Ilias A Grammatikopoulos

Prevalence and sociodemographic associations of common mental disorders in a nationally representative sample of the general population of Greece

BackgroundNo study in Greece has assessed so far the full range of common mental disorders using a representative sample of the population from both mainland and insular regions of the country. The aim of the present paper was to present the results of the first such study.MethodsThe study was carried out between 2009–2010 in a nationally representative sample of 4894 individuals living in private households in Greece. Common mental disorders in the past week were assessed with the revised Clinical Interview Schedule (CIS-R). We also assessed alcohol use disorders (using AUDIT), smoking and cannabis use.Results14% of the population (Male: 11%, Female: 17%) was found to have clinically significant psychiatric morbidity according to the scores on the CIS-R. The prevalence (past seven days) of specific common mental disorders was as follows: Generalized Anxiety Disorder: 4.10% (95% CI: 3.54, 4.65); Depression: 2.90% (2.43, 3.37); Panic Disorder: 1.88% (1.50, 2.26); Obsessive-Compulsive Disorder: 1.69% (1.33, 2.05); All Phobias: 2.79% (2.33, 3.26); Mixed anxiety-depression: 2.67% (2.22, 3.12). Harmful alcohol use was reported by 12.69% of the population (11.75, 13.62). Regular smoking was reported by 39.60% of the population (38.22, 40.97) while cannabis use (at least once during the past month) by 2.06% (1.66, 2.46). Clinically significant psychiatric morbidity was positively associated with the following variables: female gender, divorced or widowed family status, low educational status and unemployment. Use of all substances was more common in men compared to women. Common mental disorders were often comorbid, undertreated, and associated with a lower quality of life.ConclusionsThe findings of the present study can help in the better planning and development of mental health services in Greece, especially in a time of mental health budget restrictions.

Suicide, recession, and unemployment

www.thelancet.com Vol 381 March 2, 2013 721 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ Aaron Reeves and colleagues suggest that the suicide rate in the USA has increased since 2007 in direct correlation to the increase in unemployment caused by economic recession. However, although this correlation seems strong, the cause and eff ect interpretation remains problematic. In the data Reeves and colleagues provide in their appendix, there is a temporal advance of the rise in suicides in relation to the rise in unemployment. Thus if a causative correlation really exists between the two, and since the cause should appear fi rst and the eff ect should follow, then the inevitable conclusion should be that suicides cause un employment and not vice versa. Of course such an assumption is irrational, but it points to the simple fact that, despite the widely believed theory that unemployment increases suicide, the data are inconclusive. Argentina experienced a severe crisis during 1999–2002, and, according to WHO data, suicide rates increased during 2000–08 (from 6·4–6·6 per 100 000 in 1985–95 to 7·5–7·7 per 100 000 in 2000–08); however, this increase was still lower than the rates reported for the years before 1980 (9·4–9·9 per 100 000). Con cerning eastern European countries, the data are confl icting. For example, Hungary saw an increase in suicide rates in the mid-1980s, before the fall of the Berlin wall, and a relative decrease a decade later, whereas Ukraine experienced a sharp increase only after the Berlin wall had fallen. Some data suggest an increase in suicides in east Asia because of the fi nancial crisis of the late 1990s. Premature overinterpretations are not only unwise but can also be harmful. Indeed, discussion of suicidality in the media is itself an independent risk factor for suicide.

Economic crisis and challenges for the Greek healthcare system: the emergent role of nursing management

BACKGROUND Despite several reform efforts, the Greek health care system still faces problems related to misdistribution of trained health staff and finance between geographical areas. AIM The objectives of the present study were to describe the current situation of the delivery of the healthcare service in Greece, to explore the basic implications of the economic crisis from a nursing management perspective and to examine future practices opening a debate in policy developments. KEY ISSUE The principal finding of this study was the serious shortage of trained nurses, the imbalances in nursing personnel, an excess of doctors and the complete absence of a Primary Healthcare System in civil areas provided by general doctors. CONCLUSION It is important that health care policy makers become aware and seriously consider rearranging the Health Care System to become more effective and efficient for the population (client). Special attention should be paid to strengthening areas such as primary health care, public health and health promotion in the direction of minimizing the demand of hospital services. IMPLICATIONS FOR NURSING MANAGEMENT Any implementation of major health care reforms should consider seriously the role of the nursing management which formulates the substantial link between the health services and the patient.

Economic crisis-related increased suicidality in Greece and Italy: a premature overinterpretation

Sir, Recently a paper suggested that the economic crisis was responsible for a dramatic increase in suicidal rates in Italy1 and the same authors insist that a similar phenomenon is happening in Greece.2 The relevant data are shown in table 1. However, interpretation can be made: 1. In Italy, the reported completed suicidal rates are almost identical with those of attempted suicide. This is highly unlikely and in contrast to the international literature. Registered suicide attempts are reported to be at least 5–10 times higher than completed suicide. …

First reliable data suggest a possible increase in suicides in Greece

Arie recently reported that suicide and murder rates rose by 22.7% between 2007 and 2009 in Greece as a consequence of austerity.1 Previously, the Greek Ministry of Health announced that the annual suicide rate might have increased by 40% and other authors reported a 17% increase in suicide rates during 2008-09.2 3 However, data from the …

Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece

BackgroundResearch has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece.MethodsThe current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GPs from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST).ResultsThe crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029).ConclusionsThe implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.

P01-535 - Mental health policy in Greece: Implications into practice in the era of economic crisis

Introduction Budgets allocated for mental health make up a relatively small proportion of total health expenditures, although there is an increasing burden of mental disorders. Objectives To review the mental health situation in Greece with regards to mental health policy through review of relevant literature. Aims To explore the basic implications of the economic crisis from a health policy perspective, reporting constraints and opportunities. Methods A narrative review in PubMed/Medline along with a hand search in selected Greek biomedical journals was undertaken, relevant to mental health policy. Results Greece is among the OECD countries with high health expenditure as a percentage of Gross Domestic Product (9.7% of GDP in 2008) but it doesn’t have a specified budget for mental health and is mostly depended in out-of-pocket expenditure (48%). The system is plagued by problems, including geographical inequalities, overcentralization, bureaucratic management and poor incentives in the public sector. The lack of cost-effectiveness and the informal payments comprise a major source of inequity and inefficiency. Uneven regional distribution of psychiatrists exists and rural areas are mostly uncovered by mental health care facilities, as well as extramural mental health units and rehabilitation places, despite the current reorganization of the whole mental health care delivery system. Conclusions The core problem with mental health services in Greece is the shrinking budget with poor financial administration consistent with inadequate implementation of mental health policy. A clear authority with defined responsibility for overall mental health policy and budgetary matters is needed.

EPA-1720 – Suicides and mental health policy in the era of economic crisis in Greece

Introduction Socioeconomic instability might be related to increased suicidality and burden of mental disorders. Aims To explore the basic implications of the economic crisis from a health policy perspective, according to recent suicide data and unemployment in Greece. Methods A narrative review in PubMed/Medline and published data from the Greek Statistics Authority (ELSTAT) along with a hand search in selected Greek biomedical journals was undertaken, relevant to suicides, unemployment and mental health policy. Results While for the years 2000-2010 the number of completed suicides ranged from 323 (in 2002) to 402 (in 2006), for 2011 the total number is 477 (393 males and 84 females), that is increased by 26,52% in comparison to 2010 (377), while the unemployment rate was approximately 27% during 2012. Although the annual growth rate in 2012 was -6,4, Greece is among the OECD countries with high health expenditure as a share of Gross Domestic Product (9.1 in 2011), but it doesn’t have a specified budget for mental health and is mostly depended in out-of-pocket expenditure (48%). The lack of cost-effectiveness and the informal payments comprise a major source of inequity and inefficiency. Despite the current reorganization of the whole mental health care delivery system, uneven regional distribution of psychiatrists exists. Mental health care facilities as well as extramural mental health units and rehabilitation places mostly uncover rural areas. Conclusions Prevention programs concerning mental disorders should be in the first line of Greek mental health policy, focusing in community networking and targeting in systematic assessment of interventions. A clear authority with defined responsibility for overall mental health policy and budgetary matters is needed.

2245 – Common mental disorders and use of mental health services in the general population in greece

Introduction General population surveys of the prevalence of common mental disorders are necessary for the organization of effective mental health services. Objectives Epidemiological studies are useful for the more objective assessment of the mental health needs of the population. Aims To present data on the pattern and correlates of 12-month use of services by persons with common mental disorders from the recently completed general population survey of psychiatric morbidity in Greece. Methods The sample (n=4894; multistage stratified random sample) was representative for the Greek population aged 18-70. Common mental disorders were assessed according to the ICD-10 criteria with the revised Clinical Interview Schedule (CISR), conducted by trained lay interviewers. Results 73,9% of participants with at least one common mental disorder (CMD) do not receive any treatment for their psychological health, 52% have never spoken to the family physician and 73.3% has not spoken to a mental health professional in the past year. The disorder associated with the most frequent use of general health services for any reason (>4 visits to any physician in the past year) was depression (43.7%). Overall, 46.5% of all participants who meet the criteria for a CMD had not spoken to a doctor or mental health professional, with men showing significantly higher rates of no use compared to women (54.6% vs 41.5%). Conclusions These findings can help in the better organization of services with the aim to improve prevention and treatment of common mental disorders in Greece, especially in a time of economic hardship.