Helen Lazaratou

Sleep problems in adolescence. A study of senior high school students in Greece.

ObjectivesThe aim of this study was to evaluate sleep habits and sleep-related problems in high school adolescent students in Greece through the Athens Insomnia Scale and to assess the relation of these problems to demographic and other variables.MethodsThe Athens Insomnia Scale 5-item version (AIS-5) was administered to 713 adolescent senior high school students in the Greater Athens Area. Data such as age, sex, school records, and time spent per week in school-related and extracurricular activities were collected.ResultsThe sample’s mean sleep duration was 7.5 h, mean bedtime 00.20 a.m. and wake-up time 7.15 a.m. Total sleep time was not affected by gender, but was influenced by time spent in various activities. Sleep complaints were related to delayed sleep, onset latency and insufficient total duration of sleep. Of the respondents, 30% estimated that their sleep onset latency was markedly delayed and 30% reported that their total sleep time was markedly insufficient. Girls complained more than boys, while correlations showed that students with lower academic performance and those in second grade were more likely to have higher AIS-5 scores.ConclusionsThe results show that the sleep time of high school students is dependent on practical matters such as school schedule and other activities, while sleep complaints are related to female gender, bad school performance as well as to the second grade. The difference between actual sleep time and sleep complaints should be considered when studying the sleep of adolescents.

The psychological impact of a catastrophic earthquake: a retrospective study 50 years after the event

Aim of the present study was to retrospectively assess the impact of a catastrophic earthquake in a sample of 121 survivors, 50 years after the event. Mean age ± SD of the responders was 72.2 ± 6.1 years. The majority of the victims (78%) acknowledged a strong overall impact of the earthquake on their lives, and almost all of them had intense recollection of the event at its anniversary. The most frequent symptom during the 6 months after the earthquake was persistent remembering or “reliving” of the event; women had considerably more often recurrent dreams of the earthquake and distress than did men. Women and young adults at the time of the earthquake appear to be the most vulnerable groups regarding the psychological effects of the event.

Medical comorbidity of sleep disorders in children and adolescents.

Purpose of review Sleep disorders in children and adolescents often present with various medical comorbidities. The aim of this review is to present the recent literature findings on this issue. Recent findings The major medical comorbid conditions that accompany insomnia or short sleep duration in children and adolescents are obesity and metabolic syndrome, growth hormone deficiency, allergic conditions, various disorders accompanied by chronic pain, neoplasms and blood malignancies, and genetic and congenital disorders. Hypersomnia is mainly related to malignancies. Children and adolescents with obstructive sleep apnoea syndrome or sleep-disordered breathing may suffer from obesity and metabolic syndrome, polycystic ovaries, hypothyroidism, asthma, epilepsy, various ear nose throat disorders, congenital malformations or genetic conditions. Parasomnias may be comorbid with some medical conditions, but the main challenge in their evaluation is the differential diagnosis from nocturnal epileptic seizures. Summary The co-occurrence of sleep disorders and medical conditions in childhood and adolescence is quite frequent and has an impact on general health and quality of life.

Psychopathology and mental health service utilization by immigrants' children and their families.

To investigate the psychopathology of immigrants’ children and psychiatric service utilization by the immigrant families, data were collected from the files of all 35 immigrant children seen over a 3-year period at the Community Mental Health Centre of the Athens University Psychiatric Department. Immigrant children were matched by age, gender and intake date with 70 Greek children. Data concerned information about the child’s place of birth, current living conditions, parents’ country of origin, social and economic situation, occupations and educational status, social insurance, psychiatric history, referral source, diagnostic and therapeutic services rendered, number of sessions and outcome. Utilization of services was assessed 6 months after intake. No significant differences were found regarding family’s structure and parents’ psychopathology. However, immigrant families had significantly worse economic situations, lower status jobs, worse housing and were usually uninsured. No significant differences were observed regarding service utilization parameters, except concerning ‘cooperation with other services’. No differences were found regarding frequency or type of psychiatric diagnosis. However, 91% of the immigrant group received a psychosocial diagnosis as opposed to 49% of the Greek group. Immigrant children did not present more serious or diverse psycho-pathology than did Greek children. Immigrant families had equal levels of service utilization as Greek families. However, it was apparent that immigrant families did not apply for help as readily as their Greek counterparts.

Treatment compliance and early termination of therapy: a comparative study.

Background: Compliance in therapy appears to be linked to the process of therapeutic alliance. A positive patient–therapist relationship usually leads to successful completion of therapy. The aim of this study was to compare evidence, collected at two time periods in a Community Mental Health Center in Athens, on factors affecting treatment compliance. The hypothesis was that by modifying the therapeutic team’s functioning, noncompliance could be reduced. Methods: Epidemiological data were collected from child and adolescent out-patient files at two time periods: time period A, 1990–1994, n = 455 (sample A) and time period B, 2000–2002, n = 476 (sample B). Variables pertaining to the patient, his family and recommended treatment were examined. Student’s t test and the Pearson χ2 test were used in order to explore the correlation of the variables with treatment completion in each sample. Logistic regression analyses were used to determine whether the effect of each variable on treatment completion differed between the two samples. Results: In sample A, most patients (58.6%) did not comply with therapy. The type of recommended treatment, the number of sessions, season of admission and the type of presented problem were found to correlate with treatment completion. Between the two time periods, certain modifications were implemented in the team’s functioning (less diagnostic sessions, focused psychotherapy techniques, less time interval between referral and first diagnostic appointment). A significant reduction in the early termination rate (45.7%) was noted in sample B. The type of recommended treatment, the number of sessions, the family’s situation, the mother’s educational level and the patient’s gender were related to treatment completion in sample B. The effect of the type of proposed treatment and the mean number of sessions of the completed treatments differed significantly between the two samples. Conclusions:Early termination rates in therapy decreased between two time periods. This decrease may be attributed to modifications in the team’s functioning, aimed at improving the therapeutic relationship. The limitation of this study is that only those factors pertaining to the service’s organization and functioning were investigated.

Depressive Symptomatology in High School Students: The Role of Age, Gender and Academic Pressure

To clarify the prevalence of depressive symptomatology in high school students in Athens and to evaluate risk factors for depressive symptomatology the CES-D scale was administered to 713 students (age 15–18). Demographic, school performance and extracurricular activities data were collected. A high prevalence (26.2%) of depressive symptomatology (CES-D cut-off score >28) was found. Regression analysis showed depressive symptomatology to be associated to gender (girls had higher scores than boys), school record (students with a better record had lower scores) and the interaction of gender and grade (males were found to have higher depressive symptomatology scores as they grew older).

Factors Affecting Compliance with Treatment in an Outpatient Child Psychiatric Practice: A Retrospective Study in a Community Mental Health Centre in Athens

Background: The literature review shows that treatment compliance in child psychiatric practice is a multifactorial issue that includes parameters such as the type of problem presented by the child, the family’s functioning and the therapeutic team’s organization and functioning. Methods: In order to examine these parameters and their inter-relationship, epidemiological data from the files of 455 cases, representing the total number of cases admitted to our Centre between 1990–1994, were collected. We noted that the majority of patients (58.6%) failed to comply with treatment. Results: The statistical analysis shows that the sex and age of the child, the socio-economic status of the family, the family’s size, the parents’ educational background as well as the referral source are unrelated to compliance. On the contrary, the type of problem presented by the child, the type of recommended treatment, the number of sessions attended and the season of admission are correlated with treatment compliance. Conclusions: Certain aspects of our team’s techniques concerning the admission procedure, therapeutic contract and parental counselling have been re-examined and improved.

Community Violence Exposure and Conduct Problems in Children and Adolescents with Conduct Disorder and Healthy Controls

Exposure to community violence through witnessing or being directly victimized has been associated with conduct problems in a range of studies. However, the relationship between community violence exposure (CVE) and conduct problems has never been studied separately in healthy individuals and individuals with conduct disorder (CD). Therefore, it is not clear whether the association between CVE and conduct problems is due to confounding factors, because those with high conduct problems also tend to live in more violent neighborhoods, i.e., an ecological fallacy. Hence, the aim of the present study was: (1) to investigate whether the association between recent CVE and current conduct problems holds true for healthy controls as well as adolescents with a diagnosis of CD; (2) to examine whether the association is stable in both groups when including effects of aggression subtypes (proactive/reactive aggression), age, gender, site and socioeconomic status (SES); and (3) to test whether proactive or reactive aggression mediate the link between CVE and conduct problems. Data from 1178 children and adolescents (62% female; 44% CD) aged between 9 years and 18 years from seven European countries were analyzed. Conduct problems were assessed using the Kiddie-Schedule of Affective Disorders and Schizophrenia diagnostic interview. Information about CVE and aggression subtypes was obtained using self-report questionnaires (Social and Health Assessment and Reactive-Proactive aggression Questionnaire (RPQ), respectively). The association between witnessing community violence and conduct problems was significant in both groups (adolescents with CD and healthy controls). The association was also stable after examining the mediating effects of aggression subtypes while including moderating effects of age, gender and SES and controlling for effects of site in both groups. There were no clear differences between the groups in the strength of the association between witnessing violence and conduct problems. However, we found evidence for a ceiling effect, i.e., individuals with very high levels of conduct problems could not show a further increase if exposed to CVE and vice versa. Results indicate that there was no evidence for an ecological fallacy being the primary cause of the association, i.e., CVE must be considered a valid risk factor in the etiology of CD.

Adolescent gambling in greater Athens area: a cross-sectional study

PurposeProblem gambling in adolescents has recently emerged as a pressing public health concern. In this context and in light of the pervasive financial crisis in Greece, the present study aimed to explore adolescents’ gambling involvement in Athens region to estimate the prevalence of its problematic form and to identify its risk/protective factors.MethodsA total of 2141 students were recruited from a representative sample of 51 schools located in greater Athens area. The presence of problem gambling was assessed through the use of the DSM-IV-MR-J questionnaire. Data were collected in the form of a self-reported questionnaire during one school hour.ResultsResults indicate that 1-year prevalence of high severity problem gambling was found to be 5.6%. Regarding the risk factors for problem gambling; male gender, parental engagement with gambling activities, living without the parents, low grades at school, foreign nationality and the referent absence of availability of food in the household, increased the risk of suffering from the disorder.ConclusionGambling behavior among adolescents constitutes a problem in Greece and highlights the need for designing and implementing appropriate preventive interventions, especially amid the ongoing financial crisis.

Socioeconomic crisis and aggressive behaviour of Greek adolescents

Background: Aggressive behaviours are common during adolescence. In Greece, adolescents and their families experience a severe and enduring recession with potentially adverse impact on mental health. Aim: This study aimed to examine the correlation between adolescents’ aggressive behaviour and economic factors. Methods: The Buss–Perry Aggression Questionnaire (AQ) was used to measure aggression. Reduction in pocket money and three items of the Household Food Insecurity Access Scale were used to measure material deprivation as a result of the economic crisis. The questionnaires were administrated to a sample of 2,159 adolescent students of the Greater Athens Metropolitan Area. Results: Students who during the previous 4 weeks had experienced household food insecurity (anxiety/uncertainty about food, insufficient food quality or insufficient food intake) or had their pocket money decreased within the last 6 months scored on average significantly higher in the AQ compared to their counterparts who did not. Conclusion: The shortage in basic goods due to the actual Greek economic crisis seems to be related to aggressive behaviours during adolescence and we should take this into account in clinical practice.