Masoumeh Amin-Esmaeili
1,2 
, Behrang Shadloo
1 , Afarin Rahimi-Movaghar
1* , Seyed Mehdi Samimi Ardestani
3 , Ahmad Hajebi
4 , Shahab Khatibzadeh
5, Vandad Sharifi
6, Roya Samadi
7, Mohammad Taghi Yasamy
8 , Mehran Zarghami
9 , Farshad Farzadfar
10 , Saeid Shahraz
5,111 Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
2 Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
3 Departments of Psychiatry, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Research Center for Addiction & Risky Behaviors (ReCARB), Psychiatric Department, Iran University of Medical Sciences (IUMS), Tehran, Iran
5 The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
6 Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
7 Psychiatry and Behavioral Sciences Research Center, Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
8 Department of Psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
9 Department of Psychiatry, School of Medicine AND Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
10 Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
11 Tufts Medical Center, Institute for Clinical Research and Health Policy, Boston, MA, USA
Abstract
One in eight adults in Iran is estimated to have major depressive disorder (MDD) – a leading cause of disability in the country. Many remain undiagnosed, and some receive only partial treatment. An estimated 60% of those with MDD were reported to have received no treatment during the past year. In this paper, we have critically reviewed the current health-care structure in the country along with prevailing patterns of health-care service utilization. We have addressed the role of psychiatrists, general practitioners (GPs), psychologists, and other health-care personnel in the treatment and care of patients with MDD, with an emphasis on the quality of service provision. In addition, the strengths and weaknesses of primary healthcare (PHC), the health insurance system, and inpatient care have been discussed. We have paid attention to the contextual issues such as mental health literacy, stigma, and healthcare inequity where relevant. Finally, practical recommendations have been provided to improve the quality of care for patients with MDD in Iran.