Part 2: Depression vs. Depression
by Dr Marianna Siapera, MSc Global Mental Health candidate
While signs of the economic crisis in Greece started showing in 2007, it became more apparent to people in 2009. The first publications on suicide rates in association with the crisis appeared in 2011, claiming that suicides rose by 17% in 2009 from 2007 and unofficial 2010 data quoted in parliament mention a 25% rise compared with 2009[1]. The Minister of Health reported a 40% rise in the first half of 2011 compared with the same period in 2010[2]. A telephone survey showed a 36% increase in the number who reported having attempted suicide in the month before a telephone survey from 24 (1-1%) in 2009 to 34 (1-5%) in 2011 and an increase in suicidal ideation[3].
In the same period, other studies supported that there was not a real increase in suicide rates as the completed suicide rates, according to the WHO report for Greece, fluctuated between 2.8 and 4.0 per 100,000 between 1960 and 2009. Furthermore, these researchers supported that there were no data to support a causal link between the economic crisis and suicide and reports in the mass media and journals were premature overinterpretations[4],[5],[6].
An increase in suicide rates was finally accepted as a fact after data of 2012 were published by the Hellenic Statistical Authority, especially in male adults[7],[8]. However, the debate remains around the ways that the crisis may correlate with the increased suicidality and suicide rates and what interventions would be more appropriate: If the hypothesis that the economic crisis produces increased suicidality in the general population holds true, improving economic indices and taking ‘horizontal’ measures which cover the whole population will be effective for decreasing suicidality. But if the economic crisis affects population vulnerable with mental health problems by decreasing, for example, the health and social provisions, then ‘vertical’ measures are needed targeting this population[9].
The situation became even more complicated when a Greek male pensioner killed himself in the main square of Athens in response to austerity conditions in 2012, leaving a detailed note where he described the political reasons of his decision. Unfortunately, this event received high publicity by the mass media and other suicides followed; researchers mentioned a temporary spike of the suicide rate in males the months following the event that gradually subsided to the initial baseline13.
Depression has risen from 3.3% in 2008, to 6.8% in 2009, 8.2% in 2011 and 12.3% in 2013 according to a survey; in 2013, in the age group of 35-45 years old, the male adults suffering from depression were slightly more than the women, 16.4% and 14.7% respectively, while in the other age groups the ratio between men and women remained in line with the international literature at 1:2[10].
It is noticeable that all these studies tried to explore the complex phenomenon of suicidality and its association with the crisis by using quantitative approaches and assuming possible causal mechanisms. There is lack of qualitative research on this matters and lack of the perspective of advocacy groups and groups of people who use or have used services. The mental health care system in Greece remains largely hierarchical and psychiatrist-led. Involving all the stakeholders and adopting more participatory approaches is likely the way to move forward in the research, management and prevention planning for complex conditions as depression and suicide in the context of a unique economic and social breakdown.
1018 (http://suicide-help.gr) is the national emergency number in Greece, 166 is the number for ambulances, 199 for the fire department, 100 is for police
References
[1] Kentikelenis, A., Karanikolos, M., Papanicolas, I., Basu, S., McKee, M., Stuckler, D. (2011) Health effects of financial crisis: Omens of a Greek tragedy. Lancet 378(9801):1457–8.
[2] Loverdos, A. (2011) Response to question by Member of Parliament. Athens: Ministry of Health and Social Solidarity.
[3] Economou, M., Madianos, M., Theleritis, C., Peppou, L.E., Stefanis, C.N. (2011) Increased suicidality amid economic crisis in Greece. Lancet [Internet] 378(9801):1459–60.
[4] Fountoulakis, K.N,, Siamouli, M., Grammatikopoulos, L. a, Koupidis, S. a, Siapera, M., Theodorakis, P.N. (2013) Economic crisis-related increased suicidality in Greece and Italy: A premature overinterpretation. J Epidemiol Community Health [Internet].67(4):379–80.
[5] Fountoulakis, K.N., Savopoulos, C., Siamouli, M., Zaggelidou, E., Mageiria, S., Iacovides, A., et al. (2013) Trends in suicidality amid the economic crisis in Greece. Eur Arch Psychiatry Clin Neurosci.263(5):441–4.
[6] World Health Organization.(2009) Number of suicides by age group and gender, Greece. 1.
[7] Papaslanis, T., Kontaxakis, V., Christodoulou, C., Konstantakopoulos, G., Kontaxaki, M.-I., Papadimitriou, G.N. Suicide in Greece 1992-2012: A time-series analysis. Int J Soc Psychiatry
[8] Branas, C.C., Kastanaki, A.E., Michalodimitrakis, M., Tzougas, J., Kranioti, E.F., Theodorakis, P.N., et al. (2015) The impact of economic austerity and prosperity events on suicide in Greece: a 30-year interrupted time-series analysis. BMJ Open. 5(1):e005619.
[9] Fountoulakis, K.N. (2016) Suicide and the economic situation in Europe: Are we experiencing the development of a “reverse stigma”? Br J Psychiatry. 209(4):273–4.
[10] Economou, M., Angelopoulos, E., Peppou, L.E., Souliotis, K., Stefanis, C. Major depression amid financial crisis in Greece: Will unemployment narrow existing gender differences in the prevalence of the disorder in Greece? Psychiatry Res