Iranians Embrace Mental Health Treatment but Shun Close Contact, National Survey Finds

A sweeping national survey of more than 4,000 Iranian adults has revealed a striking paradox at the heart of public attitudes toward mental illness: people in Iran overwhelmingly reject stereotypes about psychiatric conditions and express strong belief in the value of treatment, yet they remain deeply reluctant to welcome someone with a mental illness into their closest social circles. The study, published in BMC Psychiatry by researchers at Iran University of Medical Sciences and collaborating institutions, offers one of the most detailed portraits to date of mental illness stigma in a Middle Eastern country, using a validated Persian-language instrument to measure attitudes across a nationally distributed online sample.

The research team, led by Sara Hajisadeghi Kahdooyeh and Shayan Eghdami, who share first authorship, administered the Persian version of the Opinion toward the Mentally Ill scale, a classic psychometric tool long used internationally to gauge public attitudes. Between late 2023 and early 2024, the investigators collected complete responses from 4,360 adults across Iran. Rather than relying on a single composite score, the researchers subjected the 22 survey items to factor analysis, a statistical technique that identifies clusters of questions that tap the same underlying attitude. The analysis supported three distinct domains: Social Distance and Acceptance, which captures willingness to interact closely with people with mental illness; Stereotypes and Misconceptions, which measures endorsement of prejudicial beliefs; and Treatment and Help-seeking, which reflects confidence in psychiatric care.

The domain-level results tell a story of selective acceptance. On the Stereotypes and Misconceptions domain, respondents scored a mean of 4.14 on a scale where higher values indicate greater rejection of prejudiced beliefs, with a standard deviation of just 0.51, indicating remarkably consistent agreement across the sample. The Treatment and Help-seeking domain produced an identical mean of 4.14, with a standard deviation of 0.53, signaling broad public faith in the effectiveness of mental health care. Social Distance and Acceptance, by contrast, yielded a mean of only 3.25 with a standard deviation of 0.69, a substantially weaker endorsement of social closeness. The researchers also computed an Overall Acceptance Index by averaging the z-standardized domain scores, which by construction centered at zero with a standard deviation of 0.75.

Item-level analysis sharpened the picture further. When the researchers calculated Top-2-Box rates, the proportion of respondents selecting the two most accepting response options on each item, the average across all items was 59.1 percent. But the spread was dramatic: items concerning treatment and help-seeking reached acceptance rates of approximately 84.7 percent, among the highest possible, while items probing willingness for close interpersonal contact fell to roughly 36.4 percent, the lowest in the survey. In other words, nearly nine in ten Iranians surveyed believe psychiatric treatment works, but fewer than four in ten say they would embrace a person with mental illness as a neighbor, family member by marriage, or close friend. This gap between abstract endorsement and concrete social willingness is a well-documented phenomenon in stigma research, but the Iranian data suggest it may be particularly pronounced.

The demographic correlates of acceptance, while statistically robust, were modest in magnitude. Women showed slightly higher overall acceptance than men, with a Cohen’s d of 0.13, a small effect. Acceptance rose steadily with educational attainment, echoing a consistent finding in international stigma literature that longer exposure to formal education is associated with more tolerant attitudes. The largest demographic effect belonged to healthcare workers, who scored significantly higher on the Overall Acceptance Index than non-healthcare respondents, with a Cohen’s d of 0.53, a medium-sized difference. When the researchers entered gender, education, and healthcare-worker status into adjusted models controlling for all three predictors simultaneously, the main effects persisted: education produced an F statistic of 15.59 with 4 and 4,353 degrees of freedom, p less than 0.001 and a partial eta squared of 0.014, while healthcare-worker status yielded F of 35.59 with 1 and 4,353 degrees of freedom, p less than 0.001 and a partial eta squared of 0.008. These effect sizes are small in absolute terms, and the authors are candid that the vast majority of variance in public attitudes remains unexplained by the variables they examined.

Perhaps the most novel contribution of the study lies in its granular examination of prior contact with psychiatric care. Rather than treating contact as a single binary variable, the researchers distinguished four types: the respondent’s own experience as a psychiatric patient or having a relative who was one, crossed with whether the treatment was inpatient or outpatient. They then ran item-level linear models testing how each contact type predicted responses to individual survey items. The results revealed distinct and sometimes surprising patterns. Having a relative who received inpatient psychiatric treatment was the strongest predictor of willingness for close social contact, with standardized beta coefficients ranging from 0.16 to 0.33, all statistically significant at p less than 0.01. This suggests that witnessing a family member go through hospitalization, often an intense and prolonged experience, may humanize mental illness in a way that more distant exposures do not.

The respondent’s own outpatient contact, meaning personal experience with ambulatory psychiatric care, was linked to greater endorsement of help-seeking and reduced endorsement of stereotypes, a pattern consistent with the idea that direct, low-intensity engagement with the mental health system normalizes both treatment and the people who use it. But the fourth contact type produced an unexpected result. Having a relative who received only outpatient treatment showed mixed effects, and on some stereotype items it was paradoxically associated with lower acceptance, with beta coefficients between negative 0.09 and negative 0.11, p less than 0.01. The authors do not overinterpret this finding, but it complicates the simple contact hypothesis, the influential social-psychological theory that exposure to a stigmatized group reduces prejudice. In the Iranian context, at least, the form and intensity of contact appear to matter enormously, and some forms may even backfire or reflect pre-existing family dynamics that shape attitudes in both directions.

For stigma researchers, the study’s psychometric groundwork is as important as its substantive findings. The Persian Opinion toward the Mentally Ill scale had not previously been deployed at this scale in Iran, and the confirmation of a three-factor structure, with the Treatment and Help-seeking domain retained only cautiously, gives Iranian mental health researchers a validated instrument for tracking public attitudes over time. The study was conducted as a postgraduate thesis toward the Iranian Board of Psychiatry and was funded by Iran University of Medical Sciences under grant number 1400-2-50-19744. The protocol was approved by the university’s ethics committee under code IR.IUMS.REC.1400.1144 and carried out in accordance with the Declaration of Helsinki, with electronic informed consent obtained from all participants.

The practical implications are considerable. Stigma is widely recognized as a major barrier to mental health care in Iran, where treatment gaps for common psychiatric disorders remain large and many people who need help never seek it. The finding that Iranians already strongly believe in treatment effectiveness suggests that anti-stigma campaigns built purely around messages like mental illness is treatable may be preaching to the converted. Instead, the data point toward interventions targeting the social distance domain specifically: structured contact programs, workplace and school-based inclusion initiatives, and public narratives that feature people with lived experience of mental illness in ordinary social roles. The strong contact effects observed for relatives of inpatients hint that family-inclusive interventions, which bring relatives into the therapeutic process, could produce ripple effects that extend beyond the individual patient.

The authors also caution against overpromising. Education, healthcare employment, and prior contact each explained only a small fraction of the variance in attitudes, meaning that culture, religion, media exposure, personal values, and countless unmeasured factors shape how Iranians think about mental illness. The cross-sectional online design further limits causal inference: people tolerant of mental illness may simply be more likely to seek out contact with psychiatric care, rather than the other way around, and online samples may underrepresent older, rural, and less connected populations. Still, with 4,360 complete responses and a validated instrument, the survey provides a rigorous baseline. As Iran and other countries grapple with rising mental health needs, the study’s central message is clear: the battle against stigma is not about convincing people that treatment works, but about persuading them to open their homes, workplaces, and families to those who need it.

Subject of Research: Public attitudes toward mental illness and the effects of prior psychiatric contact on stigma in Iran

Article Title: Mental illness stigma in Iran: a national survey of public attitudes and contact effects using the Persian Opinion toward the Mentally Ill scale

Article References: Hajisadeghi Kahdooyeh, S., Eghdami, S., Shariat, S. V., Araminia, B., Nohesara, S., Kamalzadeh, L., Eyvaz Ziaei, S., & Shalbafan, M. (2026). Mental illness stigma in Iran: a national survey of public attitudes and contact effects using the Persian Opinion toward the Mentally Ill scale. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08715-5

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08715-5

Keywords: mental illness stigma, Iran, public attitudes, social distance, OMI scale, psychometrics, cross-sectional survey, help-seeking, contact hypothesis, healthcare workers, mental health, BMC Psychiatry