Volume 26, Issue 1 (4-2026)
Social Welfare Quarterly 2026, 26(1): 43-67 |
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Research code: IR.USWR.REC.1402.039
Ethics code: IR.USWR.REC.1402.039
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Alipour F, Noorbala A A, Shaabanpoor F. (2026). Psychosocial Tensions in Tehran: An Evidence-Based Policy Brief". Social Welfare Quarterly. 26(1), 43-67. doi:10.32598/refahj.26.100.7
URL: http://refahj.uswr.ac.ir/article-1-4509-en.html
URL: http://refahj.uswr.ac.ir/article-1-4509-en.html
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Extended Abstract
Introduction
Psychosocial tensions in large metropolitan areas have increasingly become a critical public health and social policy issue. Although stress is often understood as an individual psychological reaction, its intensity, persistence, and distribution across populations reveal a broader social and structural dimension. In megacities, everyday stress is not produced only by personal vulnerabilities or clinical conditions; rather, it is deeply embedded in economic uncertainty, insecure employment, housing pressure, weakened social support, environmental burdens, and the declining predictability of everyday life. When these pressures affect a large proportion of citizens and continue over time, psychosocial stress should be regarded not merely as an individual experience but as an indicator of social insecurity and structural strain.
This policy brief focuses on psychosocial tensions among adult residents of Tehran, one of the largest and most complex metropolitan settings in the Middle East. Tehran is characterized by rapid urbanization, socioeconomic heterogeneity, traffic congestion, air pollution, high living costs, housing instability, labor market insecurity, and unequal access to social and welfare resources. These conditions create a dense environment of chronic stressors that can influence both mental health and social well-being. In such a context, psychosocial tension becomes a key point of connection between public mental health, social welfare, social protection, urban governance, and broader socioeconomic policy.
The central argument of this article is that psychosocial tensions in Tehran should be reframed as a social and policy problem rather than being reduced to individual maladjustment or clinical disorder. This reframing is essential because the main sources of stress identified among citizens are largely rooted in social and structural conditions, including concern about the future, economic instability, housing costs, and job insecurity. Therefore, effective responses cannot be limited to individual counseling, psychological education, or treatment services alone. Instead, they require an integrated, intersectoral, preventive, and stress-reducing approach that addresses both the social production of stress and the resources available to individuals, families, and communities for coping with it.
Method
This policy brief is based on evidence 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 study was designed to assess the experience of severe stressful life events and their psychosocial consequences among adult citizens. A multistage cluster sampling method proportionate to population size was used to select participants from different areas of the city. The experience of severe stressors was measured using a standardized questionnaire on stressful life events that covered a broad range of economic, social, familial, cultural, health-related, and future-oriented stressors.
The evidence used in this policy brief also draws on published findings from the same survey, including analyses of psychosocial stressors and symptoms of generalized anxiety disorder among Tehran residents. These findings were interpreted in light of national and international literature on social determinants of mental health, stress and health, urban stress, social support, and population-based mental health policy. The theoretical interpretation was informed particularly by Lazarus and Folkman’s cognitive appraisal model of stress and Agnew’s General Strain Theory. These frameworks help explain how chronic social and environmental pressures become psychologically meaningful and how persistent structural strain may generate emotional, behavioral, and mental health consequences.
Given the cross-sectional design of the study, the findings should not be interpreted as evidence of direct causality. However, they provide important population-level evidence on the scope, distribution, and nature of psychosocial tensions in Tehran. The results are especially valuable for policy-making because they identify not only the prevalence of stress exposure, but also the dominant types of stressors and their implications for public mental health, social welfare, and preventive intervention.
Findings
The findings show that psychosocial tension is widespread among adult residents of Tehran. A very large proportion of participants reported exposure to at least one severe stressor during the previous year. Specifically, 92.3% of citizens had experienced at least one severe stressful event or condition in the past year. In addition, 25.9% of participants showed symptoms consistent with generalized anxiety disorder. Participants reported that, on average, they had spent approximately 8.5 months of the previous year under the influence of severe stress. These figures indicate that stress in Tehran is not an occasional or isolated experience for a small group of citizens; rather, it is a broad and persistent feature of urban life.
One of the most important findings is the dominance of economic and future-oriented stressors. The most frequently reported sources of tension included concern about the personal and family future, inflation and market instability, concern about financial and economic conditions, high housing costs, and concern about future employment. Concern about the personal and family future was reported by 57.6% of participants, inflation and market instability by 57.1%, concern about financial and economic future by 55%, high housing costs by 43.4%, and concern about future employment by 40.7%. This pattern suggests that psychosocial stress in Tehran is strongly connected to uncertainty about the future and the reduced predictability of daily life.
The findings also show that stress is multidimensional and cumulative. A considerable proportion of participants experienced severe stressors in several domains. Economic stressors were particularly prominent, with 45.6% of participants reporting at least one severe economic stressor. In addition, 32.3% experienced at least one severe family-related stressor, 28.8% experienced at least one severe health-related stressor, and 25.7% experienced at least one severe future-oriented stressor. This multidimensional pattern is important because it suggests that many citizens do not face a single isolated difficulty, but rather a combination of economic, familial, health-related, and future-oriented pressures. Such cumulative exposure can erode individual and family coping resources and increase vulnerability to mental health problems.
Another key finding is the association between psychosocial stressors and symptoms of generalized anxiety disorder. The prevalence of generalized anxiety disorder symptoms among adult residents of Tehran was approximately 26%. This finding highlights the public health significance of psychosocial tensions, showing that social and economic pressures do not remain only at the level of subjective worry or everyday discomfort. Rather, they are associated with observable mental health outcomes at the population level. Individuals with anxiety symptoms were more likely to report stressful life events, poorer health status, lower life satisfaction, and lower socioeconomic status. These findings reinforce the need to understand anxiety and stress not only as clinical issues, but also as outcomes of broader social and economic conditions.
The study also points to the protective role of social interaction and social support. Higher levels of social interaction were associated with a lower likelihood of experiencing psychosocial stress. This finding is highly relevant for policy because it suggests that social ties, community participation, neighborhood-based support, and local networks may buffer the effects of chronic social and economic pressures. In other words, strengthening social health and social connectedness should not be treated as a secondary or merely cultural intervention. It should be considered a central component of any comprehensive strategy to reduce psychosocial tensions in Tehran.
Discussion
The findings indicate that psychosocial tensions in Tehran cannot be adequately understood through a purely individual or clinical lens. The dominance of economic insecurity, concern about the future, housing costs, and job insecurity points to a form of socially produced stress. This form of stress reflects the interaction between structural pressures and limited coping resources. It emerges when citizens experience daily life as unstable, unpredictable, and insufficiently protected by social and institutional mechanisms.
Lazarus and Folkman’s cognitive appraisal model provides a useful framework for understanding how such conditions become stressful for individuals and families. According to this model, stress occurs when individuals appraise environmental demands as exceeding their available coping resources. In Tehran, factors such as inflation, housing pressure, insecure employment, and uncertainty about the future are not merely external events; they are conditions that affect people’s sense of control, planning capacity, and perceived ability to manage life. When these pressures are chronic, repetitive, and largely outside individual control, they can gradually exhaust psychological and social coping resources.
Agnew’s General Strain Theory offers a complementary explanation at the social level. This theory emphasizes that chronic strain, failure to achieve valued goals, loss of positive resources, and exposure to negative conditions can generate emotional distress and behavioral consequences. In the context of Tehran, economic instability, difficulty in securing housing, concern about future employment, and reduced feelings of social safety can be understood as forms of general strain that affect a broad urban population. From this perspective, stress is not simply the result of weak individual adaptation; it is the outcome of accumulated structural pressures and insufficient social protection.
Together, these two theoretical perspectives show that psychosocial tensions in Tehran are produced through the interaction of two main mechanisms: the intensification of social, economic, and environmental pressures, and the insufficiency of individual, familial, community, and institutional coping resources. Therefore, an effective policy response must work at both levels. It must reduce the pressures that produce stress and strengthen the resources that enable people and communities to cope with unavoidable pressures.
Policy Implications
The findings have several important implications for public policy. First, mental health services should be integrated with social and welfare services. Since the main sources of stress are closely connected to economic insecurity, housing pressure, employment uncertainty, and weakened social support, psychological and psychiatric services alone cannot adequately address the problem. Community health centers, municipal social service centers, welfare organizations, non-governmental organizations, and social work services should be connected through an integrated referral and follow-up system. In high-stress urban areas, citizens should have access to a combined package of services including stress and anxiety screening, brief counseling, social work assessment, referral to economic and family support, and follow-up for vulnerable groups.
Second, reducing future-related concerns and economic uncertainty should be recognized as a core function of social policy. Welfare and social protection policies should not be considered only as responses to harm after it occurs. They should also be understood as preventive mechanisms that reduce psychosocial stress by increasing stability, security, and predictability in people’s lives. Targeted support for low-income households, vulnerable tenants, unemployed youth, workers in unstable jobs, female-headed households, and families facing both economic pressure and weak social support can help prevent the transformation of socioeconomic hardship into severe mental health and social problems.
Third, community-based interventions should be expanded to strengthen social health. Programs aimed at reducing psychosocial tension should not focus only on individuals and families; they should also operate at the neighborhood and community levels. Local community centers, self-help groups, peer support networks, volunteer initiatives, neighborhood-based social activities, and social referral systems can help reduce isolation, increase trust, strengthen resilience, and improve access to informal and formal support. These interventions are especially important in large cities where social fragmentation and weak local ties can intensify the effects of economic and environmental stressors.
Fourth, urban environments should be addressed as determinants of psychosocial health. Air pollution, traffic congestion, crowding, limited access to green and public spaces, spatial inequality, and perceived urban insecurity can all increase everyday stress and reduce citizens’ coping capacity. Urban planning should therefore be connected to mental health and social welfare objectives. Identifying high-stress urban areas, expanding accessible green and public spaces, reducing environmental stressors, improving local safety, and linking urban development indicators with psychosocial health indicators are important components of a stress-reducing urban policy.
Finally, Tehran needs a data-driven monitoring system for psychosocial tensions. Regular monitoring can help identify high-risk areas, vulnerable groups, and changing patterns of stressors over time. Such a system could combine periodic population surveys, data from health and social service centers, neighborhood-level indicators, and municipal reporting systems. Data-driven monitoring would allow policy-makers to move from general and reactive responses toward targeted, evidence-informed, and evaluable interventions. It would also make it possible to assess whether stress-reducing policies are effective in improving psychosocial health at the population level.
The evidence from Tehran shows that psychosocial tension is widespread, persistent, and strongly linked to structural conditions of urban life. The most important sources of stress are not merely personal or clinical, but are rooted in economic uncertainty, concern about the future, housing costs, employment insecurity, and insufficient social support. The high prevalence of exposure to severe stressors and the considerable prevalence of generalized anxiety disorder symptoms indicate that psychosocial tension has become a major public health and social welfare concern in the city.
The main policy message is that psychosocial tensions in Tehran require a shift from an individual-oriented approach to an integrated social and structural approach. Mental health services remain necessary, but they are not sufficient. Effective policy must simultaneously reduce the social and economic pressures that generate stress and strengthen the coping resources of individuals, families, neighborhoods, and institutions. Therefore, a comprehensive response should be preventive, intersectoral, community-based, and stress-reducing.
In this framework, public policy should be evaluated not only by economic or administrative indicators, but also by its ability to create social safety, reduce uncertainty, improve life predictability, and prevent the conversion of structural insecurity into anxiety, distress, and psychosocial exhaustion. Psychosocial health should thus be recognized as a shared responsibility across mental health systems, social welfare institutions, urban governance, housing policy, employment policy, and social protection mechanisms. Managing psychosocial tensions in Tehran is not only a matter of treating stress; it is a matter of creating a more secure, predictable, supportive, and mentally healthy urban society.
Ethical Consideration
Compliance With Ethical Guidelines
This research was conducted in accordance with ethical principles for human studies and was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1402.039). All participants provided informed consent voluntarily, and the confidentiality of their information was guaranteed.
Authors’ contributions
Fardin Alipour: study design, methodology, data analysis, writing of the manuscript.
Ahmad Ali Noorbala: critical revision of content, scientific consultation.
Fahime Shabanpour: supervision of data collection, drafting of the initial manuscript, editing.
Funding
This research was funded by the University of Social Welfare and Rehabilitation Sciences. The funding source had no role in the study design, data collection, analysis, interpretation of data, or writing of the manuscript.
Conflicts of interest
The authors declare no conflicts of interest.
Introduction
Psychosocial tensions in large metropolitan areas have increasingly become a critical public health and social policy issue. Although stress is often understood as an individual psychological reaction, its intensity, persistence, and distribution across populations reveal a broader social and structural dimension. In megacities, everyday stress is not produced only by personal vulnerabilities or clinical conditions; rather, it is deeply embedded in economic uncertainty, insecure employment, housing pressure, weakened social support, environmental burdens, and the declining predictability of everyday life. When these pressures affect a large proportion of citizens and continue over time, psychosocial stress should be regarded not merely as an individual experience but as an indicator of social insecurity and structural strain.
This policy brief focuses on psychosocial tensions among adult residents of Tehran, one of the largest and most complex metropolitan settings in the Middle East. Tehran is characterized by rapid urbanization, socioeconomic heterogeneity, traffic congestion, air pollution, high living costs, housing instability, labor market insecurity, and unequal access to social and welfare resources. These conditions create a dense environment of chronic stressors that can influence both mental health and social well-being. In such a context, psychosocial tension becomes a key point of connection between public mental health, social welfare, social protection, urban governance, and broader socioeconomic policy.
The central argument of this article is that psychosocial tensions in Tehran should be reframed as a social and policy problem rather than being reduced to individual maladjustment or clinical disorder. This reframing is essential because the main sources of stress identified among citizens are largely rooted in social and structural conditions, including concern about the future, economic instability, housing costs, and job insecurity. Therefore, effective responses cannot be limited to individual counseling, psychological education, or treatment services alone. Instead, they require an integrated, intersectoral, preventive, and stress-reducing approach that addresses both the social production of stress and the resources available to individuals, families, and communities for coping with it.
Method
This policy brief is based on evidence 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 study was designed to assess the experience of severe stressful life events and their psychosocial consequences among adult citizens. A multistage cluster sampling method proportionate to population size was used to select participants from different areas of the city. The experience of severe stressors was measured using a standardized questionnaire on stressful life events that covered a broad range of economic, social, familial, cultural, health-related, and future-oriented stressors.
The evidence used in this policy brief also draws on published findings from the same survey, including analyses of psychosocial stressors and symptoms of generalized anxiety disorder among Tehran residents. These findings were interpreted in light of national and international literature on social determinants of mental health, stress and health, urban stress, social support, and population-based mental health policy. The theoretical interpretation was informed particularly by Lazarus and Folkman’s cognitive appraisal model of stress and Agnew’s General Strain Theory. These frameworks help explain how chronic social and environmental pressures become psychologically meaningful and how persistent structural strain may generate emotional, behavioral, and mental health consequences.
Given the cross-sectional design of the study, the findings should not be interpreted as evidence of direct causality. However, they provide important population-level evidence on the scope, distribution, and nature of psychosocial tensions in Tehran. The results are especially valuable for policy-making because they identify not only the prevalence of stress exposure, but also the dominant types of stressors and their implications for public mental health, social welfare, and preventive intervention.
Findings
The findings show that psychosocial tension is widespread among adult residents of Tehran. A very large proportion of participants reported exposure to at least one severe stressor during the previous year. Specifically, 92.3% of citizens had experienced at least one severe stressful event or condition in the past year. In addition, 25.9% of participants showed symptoms consistent with generalized anxiety disorder. Participants reported that, on average, they had spent approximately 8.5 months of the previous year under the influence of severe stress. These figures indicate that stress in Tehran is not an occasional or isolated experience for a small group of citizens; rather, it is a broad and persistent feature of urban life.
One of the most important findings is the dominance of economic and future-oriented stressors. The most frequently reported sources of tension included concern about the personal and family future, inflation and market instability, concern about financial and economic conditions, high housing costs, and concern about future employment. Concern about the personal and family future was reported by 57.6% of participants, inflation and market instability by 57.1%, concern about financial and economic future by 55%, high housing costs by 43.4%, and concern about future employment by 40.7%. This pattern suggests that psychosocial stress in Tehran is strongly connected to uncertainty about the future and the reduced predictability of daily life.
The findings also show that stress is multidimensional and cumulative. A considerable proportion of participants experienced severe stressors in several domains. Economic stressors were particularly prominent, with 45.6% of participants reporting at least one severe economic stressor. In addition, 32.3% experienced at least one severe family-related stressor, 28.8% experienced at least one severe health-related stressor, and 25.7% experienced at least one severe future-oriented stressor. This multidimensional pattern is important because it suggests that many citizens do not face a single isolated difficulty, but rather a combination of economic, familial, health-related, and future-oriented pressures. Such cumulative exposure can erode individual and family coping resources and increase vulnerability to mental health problems.
Another key finding is the association between psychosocial stressors and symptoms of generalized anxiety disorder. The prevalence of generalized anxiety disorder symptoms among adult residents of Tehran was approximately 26%. This finding highlights the public health significance of psychosocial tensions, showing that social and economic pressures do not remain only at the level of subjective worry or everyday discomfort. Rather, they are associated with observable mental health outcomes at the population level. Individuals with anxiety symptoms were more likely to report stressful life events, poorer health status, lower life satisfaction, and lower socioeconomic status. These findings reinforce the need to understand anxiety and stress not only as clinical issues, but also as outcomes of broader social and economic conditions.
The study also points to the protective role of social interaction and social support. Higher levels of social interaction were associated with a lower likelihood of experiencing psychosocial stress. This finding is highly relevant for policy because it suggests that social ties, community participation, neighborhood-based support, and local networks may buffer the effects of chronic social and economic pressures. In other words, strengthening social health and social connectedness should not be treated as a secondary or merely cultural intervention. It should be considered a central component of any comprehensive strategy to reduce psychosocial tensions in Tehran.
Discussion
The findings indicate that psychosocial tensions in Tehran cannot be adequately understood through a purely individual or clinical lens. The dominance of economic insecurity, concern about the future, housing costs, and job insecurity points to a form of socially produced stress. This form of stress reflects the interaction between structural pressures and limited coping resources. It emerges when citizens experience daily life as unstable, unpredictable, and insufficiently protected by social and institutional mechanisms.
Lazarus and Folkman’s cognitive appraisal model provides a useful framework for understanding how such conditions become stressful for individuals and families. According to this model, stress occurs when individuals appraise environmental demands as exceeding their available coping resources. In Tehran, factors such as inflation, housing pressure, insecure employment, and uncertainty about the future are not merely external events; they are conditions that affect people’s sense of control, planning capacity, and perceived ability to manage life. When these pressures are chronic, repetitive, and largely outside individual control, they can gradually exhaust psychological and social coping resources.
Agnew’s General Strain Theory offers a complementary explanation at the social level. This theory emphasizes that chronic strain, failure to achieve valued goals, loss of positive resources, and exposure to negative conditions can generate emotional distress and behavioral consequences. In the context of Tehran, economic instability, difficulty in securing housing, concern about future employment, and reduced feelings of social safety can be understood as forms of general strain that affect a broad urban population. From this perspective, stress is not simply the result of weak individual adaptation; it is the outcome of accumulated structural pressures and insufficient social protection.
Together, these two theoretical perspectives show that psychosocial tensions in Tehran are produced through the interaction of two main mechanisms: the intensification of social, economic, and environmental pressures, and the insufficiency of individual, familial, community, and institutional coping resources. Therefore, an effective policy response must work at both levels. It must reduce the pressures that produce stress and strengthen the resources that enable people and communities to cope with unavoidable pressures.
Policy Implications
The findings have several important implications for public policy. First, mental health services should be integrated with social and welfare services. Since the main sources of stress are closely connected to economic insecurity, housing pressure, employment uncertainty, and weakened social support, psychological and psychiatric services alone cannot adequately address the problem. Community health centers, municipal social service centers, welfare organizations, non-governmental organizations, and social work services should be connected through an integrated referral and follow-up system. In high-stress urban areas, citizens should have access to a combined package of services including stress and anxiety screening, brief counseling, social work assessment, referral to economic and family support, and follow-up for vulnerable groups.
Second, reducing future-related concerns and economic uncertainty should be recognized as a core function of social policy. Welfare and social protection policies should not be considered only as responses to harm after it occurs. They should also be understood as preventive mechanisms that reduce psychosocial stress by increasing stability, security, and predictability in people’s lives. Targeted support for low-income households, vulnerable tenants, unemployed youth, workers in unstable jobs, female-headed households, and families facing both economic pressure and weak social support can help prevent the transformation of socioeconomic hardship into severe mental health and social problems.
Third, community-based interventions should be expanded to strengthen social health. Programs aimed at reducing psychosocial tension should not focus only on individuals and families; they should also operate at the neighborhood and community levels. Local community centers, self-help groups, peer support networks, volunteer initiatives, neighborhood-based social activities, and social referral systems can help reduce isolation, increase trust, strengthen resilience, and improve access to informal and formal support. These interventions are especially important in large cities where social fragmentation and weak local ties can intensify the effects of economic and environmental stressors.
Fourth, urban environments should be addressed as determinants of psychosocial health. Air pollution, traffic congestion, crowding, limited access to green and public spaces, spatial inequality, and perceived urban insecurity can all increase everyday stress and reduce citizens’ coping capacity. Urban planning should therefore be connected to mental health and social welfare objectives. Identifying high-stress urban areas, expanding accessible green and public spaces, reducing environmental stressors, improving local safety, and linking urban development indicators with psychosocial health indicators are important components of a stress-reducing urban policy.
Finally, Tehran needs a data-driven monitoring system for psychosocial tensions. Regular monitoring can help identify high-risk areas, vulnerable groups, and changing patterns of stressors over time. Such a system could combine periodic population surveys, data from health and social service centers, neighborhood-level indicators, and municipal reporting systems. Data-driven monitoring would allow policy-makers to move from general and reactive responses toward targeted, evidence-informed, and evaluable interventions. It would also make it possible to assess whether stress-reducing policies are effective in improving psychosocial health at the population level.
The evidence from Tehran shows that psychosocial tension is widespread, persistent, and strongly linked to structural conditions of urban life. The most important sources of stress are not merely personal or clinical, but are rooted in economic uncertainty, concern about the future, housing costs, employment insecurity, and insufficient social support. The high prevalence of exposure to severe stressors and the considerable prevalence of generalized anxiety disorder symptoms indicate that psychosocial tension has become a major public health and social welfare concern in the city.
The main policy message is that psychosocial tensions in Tehran require a shift from an individual-oriented approach to an integrated social and structural approach. Mental health services remain necessary, but they are not sufficient. Effective policy must simultaneously reduce the social and economic pressures that generate stress and strengthen the coping resources of individuals, families, neighborhoods, and institutions. Therefore, a comprehensive response should be preventive, intersectoral, community-based, and stress-reducing.
In this framework, public policy should be evaluated not only by economic or administrative indicators, but also by its ability to create social safety, reduce uncertainty, improve life predictability, and prevent the conversion of structural insecurity into anxiety, distress, and psychosocial exhaustion. Psychosocial health should thus be recognized as a shared responsibility across mental health systems, social welfare institutions, urban governance, housing policy, employment policy, and social protection mechanisms. Managing psychosocial tensions in Tehran is not only a matter of treating stress; it is a matter of creating a more secure, predictable, supportive, and mentally healthy urban society.
Ethical Consideration
Compliance With Ethical Guidelines
This research was conducted in accordance with ethical principles for human studies and was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1402.039). All participants provided informed consent voluntarily, and the confidentiality of their information was guaranteed.
Authors’ contributions
Fardin Alipour: study design, methodology, data analysis, writing of the manuscript.
Ahmad Ali Noorbala: critical revision of content, scientific consultation.
Fahime Shabanpour: supervision of data collection, drafting of the initial manuscript, editing.
Funding
This research was funded by the University of Social Welfare and Rehabilitation Sciences. The funding source had no role in the study design, data collection, analysis, interpretation of data, or writing of the manuscript.
Conflicts of interest
The authors declare no conflicts of interest.
Type of Study: orginal |
Received: 2025/08/19 | Accepted: 2026/05/5 | Published: 2026/05/31
Received: 2025/08/19 | Accepted: 2026/05/5 | Published: 2026/05/31
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