily and without reflection (15). Mindfulness skills also include the ability to observe, describe, and fully participate in one's actions in a nonjudgmental, mindful, and effective manner (16).Therefore, it is very important to have a better understanding of depression and the factors that influence this disorder. In this study, we examined mindfulness as a mediator between childhood trauma and depression.
Methods: The current research was descriptive and correlational. The statistical population of this research was undergraduate and graduate students of Psychology and Law of Valiasr Complex of South Tehran Azad University studying in 1402-1401. For this purpose, 266 individuals were selected as the research sample group using a multistage random sampling method. The Beck Depression Inventory II (BDI-II; Beck et al., 1996), the Mindfulness Scale (MAAS; Brown and Ryan, 2003), and the Childhood Trauma Questionnaire (CTQ; Bernstein and Fink, 1998) were used for data collection were used.
Results: The results of this research showed that childhood trauma have a significant positive relationship with depression (P<0.01). Also, childhood trauma are negatively significant with mindfulness and depression (P<0.01). The model fit indices also confirmed the path from childhood trauma to depression with the mediating role of mindfulness.
Conclusion: This research was conducted to determine the mediating role of mindfulness in the relationship between childhood trauma and depression. The results of this research showed that childhood trauma had a significant negative relationship with mindfulness. This finding was consistent with previous research (8,9). In explaining this finding, it can be said that mindful people have a great ability to face a wide range of thoughts, emotions, and experiences (both pleasant and unpleasant) (15). Mindfulness is also a state in which people pay attention to the present and what is happening without judgment and without adding or subtracting any aspect of the experience, and they are aware of this attention and do not react to the experience (15), while childhood trauma can make a person very sensitive to possible future threats (27). In this situation, mindfulness allows a person to keep their focus on the present, and when they are aware of the present, they are no longer involved in the past or the future (28). The results of this study also showed that there was a significant positive relationship between childhood trauma and depression. This finding was consistent with previous studies (5, 29, 30). In explaining this finding, it can be said that childhood maltreatment causes the emergence of negative internal messages about oneself and events (31). Thus, in the future, the person feels that he deserves to be mistreated and concludes that his experiences are inevitable and caused by something negative in him. Over time, the person generalizes these negative conclusions to other events and incidents, eventually leading to the belief that negative events are inevitable; ultimately, this style of negative, general, and generalized attributions leads to people's vulnerability to depression (32).  Another aspect of this research was the existence of a significant relationship between depression and mindfulness. This finding was consistent with previous studies (11, 12, 13, 14, 15). The possible explanation is that people who are more mindful are in a better psychological and quality of life state and experience less psychological and emotional turmoil (33). People with depressive disorders have cognitive biases and ineffective attitudes, and these attitudes and thoughts play an important role in the perpetuating of this disorder. Research shows that depression is associated with a tendency to selectively attend to negative information and cognitive biases with negative judgments and documents (34). Since mindfulness means receptive and nonjudgmental awareness of what is happening in the present moment (15), what makes a person psychologically vulnerable to depression is the mental conflict with past memories and possible future events. And since mindfulness is one of the skills that allows us to keep our focus in the present, when we are aware of the present, our attention is no longer involved with the past or the future (28). Finally, the results of this study showed that mindfulness plays a mediating role in the relationship between childhood trauma and depression, which is consistent with the findings of previous studies (8, 9).It seems that childhood trauma can make a person more sensitive to possible future threats (27). and cause a wide range of adverse physical and psychological consequences, including depression (29). Depression is associated with a tendency to selectively attend to negative information, as well as cognitive biases with negative judgments and documents (34). While mindfulness is a state in which people pay attention to the present and what is happening without judging and without adding or subtracting any aspect of that experience (15), depressed people also exaggerate their failures and ignore their successes (34).Therefore, what makes a person psychologically vulnerable to depression is the mental conflict with past memories and possible future events. And since mindfulness is one of the skills that keeps people focused on the present, when a person is aware of the present, he is no longer involved in the past or the future (28). Of course, it is necessary to interpret the results of this research in light of its limitations: this research was cross-sectional in nature, which makes it difficult to draw conclusions about cause. The statistical population of this research consisted of students, so its generalization to other population groups has some limitations. The present research is more of correlational type and requires the use of self-report tests, so the causal explanation of the results is not possible. Therefore, it is suggested to conduct this research with a longitudinal method. This study investigated the symptoms of depression in non-clinical population. Therefore, it is suggested that future research should be conducted in the clinical population suffering from depression. It is also suggested to conduct qualitative research in this area. In addition to these cases, holding workshops for training and prevention of childhood trauma and also teaching mindfulness skills, especially in groups with high levels of depression, is one of the suggestions of this research. The results of this study showed that mindfulness plays a mediating role in the relationship between childhood trauma and depression, and these findings support the research hypothesis. Based on the results, increasing people's level of mindfulness can reduce the effect of childhood trauma on depression to some extent. Holding mindfulness workshops to train mindfulness skills, especially in groups with high levels of depression, as well as holding workshops to teach and prevent childhood trauma can reduce and prevent it from playing a role in depression.
Keywords: depression, childhood trauma, mindfulness

Ethical approval: The Ethics Committee of Azad Islamic University, Tehran-Central Branch, approved the study (IR.IAU.CTB.REC.1402.001).

Funding: This study did not have any funds.

Conflict of interest: None declared.

 

---

Mental disorders are a group of disorders that affect the thinking, behavior, mind, psyche, mood, perception and awareness, causing discomfort for the affected person or causing disability in the functioning of the affected person. The causes of mental disorders are not well known, but what is certain is that genetic factors, various stresses, and the type of interaction a person has with others are effective in causing or causing them. The study shows that the rate of mental disorders in Iran is increasing, so that the rate of mental disorders in 2014 was reported as 22% in the general population and this rate in 2011 It has reached about 37%. Anxiety, somatization disorder, and depression, whose incidence rates were 40%, 30%, and 43% in the general population, respectively, are referred to as the most common mental disorders in Iranian society. Among mental disorders in Iran, depression is known as the most common mental disorder.
Depression is referred to as the common cold of mental disorders. According to the definition, depression is a mood disorder that causes a constant feeling of sadness or loss of interest in things that the affected person used to enjoy. Also, depression can interfere with memory, thinking, eating and sleeping. This disorder has a negative impact on a wide range of physical and mental health of affected people, so that the number of physical diseases such as cancer, heart diseases and even overweight is higher in people suffering from depression compared to normal people. Also, compared to normal people, depressed people not only have less psychological well-being, but also these people face a severe drop in academic and job performance. On the other hand, depression is known as the most common mental disorder in people with suicidal thoughts and behavior. Therefore, the importance of depression is not hidden from anyone and its treatment should be followed seriously.
One of the common treatment methods in depression is drug therapy, which fluoxetine, fluvoxamine, paroxetine, and sertraline are known as the most common antidepressant drugs, however, many patients may not respond significantly to drug therapy. And sometimes drug therapy may show less effectiveness than other treatments. Meanwhile, different types of psychotherapy such as cognitive behavioral therapy, emotional therapy, commitment and acceptance therapy, and schema therapy have also provided their treatment protocols to help depressed people. But another non-pharmacological intervention in depression, which has attracted the attention of therapists and researchers in recent years, is neurofeedback therapeutic intervention. Neurofeedback is a relatively new treatment for mental disorders and depression, using real-time scans to show how the patients' brains work and resolve these disorders .
Method
The method of the present study is descriptive and according to the implementation method, it is a systematic review article. Review studies are one of the important types of qualitative research that are used to study phenomena and evaluate important categories based on previous research sources. This method is used when the relevant previous studies related to the desired phenomenon are well covered. In this case, by using these studies, the underlying categories of the studied phenomenon can be evaluated, classified and identified.
The research community includes all articles with the English keywords Depressive Disorder, Major Depression, Mood Disorder, Depression along with Neurofeedback Training, , biofeedback, neurofeedback in foreign databases Scopus, Springer, Web of Science, Google-Scholar, Science Direct and keywords Neurofeedback, bioneurofeedback along with depression, depressive, mood disorder in the internal databases of SID, Normags, Magiran, Civilica, ISC, Google-Scholar, which were published between 1993 and 2023. In order to select relevant studies, the Prism guide for review studies was used. At first, 397 articles were selected using the above keywords in internal and external search engines. After that, 263 studies were excluded due to non-relevance, 71 studies due to duplicates in the search engines. From the remaining 63 studies, after fully reading the articles and applying the inclusion and exclusion criteria, 47 other studies were excluded and 16 studies were selected for the final sample selection.
Results
The results of this study showed that out of 16 selected studies, 8 studies were conducted in Iran, 3 studies were conducted in South Korea, and 1 study was conducted in China, Russia, Spain, Finland, and the United States. No studies were found in the continent of Africa and South America, and 1 study was selected for the continent of America, which indicates limited studies in this continent. Also, no studies related to before 20100 were found, 9 studies were between 2010 and 2018, and 7 studies were related to the last 5 years. Also, out of the 16 selected studies, most of the studies used the Beck depression questionnaire to measure depression (10 out of 16 studies). Among the conducted studies, only one study had a sample size of more than 50 people, which is because only interventional and therapeutic studies were selected and the sample size in experimental studies in each control and experimental group should be at least 8 people, so In no study, the number of their samples is not less than 16 people. It is also necessary to remember that master case studies or single-subject experimental designs were excluded from the study due to the small number of samples.
Discussion
The purpose of this study was to investigate the effectiveness of neurofeedback therapy and compare it with other treatment approaches on reducing depression. The results of this study showed that in all the studies conducted, neurofeedback therapy was able to significantly reduce depression in treatment groups. These results are in agreement with the studies of Chubforoshzadeh et al. (2015) who showed that neurofeedback treatment is effective in reducing the symptoms of depression in people with MS and also with the study of Hood et al. (2021), who showed that neurofeedback treatment has a significant effect on Reducing depression in people with generalized anxiety disorder is effective, it is consistent.
Conclusion
The results of this treatment showed that neurofeedback treatment was significantly effective in reducing depression symptoms, and this effectiveness when combined with other treatments is not only more effective, but the durability of the treatment is longer compared to a single treatment. We also need more studies to compare this treatment with other treatments. Considering the effectiveness of this treatment, it is suggested that mental health professionals combine this treatment with other treatments in order to reduce the symptoms of depression and improve the quality of life of depressed patients.

---

Background : The growth of any society depends on its students in the future; accordingly, countries spend significant amounts of their income on their education systems. However, depression reduces the quality of students’ mental health (1). Existing research, such as Mortier et al. (2) and Pillay et al. (3), show that depression is prevalent among students (4). Some students manage to cope with it, while the subjective well-being has troubled others. Therefore, it is crucial to know the effective strategies for alleviating the depression symptoms of students (5).
Mental well-being denotes individuals’ evaluation of life and comprises both reflective cognitive judgments (such as life satisfaction) and emotional responses to life when experiencing positive and pleasant emotions versus unpleasant and negative emotions (7). It includes emotional (Emotional well-being), social (Social Well-being), and psychological (Mental Well-being) categories. The psychological category can be defined as an individual’s ability to express his satisfaction without allowing others to influence the experience of positive feelings (8). The emotional category refers to the presence of positive emotions, the absence of negative emotions, and satisfaction (9). Social category is the evaluation and recognition of an individual on how he functions in society and the quality of his relationships with individuals and social groups (10).
Mindfulness-based interventions are among the efforts aimed at effectively and efficiently reducing depression symptoms in students (12). It enables clients to understand their experiences non-judgmentally and alter their relationships with others by challenging and accepting their beliefs and feelings (15).
Behavioral activation is one of the effective treatment methods (17), which assumes that the life problems of vulnerable individuals take away their ability to receive positive reinforcement from the environment. This is based on emphasizing the major and real factors causing depression, i.e., the reduction of rewarding activities and the increase of avoidance behaviors and ruminative thoughts (19).
Shahsavari (2022) found that mindfulness improved well-being scores (24). Ghamari (2021) reported that mindfulness increased psychological well-being (25). Bahreini (2021) indicated that mindfulness influenced the well-being level (26). Yosep (2023) concluded that mindfulness could help improve psychological well-being (27). Ghodrati and Vaziri Neku (2018) found that behavioral activation therapy affected psychological well-being (28). Mazzucchelli (2010) realized that the effectiveness of behavioral activation intervention was comparable to the integrated effect of positive psychology interventions on well-being (29). A meta-analysis conducted by Stiles-Shields (2014) showed that behavioral activation positively impacted depression. (30).
The review of the literature revealed that no systematic study has yet been conducted on this topic in Iran. Therefore, the purpose of the current research is to answer the question of whether there was a significant difference between the effectiveness of behavioral activation training and mindfulness training on the mental well-being of students with depressive syndrome.
Methods: The research was semi-experimental with a pre-test, post-test, control group, and 60-day follow-up design. The statistical population included all female students studying for both bachelor’s and master’s degrees who were referred to the counseling center of the University of Isfahan, among whom 45 were selected and randomly assigned to two experimental groups and a control group, each comprising 15 students.
The experimental group participants of behavioral activation received this intervention during nine two-hour sessions; the participants of the mindfulness training group underwent eight two-hour sessions, while the control group received no intervention. The participants were retested after 60 days as a follow-up. Finally, they completed the questionnaires in three stages, and the data were analyzed using the mixed analysis of variance and the Bonferroni post-hoc test by SPSS26.
Beck depression scale: This test was developed by Beck (1961) and has 21 items that measure the severity of depression symptoms using a four-point Likert scale, with scores ranging between 0 and 63. Dobson and Mohammad Khani (2006) reported Cronbach’s alpha of 0.93 for students (34).
The mental well-being questionnaire: it was developed by Keyes and Magyarmo (2003). The items are rated on a 5-point Likert scale, ranging from not at all (1) to all the time (5). The internal consistency coefficient of the questionnaire, estimated by Cronbach’s alpha, was 0.80 (36). The description of mindfulness training sessions was taken from Kabat-Zinn (2013) (36), and the description of behavioral activation sessions was provided by Lejuez et al. (2011) (37).
Results: Demographic characteristics were investigated in the descriptive statistics section, and the variables were described using mean and standard deviation. In both experimental groups, the mean score of total well-being increased compared to the pre-test. Levene’s test was used to perform a mixed analysis of variance, which indicates the confirmation of the assumption of homogeneity of variance (P<0.05). Covariance analysis was used to investigate the between-groups effect (F=0.745, p=0.32). Therefore, there was a significant difference between the mean scores of the between subjects’ group in the post-test and the follow-up of the total well-being (P<0.05). Bonferroni post-hoc test was used to examine the difference between the mean of the experimental and control groups in pairs and to determine the effectiveness. The results indicated a significant difference between the mean of the post-test and follow-up well-being of the control group and the experimental group of behavioral activation (P< 0.01), while a significant difference was observed in the mindfulness intervention group only in the follow-up phase (P<0.05); therefore, both methods effectively and equally increased well-being. It is noteworthy that only the behavioral activation treatment effect remained constant over time.
Conclusion: The results showed that both methods effectively and equally increased the mental well-being of students, but only the behavioral activation treatment effect remained constant over time. Although no similar study was found, the findings of Dominguez Rodrigues et al. (23), Shahsavari et al. (24), Ghamari et al. et al. (27), Ghodrati and Vaziri Neku (28), Mazzuchelli (29) and Shields et al. (30) are consistent with those of the present study.
In explaining the findings, it can be stated that behavioral activation is assumed to help individuals engage in different behaviors to feel pleasure and be useful (28). At the same time, mindfulness helps students become more self-aware and allows them to identify negative thought patterns and feelings associated with depression. Therefore, it can be concluded that these two approaches can improve the mental well-being of students.
One of the limitations of the study was that the results were related to female students, and the generalization of the results to the male ones should be done with caution. It is suggested that this research be conducted on other age groups as well. Therefore, it is possible to enhance the mental well-being and reduce mood disorders of students by holding training courses in university counseling centers.

---

Abstract
Background and Objective: Research on migration has shown that individuals may face difficulties adapting to their new environment after migration. Therefore, this study aimed to investigate the effect of Migration Grief Therapy based on (MCGT) on self-efficacy and depression in migrant children.
Methods: This study was a quasi-experimental and applied research in terms of its purpose, and descriptive regarding the data collection method. The statistical population consisted of all Iranian migrant children aged 9 to 15. To determine the sample size, Cochran's formula for populations of indefinite size was used, resulting in a sample of 120 participants based on the estimated variable ratio in the pilot group. The tools used in this research included the MCGT intervention, Bandura’s Self-Efficacy Questionnaire (1996), and the Children's Depression Inventory (CDI) by Kovacs and Beck (1977). Data analysis was conducted using SPSS software.
Findings: Intragroup comparisons of the mean self-efficacy scores based on the RM test showed that changes over the test times (pre-intervention, immediately post-intervention, and one month after intervention) were not significant in the control group (P=0.569), but they were significant at the 1% level in the intervention group (P=0.001). The mean depression score in the intervention group decreased by 6.5 and 10.6 points immediately after and one month after the intervention, respectively, compared to the control group. Conversely, this trend was increasing in the control group. The RM statistical analysis indicated that changes in the mean depression scores over time in the control group were not significant (P=0.307), while they were significant at the 1% level in the intervention group (P=0.000).
Conclusion: The study revealed that migrant children had low self-efficacy prior to the intervention, making them more vulnerable to life challenges. Moreover, the initially high level of depression in this group was identified as one of their major psychological issues, likely stemming from migration-related stress, isolation, and lack of social support.

---

---

Osteoarthritis (OA) is the most common joint disease in the world and it’s an important cause of longterm health problems and the most frequency reported reason for disability in the papulation. To determine the relationship between disability and depression cross sectioanl study in kerman was design in OA patients. OA was diagnosed by criteria of American college of Rheumatology, disability measured with Clin-HAQ and depression measured with Beck inventory questionnaire. Of 200 OA patients 83.5% were female, meanage of this population was 54.1±11.3 years, 6 pearson had treuma, 21 diabetes mellitus and 52 had hypertension, mean of MBI was 26.6±5.5 kg/m² and depression were 16.6±9.3 and disability was 0.97±0.4 wald foeward stepwise logestic regression models had been shown that depression and female sex were significants predictors for disability and disability was significants predictors for depression. OA Occurred in elderly people Age > 50 and is more frequent in women than men. Depression and disability have relationship together and which of them has a risk factor for other in patients with OA.

---

The objective of the present study was to compare the maximum width of the third ventricle(V3) in brain computed tomographic (CT) scans of patients with Major Depressive Disorder (MDD) and normal healthy controls in psychiatry clinics and wards of Iran University of Medical Sciences and radiology Department of Hazrat Rasoul Hospital. First, during a pilot study, interrater and intrarater reliability of the researcher in obtaining CT values were assessed. Then, patients consequently admitted to the psychiatry clinics were included if they met MDD and inclusion criteria, and if they had filled informed consent. Controls who met inclusion criteria were selected from healthy persons admitted to CT department using planimetric and densiometric methods. CT scans of 30 patients and 30 age and sex matched controls were assessed and linear values and ventricular brain ratio(VBR) were measured. Data was assessed by using independent sample, two-tailed t-test and Pearson’s correlation coefficient. The mean width of V3 showed significant difference between all age and sex subgroups of patients and controls(P<0.5). There was a significant difference between patients and controls younger than 40 in linear values of frontal lobe, Huckmann number and VBR(P<0.5 in all cases), but no difference was observed in older groups. Correlation assessment showed that the sooner the illness began and the longer its duration was, the greater the maximum width of V3 (r=-0.37 and 0.37 respectively) and interhemispheric fissure(r=-0.39 and 0.39 respectively) were. Also, number of episodes was positively correlated with VBR and maximum width of V3 (r=0.5 and 0.52 respectively). Based on the findings, it could be hypothesized that there is an enlarged third ventricle of the brain in patients with MDD. Also, MDD can accelerate age-related decrease of the brain tissue of the fronal lobe, but does not increase it.

---

    Background & Objective: Subclinical hypothyroidism is defined by an increased serum TSH(Thyroid Stimulating Hormone) level in the presence of normal concentrations of circulating thyroid hormones and may be a predisposing factor for depression and psychomotor disorders. The aim of this study was to evaluate the effcts of L-thyroxine replacement on anxiety, depression and other neuropsychiatric aspects in patients with subclinical hypothyroidism.

Method: twenty-seven patients(19 females and 8 males) ranging from 17 to 61 years old(mean: 38±13.5 years) with basal serum TSH levels of 5.0-16.3 mu/l(mean: 8.4±5.2mu/l) and normal FT4I were enrolled. After being matched for age, TSH level and antithyroid antibodies, patients were randomly allocated into two treatment groups, LT4(Levo Thyroxine) and placebo including 13 and 14 cases respectively. In the LT4 group, dosage was titrated to achieve a serum TSH level between 0.3-3.5 mu/l. Intelligence Quotient(IQ) was assessed using Raven test, memory and psychomotor speed through Caughlan test, anxiety and depression via HADS(Hospital Anxiety Depression Scale) before and after treatment. Patients had follow-up visits for 11-14 months(mean: 12±0.6 months).

Results: Ten patients in the LT4 group and 13 in the placebo group completed the study. Mean TSH levels changed from 9.6±7.1 to 1.3±1.2mu/l(P<0.002) and from 7.6±3.1 to 18±15.8mu/l(P<0.024) in the LT4 and placebo groups respectively. No significant difference in IQ, recent and late memory, anxiety and depression was observed in both groups before and after intervention.

Conclusion: There is not obvious relationship between subclinical hypothyroidism, cognitive disorders and depression. Further studies to evaluate these problems are recommended.

---

    Background & Aim: Any disturbance in the function of central aminergic system is the main cause of depression in diabetes. Since most of the available antidepressants have limitations, it is necessary to research other options of treatment. The purpose of this study was the investigation of the possible antidepressant effect of melatonin on diabetic rats.

Material and Method: This experimental study involved 40 male Wistar rats weighing 200±20 gr. The animals were divided into four groups: control, melatonin, diabetic, and melatonin-treated diabetic. Experimental diabetes was induced by intraperitoneal (i.p.) injection of 50 mg/kg streptozotocin. 72 hours after diabetes induction, melatonin (10 mg/kg/day, i.p.) was injected for 5 weeks. At the end of administration period, the modified forced swimming test (MFST) and the open-field test were used for evaluation of depression and its possible mechanism. The MFST evaluated climbing, swimming and immobility periods and the locomotor activity was evaluated by the open-field test. The experimental data were statistically analyzed by one-way analysis of variance (ANOVA) followed by Tukey test, using  the software package SPSS v.15.

Results: The swimming test shows that diabetes causes a significant (p<0.05) increase in immobility and climbing periods (as depression and noradrenergic system activity indices respectively) as compared with the control group. The swimming time (as serotonergic system activity index) and the locomotor activity (as dopaminergic system activity index) were significantly (p<0.05) decreased in diabetic rats as compared with the control group. Daily melatonin injection to diabetic rats significantly (p<0.05) modified all mentioned behavioral indices as compared with the diabetic group. Melatonin significantly (p<0.05) decreased the locomotor activity in non-diabetic rats as compared with the control group, whereas it did not have any significant effects on swimming, climbing or immobility periods in these animals.

Conclusion: Melatonin has antidepressant effects in diabetes through modifying central aminergic system.

---

  Background : Our purpose in this research was to evaluate the correlation between skill in chess (international chess rating scale) and severity of depression and anxiety and ten cognitive errors in members of Iranian Chess Federation that have international chess rating scale as well as to study the prevalence of depression and anxiety in the sample.

  Methods: 96 persons that had an international chess rating scale were sampled with convenient method and took part in this cross sectional study. All samples completed the second version of Beck Depression Inventory, Beck Anxiety Inventory and Cognitive Error Test. Data were analyzed with SPSS software.

  Results: There was a significant reverse correlation between chess rating scale and four cognitive errors including over generalization, magnification, jumping to conclusion and must statement. The depression severity decreased by increasing the numbers of hours of game playing in the day. Also there was a reverse significant correlation between chess skill and depression severity, but chess skill had no significant correlation with severity of anxiety. The prevalence of mild moderate depression was 16.7%. There was no case with severe depression. The prevalence of mild and moderate anxiety was 27.1% and severe anxiety was 5.2%.

  Conclusion: We conclude that this significant reverse correlation between chess rating scales and depression severity is mediated by decrease of cognitive errors and the number of the hours of game playing in the day, which is in accordance with Beck's Cognitive Theory and Behavioral Activation Theory.

---

 

Background: Given the increase in prevalence of Coronary Artery Bypass Graft (CABG) surgery and the significant role of psychological factors in prognosis and relapse of cardiac disease, the present study is designed to determine the relationship between psychological factors or impotency and quality of life of male patients following CABG.

 

Methods: In this descriptive- analytical study 160 male patients were randomly selected four weeks after heart surgery and were administered DASS-21, IIEF-5 and SF-36 to assess anxiety, depression and stress, impotency and quality of life, respectively. Regression analyses (One-way ANOVA) and Chi-square were performed to analyze the data.

 

Results: Findings showed that the average age of patients was 60 (±10) years. Among psychological variables the average score for depression was significantly related to the average scores of quality of life (p=0.02). Furthermore, 62.4% of patients had some degrees of depression 86.7% had some degrees of stress and 47.3% had anxiety to some degree. Also, 85.5% of patients displayed mild to severe levels of erectile dysfunction which were significantly correlated with scores in anxiety (p=0.03) and depression (p=0.001). Finally, diabetic patients had higher scores in depression and stress compared to non diabetic patients.

 

Conclusion: The findings are discussed in the context of proposing interventional strategies for improving psychological conditions of CABG patients.

 

---

 

Background: Long-term chronic diseases such as AIDS, cancer and heart disease affect patients’ attitude, always create crises in individuals’ life. The main purpose of this study was to compare the situation resiliency and depression in cardiac patients with healthy People.

 

 

 

Methods: During a descriptive of causal–comparative study and using convenience sampling 106 cardiac patients (58 women and 48 men) were selected from Motahari Hospital in Jahrom city in 2013. Also 102 healthy volunteers (52 females and 50 males) based on demographic variables matched with the patient groups were selected. Beck Depression Inventory  and Resiliency Scale and Connor Davison were administered to participants. Data based on level of 95%  were analyzed using SPSS v.16.

 

Finding: Independent t-test revealed a significant increase in depression scores and significant reduction in resiliency between people with heart disease and normal samples (p<0.001). In addition, analysis of variances revealed that women are better than men at resiliency (p<0.003). The education level was positively associated with resiliency in coping with the diseases (p<0.011).

 

Conclusion: resiliency plays mediating role in heart disease outset, and its low levels are as a risk factor for people with cardiovascular disease.

 

---

 

Background: Depression has often been considered as a major cause of human health threats in the world. The goal of the current study was to predict postpartum depression among women attended health care centers in Shiraz based on parental bonding, history of anxiety, and depression .

 

Methods: In this regard, 120 women with postpartum depression were selected among the women who had delivered in hospitals of Shiraz using convenience sampling method. The tools were Parental Bonding Instrument (PBI), Postnatal Depression Scale (Edinburgh), and the checklist of anxiety and depression using diagnostic criteria of anxiety and mood disorders (DSM- IV-IR). Data were analyzed using multiple regression analysis with stepwise method through SPSS v.16.

 

Findings: The linear regression model showed that extraordinary protective factors of caring father (p<0.001) and mother (p<0.001) have significant effect on depression. Considering the calculated coefficient determinant (R²=0.44), the extraordinary protective factors of caring father and mother, predicted 44% of postpartum depression. It means that 44% of changes by postpartum depression in caused by the extraordinary protective factors of caring father and mother.

 Conclusion: Result of regression analysis indicated that protective factors of caring father and mother are able to predict postpartum depression. The overall results of this study indicated that emotional connection between parents and their children, leads to(determine) the formation of mental disorders in children in different periods of life

---

 

Background: Obesity is a complex physical disorder caused by different biological, psychological, and social factors. Identification of the psychological factors and consequences of obesity is one of the main elements of its control and treatment. The present study was carried out to compare depression and quality of life in the obese women with different body mass indices (BMIs) with the normal women.

 

Methods: for each three groups of obesity 40 and in total 120 women were selected of all the visitors of the Minimally Invasive Surgery Research Center of Tehran University of Medical Sciences using convenience sampling method and based on the BMI table in a causal-comparative design. Forty women were the normal women sample. Instruments of the study were composed of a questionnaire of personal information, Beck Depression Inventory (second version), and Health-Related Quality of Life Questionnaire (SF-36). The data were analyzed using Multi-Variable Analysis of Variance (MANOVA), One Way Analysis of Variance (ANOVA), Bonferroni Post hoc test, and Pearson’s correlation coefficient as well as the SPSS software.

 

Results: the results suggested a significant difference between the obese women in different levels of BMI and the normal ones concerning depression and quality of life at p<0.001. In addition, it was revealed that there is a significant negative difference among the obese women in different levels of BMI concerning depression and quality of life at p<0.001.

Conclusion: Regarding the different psychological variables such as depression in obesity, psychological interventions can be useful in the prevention, control, and treatment of obesity as well as promotion of the patients’ quality of life.
  

---

Background: The present study aimed at determining the role of Intolerance of Uncertainty and positive Metacognitive Beliefs in Obsessive Compulsive and Depression disorders.

Methods: Seventy patients with obsessive compulsive disorders and depression referred to psychiatry clinics of Baghiyatallah and Taleghani hospitals of Tehran were chosen via convenient sampling and were compared with 35 normal individuals (age range of 20 to 38) on intolerance of uncertainty scale and positive metacognitive beliefs subscale. Then data were analyzed using one way variance analysis and Scheffe post-hoc test. Research design of present study was Ex post facto research.

Results: Patients suffering from obsessive compulsive disorder and depression gained higher scores than normal group in intolerance of uncertainty scale. Regarding positive metacognitive beliefs, patients with obsessive compulsive disorder gained higher scores than depressive patients; and depressive patients gained higher scores than normal group.

Conclusion: Considering the crucial role of intolerance of uncertainty and positive metacognitive beliefs in obsessive compulsive disorder and depression, they should receive special attention in treatment.

---

Abstract

Background: Levandula angustifolia and Citrus aurantium essential oils possess phenolic compounds and in Iranian traditional medicine are commonly used as sedative. The aim of this study was to evaluate the antidepressant activities of Levandula angustifolia and Citrus bigaradia in adult reserpinized mice.

Methods: In this experimental study, mice were divided into 10 groups of 8 mice each, including: Group 1, control group received normal saline. Group 2, was treated reserpine (5 mg/kg, IP). Group 3, 4, 5 and 6 were treated with reserpine (5 mg/kg, IP) and four Citrus aurantium different doses (25, 50, 100, 200 mg/kg). Group 7, 8 and 9 were treated with reserpine (5 mg/kg, IP) and three Levandula angustifolia doses (25, 50, 100 mg/kg). Group 10 was treated with reserpine (5 mg/kg, IP) and imipramine (15 mg/kg). In all groups the forced swimming test was done and the level of malondialdehyde (MDA) in brain tissue was measured to estimate the oxidative stress status. Data were analyzed by one-way ANOVA and Tukey post hoc test.

Results: Levandula angustifolia, Citrus aurantium and imipramine in reserpinized mice caused the mice to spend less time in the forced swimming test, compared to the control group (p<0.01). Also Citrus aurantium with dose of 50 and 100 mg/kg and Lavandula angustifolia with dose of 25 and 50 mg/kg in reserpinized mice reduced immobility time and levels of MDA compared the control group (p<0.01).

Conclusion: Lavander and Citrus aurantium essential oils have considerable antidepressant activity which might be attributed to their antioxidant effects.

---

Background: In this research effectiveness of mindfulness based cognitive therapy (MBCT) on depression, anxiety and somatic symptoms in asthma patients was studied. Asthma is a psychosomatic disorder that depression and anxiety were considered as a trigger or exacerbation factor for it.

Methods: According to this matter MBCT was used for reducing depression and anxiety and somatic symptoms in asthma patients. For this purpose 26 female patients that were under medical treatment for 1 year at least in Isfahan were selected and assigned in two groups randomly (experimental group and control group). Two groups were tested (pre-test) by Beck Depression Inventory (BDI_II), Beck Anxiety Inventory (BAI) and Asthma Quality of Life Questionnaire (AQLQ). Experimental group received MBCT intervention for 8 sessions weekly for two hours and control group was registered in waiting list. After finishing the therapy the two groups were tested again (post-test). Data was analyzed by ANCOVA in spss21 program.

Results: Results show that after MBCT intervention significantly depression, anxiety and somatic symptoms scores decreased in experimental group in comparison with control group (p<0/05).

Conclusion: So it shows that MBCT can reduce level of anxiety and depression in asthma patient and then reduces somatic symptom in this patients.

---

Background: Cancer is the third-leading cause of death in Iran. Depression is a prevalent disorder in cancer patients. This study was conducted to investigate emotional catharsis by writing on depression in cancer patients.
Methods: A quasi-experimental study, before and after design with a control group was conducted on 30 cancer patients referred to the Research Cancer Center affiliated with Shahid Beheshti University of Medical Sciences. The patients with cancer completed the Beck Depression Inventory (BDI; 21-items). The patients in the intervention group were asked to writ negative feelings and emotions daily, for four successive weeks and for 20 minutesthis intervention did not do for the control group. After one month, 21-items Beck Depression Inventory was completed by the two groups. Data were analyzed using SPSS software and paired t test, t-test, analysis of covariance.
Results: The mean scores of the experimental group and the control group, had no significant difference in pre-test (p=0.618) but on post-test scores, the experimental group was significantly lower than the control group (p=0.019). The post-test score in the experimental group was significantly lower than the pre-test scores (p=0.000). But were not statistically significant difference in depression scores in the post-test and post-test in control group (p=0.131). There was not statistically different between pre-test and post-test scores of depression by age, marital status and education level of the entire sample, the experimental group and the control group.
Conclusion: The emotional catharsis is effective on depression in patients with cancer. It is recommended as a cost-effective and efficient method to be used in the care of cancer patients.