Introduction: When psychosocial tensions in metropolitan settings increase in intensity, persistence, and population coverage, they can no longer be understood merely as individual or clinical experiences. Rather, they become a social and structural issue in the fields of public health and social welfare. 
Method: This policy brief is based on data from a population-based cross-sectional survey conducted in 2023–2024 among 1,008 residents aged 18 years and older across the 22 municipal districts of Tehran. The findings showed that 92.3% of citizens had experienced at least one severe stressor during the previous year, and 25.9% had symptoms of generalized anxiety disorder. Economic problems, concerns about the future, housing costs, and job insecurity were reported as the main sources of tension. 
Findings: The pattern of psychosocial tension in Tehran is consistent with global evidence on the role of economic and social insecurity in shaping mental health. However, the intensity and persistence of stress in Tehran suggest an accumulation of structural pressures in citizens’ everyday lives.  
Discussion: Managing psychosocial tensions in Tehran requires moving beyond a purely individual-oriented approach toward intersectoral, stress-reducing, and prevention-oriented interventions in the field of psychosocial health. Macroeconomic, social, and cultural policies should be assessed in terms of their effects on future-related concerns, perceived social safety, and life predictability. Integrating mental health and social services, reducing future-related concerns and economic uncertainty, developing community-based interventions to strengthen social health, and improving stress-inducing urban environments through data-driven monitoring of psychosocial tensions are key policy priorities.