Designing a Primary Prevention Framework for Mental Disorders Based on the Social Determinants of Health
Keywords:
Primary prevention, Mental disorders, Social determinants of health, Public mental health, Qualitative content analysis, TehranAbstract
This study aimed to develop a context-sensitive framework for the primary prevention of mental disorders by identifying and organizing the social determinants of health relevant to Tehran. This qualitative study employed conventional content analysis. The participants were 24 professionals and stakeholders in psychology and psychiatry, public and social health, social work, health policy, education, urban management, and Tehran-based nongovernmental organizations. They were recruited through purposive sampling with maximum variation. Data were collected exclusively through individual semi-structured interviews. Interviews continued until theoretical saturation was achieved; initial saturation occurred after the twenty-first interview, followed by three additional interviews to ensure conceptual sufficiency. All interviews were audio-recorded, transcribed verbatim, and analyzed through an inductive content-analysis process. NVivo software was used to manage the transcripts, conduct coding, compare emerging concepts, and organize categories. Credibility and trustworthiness were enhanced through participant checking, peer review, prolonged engagement with the data, maximum variation, thick description, and maintenance of an audit trail. Data analysis generated five main categories, 18 subcategories, and 72 initial codes. The main categories were “economic security and distributive justice,” “empowered families and a healthy start to life,” “social capital, belonging, and civic participation,” “healthy living, educational, and occupational environments,” and “integrated governance and preventive mental-health infrastructure.” Participants emphasized that effective primary prevention requires the simultaneous implementation of social protection, family support, violence and discrimination reduction, safe urban development, mental-health literacy, accessible community resources, and intersectoral governance. They also highlighted that universal interventions should be proportionately intensified for socioeconomically disadvantaged groups and high-risk neighborhoods. Primary prevention of mental disorders cannot be reduced to individual skills training, screening, or clinical service provision. It requires coordinated action on the conditions in which people are born, grow, study, work, form relationships, and age. The proposed framework combines universal, proportionate, place-based, and life-course interventions. It may provide a foundation for intersectoral mental-health policies, municipal prevention programs, resource allocation, and the development of measurable indicators for evaluating primary prevention in Iran.
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