[Depression and post-traumatic stress disorder among patients in intensive care units].

Recent progress in medicine and technology has produced a significant increase in the survival rate of critically ill patients who have been treated in Intensive Care Units (ICU). Consequently, researchers have become increasingly interested in the relationship between critical illness and psychiatric consequences. The experience of critical illness has been often associated with Major Depression (MD) and Post-Traumatic Stress Disorder (PTSD). There has been no similar study in Greece. The aim of the present study was to investigate the prevalence of MD and PTSD among patients after discharge from ICU in comparison with patients who discharge from pathological or surgical department. The study was conducted on five major hospitals "ATTIKON", "THRIASSIO", "KAT", "GNA GENNIMATAS", "KORGIALENIO - BENAKIO". A standardized instrument was used especially for this study and is based on "ΜΙΝΙ: Mini International Neuropsychiatric Interview" and DSM-IV. The data collection was carried out through personal interviews with the patients. It is a cross-sectional study and also a case-control study. The sample of the research was composed of 198 patients, from whom 102 were in ICU (ICU group) and 96 were not (non-ICU group). The results of the statistical processing have shown that there is a positive and statistically significant correlation between MD-PTSD and hospitalization in ICU, and particular hospitalization in ICU increases the likelihood of developing MD by 1.94 times and PTSD by 3.48 times, compared to treatment in another part of the hospital. Furthermore, the ICU group was found to suffer more than the control group from MD (32.4% vs 19.8%) and PTSD (35,3% vs 13,5%). The investigation of sociodemographic characteristics showed that being a woman discharged from ICU is nearly five times more likely to develop MD and nearly twelve times more likely to develop PTSD compared with men. Old age in ICU acts as a protective factor from PTSD. Regarding the clinical features, the clinical diagnosis is not associated with the development of MD and PTSD in either group, but there is a positive correlation of severity of illness with MD and PTSD in ICU. The length of stay is an important prognostic factor only in the development of MD in ICU group. In this study 11.6% of the total sample (ICU: 17.6%, non-ICU group: 5.2%) was found to meet the criteria for both MD and PTSD. These results are in agreement with similar studies in the literature. Early recognition and treatment of MD and PTSD in critically ill patients could contribute to faster recovery and improved quality of life.

A study of acculturation in psychotic and non-psychotic immigrants living in Athens.

BACKGROUND: Acculturation is the phenomenon that results when a group with one culture comes into continuous contact with a host culture. AIMS: To investigate the correlation between acculturation and psychotic symptomatology in a group of immigrants suffering from psychosis and to explore differences in demographic factors related with the acculturation process between individuals with and without psychosis. METHODS: Sixty-five patients and 317 non-psychotic immigrants were interviewed using the Immigrant Acculturation Scale (IAS) and a structured questionnaire for demographic data. The Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Global Assessment of Functioning (GAF) were also administered to all immigrants suffering from psychosis. RESULTS: Total IAS scores, as well as IAS everyday life scores, were positively correlated with GAF scores. IAS everyday life score in the patient group related with religion, marital status, gender and years in Greece, while in the non-psychosis group it was related with gender and years in Greece. IAS wishful orientation/nostos (the strong desire for one's homeland) related with religion in both groups. The IAS identity in the psychosis group did not show any significant relation with any of the variables, while in the non-patient group, it was related with marital status, gender and years in Greece. Age, duration of residence in Greece and higher adoption of Greek ethnic identity were the variables that differentiated the two groups of immigrants. CONCLUSION: Acculturation in immigrants suffering from psychosis could be seen as a process that does not correlate strongly with the severity of the symptomatology but is probably influenced by different set of factors.

[Economic crisis and mental health: effects on the prevalence of common mental disorders].

Economic crises have been found to bring adverse repercussions on physical and mental health internationally through various pathways. Research corroborates a link between financial distress and common mental disorders. In this context, the University Mental Health Research Institute conducted epidemiological nationwide surveys in an endeavour to gauge the impact of the ongoing financial crisis on the mental health of the Greek population. The purpose of the present analysis pertains to investigating changes in the prevalence of common mental disorders in the population as a whole as well as in various population sub-groups between years 2009 and 2011. In addition, the association of financial strain with common mental disorders was also explored. For investigating the particular research objectives, two cross-sectional surveys following the same methodology were conducted. A random and representative sample of 2192 respondents in 2009 and 2256 respondents in 2011 took part in telephone interviews. Generalized anxiety disorder and major depression were assessed with the germane modules of Structured Clinical Interview, while financial difficulties with the Index of Personal Economic Distress (IPED), an original scale developed for the purposes of the particular surveys. All measures displayed good psychometric properties. Between the two years, a noteworthy, albeit non-significant, increase in one-prevalence of major depression was documented. On the other hand, the prevalence of generalized anxiety disorder remained largely unchanged. Statistically significant differences in the prevalence of both disorders were reported for particular population subgroups, with married persons and employed people emerging as the most afflicted individuals. Regarding financial distress, it was found to bear a statistically significant association with major depression but not with generalized anxiety disorder. For mitigating the mental health effects of the crisis on the general population, study findings underline the necessity of implementing targeted interventions, tailored to the needs and difficulties of each population sub-group.

[Studies of psychopathology of homeless individuals in European countries].

Most research on the homeless is coming from the US, where the prevalence of mental disorders concerning this population was pointed out. The surveys for the homeless in European countries focus on the mental state and community care of the homeless very early, since the 1980's. Homelessness is gradually developing in these countries, while in the countries of North America the phenomenon is much older. The prevalence of mental disorders in European countries is higher in the homeless population, with rates of 58% -100% compared with the general population. In countries like Germany, Spain, Holland, France, Switzerland, where the phenomenon of homelessness has been studied, one of the most striking features was the high prevalence of substance abuse disorders, emotional disorders, while small percentages were reported for psychotic disorders. The prevalence of alcohol abuse was very high in Germany, perhaps because it is easily accessible and less expensive than in other countries. Limited use by homeless of relevant health services was also very common in this country. The same observation was also recorded in Spain, France and the Netherlands. High rates in these countries was reported for comorbidity, most often concerning the combination of substance abuse disorder and emotional disorders. Another interesting finding in the European countries is the high prevalence of depressive and anxiety disorders and the low prevalence of schizophrenia and antisocial personality disorder. The low prevalence of schizophrenia and antisocial personality disorder is in contrast with studies from North America according to some authors who compared their samples with samples of homeless people in Los Angeles. The level of abuse of illegal substances was also found high in countries such as England. In Spain affective disorders was reported to be very high among the homeless population. The homeless population faces many complex mental health problems compared with those of the general population. What is a source of concern is that these problems are not adequately faced either by mental health services and rehabilitation programs, or the social services for the homeless. It is recommended that these services have to achieve integration in therapeutic and organizational level, in order to better meet the needs of this complex and heterogeneous population.

[Help-seeking from a Community Mental Health Centre].

Help-seeking is a multi-dimensional process. Individual, family and social factors all may be relevant in determining if and when help is sought. This study explored the possible factors affecting the help-seeking behaviour of individuals with mental health problems and their first contact with a mental health professional. Ιndividuals, who sought help from the Community Mental Health Centre (CMHC) during 2003-2007, completed a questionnaire and information was obtained on a number of variables including demographic characteristics. Women, compared to men, seek help from the CMHC at a greater frequency. Individuals with psychotic symptoms don't seek help initially from a CMHC and they used to visit other mental health services. The percentage of individuals diagnosed with psychosis, emotional and anxiety disorders, seeking help for the first time in their lives 12 months after the onset of psychopathology, was high. Delays in initiating treatment are often prolonged and the duration of untreated disorder is associated with substantial functional decline and poorer quality of life. Reduction of these delays will require clearer understanding of the contributing factors.

Measuring acculturation and symptoms of depression of foreign immigrants in the Athens area.

BACKGROUND: Acculturation is the phenomenon that results when a group with one culture comes into continuous contact with a host culture and changes occur in the original culture of either one or both groups. Acculturation has also been linked with stress-related psychological disorder and depression. AIMS: This article investigates the acculturation process and the depressive state of foreign immigrants living in the greater Athens area. METHODS: All consecutive cases of 157 foreign immigrants who visited a nongovernmental organization (NGO) providing consultative services to immigrants were interviewed using a structured questionnaire including the Immigrant Acculturation Scale (IAS) and the Centre for Epidemiologic Studies - Depression (CES-D) scale. RESULTS: Factor analysis of IAS yielded a three-factor solution and 17 items with loadings ranging from 0.74 to 0.41. This scale was also tested and proven to be reliable. The main finding is that the higher the acculturation level of the immigrant individual, the lower the CES-D scale score; the fewer the depressive symptoms are self-reported. Length of stay, existence of family in Greece, legal status of residence and employment were also found to have an effect on depressive symptomatology. CONCLUSION: Acculturation could be seen as a beneficial mechanism protecting the individual to be exposed to stressful non-adaptive behaviour.

Is psychosocial rehabilitation of schizophrenic patients preventing family burden? A comparative study.

This study examined the dimensions of perceived burden by caregivers-relatives of patients suffering from schizophrenia and participating in a rehabilitation programme (group A) compared to a group of patients and their corresponding caregivers who were maintained in regular treatment procedure (group B). Subjective and objective burden perceived by caregivers group A patients attending a rehabilitation programme, was found to be lower compared to that of group B of caregivers of patients in regular maintenance treatment. Low level of functioning of patients was correlated with higher degree of family burden and the more psychological distress of the caregiver. The patient's compliance with medication and psychosocial functioning as well as the participation in a rehabilitation programme, the diagnostic subtypes and the mean daily hours spent with the patient were found to predict the presence of burden of caregiver. It seems that the various socio-therapeutic activities of rehabilitation improve patient's levels of psychosocial functioning, and alleviate the serious psychosocial and emotional problems of caregivers caused by their relative's chronic and severe illness.

Suicide in cyprus 1988-1999.

Suicide is a universally observed human behavior related to bio-psychological, social and cultural factors. The aim of the present study was to examine suicide in Cyprus, an island that has known many civilizations and cultures. All completed suicide cases in the Christian population of Cyprus during the years 1988-1999 were included in the study and they were analyzed according to age, gender, reported reasons for suicide and suicide methods. The main results indicate that: 1. The mean age-standardized suicide rate is the lowest in Europe, in males (3.08/100,000) and also in females (1.05/100,000). 2. Mean suicide rates increase significantly with age in males only. 3. Female suicide rates are highest in the 15-24 age group. 4. Statistically significant rising trends of male and female suicide rates in the all-ages group. 5. Suicide methods were mostly violent. Among males, the most common methods were poisoning, firearms-explosives, and hanging, while in females, jumping, hanging and poisoning. 6. Mental disorders, physical illness, interpersonal and financial problems were the main reported reasons for suicide. The epidemiological characteristics of suicide in Cyprus might be attributed to a combined effect of social and cultural factors and probably reflect influences from countries to which Cyprus is ethnically, historically or geographically related.

Family disruption, economic hardship and psychological distress in schizophrenia: can they be measured?

This study examined the dimensions of burden perceived by key-relatives of patients suffering from schizophrenia spectrum disorder by the development of an instrument, the Family Burden Scale (FBS) and the underlying predictors. One hundred and seventy one primary caregivers, living with 158 patients suffering from chronic psychotic illness and maintained on community basis in Athens area, were interviewed by the use of FBS supplemented by the Family Atmosphere Scale and GHQ. Construction procedure and factor analysis of FBS produced a scale of 23 items in four factors, three of them measuring objective and the fourth one, subjective burden. The scale was also proved to be reliable and valid. Forty-five percent of primary caregivers reported high levels of burden. Psychological impairment (high GHQ scores) was related with high levels of burden and negative family atmosphere. Previous admissions and duration of illness were also found to predict burden. The results suggest that FBS differentiates objective from subjective burden. Psychological well being of carers is affected by the dimensions of perceived burden.

Psychosocial adaptation of immigrant Greek children from the former Soviet Union.

BACKGROUND: The objective of this study was to assess psychiatric disorders in, and the psychosocial adaptation and academic performance of, children of immigrant families of Greek origin from countries of the former Soviet Union. METHOD: At a preliminary stage, all immigrant children (276) aged 8-12 years attending 22 schools in a working-class suburb of Athens were assessed by their teachers in terms of behaviour and academic performance. They and their families had migrated to Greece within the previous three years. A matching control group of native children (251) attending the same schools and classes was also assessed. For an in-depth assessment of psychopathology and social adaptation, 65 immigrant and 41 native children were randomly selected from the two larger groups and were further assessed. RESULTS: No statistically significant differences were observed between the immigrant and native children in terms of psychopathology and social adaptation, although a few differences were observed in subscales. However, there were significant differences between the groups in academic performance, that of the immigrant group being poorer, particularly in language-related areas (p < 0.01). In the light of these results, language enrichment classes are suggested for immigrant children who need them.

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.

Utilization of psychiatric inpatient care in Greece: a nationwide study (1984-1996).

This report examines the trends in the utilization of psychiatric inpatient care for the period 1984-1996, when the implementation of the psychiatric reform programme was initiated in Greece. Admissions in public mental hospitals declined by 7.2%. However discharges have been increased by 30.6% with a parallel decrease of the length of stay by 53.7% followed by an increase in discharges of patients diagnosed as suffering from schizophrenia and affective psychoses by 61.1% and 123.8% respectively. In the private sector a remarkable reduction in both admissions and discharges was noticed. Admissions in psychiatric departments of general hospitals for the same years have been increased by 1054.1%. It seems that the recent deinstitutionalization process resulted in increasing trends in the discharges of patients suffering from psychoses. Additionally, a substantial increase in the number of extramural psychiatric services and rehabilitation places between 1994-1996 was observed. The demand for the mental health care services expressed as the urbanization index was found to be related with mental health professionals and the extramural units ratios. The higher degree of urbanism is, the greater the number of extramural services exist. The models explained variance reached 50.6%.

Geographical variation in mental hospital discharges in Greece and socioeconomic correlates: a nationwide study (1978-1993).

BACKGROUND: In this paper the geographical distribution of discharge rates of psychiatric patients in Greece, nationwide, is shown. METHOD: Utilization rates are estimated by the number of discharged patients from all public and private mental hospitals for the period 1978-1993. RESULTS: During this period six prefectures were repeatedly found to exhibit the highest discharge rates for both sexes. Five out of those six areas are mountainous, socially isolated and of a lower level of socioeconomic development, lacking mental health services. The correlation coefficients for the annual mean age-standardized discharge rates of psychiatric patients and the corresponding General Index of Development score of each area were found to be statistically significant for all diagnoses, and for schizophrenic psychoses taken separately, in each prefecture for each of those years (1978-1993). CONCLUSIONS: It seems that the higher the hospital treated psychiatric morbidity is, the lower is the level of general socioeconomic development of the area. It is possible that families from socially disadvantaged areas, with limited support resources, are unable to avoid the hospitalization of their mentally ill members.

The impact of a Community Mental Health Center on psychiatric hospitalizations in two Athens areas.

This paper explores the impact of a Community Mental Health Center intervention activities on the inpatient psychiatric morbidity of two areas served by this center. Athens University established this Center, the first of its kind in the Greater Athens area. A comparison among the utilization rates of inpatient psychiatric services by community residents during the years 1979, 1985, 1991 and 1995 is made. The results of the 1995 survey show a significant reduction in the number and days of hospitalization and a remarkable cut in compulsory admissions when compared with those in 1979. It is concluded that medication monitoring, outreach, domiciliary care for patients in crisis, and day care are effective and robust principles of mental health services.

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.

Changing patterns of mental health care in Greece (1984-1996).

Greece joined the European Community in 1981 and, three years later, the Commission of the European Communities provided financial and technical assistance under EEC Regulation 815/84 for the modernisation of the traditional psychiatric care system, with the emphasis on decentralisation of mental health services and the development of community-based services, as well as on deinstutionalization of long-stay patients and improvement of conditions in public mental hospitals. Over the last 11 years, the implementation of the EEC Reg. 815/84 programme contributed to a significant shift towards extramural care and rehabilitation. The role of the large mental hospitals has gradually been diminished and a large number of long-stay patients have been deinstitutionalised. It is commonly accepted that the EEC-funded psychiatric reform programme, despite inadequacies and constraints, had an impact on the changing mental health scene in Greece.

Suicide in Greece 1980-1995: patterns and social factors.

A nationwide study of suicide in Greece from 1980 through 1995 demonstrated: 1. A mean age-standardized suicide rate of 5.86/100,000 for males and 1.89/100,000 for females. 2. An increase in suicide rates with age, especially in males. 3. Significant rising trends of male suicides in the 45-54 age group. 4. Significant declining trends of female suicides in age groups 15-24, 75-84, and total. 5. The lowest suicide rates among married men and women. 6. Exceptionally high rates in young widowed men. 7. Rural suicide rates were twice as high as urban rates. 8. Suicide methods were mostly violent, especially in males. 9. Hanging was the most common method, employed in approximately 50% of all suicides. The low suicide rates and the trends observed can probably be attributed to a synthesis of social and cultural characteristics of the Greek people and ongoing changes in Greek lifestyle.

Burden on the families of patients with schizophrenia: results of the BIOMED I study.

The burden, the coping strategies and the social network of a sample of 236 relatives of patients with schizophrenia, living in five European countries, were explored by well-validated assessment instruments. In all centres, relatives experienced higher levels of burden when they had poor coping resources and reduced social support. Relatives in Mediterranean centres, who reported lower levels of social support, were more resigned, and more often used spiritual help as a coping strategy. These data indicate that family burden and coping strategies can be influenced by cultural factors and suggest that family interventions should have also a social focus, aiming to increase the family social network and to reduce stigma.

Long-term outcome of psychiatric disorders in the community: a 13-year follow-up study in a nonclinical population.

In 1980, a two-stage cross-sectional study on the prevalence of mental disorders was performed on a probability sample of 1,574 adult residents of two boroughs in Greater Athens served by a Community Mental Health Center (CMHC). After completion of the interviews, a "case" identification procedure was applied through the use of clinical criteria allocating each respondent to one of five categories ranging from "well" to definite "cases" (stage A). In stage B time 1 (1980 to 1981), two psychiatrists interviewed a sample of 360 respondents consisting of all the probable and definite cases together with randomly selected individuals from the other three mental status categories. In 1994 (time 2), a follow-up study was conducted to reinterview the sample of 360 respondents through the use of the Structured Clinical Interview for DSM-III-R (SCID). The follow-up search resulted in 182 baseline respondents being located alive, plus 38 certified as dead and a residual 140 (38.8% of the baseline sample) categorized as definitely unlocatable. We report results for the outcome of specific nosological entities over the 13-year period. Among the main findings, of the previously (1980 to 1981) identified cases, 42.8% were similarly diagnosed as cases in the follow-up study at time 2; 92.4% of the baseline stage B (1980 to 1981) noncases were also found to be noncases in 1994. "Caseness" was found to be associated with high mortality. Of the subjects interviewed at both cross-sections and diagnosed as having a psychiatric nosological entity at time 1 (1980 to 1981), 67.5% were found to be mentally healthy at time 2 (1994).

Factors affecting illicit and licit drug use among adolescents and young adults in Greece.

A cross-sectional survey on psychosocial issues, drug use, alcohol and health was carried out in Greece, with a nationwide probability sample of 2448 respondents aged 12-17 and 18-24. Factors potentially associated with illicit and unprescribed licit drug use were tested by logistic regression analysis. Several predictors were revealed. Sex and age were related to a higher lifetime use of illicit drugs, the male young adults reported a higher lifetime use of illicit drugs than the females. Positive attitudes toward hashish use, systematic smoking and use of drugs by close friends were more closely related to illicit than to unprescribed licit drug use. In addition "low self-esteem, family members using tobacco and alcohol" and "problematic drinking" were found only to predict illicit drug use. Other variables, "family members using drugs with or without a doctor's prescription", "being dissatisfied with social life" and "suffering from anxiety, depression and depersonalization symptoms" were found to be significantly associated with licit but unprescribed drug use.