Lily Evangelia Peppou

Increased suicidality amid economic crisis in Greece

Greece has entered a long period of economic crisis with adverse eff ects on various aspects of daily life, including the mental health of its citizens. Within this context, the Greek Ministry of Health reported that the annual suicide rate has increased by 40%; nonetheless, a systematic investigation to address the eff ect of the Greek economic crisis on suicidality is still lacking. In an endeavour to fi ll this gap, the University Mental Health Research Institute (UMHRI) imple mented a nationwide cross-sectional telephone survey, completed on May 1, 2011. The study adopted the same methods as an earlier one done during February–April, 2009, which explored the links between major depressive symptoms and socioeconomic variables. A representative sample of 2256 respondents was drawn from the national telephone-number databank, with telephone numbers belonging to businesses or services being excluded. Informed consent was obtained from all participants and the study was approved by the UMHRI Ethics Committee. Recent suicidality was assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and fi nancial strain was measured by the Index of Personal Economic Distress (IPED), an eight-item scale with good psychometric properties. Of the study fi ndings, the most alarming one pertained to suicidal attempts. There was a 36% increase in the number who reported having attempted suicide in the month before the survey from 24 (1·1%) in 2009 to 34 (1·5%) in 2011. We also found that a signifi cantly higher proportion of respondents with an IPED score of 15 or more (ie, high economic distress) had attempted suicide in the month before the survey than had respondents with an IPED lower than 15 (27 [10%] vs 7 [0·6%], p<0·001). Similarly, a IMF and European co-workers attack public health in Greece

Suicidal ideation and reported suicide attempts in Greece during the economic crisis.

The financial crisis in Greece is largely impinging on the health and mental health of the population, raising concerns about a potential rise in suicide rates. The aim of this study was to explore changes in suicidal ideation and reported suicide attempts between 2009 and 2011 in a representative sample of the population and in several population subgroups. The socio‐economic predictors of suicidal ideation and suicide attempts in 2011 were also investigated. Two nationwide cross‐sectional telephone surveys were conducted in 2009 and 2011 using the same methodology. A random and representative sample of 2192 and 2256 people, respectively, took part in the surveys. Between 2009 and 2011, there was a substantial increase in the prevalence of suicidal ideation and reported suicide attempts. People suffering from depression, men, married individuals, people experiencing financial strain, people with low interpersonal trust, and individuals with a history of suicide attempts were particularly vulnerable.

Fighting psychiatric stigma in the classroom: The impact of an educational intervention on secondary school students’ attitudes to schizophrenia

Background: Adolescents constitute an appealing target group for fighting stigma and discrimination surrounding mental illness, since it is during this developmental period that adult attitudes about mental illness are formed and consolidated. Aim: The aim of the present study was twofold, to explore adolescents’ beliefs and attitudes to schizophrenia and to evaluate the effectiveness of an anti-stigma intervention in altering them. Methods: A total of 616 high school students participated in the study, divided into a control condition and an anti-stigma intervention group. Data were collected at three time points: before the intervention, upon its completion and at a 12-month follow-up. Results: Baseline measurements indicated that students espoused certain stereotypical beliefs about patients with schizophrenia and were reluctant to interact with them on some occasions. Upon completion of the intervention, positive changes were recorded in students’ beliefs, attitudes and desired social distance; however, only the changes in beliefs and attitudes were maintained after one year. Conclusion: For anti-stigma interventions to be effective, they should be continuously delivered to students throughout the school years and allow for an interaction between students and patients. Health promotion programmes might be an appropriate context for incorporating such interventions.

Suicidality and the economic crisis in Greece

www.thelancet.com Vol 380 July 28, 2012 337 there are data that suggest improved congestive heart failure outcomes while patients are taking thyroxine compared with when they are not, and one study has shown that serum TSH concentrations of 10 mU/L or above are a risk factor for progression to overt thyroid failure even in people aged 65 years and older, suggesting benefi t of treatment in this group of patients, consistent with the recommendations in our Seminar. Also consistent with our recommendations to consider treatment in younger and middle-aged people with serum TSH between 5 and 10 mU/L, but not older people, is a paper published after ours appeared, showing that there were fewer ischaemic heart disease events in a cohort aged 40–70 years with mild subclinical hypothyroidism who were treated with levothyroxine, but no benefi t in patients with similar TSH concentrations who were older than 70 years. We are not surprised that the recommendations in our Seminar raised serious and legitimate concerns, because the management of subclinical thyroid disease will remain a subject of discussion and controversy until the results of the two randomised trials to assess treatment of subclinical hypothyroidism are available. It is unfortunate that there are evidently still no planned trials to examine the treatment of subclinical hyperthyroidism—an equally problematic, albeit less common, disorder.

Measuring public attitudes to severe mental illness in Greece: Development of a new scale

Background and Objectives: The purpose of the present study was to develop an attitudinal schedule, the Attitudes to Severe Mental Illness (ASMI) scale, which synthesizes elements from different conceptual frameworks of the field, while addressing gaps on the existing literature on stigma measurement. Methods: A national representative sample of 2039 adults from the general population was interviewed by telephone. Results: Factor analysis revealed 4 factors to underlie the data, namely �stereotyping� �optimism�, �coping� and �understanding�, which explained 67% of total variance. The instrument�s face and predictive validity were also supported, while its internal consistency and test �retest reliability were found to be high for the overall scale and its factors. Conclusions: Consistent with these, the ASMI scale emerges as a valid and reliable tool for the assessment of attitudes towards severe mental illness, while it opens new directions for advancing scientific understanding of the topic.

Suicidal ideation and suicide attempts in Greece during the economic crisis: an update.

The current financial crisis has exerted untoward effects on the mental health of the population worldwide, in the form of increasing prevalence rates of affective disorders and suicide1. Greece is among the countries most severely hit by the crisis and has thus attracted global attention with regard to the social and health‐related repercussions of the economic downturn. In particular, throughout the years of recession, unemployment rates rocketed from 7.8% in 2008 to 9.6% in 2009, 12.7% in 2010, 17.9% in 2011, 24.5% in 2012, 27.5% in 2013 and 26.5% in 20142. At the same time, the proportion of the population at risk of poverty or social exclusion rose from 28.1% in 2008 to 35.7% in 2013 and 36% in 20143. Nonetheless, the impact of the recession on suicides has been a highly contentious issue in the country. Recently, a 30‐year interrupted time series analysis on the influence of austerity‐ and prosperity‐related events on suicide rates in the period 1983‐2012 found a rise in total suicides by 35.7% after the introduction of new austerity measures in June 20114. In a similar vein, another ecological study reported an increase in suicides by 35% between 2010 and 2012, with unemployment bearing a strong correlation with suicide mortality especially among working age men5. A series of nationwide surveys conducted by our research team has arrived at similar conclusions, confirming a significant rise in the one‐month prevalence of suicidal ideation (from 5.2% in 2009 to 6.7% in 2011) as well as suicide attempt (from 1.1% in 2009 to 1.5% in 2011)6. In the same report, people suffering from major depression, married individuals, people experiencing financial strain, people with low levels of interpersonal trust and individuals with a history of suicide attempt were at elevated odds of manifesting suicidality symptoms6. In this frame, another cross‐sectional study was implemented in 2013 in order to monitor the impact of the recession on suicidality as well as to identify at‐risk population subgroups. A random and representative sample of 2,188 people participated in the study. Information about the occurrence of major depression, suicidal ideation and suicidal attempt during the past month was assessed with the pertinent modules of the Structured Clinical Interview for DSM‐IV Axis Disorders7. Participants’ degree of economic hardship was measured by the Index of Personal Economic Distress8, while their levels of interpersonal trust was assessed by the germane questions of the European Social Survey9. Comparative results from surveys demonstrate that one‐month prevalence of suicidal ideation has declined in 2013: 2.4% in 2008, 5.2% in 2009, 6.7% in 2011 and 2.6% in 2013 (p<0.05). Similar findings were observed for one‐month prevalence of suicidal attempt: 0.6% in 2008, 1.1% in 2009, 1.5% in 2011 and 0.9% in 2013 (p<0.05). Regarding the risk and protective factors for suicidality, a different pattern of results emerges for suicidal ideation and suicidal attempt. The presence of major depression (adjusted OR = 12.35, 95% CI: 6.34‐24.08, p<0.01), a previous suicide attempt (adjusted OR = 5.54, 95% CI: 2.19‐14.00, p<0.01), unemployment (adjusted OR = 2.55, 95% CI: 1.04‐4.34, p<0.05) and economic hardship (adjusted OR = 1.07, 95% CI: 1.01‐1.14, p<0.05) were found to increase the odds of manifesting suicidal thoughts. With regard to suicide attempt, the presence of major depression remained the strongest risk factor (adjusted OR = 8.02, 95% CI: 2.67‐24.14, p<0.01), followed by previous suicide attempt (adjusted OR = 5.22, 95% CI: 1.44‐18.94, p<0.05) and low levels of interpersonal trust (adjusted OR = 3.84, 95% CI: 1.17‐5.81, p<0.05). From the above‐mentioned results, it is clear that the prevalence of suicidal ideation and suicidal attempt has returned to pre‐crisis levels in Greece. This is consistent with the view that suicidal acts may reflect an acute response to an economic crisis10, as evidenced by the surge in suicides after the outset of the recession in South Korea in 1998 and their subsequent decline11. Concerning the risk factors for suicidal ideation and attempt, the differences illustrate the multifaceted nature of suicidality, which is better conceptualized as lying on a spectrum from ideation to act, with different factors playing a prominent role in each step of the spectrum. The presence of major depression and previous suicide attempt increase the odds of manifesting suicidality symptoms throughout the whole spectrum, in line with other studies corroborating their strength of association12, even amid recession. Although suicidality rates have decreased in Greece, depression is still on the rise13 and the socio‐economic climate in the country remains unstable. There is imperative need for tailored public health interventions, including labour market and debt relief programmes, as well as for enhancing the social capital of the population14. From the clinical standpoint, timely screening of suicidal history and suicidal symptoms, effective treatment of major depression, and capitalizing upon a patients social networks should become a priority. Marina Economou1,2, Elias Angelopoulos1,2, Lily E. Peppou1, Kyriakos Souliotis3,4, Costas Stefanis1 1University Mental Health Research Institute, Athens, Greece; 2First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece; 3Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece; 4Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National & Kapodistrian University, Athens, Greece

Major depression amid financial crisis in Greece: Will unemployment narrow existing gender differences in the prevalence of the disorder in Greece?

Rises in unemployment as a corollary to the global economic crisis may impinge on the prevalence of depression disproportionally for the two genders. Therefore, differences in the prevalence of the disorder as a function of gender and age were explored in four nationwide surveys in Greece in 2008, 2009, 2011 and 2013. Results indicate that in 2013, men of productive age had a higher prevalence of major depression than women, in contrast to the epidemiology of the disorder. The psychiatry community should be in tune to future changes in the mental health landscape elicited by the social fermentation processes of the global recession.

Attitudes towards depression, psychiatric medication and help-seeking intentions amid financial crisis: Findings from Athens area.

Background: The financial crisis has yielded adverse effects on the population worldwide, as evidenced by elevated rates of major depression. International recommendations for offsetting the mental health impact of the recession highlight the need for effective treatment, including reduction in the stigma attached to the disorder. Aims: This study endeavoured to explore lay attitudes to depression and psychiatric medication during a period of financial crisis and to identify their correlates. Furthermore, it investigated their link to help-seeking intentions. Method: A random and representative sample of 621 respondents from Athens area participated in the study (Response Rate = 81.7%). The telephone interview schedule consisted of the Personal Stigma Scale, a self-constructed scale tapping attitudes to psychiatric medication and one question addressing help-seeking intentions. Results: The preponderant stigmatising belief about depression pertains to perceiving the disorder as a sign of personal weakness. In addition, stereotypes of unpredictability and dangerousness were popular among the sample. Nonetheless, stigmatising beliefs are much stronger with regard to psychiatric medication; perceived as addictive, capable of altering one’s personality, less effective than homeopathic remedies and doing more harm than good. Help-seeking intentions were predicted by education, unemployment and attitudes to psychiatric medication solely. Conclusion: Research on the mental health effects of the global recession should encompass studies investigating the stigma attached to mental disorders and its implications.

Social Suffering and Mental Health in Metropolitan Athens: A Qualitative Approach

Modern metropolises have now transformed into anonymous zones without history, similar to anywhere else in the world, overcrowded with various people who do not know each other and who have never come into contact. Social inequalities in such environments and the consequent social exclusion have a negative effect on health, mental health and the well-being of the population. The aim of this study is to explore social exclusion in metropolitan Athens and in particular to record its socio-demographic profile, its self-image, experiences of social racism and health problems for the homeless in the centre of the Greek capital. The homeless characterise themselves as unfortunate and unlucky, and some have experienced others as being indifferent towards them or have suffered social racism, while others have described a completely positive response from others. At the same time, they have quite a few health problems, and almost one in two has a clear sense of sadness and stress. A major percentage also report substance and alcohol abuse, while quite a few appear to use alcohol as a form of self-treatment. In conclusion, the city generates alienation, fear, insecurity and unhappiness. Every community ought to use any resources it has to implement organised policies and create social networks to address the complex needs that arise.

Assessing Patient Organization Participation in Health Policy: A Comparative Study in France and Italy

Background: Even though there are many patient organizations across Europe, their role in impacting health policy decisions and reforms has not been well documented. In line with this, the present study endeavours to fill this gap in the international literature. To this end, it aims to validate further a previously developed instrument (the Health Democracy Index - HDI) measuring patient organization participation in health policy decision-making. In addition, by utilizing this tool, it aims to provide a snapshot of the degree and impact of cancer patient organization (CPO) participation in Italy and France. Methods: A convenient sample of 188 members of CPOs participated in the study (95 respondents from 10 CPOs in Italy and 93 from 12 CPOs in France). Participants completed online a self-reported questionnaire, encompassing the 9-item index and questions enquiring about the type and impact of participation in various facets of health policy decisionmaking. The psychometric properties of the scale were explored by performing factor analysis (construct validity) and by computing Cronbach α (internal consistency). Results: Findings indicate that the index has good internal consistency and the construct it taps is unidimensional. The degree and impact of CPO participation in health policy decision-making were found to be low in both countries; however in Italy they were comparatively lower than in France. Conclusion: In conclusion, the HDI can be effectively used in international policy and research contexts. CPOs participation is low in Italy and France and concerted efforts should be made on upgrading their role in health policy decision-making.