{"paper_id":"16eb7c61-ffbd-4e18-b879-9df7960c91d6","body_text":"Survey on the Health Status of Married Afghan Women Residing in Mehmanshahr Camp, Torbat-e Jam, Iran, 2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Survey on the Health Status of Married Afghan Women Residing in Mehmanshahr Camp, Torbat-e Jam, Iran, 2024 Mohammad Rahimian, Masoumeh Abbasi.Shavazi, Mohammad.Ali Morowati.Sharifabad, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5197429/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Mental health plays an important role in the quality of life and survival of people, especially refugees and asylum seekers. Afghanistan is one of the largest immigrant countries in the world and about 2.5 million Afghans live in Iran. The purpose of this study is to investigate and estimate mental disorders in married Afghan women living in Iran's Torbet Jam camp in 2024. Methods : The sample consisted of 226 married women living in Torbat Jam camp who were selected by random sampling. DASS-21 standard questionnaire was used to collect mental health information of the participants and the data was analyzed with SPSS after collection. Results : The average age of the participants was 38.7 years and 15% of them were pregnant. More than half of the participants (51.3%) reported at least one mental health disorder. The prevalence of depression, anxiety, and stress in the population under study was 42.9%, 51.3%, and 47.2%, respectively. Conclusion : Considering that Afghan refugee women in Iran are vulnerable to intimate partner violence, economic and livelihood problems, it is very important to address mental health and in addition to the efforts of the host country, international assistance is needed. Introduction Refugees are individuals unable or unwilling to return to their country due to a well-founded fear of persecution based on race, religion, nationality, membership of a particular social group, or political opinion(1, 2). Refugees, regardless of their nationality, need international attention. Considering that their relationship with their own country is broken, the responsibility of the international community to protect their fundamental rights is high(3). Asylum seekers and Refugees are particularly vulnerable(4).Some studies have shown that the health needs of immigrants due to discrimination; bad employment conditions; Differences in access and use of health services tend to worsen over time(5). Several studies have shown that immigrants suffer from more mental illnesses than non-immigrants due to their living conditions(5-7). Afghan migrants, a significant population of migrants and refugees, have long confronted various challenges and disadvantages(8) and Iran is the third host country for refugees in the world with the presence of Afghan immigrants(9). About 2.5 million Afghans live in Iran (10) ;However, in recent years, the Iranian government has introduced policies aimed at increasing access to education, health care, and livelihood services for Afghan refugees residing in Iran(11). More than four decades of civil war has made Afghanistan known as one of the largest countries with immigrants, and this migration continues, especially to neighboring countries(4, 12).Afghan women's access to health care has been weakened for years due to armed conflicts and also based on their culture, law and family power structures that is considered a form of gender inequality and continues(3). Mental disorders are one of the most effective factors in the lives of people of all ages around the world. So among mental disorders, 40.5% of disability-adjusted life years (DALYs) are depression disorders and 14.6% of DALYs are anxiety disorders(13). Several risks affect the mental health of refugees, including marginalization and minority status, socio-economic damages, poor physical health, collapse of social support, psychological distress, and difficulty adapting to the host culture(14). Results of a study find a psychological disturbance rate of 0.22 per 1,000 Afghan refugees in Pakistan(15). 35.7% of immigrant women living in Tehran suffered from psychiatric disorders(16), Severe depression is the most common sign of mental disorders among Afghan refugees in Tehran(17). The results of a systematic review in Iran showed that in Iran, most of the studies were in the field of physical health and mental health and access/use of health care were less(17). Considering the importance of providing the best medical services for immigrants, it is necessary to get a general view of immigrants' health status in Iran. Method This is a cross-sectional study that was conducted aimed to evaluate the health status of the Afghan refugees and IDPs in Iran on married women living in the Afghan refugee camp in Torbat Jam, Iran, in 2024. The Inclusion criteria were permanent residence in the camp, marriage and living with a spouse, and interest in participating in the study, and the Exclusion criteria were failure to continue participating in the study, divorce, and leaving the camp. Persian version of DASS-21 was used to assess the depression, anxiety and stress. The DASS-21 instrument, developed by Lovibond and Lovibond in 1995 and is a well-established tool for assessing symptoms of depression, anxiety, and stress. It consists of 21 items (7 for each subscale) based on the tripartite model of depression, anxiety, and stress. The scale is brief and can be used in both clinical and general populations, with similar psychometric properties across its three dimensions(13). Each item is scored on a 4-point Likert scale with values from 0=did not apply to me at all to 3=applied to me very much or most of the time. Each item multiplying them by 2. A higher score indicates a higher intensity of depression, anxiety and stress(18).The data were analyzed after collection with SPSS26 software. This research was performed by the latest version of the Declaration of Helsinki and with the approval of the research ethics committee of Shahid Sadoughi University of Medical Sciences (IR.SSU.SPH.REC.1402.099) Results The total number of participants was 226, their minimum age was 17 years, the maximum age was 68, and the average age was 34 years, and the average age of their spouses was 38.7±9 years. 34 women (15%) were pregnant. 25.2% of them were illiterate and only 8% had academic education, while 16.4% of their husbands were illiterate and 11.5% had university education. 95.6% were housewives and the number of people working outside the home was 10. On average, the last years of their marriage were 15 years (1-54years) and on average each of the participants had 3 children. The number of years of residence in Iran ranged from 1 to 50 years, with an average of 19.3 years (Table 1) . Table1: Demographic data Age Group N % Cumulative Percent 15-25y 29 12.8 12.8 26-35y 117 51.8 64.6 36-45y 56 24.8 89.4 46-55 16 7.1 96.5 56-65y 7 3.1 99.6 >65y 1 .4 100.0 Total 226 100.0 Years of residence in Iran >10 97 42.9 42.9 11-20y 12 5.3 48.2 21-30y 41 18.1 66.4 31-40 66 27.9 94.2 41-50y 13 5.8 100.0 Total 226 100.0 Number of children 0 9 4.0 4.0 1 34 15.0 19.0 2 50 22.1 41.2 3 39 17.3 58.4 4 39 17.3 75.7 5 23 10.2 85.8 6 15 6.6 92.5 7 14 6.2 98.7 8 3 1.3 100.0 Total 226 100.0 pregnancy pregnant 34 15.0 15.0 non-pregnant 192 85.0 100.0 Total 226 100.0 Based on the results, 43% of the participants had some degree of depression, and more than 17% had severe and very severe depression. Also, about 52% of the participants in this survey had anxiety and more than 62% had not experienced stress during the last week. (Table 2) Table 2. Results on DASS Depression Anxiety Stress M ± se 9.9±0.6 9.4±0.5 12.8±0.6 Range min-max 0-40 0-36 0-38 Normal (%) 57.1 48.7 62.8 Mild (%) 12.8 4.4 9.7 Moderate (%) 12.4 23.0 13.7 severe (%) 8.0 8.8 10.6 extremely severe (%) 9.7 15.0 3.1 There was a significant positive and direct correlation between the average score of depression, anxiety and stress of the participants. Also, a positive and significant relationship was observed between the number of children and the average score of depression, anxiety and stress; But the correlation between education level and depression, anxiety and stress were not statistically significant (Table 3). Table3: correlation between DASS, Education level, Number of children and Years of residence in Iran Correlations Depression Anxiety Stress Education level Number of children Years of residence in Iran Depression 1 Anxiety .757 ** 1 Stress .811 ** .843 ** 1 Education level .020 .059 .042 1 Number of children .179 ** .308 ** .232 ** -.485 ** 1 Years of residence in Iran .145 * .259 ** .195 ** -.246 ** .234 ** 1 **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). According to the results of this study, the average score of depression, anxiety and stress increases with increasing age, so that the average score in people over 55 years old is higher than others. This difference is statistically significant (<.05). Based on the results, the average score of depression, anxiety and stress in people whose length of stay in Iran is between 30-40 years was more than others, this difference was not significant in depression, but it is statistically significant in anxiety and stress (<.05). Discussion Afghans are the primary refugee group in Iran, seeking asylum in the country over 50 years ago. This study focuses on examining the mental health status of married women living in Torbat Jam city camp in Iran. Studies on refugees have shown varying rates of mental disorders among different refugee groups, possibly due to their diverse backgrounds, characteristics, and levels of support within the host country. Additionally, differences in research methodologies, particularly in sampling methods, may also contribute to the variability in findings(19). While the prevalence of depression in the Iranian population is estimated at 45.5%, anxiety at 35.5%, and stress at 40.2%(20); in this study, its prevalence for Afghan women living in Iran's Torbat Jam camp was estimated to be 42.9%, 51.3%, and 47.2%, respectively. This is consistent with Ahmadi et al.'s (2021) study(21) in Afghanistan, where almost half of the participants met criteria for a possible diagnosis of PTSD (51.6%), depression (48.9%), or anxiety (45.2%) and less than its prevalence in the study of Islam Parast (22). In this study, no significant statistical relationship was observed between the place of birth (Iran or Afghanistan) and the average score of DASS-21, while the study of Eslam Parast(22) showed that women who were born in Afghanistan had a significant increase in depression and stress scores compared to other groups. This could be due to the cultural affinity of Iran and Afghanistan and instead the lack of cultural compatibility between Afghanistan and Turkey. The findings of this study show the direct effect of anxiety on stress levels and similarly Anxiety has a significant positive effect on depression, suggesting that people with higher anxiety levels are more likely to experience higher levels of depression. This finding supports the existing literature(23, 24) Anxiety is linked to higher stress levels and represents the psychological strain felt by individuals with high anxiety, also this result confirms the strong connection between anxiety and depression, emphasizing the importance of addressing both types of symptoms in interventions and support systems. In confirmation of previous studies (25) the results show that stress is linked to depression in a positive way. People with higher stress levels are more likely to report higher levels of depression. This shows how stress can harm mental health and emphasizes the importance of managing stress and coping strategies to reduce depression symptoms. The difference in the mean score of depression, anxiety and stress at the time of the arrival of refugees to Iran is statistically significant, so that immigrants who entered Iran in the 1990s to 2000s reported a higher DASS score. These years coincided with the first period of Taliban rule over Afghanistan. Conclusion Afghan women in Iran often face intimate partner violence, restricted maternity care access, and financial and housing challenges(10). Our study emphasizes the important role the host country can play in improving the psychological wellbeing of individuals. The role of international organizations and associations supporting immigrants is very important in improving the health status of asylum seekers and refugees. The study's results are important for improving the mental health and overall wellbeing of Afghan migrants through policy and practice. Suggested ways to deal with the mental health of people outside Afghanistan can include early conflict resolution inside Afghanistan, online mental health interventions, the presence of experienced counselors and psychologists in camps, distraction techniques and international helps. Future research should further examine the mental health experiences and needs of Afghan immigrants, taking into account factors such as employment problems, transportation, commuting, and economic issues. Declarations Declaration of competing interest: The authors have disclosed no potential conflict in researching, authoring and/or publishing this article. Ethics declaration: This research was performed by the latest version of the Declaration of Helsinki and with the approval of the research ethics committee of Shahid Sadoughi University of Medical Sciences (IR.SSU.SPH.REC.1402.099) Acknowledgments : We appreciate the personnel of the camp for foreign nationals and the University of Medical Sciences and Health Services of Torbat jam for their cooperation in the implementation of this plan. Funding: None declared. Declaration of informed consent to participation: Before collecting the data, a form was given to all the participants in which the purpose of the study and its executor were specified, and they were assured that their participation in this research is entirely voluntary and nothing will be shared with anybody outside the research team. References Andersen MH, Kruse A, Frederiksen HW, Ahmadi A, Norredam M. Health status of refugees newly resettled in Denmark. Dan Med J. 2020;67(12). Tomasi AM, Slewa-Younan S, Narchal R, Rioseco P. Professional Mental Health Help-Seeking Amongst Afghan and Iraqi Refugees in Australia: Understanding Predictors Five Years Post Resettlement. Int J Environ Res Public Health. 2022;19(3). Matsangos M, Ziaka L, Exadaktylos AK, Klukowska-Rötzler J, Ziaka M. Health Status of Afghan Refugees in Europe: Policy and Practice Implications for an Optimised Healthcare. Int J Environ Res Public Health. 2022;19(15). Hynie M. The Social Determinants of Refugee Mental Health in the Post-Migration Context: A Critical Review. Can J Psychiatry. 2018;63(5):297-303. Lebano A, Hamed S, Bradby H, Gil-Salmerón A, Durá-Ferrandis E, Garcés-Ferrer J, et al. Migrants' and refugees' health status and healthcare in Europe: a scoping literature review. BMC Public Health. 2020;20(1):1039. Crepet A, Rita F, Reid A, Van den Boogaard W, Deiana P, Quaranta G, et al. Mental health and trauma in asylum seekers landing in Sicily in 2015: a descriptive study of neglected invisible wounds. Conflict and health. 2017;11:1-11. Simonnot N, Rodriguez A, Nuenberg M, Fille F, Aranda-Fernandez P-E, Chauvin P. Access to healthcare for people facing multiple vulnerabilities in health in 31 cities in 12 countries. 2016. Khozaei F, Islam QU, Ramayah T, Ayub N, Carbon C-C. Factors contributing to the mental wellbeing of Afghan migrants in Iran during the COVID-19 pandemic. Journal of Migration and Health. 2024;9:100211. Delkhosh M, Merghati Khoei E, Ardalan A, Rahimi Foroushani A, Gharavi MB. Prevalence of intimate partner violence and reproductive health outcomes among Afghan refugee women in Iran. Health care for women international. 2019;40(2):213-37. Dadras O, Nakayama T, Kihara M, Ono-Kihara M, Seyedalinaghi S, Dadras F. The prevalence and associated factors of adverse pregnancy outcomes among Afghan women in Iran; Findings from community-based survey. Plos one. 2021;16(1):e0245007. Shams L, Tajik M, Heidari P, Nasiri T, Mohammadshahi M. Quality of life of Iranian and Afghan pregnant women in rural Iran. Ann Ig. 2022;34(1):70-8. Fatima M, Nosheen F, Afzaal M, Islam F, Noreen R, Imran A, et al. Nutritional and health status of Afghan refugee women living in Punjab: A cross-sectional study. Food Sci Nutr. 2023;11(6):2872-82. Bibi A, Lin M, Zhang XC, Margraf J. Psychometric properties and measurement invarianceof Depression, Anxiety and Stress Scales (DASS-21)across cultures. International Journal of Psychology. 2020;55(6):916-25. Kassam A, Nanji A. Mental health of Afghan refugees in Pakistan: a qualitative rapid reconnaissance field study. Intervention. 2006;4(1):58-66. Malik MS, Afzal M, Farid A, Khan FU, Mirza B, Waheed MT. Disease Status of Afghan Refugees and Migrants in Pakistan. Front Public Health. 2019;7:185. Mohammadian M, Dadfar M, Bolhari J, Karimi Keisami E. Screening For Mental Disorders Among Afghan Immigrants Residing in Tehran. Iranian Journal of Psychiatry and Clinical Psychology. 2005;11(3):270-7. Rahimitabar P, Kraemer A, Bozorgmehr K, Ebrahimi F, Takian A. Health condition of Afghan refugees residing in Iran in comparison to Germany: a systematic review of empirical studies. Int J Equity Health. 2023;22(1):16. Škegro B, Bjedov S, Mikuš M, Mustač F, Lešin J, Matijević V, et al. Endometriosis, Pain and Mental Health. Psychiatr Danub. 2021;33(Suppl 4):632-6. Giacco D, Laxhman N, Priebe S. Prevalence of and risk factors for mental disorders in refugees. Seminars in Cell & Developmental Biology. 2018;77:144-52. Raeisvandi A, Amerzadeh M, Hajiabadi F, Hosseinkhani Z. Prevalence and the affecting factors on depression, anxiety and stress (DASS) among elders in Qazvin City, in the Northwest of Iran. BMC Geriatr. 2023;23(1):202. Ahmadi SJ, Jobson L, Earnest A, McAvoy D, Musavi Z, Samim N, et al. Prevalence of poor mental health among adolescents in Kabul, Afghanistan, as of November 2021. JAMA Network Open. 2022;5(6):e2218981-e. Eslam Parast N, Taştekin Ouyaba A. The impact of the demographic and migration process factors of refugee women on quality of life and the mediating role of mental health. Perspectives in Psychiatric Care. 2022;58(2):785-94. Amini B, Raheel O, Exum A, Fazzino TL. Mental health of Iranian immigrants and their descendants: A review. Professional Psychology: Research and Practice. 2022;53(2):192. Jia S, Hou Y, Wang D, Zhao X. Flavonoids for depression and anxiety: a systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition. 2023;63(27):8839-49. Werner EA, Aloisio CE, Butler AD, D'Antonio KM, Kenny JM, Mitchell A, et al., editors. Addressing mental health in patients and providers during the COVID-19 pandemic. Seminars in perinatology; 2020: Elsevier. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5197429\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":369017497,\"identity\":\"9f948718-2d7a-43aa-91f0-9048c63bd787\",\"order_by\":0,\"name\":\"Mohammad Rahimian\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYFACHoYDDAZAWv7xASApIUOCFoa0BJAWHqK0QEGOAQoXJzBvP3vw0I0CuzzdhjOfX92oseBhYD98dAM+LTJn8hIO5xgkF5sd7N1mnXMM6DCetLQb+LRIAN0D1MKcuO0w7zbjHDagFgkeM/xa+N+AtNQnbjvG88w45x8xWiTAthxO3HaGh/lxbhtRWsC2HE/cdoPNjDm3T4KHjaBf+HOMP+f8qQZqYX78OedbnRw/++FjeLUgAzYJMEmschBg/kCK6lEwCkbBKBg5AABNykgkOHzWTAAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Shahid Sadoughi University of Medical Sciences\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Mohammad\",\"middleName\":\"\",\"lastName\":\"Rahimian\",\"suffix\":\"\"},{\"id\":369017498,\"identity\":\"6232be8c-5634-49d3-b0fe-cf273f473340\",\"order_by\":1,\"name\":\"Masoumeh Abbasi.Shavazi\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shahid Sadoughi University of Medical Sciences\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Masoumeh\",\"middleName\":\"\",\"lastName\":\"Abbasi.Shavazi\",\"suffix\":\"\"},{\"id\":369017499,\"identity\":\"bc1c1c45-66fb-4f23-952d-6f925500bec2\",\"order_by\":2,\"name\":\"Mohammad.Ali Morowati.Sharifabad\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shahid Sadoughi University of Medical Sciences\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mohammad.Ali\",\"middleName\":\"\",\"lastName\":\"Morowati.Sharifabad\",\"suffix\":\"\"},{\"id\":369017500,\"identity\":\"fbcc4804-83e5-432b-bb35-d5cf73b123dd\",\"order_by\":3,\"name\":\"Sara jambarsang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Shahid Sadoughi University of Medical Sciences\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sara\",\"middleName\":\"\",\"lastName\":\"jambarsang\",\"suffix\":\"\"},{\"id\":369017501,\"identity\":\"332e1c80-67cd-4b17-844b-3373677e6bd2\",\"order_by\":4,\"name\":\"Zhoreh Nasiri\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Zhoreh\",\"middleName\":\"\",\"lastName\":\"Nasiri\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-10-03 09:53:17\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5197429/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5197429/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":95798202,\"identity\":\"04101fce-903a-4167-a795-75b3884510d1\",\"added_by\":\"auto\",\"created_at\":\"2025-11-13 08:16:01\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":478401,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5197429/v1/4c1ab47d-2135-43bb-9d53-18a3dbbc353f.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Survey on the Health Status of Married Afghan Women Residing in Mehmanshahr Camp, Torbat-e Jam, Iran, 2024\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eRefugees are individuals unable or unwilling to return to their country due to a well-founded fear of persecution based on race, religion, nationality, membership of a particular social group, or political opinion(1, 2). Refugees, regardless of their nationality, need international attention. Considering that their relationship with their own country is broken, the responsibility of the international community to protect their fundamental rights is high(3).\\u003c/p\\u003e\\n\\u003cp\\u003eAsylum seekers and Refugees are particularly vulnerable(4).Some studies have shown that the health needs of immigrants due to discrimination; bad employment conditions; Differences in access and use of health services tend to worsen over time(5). Several studies have shown that immigrants suffer from more mental illnesses than non-immigrants due to their living conditions(5-7).\\u003c/p\\u003e\\n\\u003cp\\u003eAfghan migrants, a significant population of migrants and refugees, have long confronted various challenges and disadvantages(8) and Iran is the third host country for refugees in the world with the presence of Afghan immigrants(9). About 2.5 million Afghans live in Iran (10) ;However, in recent years, the Iranian government has introduced policies aimed at increasing access to education, health care, and livelihood services for Afghan refugees residing in Iran(11).\\u003c/p\\u003e\\n\\u003cp\\u003eMore than four decades of civil war has made Afghanistan known as one of the largest countries with immigrants, and this migration continues, especially to neighboring countries(4, 12).Afghan women's access to health care has been weakened for years due to armed conflicts and also based on their culture, law and family power structures that is considered a form of gender inequality and continues(3).\\u003c/p\\u003e\\n\\u003cp\\u003eMental disorders are one of the most effective factors in the lives of people of all ages around the world. So among mental disorders, 40.5% of disability-adjusted life years (DALYs) are depression disorders and 14.6% of DALYs are anxiety disorders(13). Several risks affect the mental health of refugees, including marginalization and minority status, socio-economic damages, poor physical health, collapse of social support, psychological distress, and difficulty adapting to the host culture(14). Results of a study find a psychological disturbance rate of 0.22 per 1,000 Afghan refugees in Pakistan(15). 35.7% of immigrant women living in Tehran suffered from psychiatric disorders(16), Severe depression is the most common sign of mental disorders among Afghan refugees in Tehran(17).\\u003c/p\\u003e\\n\\u003cp\\u003eThe results of a systematic review in Iran showed that in Iran, most of the studies were in the field of physical health and mental health and access/use of health care were less(17). Considering the importance of providing the best medical services for immigrants, it is necessary to get a general view of immigrants' health status in Iran.\\u003c/p\\u003e\"},{\"header\":\"Method\",\"content\":\"\\u003cp\\u003eThis is a cross-sectional study that was conducted aimed to evaluate the health status of the Afghan refugees and IDPs in Iran on married women living in the Afghan refugee camp in Torbat Jam, Iran, in 2024. The Inclusion criteria were permanent residence in the camp, marriage and living with a spouse, and interest in participating in the study, and the Exclusion\\u003cspan dir=\\\"RTL\\\"\\u003e\\u0026nbsp;\\u003c/span\\u003ecriteria were failure to continue participating in the study, divorce, and leaving the camp.\\u003c/p\\u003e\\n\\u003cp\\u003ePersian version of DASS-21 was used to assess the depression, anxiety and stress. The DASS-21 instrument, developed by Lovibond and Lovibond in 1995 and is a well-established tool for assessing symptoms of depression, anxiety, and stress. It consists of 21 items (7 for each subscale) based on the tripartite model of depression, anxiety, and stress. The scale is brief and can be used in both clinical and general populations, with similar psychometric properties across its three dimensions(13). Each item is scored on a 4-point Likert scale with values from 0=did not apply to me at all to 3=applied to me very much or most of the time. Each item multiplying them by 2. A higher score indicates a higher intensity of depression, anxiety and stress(18).The data were analyzed after collection with SPSS26 software. This research was performed by the latest version of the Declaration of Helsinki and with the approval of the research ethics committee of Shahid Sadoughi University of Medical Sciences (IR.SSU.SPH.REC.1402.099)\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThe total number of participants was 226, their minimum age was 17 years, the maximum age was 68, and the average age was 34 years, and the average age of their spouses was 38.7\\u0026plusmn;9 years. 34 women (15%) were pregnant. 25.2% of them were illiterate and only 8% had academic education, while 16.4% of their husbands were illiterate and 11.5% had university education. 95.6% were housewives and the number of people working outside the home was 10. On average, the last years of their marriage\\u003cspan dir=\\\"RTL\\\"\\u003e\\u0026nbsp;\\u003c/span\\u003ewere 15 years (1-54years) and on average each of the participants had 3 children. The number of years of residence in Iran ranged from 1 to 50 years, with an average of 19.3 years\\u003cspan dir=\\\"RTL\\\"\\u003e\\u0026nbsp;\\u003c/span\\u003e(Table 1)\\u003cspan dir=\\\"RTL\\\"\\u003e.\\u003c/span\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTable1: Demographic data\\u003c/p\\u003e\\n\\u003cdiv align=\\\"Left\\\"\\u003e\\n \\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"432\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003eAge Group\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003eN\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003eCumulative Percent\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e15-25y\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e12.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e12.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e26-35y\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e117\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e51.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e64.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e36-45y\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e24.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e89.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e46-55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e7.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e96.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e56-65y\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e3.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e99.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;65y\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e100.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003eTotal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e226\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e100.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003eYears of residence in Iran\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"3\\\" style=\\\"width: 52.7778%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e42.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e42.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e11-20y\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e5.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e48.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e21-30y\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e18.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e66.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e31-40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e27.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e94.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e41-50y\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e5.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e100.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003eTotal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e226\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e100.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003eNumber of children\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e4.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e4.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e34\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e15.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e19.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e22.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e41.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e17.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e58.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e17.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e75.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e23\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e10.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e85.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e6.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e92.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e6.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e98.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e1.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e100.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003eTotal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e226\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e100.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003epregnancy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003epregnant\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e34\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e15.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e15.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003enon-pregnant\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e192\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e85.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e100.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 47.2222%;\\\"\\u003e\\n \\u003cp\\u003eTotal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e226\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 18.0556%;\\\"\\u003e\\n \\u003cp\\u003e100.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 16.6667%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eBased on the results, 43% of the participants had some degree of depression, and more than 17% had severe and very severe depression. Also, about 52% of the participants in this survey had anxiety and more than 62% had not experienced stress during the last week. (Table 2)\\u003c/p\\u003e\\n\\u003cp\\u003eTable 2. Results on DASS\\u003c/p\\u003e\\n\\u003cdiv align=\\\"Left\\\"\\u003e\\n \\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 40.2174%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20.3804%;\\\"\\u003e\\n \\u003cp\\u003eDepression\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.5652%;\\\"\\u003e\\n \\u003cp\\u003eAnxiety\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.837%;\\\"\\u003e\\n \\u003cp\\u003eStress\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 40.2174%;\\\"\\u003e\\n \\u003cp\\u003eM \\u0026plusmn; se\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20.3804%;\\\"\\u003e\\n \\u003cp\\u003e9.9\\u0026plusmn;0.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.5652%;\\\"\\u003e\\n \\u003cp\\u003e9.4\\u0026plusmn;0.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.837%;\\\"\\u003e\\n \\u003cp\\u003e12.8\\u0026plusmn;0.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 40.2174%;\\\"\\u003e\\n \\u003cp\\u003eRange min-max\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20.3804%;\\\"\\u003e\\n \\u003cp\\u003e0-40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.5652%;\\\"\\u003e\\n \\u003cp\\u003e0-36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.837%;\\\"\\u003e\\n \\u003cp\\u003e0-38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 40.2174%;\\\"\\u003e\\n \\u003cp\\u003eNormal (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20.3804%;\\\"\\u003e\\n \\u003cp\\u003e57.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.5652%;\\\"\\u003e\\n \\u003cp\\u003e48.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.837%;\\\"\\u003e\\n \\u003cp\\u003e62.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 40.2174%;\\\"\\u003e\\n \\u003cp\\u003eMild (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20.3804%;\\\"\\u003e\\n \\u003cp\\u003e12.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.5652%;\\\"\\u003e\\n \\u003cp\\u003e4.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.837%;\\\"\\u003e\\n \\u003cp\\u003e9.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 40.2174%;\\\"\\u003e\\n \\u003cp\\u003eModerate (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20.3804%;\\\"\\u003e\\n \\u003cp\\u003e12.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.5652%;\\\"\\u003e\\n \\u003cp\\u003e23.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.837%;\\\"\\u003e\\n \\u003cp\\u003e13.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 40.2174%;\\\"\\u003e\\n \\u003cp\\u003esevere (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20.3804%;\\\"\\u003e\\n \\u003cp\\u003e8.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.5652%;\\\"\\u003e\\n \\u003cp\\u003e8.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.837%;\\\"\\u003e\\n \\u003cp\\u003e10.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 40.2174%;\\\"\\u003e\\n \\u003cp\\u003eextremely severe (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20.3804%;\\\"\\u003e\\n \\u003cp\\u003e9.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.5652%;\\\"\\u003e\\n \\u003cp\\u003e15.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19.837%;\\\"\\u003e\\n \\u003cp\\u003e3.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eThere was a significant positive and direct correlation between the average score of depression, anxiety and stress of the participants. Also, a positive and significant relationship was observed between the number of children and the average score of depression, anxiety and stress; But the correlation between education level and depression, anxiety and stress were not statistically significant (Table 3).\\u003c/p\\u003e\\n\\u003cp\\u003eTable3: correlation between DASS, Education level, Number of children and Years of residence in Iran\\u003c/p\\u003e\\n\\u003cdiv align=\\\"Left\\\"\\u003e\\n \\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"554\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"7\\\" style=\\\"width: 554px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCorrelations\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003eDepression\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003eAnxiety\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003eStress\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003eEducation level\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003eNumber of children\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003eYears of residence in Iran\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003eDepression\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003eAnxiety\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.757\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003eStress\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.811\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.843\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003eEducation level\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.059\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.042\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003eNumber of children\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.179\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.308\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.232\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e-.485\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003eYears of residence in Iran\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.145\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.259\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.195\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e-.246\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e.234\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 73px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u0026nbsp;**. Correlation is significant at the 0.01 level (2-tailed).\\u003c/p\\u003e\\n\\u003cp\\u003e*. Correlation is significant at the 0.05 level (2-tailed).\\u003c/p\\u003e\\n\\u003cp\\u003eAccording to the results of this study, the average score of depression, anxiety and stress increases with increasing age, so that the average score in people over 55 years old is higher than others. This difference is statistically significant (\\u0026lt;.05).\\u003c/p\\u003e\\n\\u003cp\\u003eBased on the results, the average score of depression, anxiety and stress in people whose length of stay in Iran is between 30-40 years was more than others, this difference was not significant in depression, but it is statistically significant in anxiety and stress (\\u0026lt;.05).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eAfghans are the primary refugee group in Iran, seeking asylum in the country over 50 years ago. This study focuses on examining the mental health status of married women living in Torbat Jam city camp in Iran.\\u003c/p\\u003e\\n\\u003cp\\u003eStudies on refugees have shown varying rates of mental disorders among different refugee groups, possibly due to their diverse backgrounds, characteristics, and levels of support within the host country. Additionally, differences in research methodologies, particularly in sampling methods, may also contribute to the variability in findings(19). While the prevalence of depression in the Iranian population is estimated at 45.5%, anxiety at 35.5%, and stress at 40.2%(20); in this study, its prevalence for Afghan women living in Iran's Torbat Jam camp was estimated to be 42.9%, 51.3%, and 47.2%, respectively. This is consistent with Ahmadi et al.'s (2021) study(21)\\u0026nbsp;in Afghanistan, where almost half of the participants met criteria for a possible diagnosis of PTSD (51.6%), depression (48.9%), or anxiety (45.2%) and less than its prevalence in the study of Islam Parast\\u0026nbsp;(22). In this study, no significant statistical relationship was observed between the place of birth (Iran or Afghanistan) and the average score of DASS-21, while the study of Eslam Parast(22)\\u0026nbsp;showed that women who were born in Afghanistan had a significant increase in depression and stress scores compared to other groups. This could be due to the cultural affinity of Iran and Afghanistan and instead the lack of cultural compatibility between Afghanistan and Turkey.\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings of this study show the direct effect of anxiety on stress levels and similarly Anxiety has a significant positive effect on depression, suggesting that people with higher anxiety levels are more likely to experience higher levels of depression. This finding supports the existing literature(23, 24) Anxiety is linked to higher stress levels and represents the psychological strain felt by individuals with high anxiety, also this result confirms the strong connection between anxiety and depression, emphasizing the importance of addressing both types of symptoms in interventions and support systems. In confirmation of previous studies\\u0026nbsp;(25)\\u0026nbsp;the results show that stress is linked to depression in a positive way. People with higher stress levels are more likely to report higher levels of depression. This shows how stress can harm mental health and emphasizes the importance of managing stress and coping strategies to reduce depression symptoms.\\u003c/p\\u003e\\n\\u003cp\\u003eThe difference in the mean score of depression, anxiety and stress at the time of the arrival of refugees to Iran is statistically significant, so that immigrants who entered Iran in the 1990s to 2000s reported a higher DASS score. These years coincided with the first period of Taliban rule over Afghanistan.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eAfghan women in Iran often face intimate partner violence, restricted maternity care access, and financial and housing challenges(10). Our study emphasizes the important role the host country can play in improving the psychological wellbeing of individuals. The role of international organizations and associations supporting immigrants is very important in improving the health status of asylum seekers and refugees. The study's results are important for improving the mental health and overall wellbeing of Afghan migrants through policy and practice.\\u003c/p\\u003e\\n\\u003cp\\u003eSuggested ways to deal with the mental health of people outside Afghanistan can include early conflict resolution inside Afghanistan, online mental health interventions, the presence of experienced counselors and psychologists in camps, distraction techniques and international helps.\\u003c/p\\u003e\\n\\u003cp\\u003eFuture research should further examine the mental health experiences and needs of Afghan immigrants, taking into account factors such as employment problems, transportation, commuting, and economic issues.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eDeclaration of competing interest:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;The authors have disclosed no potential conflict in researching, authoring and/or publishing this article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics declaration:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research was performed by the latest version of the Declaration of Helsinki and with the approval of the research ethics committee of Shahid Sadoughi University of Medical Sciences (IR.SSU.SPH.REC.1402.099)\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments\\u003c/strong\\u003e:\\u003c/p\\u003e\\n\\u003cp\\u003eWe appreciate the personnel of the camp for foreign nationals and the University of Medical Sciences and Health Services of Torbat\\u0026nbsp;jam for their cooperation in the implementation of this plan.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNone declared.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDeclaration of informed consent to participation:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eBefore collecting the data, a form was given to all the participants in which the purpose of the study and its executor were specified, and they were assured that their participation in this research is entirely voluntary and nothing will be shared with anybody outside the research team.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eAndersen MH, Kruse A, Frederiksen HW, Ahmadi A, Norredam M. Health status of refugees newly resettled in Denmark. Dan Med J. 2020;67(12).\\u003c/li\\u003e\\n\\u003cli\\u003eTomasi AM, Slewa-Younan S, Narchal R, Rioseco P. Professional Mental Health Help-Seeking Amongst Afghan and Iraqi Refugees in Australia: Understanding Predictors Five Years Post Resettlement. Int J Environ Res Public Health. 2022;19(3).\\u003c/li\\u003e\\n\\u003cli\\u003eMatsangos M, Ziaka L, Exadaktylos AK, Klukowska-R\\u0026ouml;tzler J, Ziaka M. Health Status of Afghan Refugees in Europe: Policy and Practice Implications for an Optimised Healthcare. Int J Environ Res Public Health. 2022;19(15).\\u003c/li\\u003e\\n\\u003cli\\u003eHynie M. The Social Determinants of Refugee Mental Health in the Post-Migration Context: A Critical Review. Can J Psychiatry. 2018;63(5):297-303.\\u003c/li\\u003e\\n\\u003cli\\u003eLebano A, Hamed S, Bradby H, Gil-Salmer\\u0026oacute;n A, Dur\\u0026aacute;-Ferrandis E, Garc\\u0026eacute;s-Ferrer J, et al. Migrants\\u0026apos; and refugees\\u0026apos; health status and healthcare in Europe: a scoping literature review. BMC Public Health. 2020;20(1):1039.\\u003c/li\\u003e\\n\\u003cli\\u003eCrepet A, Rita F, Reid A, Van den Boogaard W, Deiana P, Quaranta G, et al. Mental health and trauma in asylum seekers landing in Sicily in 2015: a descriptive study of neglected invisible wounds. Conflict and health. 2017;11:1-11.\\u003c/li\\u003e\\n\\u003cli\\u003eSimonnot N, Rodriguez A, Nuenberg M, Fille F, Aranda-Fernandez P-E, Chauvin P. Access to healthcare for people facing multiple vulnerabilities in health in 31 cities in 12 countries. 2016.\\u003c/li\\u003e\\n\\u003cli\\u003eKhozaei F, Islam QU, Ramayah T, Ayub N, Carbon C-C. Factors contributing to the mental wellbeing of Afghan migrants in Iran during the COVID-19 pandemic. Journal of Migration and Health. 2024;9:100211.\\u003c/li\\u003e\\n\\u003cli\\u003eDelkhosh M, Merghati Khoei E, Ardalan A, Rahimi Foroushani A, Gharavi MB. Prevalence of intimate partner violence and reproductive health outcomes among Afghan refugee women in Iran. Health care for women international. 2019;40(2):213-37.\\u003c/li\\u003e\\n\\u003cli\\u003eDadras O, Nakayama T, Kihara M, Ono-Kihara M, Seyedalinaghi S, Dadras F. The prevalence and associated factors of adverse pregnancy outcomes among Afghan women in Iran; Findings from community-based survey. Plos one. 2021;16(1):e0245007.\\u003c/li\\u003e\\n\\u003cli\\u003eShams L, Tajik M, Heidari P, Nasiri T, Mohammadshahi M. Quality of life of Iranian and Afghan pregnant women in rural Iran. Ann Ig. 2022;34(1):70-8.\\u003c/li\\u003e\\n\\u003cli\\u003eFatima M, Nosheen F, Afzaal M, Islam F, Noreen R, Imran A, et al. Nutritional and health status of Afghan refugee women living in Punjab: A cross-sectional study. Food Sci Nutr. 2023;11(6):2872-82.\\u003c/li\\u003e\\n\\u003cli\\u003eBibi A, Lin M, Zhang XC, Margraf J. Psychometric properties and measurement invarianceof Depression, Anxiety and Stress Scales (DASS-21)across cultures. International Journal of Psychology. 2020;55(6):916-25.\\u003c/li\\u003e\\n\\u003cli\\u003eKassam A, Nanji A. Mental health of Afghan refugees in Pakistan: a qualitative rapid reconnaissance field study. Intervention. 2006;4(1):58-66.\\u003c/li\\u003e\\n\\u003cli\\u003eMalik MS, Afzal M, Farid A, Khan FU, Mirza B, Waheed MT. Disease Status of Afghan Refugees and Migrants in Pakistan. Front Public Health. 2019;7:185.\\u003c/li\\u003e\\n\\u003cli\\u003eMohammadian M, Dadfar M, Bolhari J, Karimi Keisami E. Screening For Mental Disorders Among Afghan Immigrants Residing in Tehran. Iranian Journal of Psychiatry and Clinical Psychology. 2005;11(3):270-7.\\u003c/li\\u003e\\n\\u003cli\\u003eRahimitabar P, Kraemer A, Bozorgmehr K, Ebrahimi F, Takian A. Health condition of Afghan refugees residing in Iran in comparison to Germany: a systematic review of empirical studies. Int J Equity Health. 2023;22(1):16.\\u003c/li\\u003e\\n\\u003cli\\u003e\\u0026Scaron;kegro B, Bjedov S, Miku\\u0026scaron; M, Mustač F, Le\\u0026scaron;in J, Matijević V, et al. Endometriosis, Pain and Mental Health. Psychiatr Danub. 2021;33(Suppl 4):632-6.\\u003c/li\\u003e\\n\\u003cli\\u003eGiacco D, Laxhman N, Priebe S. Prevalence of and risk factors for mental disorders in refugees. Seminars in Cell \\u0026amp; Developmental Biology. 2018;77:144-52.\\u003c/li\\u003e\\n\\u003cli\\u003eRaeisvandi A, Amerzadeh M, Hajiabadi F, Hosseinkhani Z. Prevalence and the affecting factors on depression, anxiety and stress (DASS) among elders in Qazvin City, in the Northwest of Iran. BMC Geriatr. 2023;23(1):202.\\u003c/li\\u003e\\n\\u003cli\\u003eAhmadi SJ, Jobson L, Earnest A, McAvoy D, Musavi Z, Samim N, et al. Prevalence of poor mental health among adolescents in Kabul, Afghanistan, as of November 2021. JAMA Network Open. 2022;5(6):e2218981-e.\\u003c/li\\u003e\\n\\u003cli\\u003eEslam Parast N, Taştekin Ouyaba A. The impact of the demographic and migration process factors of refugee women on quality of life and the mediating role of mental health. Perspectives in Psychiatric Care. 2022;58(2):785-94.\\u003c/li\\u003e\\n\\u003cli\\u003eAmini B, Raheel O, Exum A, Fazzino TL. Mental health of Iranian immigrants and their descendants: A review. Professional Psychology: Research and Practice. 2022;53(2):192.\\u003c/li\\u003e\\n\\u003cli\\u003eJia S, Hou Y, Wang D, Zhao X. Flavonoids for depression and anxiety: a systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition. 2023;63(27):8839-49.\\u003c/li\\u003e\\n\\u003cli\\u003eWerner EA, Aloisio CE, Butler AD, D\\u0026apos;Antonio KM, Kenny JM, Mitchell A, et al., editors. Addressing mental health in patients and providers during the COVID-19 pandemic. Seminars in perinatology; 2020: Elsevier.\\u003cspan dir=\\\"RTL\\\"\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5197429/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5197429/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e: Mental health plays an important role in the quality of life and survival of people, especially refugees and asylum seekers. Afghanistan is one of the largest immigrant countries in the world and about 2.5 million Afghans live in Iran. The purpose of this study is to investigate and estimate mental disorders in married Afghan women living in Iran's Torbet Jam camp in 2024.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e: The sample consisted of 226 married women living in Torbat Jam camp who were selected by random sampling. DASS-21 standard questionnaire was used to collect mental health information of the participants and the data was analyzed with SPSS after collection.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e: The average age of the participants was 38.7 years and 15% of them were pregnant. More than half of the participants (51.3%) reported at least one mental health disorder. The prevalence of depression, anxiety, and stress in the population under study was 42.9%, 51.3%, and 47.2%, respectively.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e: Considering that Afghan refugee women in Iran are vulnerable to intimate partner violence, economic and livelihood problems, it is very important to address mental health and in addition to the efforts of the host country, international assistance is needed.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Survey on the Health Status of Married Afghan Women Residing in Mehmanshahr Camp, Torbat-e Jam, Iran, 2024\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-11-08 10:26:53\",\"doi\":\"10.21203/rs.3.rs-5197429/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"ea71dfd4-2eaa-44b4-991a-f29fc2a7bdac\",\"owner\":[],\"postedDate\":\"November 8th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-11-11T14:24:16+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-11-08 10:26:53\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5197429\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5197429\",\"identity\":\"rs-5197429\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}