Does the socioeconomic status affect the prevalence of psychiatric distress and violent behaviors in children and adolescents? The CASPIAN-IV study.

Background: This nationwide study aims to investigate the prevalence of psychiatric distress and violent behaviors in a nationally-representative sample of Iranian children and adolescents according to the socioeconomic status (SES) of their living region.

Methods: In this study, 14,880 school students, aged 6-18 years, were selected from 30 provinces in Iran. The World Health Organization Global School-based Health Survey questionnaire was used. Data were compared at national and subnational levels according to the SES of the living region.

Results: Overall, 13,486 students (49.2% girls) with mean (SD) age of 12.47 (3.36) years completed the study. At national level, the prevalence of psychiatric distress ranged between 9 to 38%; the most and least prevalent psychiatric distresses were angriness (37.73%, 95% CI: 36.5-38.99) and confusion (8.65%, 95% CI: 8.04-9.29), respectively. Students living in regions with highest SES experienced angriness (41.24%, 95% CI: 38.94-43.59) more than in those from the regions with lowest SES (31.18%, 95% CI: 26.71-36.02). The prevalence of bullying, being bullied and physical fight was 17.56% (95% CI: 16.73-18.42), 27.36% (95% CI: 26.34-28.42), and 39.94% (95% CI: 38.69-41.20), respectively. The prevalence of violent behavior did not differ significantly in various regions of Iran.

Conclusions: The relatively high prevalence of psychiatric distress in Iranian children and adolescents necessitates paying more attention to mental health of this vulnerable age group. Differences in the prevalence of such disorders according to the SES of the living area should be considered in planning evidence-based preventive programs and in international comparisons.