Michael G. Madianos

Ιστοσελίδα Περιοδικού Ψυχιατρική

Psychiatric care in Greece has a long history of traditional in-patient treatment in large public institutions (the public asylum period), which lasted until 1983. European Economic Community (EEC) intervention in 1984 marked a transitional period (1984–1989) characterised by the beginning of the transformation of the mental healthcare system. The current reform era started in 1999 and has included new mental health law, the closure of six public mental hospitals and the establishment of several sectorised mental health services.

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.

Homelessness, a worldwide psychosocial phenomenon, is now also prevalent in Greece, mainly in Athens area. The possible psychiatric morbidity related to help-seeking and the underlying factors were explored in a sample of 254 homeless people from Greater Athens area, using the Mini International Neuropsychiatric Interview (M.I.N.I.). The sample was predominantly male (74%) with mean age of 51 years, being in their majority homeless for over 25 months, 34.3% of them living in rough sleeping places. Overall, 56.7% of the sample met the criteria for a current Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV) psychiatric disorder with 20.8% comorbidity. Only 36.2% of the identified psychiatric cases had any recent psychiatric care, while 44.4% were taking non-prescribed medication and 20.2% have been hospitalized in the last year. On the contrary, 70% of alcohol- and drug-dependent persons have been treated in a psychiatric agency, while 60.0% of them participated in rehabilitation program the last year. Logistic regression analysis revealed that being older, more educated with longer duration of homelessness, recognizing the suffering from a psychiatric problem as well as being diagnosed as ‘psychotic’ increased the likelihood to seek help. The vast majority of the homeless mentally ill persons were lacking any current psychiatric care. The planning of a mental health–care delivery parallel to the existing social welfare system is needed to serve the unmet mental health needs of this population.

Purpose Homelessness is a chronic social phenomenon in European and other Western cities. In the recent years, the number of homeless people in Greece, mainly in Athens, is also increasing. Method The aim of this study was to explore the prevalence of psychiatric disorders among a sample of 254 homeless people, using the Mini International Neuropsychiatric Interview (M.I.N.I.). The sample was drawn from the existing shelters, soup kitchens, and the streets. Results The sample was predominantly male (74 %) with mean age 51 years, being in their majority homeless for over 25 months, 27 % of them living in the streets. The vast majority of the sample was single or separated with an education level <12 years. Current prevalence of psychiatric disorders was 56.7 % with 20.8 % comorbidity. For psychotic and mood disorders, current prevalence rates were 13 and 16 %, respectively. One year prevalence of alcohol and drug dependence was found to be low. Logistic regression analysis revealed that being older with higher number of months living in the streets and exposed to high frequency of adverse social events, increase the likelihood to become a psychiatric case. Finally, the vast majority of the identified psychiatric cases were lacking any current psychiatric care. Conclusions The magnitude of the prevalence of psychiatric morbidity was more than three times higher than that of the general population in Athens. Implications for psychosocial care and the organization of a support network for the homeless people are discussed.

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.

The purpose of the present study was to investigate the association of opinions towards seeking psychiatric help with the duration of untreated mental disorders in a sectorized Athens area, served by a Community Mental Health Centre. The sample consisted of 134 individuals who had sought help from health or mental health non sectorized services prior to their visit to the Centre (group A) and 156 individuals whose visit to the Center was their first ever contact with a mental health service (group B). Opinions were assessed by the “Attitudes Toward Seeking Professional Psychological Help scale. Both groups were selected from a total of 1,008 individuals who had visited the Centre in four consecutive years. The duration of untreated mental disorders was found to be shorter in group A compared to group B. Males and females of both groups, who had visited the Centre in a time period shorter than 12 months since the onset of their psychopathology, expressed more positive views towards help-seeking, compared to their counterparts with longer duration of untreated mental disorder. The variables of gender (females), age at symptom onset (younger) and education (higher) predicted a shorter duration without psychiatric treatment and more positive views about the necessity of help-seeking. More severe type of diagnoses was associated with shorter durations before accessing care. Our findings underline that mental health awareness programs are clearly required in order to strengthen the early recognition of the need for help- seeking. The development of liaison and outreach activities could also prevent prolonged delays in psychiatric treatment.

Background: In recent decades entire populations have been living under chronic strain, apprehension and violence. This is the case for Palestinians. Despite the increased volume of mass media attention on this situation, little is known about the psychological effects of this condition on this population. Aims: The study was designed to investigate the lifetime and one-month prevalence of major depression episode (MDE) in a multi-stage sample of 916 adult Palestinians drawn from the Al-Aqsa Intifada. Methods: The survey was based on personal interviews and was carried out from February to September 2007. The clinical examination used DSM-IV criteria for the detection of MDE, extracted from SCID-I. Data, suicidal behaviour, previous help seeking, medication use and exposure to trauma were also collected. Results: Lifetime and one-month prevalence of MDE was found to be 24.3% and 10.6%, respectively. Male Palestinians suffered from slightly higher rates of MDE than their female counterparts, but this difference was not statistically significant. Being widowed and living in towns in West Bank also increased the likelihood to develop MDE. A comparison of prevalence rates in refugee and non-refugee populations showed no significant differences. This could be explained by the fact that though refugees were forcibly displaced, they were living among compatriots (non-refugees), thus both groups were experiencing the same sociopolitical adversities. Being also exposed to traumatic events increased the risk of suffering from MDE. Conclusions: This study provides evidence that a population under continuous strain and apprehension, living in unremitting socioeconomic deprivation, is more likely to suffer from major depression.

Background and Objectives: The prevalence of Post Traumatic Stress Disorders (PTSD) comorbid with Major Depressive Episodes (MDE) were explored in four areas of West Bank of Palestine in the aftermath of the second intifada. Methods: The sample consisted of 916 adult Palestinians representative of the general population. The interview was personal with the use of DSM IV criteria for PTSD and MDE (the SCID I modules). Results: The prevalence of chronic PTSD comorbid with lifetime MDE and chronic PTSD alone were found 18.7% and 26.5% respectively. Another 6.1% were diagnosed as suffering from lifetime MDE. Higher numbers of refugees were found to suffer from PTSD comorbid with MDE. The majority of respondents who reported previous suicidal behavior were comorbid cases of PTSD/MDE. The predictors differentiating between MDE alone and no diagnosis and between comorbid PTSD/MDE and no diagnosis were almost identical. Conclusions: This sample of adult Palestinians living under conditions of mass violence and continuous economic deprivation were found suffering from high rates of post PTSD and comorbid PTSD with MDE, a common finding among populations under serious traumatic exposure.

Purpose In many western countries during the recent years, people have witnessed the deterioration of their economies and the emergence of related phenomena such as loss of property, unemployment and social disruption. These phenomena have also been associated with increasing levels of demoralization and the developing of major depressive episodes (MDE). Greece in the years 2008 and mainly in 2009 started facing a sharp economic decline. The purpose of this study was to explore the consequences of this condition and the ways are reflected in the prevalence of MDE during these two critical years. Method Two nationwide cross-sectional telephone surveys were carried out in 2008 and 2009 with representative samples of 2,197 and 2,192 respondents, respectively. The interview comprised the SCID I module of MDE and an Index of Personal Economic Distress (IPED). Results The 1-month prevalence of MDE in 2009 was found to be 6.8%, compared to corresponding rates of 3.3% in 2008. Respondents facing serious economic hardship (with higher scores in IPED) were mostly at risk for developing an MDE. Conclusions The findings of both studies underline the significance of the risk involved in developing MDE when individuals have been exposed in extreme and stressful economic situations.