The aim of this thesis was to carry out an epidemiological study on mental health related issues in the Kurdish population of Iran. This part of Iran suffered directly during the Iran-Iraq war 1980-1988. Iran is an Islamic republic with strict adherence to Islamic traditions, which has implications for the way of life and gender issues. Suicide is prohibited according to Islamic teaching, but still there is a rather high suicide incidence especially among young women, who burn themselves to death. This thesis deals with mental health in general, the prevalence of post traumatic stress disorder and issues related to suicide. In a cross- sectional study in Sanandaj, the capital of the province of Iranian Kurdistan, 1000 households were approached. One member of each household was asked to respond to the following internationally well-known questionnaires; General Health Questionnaire (GHQ12), Posttraumatic Stress Disorder Checklist (PCL), Life Events Check List (LEC), Beck Depression Inventory (BDI-II) and Attitude Toward Suicide (ATTS). PCL and LEC were translated to Farsi and their psychometric properties were studied. The other instruments have already been translated and used by other researchers in Iran. About 27% of the subjects were found to suffer from mental distress according to GHQ-12. No gender differences were found. Unmarried and unemployed belong to the most afflicted. The participants in the investigation reported, not surprisingly, a low level of personal experiences of suicidal behaviour in their family. Females were more prone to believe that suicide is preventable compared to males. A low number reported suicide attempts during the last year. Being married seemed to have a protective effect against suicide attempts for males but not for females. Suicide behaviour was not substantially related to PTSD, but to severe depression. The idea that there is a continuity of suicidal behaviour from suicidal thoughts to suicide attempts was supported. Younger individuals more often reported thoughts of life weariness and those who reported suicide attempts were younger than individuals with no suicidal attempts. Females reported more death wishes than males during the last year and married women more often reported suicide attempts than men. The prevalence of posttraumatic stress disorder was 10, 9% which is higher than reported in other countries, but still lower than expected. Women suffered significantly more often from PTSD than men. Women reported also more often re-experiencing and more arousal symptoms than men. The finding supported a good construct validity of PCL. One major limitation of these studies is the fact that the sample was drawn from the population of the capital city of the province. So the finding cannot probably be generalized to Iranian Kurds from rural areas. The sample also had a rather high educational level compared to the population of Sanandaj. To this should be added the fact that the instruments used are developed in the western culture, which might influence the way questions are perceived. So, the result should be interpreted with some caution. The results, however, give indications that there are mental health problems of a magnitude that should be taken seriously.

Flera modeller och skalor har gjorts genom psykologins historia för att bättreförstå och reflektera kring individens hälsa och dennes perception av den.Studiens syfte var att undersöka samband mellan femfaktorsmodellen,KASAM samt generell mental hälsa med bakgrundsvariablerna kön, ålderoch civilstatus. Totalt 86 högskolestudenter från mellersta Sverige deltog istudien genom att fylla i en enkät innehållande GHQ-12 skala, Shafer’sfemfaktorsskala och Antonovskys KASAM skala. Resultaten visade inget samband mellan generell mental hälsa och de valda bakgrundsvariablerna;negativt samband mellan psykisk ohälsa och KASAM; negativt sambandmellan mental ohälsa och extraversion, positivt samband mellan generellmental ohälsa och neuroticism, inget samband mellan mental hälsa och andrapersonlighetsegenskaper. Totalt kunde 47 % av variationen i generell mentalhälsa förklaras av samtliga prediktorvariablerna. Svagheten med studien varbl.a. urval och andel deltagare samt förståelse av modellerna. Vidarediskuteras resultaten i jämförelse med andra relevanta studier.

International studies of disasters indicate the risk for developing posttraumatic stress reactions among survivors is high. Modern life implicates increased traveling. During the last decades a large number of Swedish citizens were confronted with disasters taking place outside of their country. The prevalence of trauma reactions in a population that does not  normally  experience natural disasters, but are able to return to a community unaffected by the catastrophe, is not well studied. In addition, the effects of bereavement after traumatic circumstances have not been satisfactorily explored. Longitudinal studies on the effects of natural disasters are underrepresented and there are few studies investigating the course of recovery after traumatic exposure. The aim for this thesis was to examine long-term post-traumatic stress reactions, mental health, and complicated grief after disaster exposure and traumatic bereavement.  Data from returned questionnaires were analysed from bereaved Italian and Swedish relatives 18 months after the Linate airplane disaster 2001, and at 14 months and three years from Swedish travelers returning from Southeast Asia after the 2004 tsunami disaster, and from home staying bereaved relatives within the second year after the tsunami disaster. The main outcome measures were GHQ-12, IES-R and Inventory of Complicated Grief. The findings indicated many survivors were resilient and had ability to recover, but severe exposure to a disaster had considerable impact on psychological distress. Life threat was associated with higher levels of post-traumatic stress reactions, and increased the risk for affected mental health and suicidal ideation. Loss in combination with severe life threat exposure indicated a further increased risk of posttraumatic stress reactions and for complicated grief; this should be considered a substantial risk factor for general mental health. Loss of close relatives, especially loss of children, was associated with higher levels of posttraumatic stress and created a greater risk for complicated grief. Many survivors recovered over time; however, severe exposure and traumatic loss appeared to slow the recovery process. The findings have implications for government and health agencies, regarding the importance of knowledge and awareness of these risks for health, and for organizational structure, training, and accessibility of support and adequate treatment.

Introduction Numerous preventive programmes have emerged, and need to be investigated to determine their effects on the normal population. Earlier studies have shown a decrease in depressive symptoms, positive effects on children’s disruptive behaviour problems, and an improvement in parental competence. About a fifth of the parents in previous studies had problem-oriented (targeted) reasons for enrolment, whereas the rest of the parents had general (universal) reasons. The results of those studies suggest that the programmes are cost effective in terms of Quality-Adjusted Life Years. Aim Four sub-studies were performed, and their aims were to investigate the effect of parental training programmes (PTPs) in a naturalistic setting on parents’ mental health in the general population, to investigate how PTPs affect parents’ sense of parental competence, to investigate how PTPs affect parental stress and analyse the parents open questions about the PTPs, and to investigate the feasibility and to measure the effect on depression, anxiety, and social problems of two preventive school programmes for pupils in grade 7. Method In a longitudinal quantitative study in a real-world setting, 279 parents from the general population in northern Sweden participated in five PTPs. A comparison group of 702 parents without intervention was included. Simultaneously, a community sample of 59 pupils in grade 7 participated in two preventive school programmes. Both studies were conducted from 2010 to 2013. Parents were assigned to professionally supported interventions that included 5-10 two-hour sessions. Respondents filled in a web-based questionnaire with the General Health Questionnaire (GHQ), the Parents Sense of Competence (PSOC) for parents who had children aged 0-17 years, and the Swedish Parenthood Stress Questionnaire (SPSQ) for parents who had children aged 0-10 years. The intervention groups’ results were compared to comparison group of 702 parents from northern Sweden that had not participated in any parental training programme. In the school study, one of the preventive programmes was an ongoing programme called “Life-Skills”, and the other was an implemented Canadian programme called “Choosing Healthy Actions and Thoughts” (CHAT). The pupils completed a test battery including the Sense of Coherence (SOC), the Children’s Depression Inventory (CDI), and the Youth Self-Report (YSR) instruments. Follow up of the parental programme study was done six months after the post-intervention measure, and follow up of the school study was at one year. Results The improvements in GHQ were statistically significant for the mean of the 279 parents in the intervention group compared to the mean of a comparison group of the 702 parents who did not receive any intervention. This suggests that evidence-based PTPs enhance parental well-being even for parents without problems. The intervention group showed a statistically significant improvement in parental competence compared to the comparison group over time. The intervention itself had a significant effect on parental satisfaction, but the efficacy effect was not sustained when taking into account potential confounders. In the SPSQ, the intervention group was smaller due to the fact that the instrument was not validated for children over the age of 10 and one of the parental training groups was only for parents of teenagers. A reduction of stress in the sub-scale of health problems was detected, but no other subscale showed the intervention to have a significant effect when controlling for confounding variables. In the school study, both programmes had good feasibility according to the stake- holders and had several positive mental health outcomes over time. Compared to Life-Skills, CHAT had more significant positive effects on reducing anxious/depressive symptoms and girls experienced significant positive effects on reduced anxious/depressive behaviour, while boys reduced their aggressive behaviours. Conclusions Earlier studies indicate that PTPs enhance perceived parental competence among referred parents. The present study shows that PTPs applied in the general population might also enhance perceived parental benefits such as improved health and satisfaction, suggesting that PTPs can be an important preventive strategy to enhance parenthood. The results suggest that parents who feel a need to increase their parenting competence might participate in PTPs based on lower scores than the comparison control group both before and after the intervention. The school-based programme shows that schools may be a suitable arena for preventive programmes because there was a significant short-term improvement in depression symptoms. Further studies need to explore how parents’ participation in PTPs affects children’s mental health in the general population in quantitative longitudinal studies in real-word settings. There is also a need for bigger studies and RCTs on school preventions and on how children’s health develops naturally in the population.