Children and Adolescents’ Mental Health in Iran’s Primary Care: Perspectives of General Practitioners, School Staff, and Help Seekers

  • Hadi Zarafshan
  • Lawrence S. Wissow
  • Zahra Shahrivar
  • Ramin Mojtabai
  • Mojgan Khademi
  • Morteza JafariNia
  • Ahmad Hajebi
  • Farid Abolhassani
  • Vandad SharifiEmail author



Iran has well-established networks for primary care staffed by general practitioners who provide services to patients across the lifespan. Iran recently established collaborative care networks to build general practitioners’ capacity to provide adult mental health services. In an NIH-funded study, we are designing and evaluating a training program for general practitioners (GPs) to extend this collaboration to include services for children and adolescents. In the formative phase of this project, we conducted a qualitative study to obtain information relevant to the design of the training program.


We conducted semi-structured individual interviews with 28 stakeholders, including 15 GPs working in a collaborative care network, 6 parents and 4 adolescents who had received child mental health care from a GP, and 3 policymakers. We also held a focus group discussion with 8 school teachers and counselors. All interviews were transcribed during the interviews’ sessions and then were thematically analyzed.


GPs reported seeing a range of child emotional and behavioral problems but felt the need for additional training in diagnosis and management, especially in skills for interviewing and communicating with children. GPs also expressed the need to understand legal issues involved in treating children, including cases of possible child abuse. School staff agreed that GPs could help with children’s educational and emotional problems but also believed GPs would need extra training. Parents indicated a preference for GPs over psychiatrists (as did adolescents) as a source of mental health care and for psychological over pharmacological interventions. Adolescents expressed a preference not to speak about private issues in the presence of their parents and expressed concern that the GPs did not respect their preference. They also desired a more active role during visits.


Before expanding the scope of practice of Iranian GPs to provide management of common emotional and behavioral problems in children and adolescents, the concerns and specific needs of these practitioners need to be addressed. Parents and youth in the study expressed a preference for mental health care from a GP rather than a specialist. However, they also commented on the need for restructuring the current GP visits to facilitate youth participation. These findings provide directions for expanding the scope of practice of adult collaborative care networks to meet the mental health care needs of children and adolescents more expeditiously and effectively.


Children Adolescents Mental health Primary care GP’s role 



We appreciate all the stakeholders participating in the study, as well as the colleagues who conducted the interviews (Leila Moazami Goodarzi, Shima Sadat Zohrabi, and Hoda Layegh).


This study was funded by the US National Institute of Mental Health (grant number 1R34MH106645-01A1).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the Institutional Research Boards of the Tehran University of the Medical Sciences and the Johns Hopkins Medical Institutions. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Hadi Zarafshan
    • 1
  • Lawrence S. Wissow
    • 2
  • Zahra Shahrivar
    • 3
  • Ramin Mojtabai
    • 4
  • Mojgan Khademi
    • 5
  • Morteza JafariNia
    • 6
  • Ahmad Hajebi
    • 7
  • Farid Abolhassani
    • 8
  • Vandad Sharifi
    • 3
    Email author
  1. 1.Psychiatry and Psychology Research Center, Roozbeh HospitalTehran University of Medical SciencesTehranIran
  2. 2.Division of Child and Adolescent PsychiatryJohns Hopkins School of MedicineBaltimoreUSA
  3. 3.Department of Psychiatry, Roozbeh HospitalTehran University of Medical SciencesTehranIran
  4. 4.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Department of Psychiatry, Imam Hossein HospitalShahid Beheshti University of Medical SciencesTehranIran
  6. 6.Shahid-Emami Community Mental Health CenterTehran University of Medical SciencesTehranIran
  7. 7.Research Center for Addiction & Risky Behaviors (ReCARB) and Department of PsychiatryIran University of Medical SciencesTehranIran
  8. 8.National Institute of Health ResearchTehran University of Medical SciencesTehranIran

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