Increased suicidality amid economic crisis in Greece

Abstract

Greece has entered a long period of economic crisis with adverse effects 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%;1Anon. Sharp rise in suicides amid crisis. ekathimerini.com June 30, 2011. http://www.ekathimerini.com/4dcgi/_w_articles_wsite1_1_30/06/2011_396649 (accessed Sept 1, 2011).Google Scholar nonetheless, a systematic investigation to address the effect of the Greek economic crisis on suicidality is still lacking.In an endeavour to fill this gap, the University Mental Health Research Institute (UMHRI) implemented a nationwide cross-sectional telephone survey, completed on May 1, 2011. The study adopted the same methods as an earlier one2Madianos M Economou M Alexiou T Stefanis C Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide.Soc Psychiatry Psychiatr Epidemiol. 2011; 46: 943-952Crossref PubMed Scopus (112) Google Scholar 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 financial strain was measured by the Index of Personal Economic Distress (IPED), an eight-item scale with good psychometric properties.2Madianos M Economou M Alexiou T Stefanis C Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide.Soc Psychiatry Psychiatr Epidemiol. 2011; 46: 943-952Crossref PubMed Scopus (112) Google ScholarOf the study findings, 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 20092Madianos M Economou M Alexiou T Stefanis C Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide.Soc Psychiatry Psychiatr Epidemiol. 2011; 46: 943-952Crossref PubMed Scopus (112) Google Scholar to 34 (1·5%) in 2011. We also found that a significantly 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 significantly higher proportion of respondents with a high IPED had shown suicidal ideation in the month before the survey than had respondents with low IPED (58 [21·2%] vs 86 [7·4%], p<0·001). These results accord with those of Stuckler and colleagues,3Stuckler D Basu S Suhrcke M Coutts A McKee M Effects of the 2008 recession on health: a first look at European data.Lancet. 2011; 378: 124-125Summary Full Text Full Text PDF PubMed Scopus (320) Google Scholar who reported a 17% increase in suicides in Greece, and might suggest that the ways in which economic distress is experienced by the population could be discerned in their increased suicidality.Consequently, there is an urgent need for intensive screening, follow-up, and treatment of people with suicidal ideation, especially now that the recession has led to increases in both suicide attempts and suicides. Despite the turmoil, Greece is struggling to maintain a social welfare state; however, gaps in primary health care render the situation hard to address.4Oikonomou N Tountas Y The Greek economic crisis: a primary health-care perspective.Lancet. 2011; 377: 28-29Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar Telephone helplines5Economou M Louki E Charitsi M Kolostoumpis D Stefanis C The depression helpline of the Greek “anti-stigma” program. Fourth International Stigma Conference; Jan 21–23, 2009; London, UK.http://stigma.iop.kcl.ac.uk/Plenary,%20poster%20and%20oral%20presentation%20abstracts%20(A-Z).pdfGoogle Scholar might contribute to alleviating the stress germane to financial hardship, prevent the proliferation of suicidal thoughts, and guide people to effective and timely treatment.We declare that we have no conflicts of interest. Greece has entered a long period of economic crisis with adverse effects 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%;1Anon. Sharp rise in suicides amid crisis. ekathimerini.com June 30, 2011. http://www.ekathimerini.com/4dcgi/_w_articles_wsite1_1_30/06/2011_396649 (accessed Sept 1, 2011).Google Scholar nonetheless, a systematic investigation to address the effect of the Greek economic crisis on suicidality is still lacking. In an endeavour to fill this gap, the University Mental Health Research Institute (UMHRI) implemented a nationwide cross-sectional telephone survey, completed on May 1, 2011. The study adopted the same methods as an earlier one2Madianos M Economou M Alexiou T Stefanis C Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide.Soc Psychiatry Psychiatr Epidemiol. 2011; 46: 943-952Crossref PubMed Scopus (112) Google Scholar 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 financial strain was measured by the Index of Personal Economic Distress (IPED), an eight-item scale with good psychometric properties.2Madianos M Economou M Alexiou T Stefanis C Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide.Soc Psychiatry Psychiatr Epidemiol. 2011; 46: 943-952Crossref PubMed Scopus (112) Google Scholar Of the study findings, 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 20092Madianos M Economou M Alexiou T Stefanis C Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide.Soc Psychiatry Psychiatr Epidemiol. 2011; 46: 943-952Crossref PubMed Scopus (112) Google Scholar to 34 (1·5%) in 2011. We also found that a significantly 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 significantly higher proportion of respondents with a high IPED had shown suicidal ideation in the month before the survey than had respondents with low IPED (58 [21·2%] vs 86 [7·4%], p<0·001). These results accord with those of Stuckler and colleagues,3Stuckler D Basu S Suhrcke M Coutts A McKee M Effects of the 2008 recession on health: a first look at European data.Lancet. 2011; 378: 124-125Summary Full Text Full Text PDF PubMed Scopus (320) Google Scholar who reported a 17% increase in suicides in Greece, and might suggest that the ways in which economic distress is experienced by the population could be discerned in their increased suicidality. Consequently, there is an urgent need for intensive screening, follow-up, and treatment of people with suicidal ideation, especially now that the recession has led to increases in both suicide attempts and suicides. Despite the turmoil, Greece is struggling to maintain a social welfare state; however, gaps in primary health care render the situation hard to address.4Oikonomou N Tountas Y The Greek economic crisis: a primary health-care perspective.Lancet. 2011; 377: 28-29Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar Telephone helplines5Economou M Louki E Charitsi M Kolostoumpis D Stefanis C The depression helpline of the Greek “anti-stigma” program. Fourth International Stigma Conference; Jan 21–23, 2009; London, UK.http://stigma.iop.kcl.ac.uk/Plenary,%20poster%20and%20oral%20presentation%20abstracts%20(A-Z).pdfGoogle Scholar might contribute to alleviating the stress germane to financial hardship, prevent the proliferation of suicidal thoughts, and guide people to effective and timely treatment. We declare that we have no conflicts of interest. Mental health care—the economic imperativeCountries at all stages of economic development have been hit by the global financial downturn. Some have been affected (and continue to be affected) more than others. Greece is one such country, and three letters in The Lancet today describe some of the negative health consequences of the debt crisis in this population. These include worrying effects on mental health such as increased rates of suicide attempts and suicide itself. Full-Text PDF