Marina Economou

Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey

BACKGROUND Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. METHODS In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. FINDINGS 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coefficient 0·20 [95% CI 0·09-0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032; unpaid employed 0·34 [0·09-0·60], p=0·007; looking for a job 0·26 [0·09-0·43], p=0·002; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p<0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in finding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination. INTERPRETATION Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving effective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the effects of stigma when it is already established. FUNDING European Commission, Directorate General for Health and Consumers, Public Health Executive Agency.

Family burden and coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study

Background: To date, only few data are available on how family burden in schizophrenia changes over time. In addition, no study has explored how such factors as coping styles and social support influence burden over time. This paper presents the 1-year follow-up data from the BIOMED I study on family burden and coping strategies in schizophrenia. Methods: A sample of 159 relatives of patients with schizophrenia living in five European countries was followed up prospectively for 1 year with regard to burden and coping strategies, using validated questionnaires. Results: In the sample as a whole, the burden was stable. A reduction of family burden over time was found among relatives who adopted less emotion-focused coping strategies and received more practical support from their social network. In addition, family burden decreased in relation to the improvement of patients social functioning. Conclusions: When relatives of patients with schizophrenia are able to improve their coping strategies, it is possible for burden to be reduced even after several years. This points to the necessity to provide families of chronic psychotic patients with psychoeducational interventions emphasising the adoption of an effective coping style.

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.

Social and clinical factors influencing the choice of coping strategies in relatives of patients with schizophrenia: results of the BIOMED I study

Abstract The impact of social and clinical factors on the choice of coping strategies of a sample of 236 relatives of patients with schizophrenia, living in five European countries, was explored using well-validated questionnaires. The adoption of problem-focused coping strategies was more frequent among young relatives and among relatives of younger patients, and was associated with higher levels of practical and emotional social support and of professional help. In contrast, emotion-focused strategies were more frequently adopted by relatives who had been living longer with the patient and who had poorer social support. It is suggested that supportive and educational interventions should be provided as early as possible to relatives of patients with schizophrenia, which, in addition to having a practical focus, should also have a social focus, aiming at extending the familys social network.

Changes in public attitudes towards mental illness in the Athens area (1979/1980-1994).

Opinions about mental illness were measured, in 1994, in a probability sample consisting of 360 residents of two boroughs in greater Athens. These boroughs represent the catchment area of a community mental health centre. The aim of this study was to compare the differences in attitudes towards mental illness with a matched sample of 360 respondents drawn from the sample of the 1979/1980 attitudinal study, conducted in the same area. The instrument used was the Opinion about Mental Illness scale. which yields five factors. In all five factors statistically significant differences between the two samples were observed. The recent study sample expressed more positive attitudes towards the social integration of the mentally ill, and did not favour the social discrimination against and restriction of mental patients. These results could be explained in the context of a positive and tolerant social climate in the Athens area, strengthened by the implementation of local community mental health intervention programmes.

Suicide, unemployment and other socioeconomic factors: evidence from the economic crisis in Greece

Background and Objectives: Economic adverse conditions are acknowledged as having a major impact on the exacerbation of mental disorders and suicides. The severity of current European crisis and the local unrelenting spending is affecting largely the economy of Greece. METHODS: The aim of this study was to explore changes in suicides and their possible association with macroeconomic and behavioural factors. Data for the period 1990-2011 were drawn mainly from the Hellenic Statistical Authority and Eurostat. Suicide mortality rates were correlated with economic and behavioural factors. RESULTS: Suicide mortality rates were increased by 55.8% between 2007 and 2011 while the total mortality was increased by 1.1% only. Significantly increasing trends in public debt, unemployment rates, consumption of daily units of antidepressants as well as divorces per 1000, homicides per 100,000 and persons with HIV per 100,000 were also observed. Suicides have been found to bear strong correlation with unemployment (r. 0.64). Significant associations were also found between suicide mortality and the percentage of public debt as percentage of GDP, the incidence of infections from HIV and homicides. CONCLUSIONS: People suffering from income and job losses, living in a demoralized social state caused by severe austerity measures and restrictive health policies, are exposed to risks for developing depression or commit suicide. KEYWORDS: Suicide; Unemployment; Public debt; Antidepressants; Economic factors. Language: en

The Impact of a Community Mental Health Center on Psychiatric Hospitalizations in Two Athens Areas

This paper explores the impact of a CommunityMental Health Center intervention activities on theinpatient psychiatric morbidity of two areas served bythis center. Athens University established this Center, the first of its kind in the Greater Athensarea. A comparison among the utilization rates ofinpatient psychiatric services by community residentsduring the years 1979, 1985, 1991 and 1995 is made. The results of the 1995 survey show a significantreduction in the number and days of hospitalization anda remarkable cut in compulsory admissions when comparedwith those in 1979. It is concluded that medication monitoring, outreach, domiciliary care forpatients in crisis, and day care are effective androbust principles of mental health services.

Quality of life in schizophrenia spectrum disorders: Associations with insight and psychopathology

Therapeutic interventions in chronic mental illness face the important challenge to pursuit the quality of life (QOL) of patients. Insight into chronic mental illness, though a prerequisite for treatment adherence and a positive therapeutic outcome, has shown adverse associations with subjective QOL. This study aims to explore the contribution of psychopathological symptoms on the ambiguous role of insight on QOL. Seventy-two outpatients with schizophrenia spectrum disorders were assessed using the positive and negative syndrome scale, the scale to assess unawareness of mental disorder, and the WHOQOL-100 instrument for the assessment of quality of life. Insight was found to associate inversely with quality of life. Among psychopathological symptoms, depressive symptoms were the strongest negative contributor on QOL. Mediation analysis revealed that the effects of awareness of the consequences of illness on QOL were largely mediated by depressive symptoms (full mediation for the effect on physical and psychological domain and partial mediation for the effect on independence and environment domain of the QOL). Our results suggest that the inverse relationship between insight and subjective quality of life is partially mediated by depressive symptoms. We discuss theoretical and therapeutic implications of the findings, in conjunction with similar recent research data.

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.

Violence, misconduct and schizophrenia: Outcome after four years of optimal treatment

BackgroundAggressive behaviour in patients with schizophrenic disorders is an ongoing source of concern to community-based services. It has been suggested that optimal treatment may reduce the risk of serious misconduct.ObjectiveTo assess prospectively aggressive and sexual misconduct in a cohort of patients receiving continued evidence-based community treatment.MethodFifty patients with a DSM-IV diagnosis of a schizophrenic disorder were treated for 4 years with integrated biomedical and psychosocial strategies. The frequency and context of all aggressive and sexually inappropriate behaviour were assessed throughout. Correlations between an index of misconduct and demographic and clinical variables were examined.ResultsLevels of serious misconduct were low at the start of the project and declined as treatment progressed. Close examination of predictors of misconduct supported larger epidemiological studies imputing persistent psychotic symptoms, personality disorders and substance use.ConclusionThe study supports the hypothesis that effective treatment reduces aggressive and sexual misconduct in schizophrenic disorders.