Population Well-Being in Mashhad: Mental Health Distribution and Demographic Gradients

Objective: Positive mental health is a distinct dimension of population health. Despite the validation of the Persian Mental Health Continuum-Short Form (MHC-SF), population-based estimates for adult municipal surveillance in Iran are limited. To describe MHC-SF score distributions, internal consistency, and demographic gradients among adults in Mashhad. Method : A population-based cross-sectional survey (May 2024-March 2025) used stratified cluster sampling across five health districts (50 clusters; Kish-grid household selection). Adults aged ≥ 18 years completed the 14-item Persian MHC-SF indexing emotional well-being (EWB), social well-being (SWB), and psychological well-being (PWB). Results: Among 2,066 adults (57.6% women), the overall mean (SD; median) MHC-SF score was 61.55 (13.21; 63), with domain scores of 28.99 (6.19; 30) for PWB, 19.01 (5.63; 19) for SWB, and 13.54 (4.11; 14) for EWB. Men scored slightly higher than women on the total scale, EWB, and PWB (all P < 0.001; small effect sizes), while the SWB difference was not statistically significant (p = 0.075). Age showed weak positive associations with total, EWB, and SWB scores (ρ = 0.060-0.069; P ≤ 0.006), but not PWB (ρ = 0.018; P = 0.408). Item-level contrasts suggested higher male endorsement of agency/meaning indicators and higher female endorsement of benevolence/collective optimism; both sexes reported high levels of warm, trusting relationships. In a multivariable linear regression adjusting for age and sex simultaneously, demographic predictors accounted for < 1% of outcome variance, with male sex independently associated with higher total, EWB, and PWB scores, and age independently associated with slightly higher total, EWB, and SWB scores. Conclusion: In this representative urban population-based study, positive mental health was moderately high; PWB ranked highest, while SWB lagged. Demographic gradients were small: men slightly exceeded women, and older adults reported marginally higher EWB and SWB. For surveillance, the MHC-SF total score appears suitable as a summary indicator, while the SWB profile may help identify community-level levers (e.g., social capital and trust) to strengthen social connectedness in Mashhad, Iran.