Original Article Regional Disparities in Psychiatric Distress, Violent Behavior, and Life Satisfaction in Iranian Adolescents: The CASPIAN-III Study Zeinab Ahadi, MS,* Mostafa Qorbani, PhD,† Roya Kelishadi, MD,‡ Gelayol Ardalan, MD,‡ Mahnaz Taslimi, MS,‡ Minoosadat Mahmoudarabi, MD,‡ Mohammad Esmaeil Motlagh, MD,§ Hamid Asayesh, MS,\ Gita shafiee, MD,*¶ Bagher Larijani, MD,¶ Ramin Heshmat, MD, PhD*¶ ABSTRACT: Objectives: The purpose of this study was to assess the prevalence of violence behaviors, psy- chiatric distress, and life satisfaction among 10- to 18-year-old Iranian adolescents at national and regional disparities. Methods: In this national survey, 5570 students of age 10 to 18 years from urban and rural regions of 27 provinces of Iran were selected through stratified multistage sampling method. Violence behaviors, psychiatric distress, and life satisfaction were assessed by a questionnaire that was prepared based on WHO global school-based student health survey and the WHO-stepwise approach to non- communicable diseases (Tools version 9.5). The country classification into 4 subnational regions was done based on combination of geography and socioeconomic status (SES). The data were analyzed by the SPSS software. Results: The prevalence of emotional, depressive, and anxiety problem among Iranian students was 17.7%, 16.3%, and 5.7%, respectively. The percentage of emotional and depressive problem differed sig- nificantly between different SES distress (p value <.001). The prevalence of bullying, victim, and physical fight was 27.1%, 32.7%, and 50.6% among students aged 10 to 18 years, respectively. Bullying and victim expe- rience were linearly associated with regions’ SES. Students who were living in the north-northeast region had maximum self-rated health and life satisfaction in Iran. Conclusions: The results declared that psychiatric distress was more frequent in high SES distress, whereas violence behavior was more frequent in the lowest SES distress. Therefore, in communities with large variations in health and SES in regional level, health policies for primordial and primary prevention of mental and behavioral distress have to be made at regional levels. (J Dev Behav Pediatr 35:582–590, 2014) Index terms: psychiatric distress, violence, bullying, life satisfaction, general health, adolescent. Bullying in school and victimization are frequent ex- perience and problematic behavior among adolescents. School bullying with rates ranging from 9% to 54% 1 and being victim weekly or more frequent around 3% to 10% in secondary school 2 were reported in studies. Bullying was defined as exposure to a negative physical or verbal action, and it was repeated over time. 3,4 Verbal and physical bullying are direct forms of bullying. Results of studies have shown that boys are more involved in direct bullying. 5 The children exposed to violence suffer from mental and behavioral problems such as depression, anxiety, loneliness, isolation, panic of going to school, and poor concentration compared with non-victimized children. 6–9 Studies have shown that students had victimization experience, reduced their ability to learn in school, tried suicide, ran away, or refused to go to school. 10,11 Rate of psychiatric distress have increased in youth during recent decades. At least 1 of every 4 to 5 youth will suffer from at least 1 mental distress. 12 Study of Noorbala et al 13 showed that 25.9% and 14.9% of Iranian women and men, aged 15 to 24 years, had mental dis- orders, respectively. Poor mental health is associated with lower educational achievement, unhealthy lifestyle, physical ill-health, and increased health care costs. 12,14 Previous studies show the strong relation between mental health and socioeconomic status (SES), such as income, education, condition of working, etc in in- dividual level. 15,16 Results show that subjects with low socioeconomic condition have higher mental health symptoms. For example, persons with low economic status had more prevalence of obsessive-compulsive disorders, depression, and anxiety. 17,18 Aggressive peers and socioeconomic status such as income and education influence directly and indirectly how people From the *Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; †Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran; ‡Pediatrics Department, Child Growth and Development Research Center and Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; §Department of Pediatrics, Ahvaz Jundishapur University of Medical Sci- ences, Ahvaz, Iran; \Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran; ¶Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Received October 2013; accepted July 2014. Disclosure: The authors declare no conflict of interest. Address for reprints: Ramin Heshmat, MD, PhD, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 111 19th St, North Kargar Avenue, Tehran, Iran 14579-65597; e-mail: rheshmat@tums.ac.ir. Copyright Ó 2014 Lippincott Williams & Wilkins 582 | www.jdbp.org Journal of Developmental & Behavioral Pediatrics