Introduction
According to the World Health Organization (WHO), mental health is more than the absence of mental disorders. It also denotes positive mental health. Based on this view, people with mental disorders may experience different degrees of positive mental health. Various studies have shown that promoting positive mental health can reduce the prevalence, incidence and burden of mental disorders. The social determinants of health (SDH) play important roles in different aspects of health such as mental health or positive mental health. According to the WHO, the SDH include structural and intermediary factors. Education, employment, gender are examples of structural determinants and psychosocial, behavioral and biological factors are among intermediary determinants. Identifying the SDH of positive mental health is necessary to implement interventions for promoting mental health in society. Therefore, the present study aims to identify the SDH of positive mental health in Iranian adults.

Methods 
This is a quantitative and correlational study that was conducted on adults aged 30-60 in Tehran, Iran. The sampling method was a multi-stage sampling method including stratified random sampling, cluster sampling, and simple random sampling techniques. The sample size was estimated to be 547 using G*Power software, considering the effect size of 0.12, α=0.05, and P=0.80. To design the conceptual model of the SDH of positive mental health, we first reviewed the literature. Then, by holding a meeting with experts in mental health and SDH as well as people, a list of the SDH of positive mental health was extracted and the conceptual model of the study was plotted (Figure 1). Based on this conceptual model, the structural equation modeling (SEM) was conducted. The data collection tools included the mental health continuum–short form (MHC–SF), the socioeconomic status questionnaire, multidimensional scale of perceived social support,  perceived stress scale-10 items, International physical activity questionnaire- short form, Neissi’s job security questionnaire, Ten Horn’s job security questionnaire, visual analogue scale for occupational stress assessment, the neighborhood status checklist, Internet use checklist, and social security insurance checklist. These questionnaires included 117 items that were completed by a self-report method. The collected data were analyzed using SPSS software, vesion 21 and LISREL vesion 8.8. The significant level was set at 0.05. 

Results
The data of 607 questionnaires were analyzed in this study. Participants were 308 women (50.7%) and 299 men (49.3%) with mean age of 44.04±9.4 years. The mean total score of MHC–SF (positive mental health) was 45.96±8.65. Regarding its domains of emotional, social, and psychological well-being, the scores were 9.8±2.54, 14.22±3.41, and 21.93±4.4, respectively. For conducting SEM, the variables with a significance level (P≥0.2 were entered into the model. The social class (B=0.181), perceived socio-economic status (B=0.114), job position (B=0.08), building volume per capita (B=0.092) and education (B=-0.071) had indirect effect on positive mental health. Perceived stress (B=-0.62), job satisfaction (B=0.16), social support (B=0.23) and insurance (B=0.14) had direct effect on positive mental health. In general, all variables positively explained about 53% of mental health changes (Table 1 and Figure 2).




Conclusion
The structural model of the SDH indicated that perceived stress was the most important intermediary determinant of positive mental health in Iranian adults, which transfers the effect of structural determinants on the positive mental health. Perceived stress had the most direct and negative impact on positive mental health, while social support, job satisfaction and insurance had the most positive and direct effects on positive mental health. Therefore, planning for the implementation of interventions to optimally manage stress of Iranian adults and teaching them how to use adaptive mechanisms to deal with it along with increasing social support for them, strengthening their family foundation, and improving their working conditions and insurance coverage can be effective in improving the positive mental health of Iranian adults.

Ethical Considera tions
Compliance with ethical guidelines
All ethical considerations were considered in this study. The study was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Code: IR.USWR.REC.1396.204).

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
Conceptualization: Monir Baradaran Eftekhari and  Arash Mirabzadeh; Methodology: Monir Baradaran Eftekhari and Katayoun Falahat; Data gathering: Katayoun Falahat; Writing: Monir Baradaran Eftekhari.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank all participants for their cooperation in this study.

 

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