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.

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.

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.

Patterns of alcohol consumption and related problems in the general population of Greece.

This paper focuses on patterns of alcohol consumption and related problems, based on a nation-wide home survey sample of 4290 respondents aged 12-64 years. The prevalence of lifetime, past year and past month alcohol use, as well as levels of quantity of alcohol consumed and the reported alcohol-related problems, are presented. Frequency and quantity of consumption increases as age increases. Males were found to drink alcohol more frequently and in higher quantities than females. A higher proportion of young adults reported alcohol-related problems, in comparison to the other age groups. Regional variations in the frequency of consumption of alcohol were observed. However, no differences were found in the geographic distribution of persons of all age groups reporting alcohol-related problems. Respondents of all groups with two or more alcohol related problems expressed a high number of dysphoric and depressive symptoms. Finally, a stepwise discriminant analysis revealed certain socio-demographic, familial, psychological and medical factors to discriminate optimally the "problem" and "non-problem" drinkers in both adolescent and adult age groups.

Familial correlates of drug and alcohol use in a nationwide general population survey.

Familial correlates such as parental stability and past family medical history of respondents reporting recent illicit and licit unprescribed drug use or 'problematic' drinking, in a nationwide general population sample in Greece, were explored. The type of survey was cross-sectional and the respondents, aged 12-64, were interviewed in their homes with a multidimensional structured questionnaire. Familial pathology was recorded by the Family Medical History Index, an originally developed instrument. An association between familial instability and illicit or unprescribed drug use was observed. Higher levels of familial pathology expressed in the form of prevalence of mental or somatic illness, excessive tobacco smoking, alcohol and drug use was found to be related with higher rates of illicit or unprescribed drug use and 'problematic' drinking among the probands. These results are discussed within the context of the limitations of the study and the usefulness of obtaining information on the family atmosphere of drug users.

Psychiatric morbidity among repatriated Greek migrants in a rural area.

This paper reports on psychiatric case identification by the application of the Structured Clinical Interview for DSM-III-R (SCID) in a sample of 198 Greek migrants repatriated from western europe in a northwestern province of Greece. The current (1 month) prevalence of psychiatric morbidity, based on the total number of diagnosed cases, was found to be 43.4%. Lifetime prevalence of psychiatric disorders was found to be higher (49.4%). The majority of the sample were diagnosed as suffering from anxiety disorders and dysthymia. Psychiatric disorders were found to be more prevalent among middle-aged respondents. Duration of stay in the foreign country was a factor correlated with psychiatric morbidity. Of short-term migrants 54% were found to suffer from specific nosological entities, whereas 32% of long-term migrants were diagnosed as cases. The results are discussed within the framework of the existing sociocultural context of emigration and repatriation.

Drinking practices of illicit and licit drug users in the general population across Greece.

This article presents the results on the patterns of alcohol consumption among illicit and licit drug users in a Greek nationwide sample of general population with 4,290 respondents aged 12 to 64. The type of survey was cross sectional and the respondents were interviewed in their homes with a multidimensional structured questionnaire. The illicit drug users of all age groups reported a higher frequency of alcohol consumption in their lifetime, past year, month, and week prior to interview than the unprescribed licit drug users and the nonusers. The majority of illicit drug users of all ages reported their reason for drinking "to feel better or to get high." Illicit drug users of all age groups had a higher frequency of episodes of drunkenness than the other categories. Finally, the higher the frequency (> or = 3 times) of illicit drug use, the more excessive drinking reported during the past year and month. Forty percent of this category of illicit drug users reported that they had two or more serious alcohol-related problems.

Adolescent drinking and alcohol-related problems in a nationwide general population.

A sample of 1,325 adolescents drawn from a nationwide multistage probability master sample of 4,290 persons were interviewed at their homes in 1984. The purpose of this study was to investigate the patterns and quantity of alcohol consumption and related problems. Moreover, mental health status of respondents and "risk" factors were explored. Alcohol use increased from the very young to the older ones and decreased between lifetime and past week frequencies. Of adolescents, 18% reported two or more alcohol-related problems including suffering from depressive symptoms. Discriminant analysis revealed 14 predictors with high discriminating power between problematic and nonproblematic drinking.

Symptoms of depression, suicidal behaviour and use of substances in Greece: a nationwide general population survey.

This study aimed at investigating the relationship between the use of unprescribed licit and illicit drugs and problematic drinking with reported depressive symptoms and suicidal behaviour in a nationwide general population sample of 4291 respondents aged 12 to 64. Depressive symptoms were detected by the use of the Center for Epidemiological Studies Depression Scale (CES-D). A higher proportion of respondents who have reported illicit drug use in their lifetime were found to be depressed with a > 16 score in the CES-D in all age groups and both sexes, than of the other categories of substance use. A multiple range test revealed 3 groups of substance users. The more frequent illicit drug users together with the problematic drinkers exhibited the higher average depressive symptoms scores. The 12-month prevalence of suicidal ideation and suicide attempts was found to be in accordance with the severity and frequency of substance consumption.

Recent advances in community psychiatry and psychosocial rehabilitation in Greece and the other southern European countries.

During the late 1960s and early 1970s community psychiatry and the transformation of psychiatric services was introduced in several Northern European countries. In Southern Europe, with the exception of Italy, changes in the mental health care delivery system regarding mental health legislation and decentralisation of services have only taken place since the mid-1980s. In this report several issues related to developments in institutional and community psychiatric care in Greece, Italy, Portugal and Spain are presented. A comparison is provided between some socioeconomic and psychiatric morbidity indicators and the availability of alternative community based care and rehabilitation in these countries.