Michael G. Madianos

Major depression in the era of economic crisis: a replication of a cross-sectional study across Greece.

BACKGROUNDnThe study endeavoured to gauge the impact of the current economic crisis on the mental health of the Greek population. Particularly, it explored changes in the prevalence rates of major depression between 2008 and 2011, and its link to financial hardship. Furthermore, the study also identified potential predictors of major depression in 2011.nnnMETHODSnTwo nationwide cross-sectional teleophone surveys were conducted in 2008 and 2011 following the same methodology. A random and representative sample of 2.197 and 2.256 people, respectively, participated in the studies. Major depression was assessed with the Structural Clinical Interview, whereas financial strain with the Index of Personal Economic Distress (IPED), an original scale with good psychometric properties.nnnRESULTSnIn 2011, one-month prevalence rate of major depression was found to be 8.2%, as compared to the corresponding rate in 2008, which was 3.3%. Significant increases in prevalence rates were observed for the majority of the population subgroups. A significant association was recorded between major depression and economic hardship. Young people, married persons, individuals with financial distress and people who use medication displayed increased odds of suffering from major depression in 2011.nnnLIMITATIONSnParticipants responses concerning financial difficulties were not confirmed from collateral accounts. Moreover, the direction of causality between financial hardship and major depression is unclear.nnnCONCLUSIONSnThe impact of the economic crisis on the mental health of the population is pervasive. Services and clinicians should focus on the primary prevention of major depression as well as on its timely recognition and treatment.

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.

Psychiatric Disorders in Burn Patients: A Follow-Up Study

Background: We report on a prospective study of 45 patients with burn injuries admitted to a major burn unit in the greater Athens area. The study aimed to explore the prevalence of psychological and psychiatric disorders among burn survivors. Methods: The sample comprised all consecutive cases of adult burn patients in a 6-month period. Personal interviews were conducted by the administration of the Langner scale and the DSM-III-R Structured Clinical Interview. Twelve months later, 30 patients of the baseline sample were reexamined. Results: Psychological impairment was found to be 45.5 and 40% at the baseline and follow-up assessments, respectively. The extent of burns was found to be associated with psychological impairment. The prevalence of psychiatric disorders (any DSM-III nosological entity) reached 46.6% at both baseline and follow-up examinations. Posttraumatic stress disorder was diagnosed in 17.8 and 20.0% of burn survivors at the baseline and the 12-month follow-up assessments, respectively. Logistic regression analysis revealed that face disfigurement was the only burn characteristic significantly associated with the presence of psychiatric morbidity. Conclusions: The results of the study suggest that the extent of burns is not so important when compared to the possibility of disfigurement from the point of risk of developing a psychiatric disorder.

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.

The mental health care delivery system in greece: regional variation and socioeconomic correlates

BACKGROUND: In Greece, the functional capacity of the mental health care system until 1980, was totally inadequate to meet the increasing mental health needs of the population and to provide efficient and community-based services. This situation was brought to the attention of the Commission of European Communities and a special EEC Regulation No 815/84 provided the financial technical support for an extended psychiatric reform programme. The psychiatric reform programme initiated in 1984 and ended in 1995. AIMS OF THE STUDY: This study compared the geographical distribution of neuropsychiatrists and the mental health care delivery system structural components (psychiatric beds, extramural mental health units and places in rehabilitation services), according to the regional socioeconomic development for the years 1984, 1990 and 1996. Additionally the possible effects of the operation of community-based mental health services on the psychiatric hospitalizations were examined. METHODS: Data on the geographical distribution of neuropsychiatrists in the previously mentioned years were drawn from local Medical Association from each of 54 prefectures of the country. The corresponding distribution of the mental health care delivery system components was made available from the database of the Monitoring and Evaluation of Mental Health Services Unit. Pearson product moment correlations of the regional distribution of neuropsychiatrists and the various components of the mental health care system, as population-based ratios, with the corresponding socioeconomic development in the form of the general index of development were performed. Mental hospital age standardized rates were collected from the Hospital Central Register for the periods 1984-1987 and 1990-1993. Discharge rates were elaborated according to the existence of mental health services in specific regions. RESULTS: A wide regional variation in neuropsychiatrists per 100000 population was found in all three years, with the majority of them working in the greater Athens and Thessaloniki areas. In the geographical distribution of health regions, there is an uneven significant decrease in psychiatric beds between 1984 and 1996. However in almost all regions an increase in extramural services between the two critical periods was noticed, as part of the implementation of the psychiatric reform programme. A parallel and more dramatic increase in the places of rehabilitation in 12 out of 13 regions has been observed during the implementation of the reform programme. At the level of prefectures, the changes across time, in the mean ratios of beds, extramural services and rehabilitation places were not found to be significant. A significant decrease of discharges in prefectures covered by newly established extramural services for the period 1990-1993, compared to discharge rates during the period 1984-1987, when none of these services were in operation in these prefectures, was noticed. The intercorrelation matrix between the various mean values (1990-1996) of the mental health care system components in the 54 prefectures and the local general index of development scores produced statistically significant correlation coefficients. It seems that the greater the level of local socioeconomic development the higher the degree of mental health care delivery system growth. DISCUSSION: Our results have shown uneven regional distribution of neuropsychiatrists, as well as extramural mental health units and rehabilitation places, despite the current reorganization of the whole mental health care delivery system. The positive correlation between the various structural components of the system in the 54 prefectures and the local socioeconomic conditions could be interpreted as follows. Urban areas of higher socioeconomic growth had a long history of development of inpatient services in mental hospitals. In these several community-based alternatives have been established for their transformation into modern ones. Urban areas exhibit also higher psychiatric morbidity and therefore increasing mental health needs. Additionally in several cities local University Psychiatric Departments have developed a variety of mental health and rehabilitation services. Many new services highly specialized and complementary to existing mental hospitals were established in urban areas. Rural areas are mostly uncovered by mental health care facilities. However it seems that the establishment of community-based services could have an effect on mental hospital utilization. CONCLUSION: It becomes evident that after the implementation of the psychiatric reform programme in Greece significant progress in the areas of decentralization of mental health and rehabilitation services has been observed. However there are still areas in many prefectures, mainly rural or semirural, lacking the appropriate delivery of mental health care. IMPLICATIONS FOR HEALTH CARE AND POLICY FORMULATION: Our results suggest that flexible models of services should be introduced for the benefit of population living in areas lacking the necessary socioeconomic resourses. IMPLICATIONS FOR FUTURE RESEARCH: Mental health services research in Greece should focus on quasi-experimental studies on the effectiveness of various models of mental health care in areas of different socioeconomic growth.

Cognitive social capital and mental illness during economic crisis: A nationwide population-based study in Greece

The ongoing financial crisis in Greece has yielded adverse effects on the mental health of the population. In this context, the particular study investigates the link between two indices of cognitive social capital; namely interpersonal and institutional trust, and the presence of major depression and generalized anxiety disorder. A random and representative sample of 2256 respondents took part in a cross-sectional nationwide telephone survey the time period February-April 2011 (Response Ratexa0=xa080.5%), after being recruited from the national phone number databank. Major depression and generalized anxiety disorder were assessed with the Structured Clinical Interview, while for interpersonal and institutional trust the pertinent questions of the European Social Survey were utilized. Socio-demographic variables were also encompassed in the research instrument, while participants degree of financial strain was assessed through the Index of Personal Economic Distress. Both interpersonal and institutional trust were found to constitute protective factors against the presence of major depression, but not against generalized anxiety disorder for people experiencing low economic hardship. Nonetheless, in people experiencing high financial strain, interpersonal and institutional trust were not found to bear any association with the presence of the two disorders. Consistent with these, the present study shows that the effect of social capital on mental health is not uniform, as evident by the different pattern of results for the two disorders. Furthermore, cognitive social capital no longer exerts its protective influence on mental health if individuals experience high economic distress. As a corollary of this, interventions aiming at mitigating the mental health effects of economic downturns cannot rely solely on the enhancement of social capital, but also on alleviating economic burden.

Trauma and Natural Disaster: The Case of Earthquakes in Greece

In Greece, a seismogenic country, several studies have explored the psychopathological reactions among exposed populations. In this article, all research publications related to psychological and traumatic consequences of earthquakes on affected population samples in the cities of Athens, Thessaloniki, Kalamata, and Aegion over the last 40 years are reviewed. Significant magnitudes of prevalence in anxiety and depressive symptomatology levels were recorded in the studies under review. The majority of individuals were found also to have developed acute stress reactions and posttraumatic stress disorder. These subjects were more vulnerable due to previous psychopathology or because they have been exposed to serious material losses. A decrease in suicide attempts following the Athens earthquake of 1981 and an increase in the incidence of fatal health attack mortality were also observed. Some methodological and ethical issues were noted, such as the time pressure for the completion of surveys during the acute social disruption followed by limited psychological support.