Where the Hope Runs Out
The Payam Foundation report, drawing on 6,412 adult responses to a 13-question depression screening on the Beporsim platform between 2017 and 2020, finds that everyday tasks are the most common struggle and that thoughts of self-harm climb steeply as hope fades.
Getting started is the hardest part, and the darkest answers begin where hope ends
Between January 2017 and December 2020, Iran went through a run of shocks. Protests began on 28 December 2017. In May 2018 the United States left the nuclear deal; the dollar, which traded at about 64,500 rials the day before, sold for as much as 315,000 by October 2020, and inflation passed 40% in 2019. In November 2019 protests over fuel prices were followed by a near-total internet shutdown that lasted close to a week. In January 2020 Iran's military shot down flight PS752 shortly after take-off from Tehran, killing all 176 people aboard, and admitted it three days later. The first COVID-19 cases were confirmed six weeks after that.
How people felt through those years is harder to see in the data. The Iranian Mental Health Survey, the best-known national benchmark, interviewed households in 2011 and found that 12.7% of people aged 15 to 64 had met the criteria for major depression in the previous year. It predates every event above.
This article draws on a different source: 6,412 adults who took a free 13-question depression screening on the Beporsim platform between January 2017 and December 2020. It describes people who chose to take a mental health test and does not represent Iran. Seventy-three percent are men, 85% are under 35, and a third describe themselves as unemployed. The data can compare groups inside the sample and show which symptoms go together. That is the starting point of "Where the Hope Runs Out," a Payam Foundation report.
Close to half need a closer look
Of the 6,412 adults, 45.2% scored 8 or more on the 0 to 39 scale, the moderate range or above in Beck's bands, and 22.6% scored 16 or more, the severe range. A high score is not a diagnosis. It means a person described symptoms that would usually call for a closer look by a professional.
These figures run higher than household surveys, as expected. A free test about depression draws people who already wonder about their mood. Household surveys in Turkey and Iraq found 4% to 6% on their own scales, while a voluntary online survey in Turkey found 57.6%. Method changes the figure more than country does.
Share above each survey's own threshold, or with a diagnosis in interview surveys. Instruments, time frames and samples differ, so the figures are not directly comparable.
The hardest part is getting started
Asked what they struggled with, adults named everyday tasks first. Starting any task takes extra effort for 54%, 52% have pulled back from other people and 52% tire more easily than before. Sadness and indecision follow at about 50% each.
Two families of symptoms sit inside the same score: how people see themselves and their future, and what is happening to their body and their day. Among the 2,827 adults at the moderate level or above, clustering the answers found four patterns with similar total scores: one dominated by hopelessness, one by worry about appearance, one by exhaustion, and a fourth, 22% of the group, that reports thoughts of self-harm alongside guilt and withdrawal and has the highest average score, 21.2.
Hope and harm travel together
Of the 13 questions, the one about the future says the most about thoughts of self-harm. Among adults with no pessimism, 8% reported some thought of self-harm. Among those discouraged about the future it was 38%, and among those who said they had no hope, 66%. The link holds after accounting for sadness, sex and age: the odds are about eight times higher for people with no hope than for people with no pessimism.
Overall, 24% of adults reported some thought of self-harm, and 12% chose one of the two most serious statements, a definite plan or saying they would act if they could. In the severe range 79% report such thoughts, but those adults make up 73% of everyone who does, which leaves more than a quarter outside it.
The question covers thoughts, not actions, and cannot measure the risk of suicide. It does show where distress runs deepest: 28% of 18 to 24 year olds, 27% of single adults against 19% of married adults, and 30% of unemployed adults against 16% of public-sector employees.
If you are struggling, help is available. In Iran, the social emergency line 123 answers 24 hours a day. The counselling line 1480 is open from 8:00 to 24:00, and the Ministry of Health line 4030 also offers free psychological counselling. Talking to someone you trust is a good first step.
When pessimism is about the country
One answer breaks the pattern. On every other question, people who choose a more severe statement also score higher on the rest of the questionnaire. At the top of the question about the future, the line turns down. Of the 925 adults (14%) who chose "the future is hopeless and things will not get better," 59% reported thoughts of self-harm, fewer than the 66% who chose "no hope for the future," and 18% said they were not sad at all, against 11% of those who chose the milder statement.
The likeliest reading is that some respondents heard "things will not get better" as a verdict on the country rather than on their own lives. That is an interpretation the data cannot confirm. It does mean the item needs care when scores are compared across groups or over time.
Education and employment, more than age or sex
Women and men score about the same, 8.9 on average for women and 9.4 for men, and 21% of women and 23% of men are in the severe range, a gap that is not statistically clear. The symptoms differ: women report more fatigue (56% against 50%), men more pessimism, guilt and loss of appetite.
The widest gaps follow education and work. Among adults over 25, 32% of those without a high-school diploma are in the severe range, against 17% of bachelor's graduates and 14% of doctorate holders. Unemployed adults (29%) and labourers (28%) are highest, managers (13%) lowest. The 2011 national survey found the same direction: more disorders among the unemployed, fewer among university graduates. This questionnaire did not ask about income, so it cannot say whether low income, insecure work or lost status does the damage.
With everything counted at once, three things stay clear: not finishing high school (2.5 times the odds of a bachelor's graduate), being single or divorced (1.5 and 2.0 times the odds of married adults) and being unemployed (1.5 times the odds of public-sector employees). Together they predict a severe score only modestly better than chance. In this sample, distress is spread across every group.
Where and when
Averages vary little from place to place. Sistan and Baluchestan (11.1) and Mazandaran (7.3) are the only two of 31 provinces that clearly differ from the sample average of 9.2, and seven provinces have fewer than 70 respondents.
Province data table
| Province | Value |
|---|
Average score on the 0 to 39 scale. Seven provinces have fewer than 70 adults, so their averages are less precise.
2017-2020
Over time the average rises and falls without a trend. Scores were higher in the 60 days after the December 2017 protests, the November 2019 protests and the first COVID-19 cases than in the 60 days before them, and lower after the US left the nuclear deal, but none of the five shifts is statistically clear once all five are tested together. The clearest mark of events is a gap: from 17 to 25 November 2019, during the internet shutdown, nobody completed the questionnaire, after about two responses a day in October.
One more clue sits in the timestamps. Adults who answered between 2 and 7 am scored 10.4 on average, against 9.1 for those who answered between 9 am and 9 pm, a gap of 1.2 points after accounting for age, sex and work. The questionnaire has no question about sleep, and being awake at 4 am is not a diagnosis.
Teenagers
The 1,550 respondents aged 12 to 17 are reported separately. Their average score, 9.8, is close to the adults', but 51% report guilt against 44% of adults, and 31% report some thought of self-harm against 24%. Eighty-six percent are boys, and with only 217 girls the two groups cannot be compared with confidence. These are young people who chose to take a mental health test on their phone, so they should not be read as Iran's teenagers in general. That nearly one in three reported thoughts of self-harm still calls for attention from schools and families.
For school students in Iran, the Ministry of Education counselling line 1570 is open from 8:00 to 20:00. The social emergency line 123 answers 24 hours a day.
Read the full report
This article covers the main findings. The full report, "Where the Hope Runs Out," adds:
- Results for all 31 provinces with margins of error.
- Breakdowns by age, sex, education and work.
- The four symptom patterns in detail and how the groups were formed.
- Comparisons with surveys in Iran and neighbouring countries.
- The full methodology and limitations.
The full report is available to download. Payam Foundation publishes it under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 license (CC BY-NC-SA 4.0).
How it was done
Methodology
The report is based on 6,412 questionnaires completed by adults on the Beporsim platform between 5 January 2017 and 29 December 2020. A further 1,550 questionnaires from respondents aged 12 to 17 are reported separately.
Sample and exclusions
The sampling frame was the 140,000 users of the Beporsim platform, who can use one account through the app or the website from anywhere in Iran. The questionnaire remained open on the platform from 5 January 2017 to 23 July 2021, and users chose whether to complete it, forming a self-selected, non-probability sample. It was offered as a test of mental health and depression on a platform that rewards answers with points. It received 9,294 responses, a participation rate of 6.6% of platform users. Because users were not individually sampled and invited, this is not a response rate. Of these responses, 14 were incomplete, 9 were recorded in 2021, 1,204 came from accounts with no age on record and 105 carried a birth date that would make the respondent younger than 12. Of the remaining 7,962 respondents, 6,412 were adults and 1,550 were aged 12 to 17; the latter were analysed separately. Among the adults, 73.1% are men, 85.1% are under 35, 61.2% have some university education, 27.0% live in Tehran or Alborz and 33.5% describe themselves as unemployed.
Because the sample was not drawn at random, we assessed its adequacy by the precision of key estimates rather than by a sample-size calculation. Among adults, the 95% confidence interval was ±1.2 percentage points for the share scoring 8 or more (45.2%) and ±1.0 for the share scoring 16 or more (22.6%). Precision was lower in smaller subgroups: for provincial average scores, the interval ranged from ±0.5 points in Tehran (n = 1,474) to ±2.8 points in North Khorasan (n = 57). These intervals assume simple random sampling within each group and reflect sampling error only. They do not capture self-selection bias and are therefore a lower bound on total error. Results describe the respondents and comparisons between groups within the sample, and do not provide prevalence estimates for Beporsim users or Iran’s population. The study is reported in accordance with the CHERRIES (Eysenbach, 2004) and STROBE guidelines.
Instrument and scoring
The questionnaire is the 13-item short form of the Beck Depression Inventory (Beck and Beck, 1972), in a Persian version. Each item has four statements scored 0 to 3, giving a total from 0 to 39. The report uses Beck's bands: 0 to 4 minimal, 5 to 7 mild, 8 to 15 moderate and 16 to 39 severe. Persian-language norms (Dadsetan and Mansour, 1990) divide the range differently, but the severe band is the same. Internal consistency is high (Cronbach's alpha 0.93, or 0.90 without people who gave the same answer to every item).
Weighting and statistical checks
Headline figures are shown as collected and rebalanced so that men and women count equally; the two versions are close (45.2% and 45.1% in the moderate range or above). No other weighting was applied. Differences between groups were tested with chi-square tests, and differences between men and women on single items with Mann-Whitney tests, with a Benjamini-Hochberg correction. Confidence intervals assume simple random sampling within each group. The adjusted model is a logistic regression on 6,363 adults with complete data. The four symptom patterns come from k-means clustering of the 2,827 adults at or above the moderate band, after removing each person's own average so that groups differ in pattern rather than in total score; the 74 adults who chose the most severe answer on every item were left out of that step. Quarterly averages are standardised to the age and sex mix of the whole sample, and event windows compare the 60 days before and after each date, corrected for five tests.
What this survey can't tell you
The survey describes people who chose to answer a mental health questionnaire and does not estimate depression across Iran. A high score points to symptoms worth a closer look and is not a diagnosis. The most severe statement was always listed first, and 74 adults chose it on every question; setting them aside lowers the severe share from 22.6% to 21.7%. The self-harm question asks about thoughts, not acts, and cannot measure the risk of suicide. Each person answered once, so the survey cannot show how anyone's mood changed or why. Nearly half the responses arrived in 2017 and relatively few in 2020, so estimates for later periods are less precise. It supports comparisons between groups, a view of which symptoms go together and a picture of where distress is concentrated.
Stay in the conversation
If you see a chance to collaborate, have a question about the method, or want to reuse this work, write to us.